title: Failure on all fronts: general dental practitioners' views on promoting oral health in high caries risk children--a qualitative study.
abstract: BACKGROUND
  Despite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. As such, children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners' (GDPs) views and experiences in trying to promote better oral health for those children.
  
  
  METHODS
  A qualitative study, utilizing face-to-face, semi-structured interviews with GDPs in three London boroughs who refer children for extraction of decayed teeth under GA selected based on referral rate. Qualitative Framework Analysis was used to present the results.
  
  
  RESULTS
  Eighteen GDPs (56% male) were interviewed: average age 42 years (range: 26-73 years). informants reported challenges to promotion of oral health categorised as: (1) child's young age, poor cooperation, and high treatment need; (2) parental skills to face up to modern day challenges and poor attitudes towards good oral health (3); social inequality, exclusion and cultural barriers in immigrant families; (4) National Health Services (NHS) primary care practice remuneration, constraints and training; (5) inadequate secondary care communication and engagement; and (6) failure in establishing national policy to grasp the width and depth of the problem.
  
  
  CONCLUSIONS
  GDPs feel frustrated and isolated in their efforts to promote oral health in those children. These findings suggest difficult challenges on all fronts. Reform of preventive dentistry funding and delivery, as well as a multiagency multidimensional approach that is mindful of the social determinants of children's oral health and barriers to application of oral and wider health initiatives are needed to address this important public health issue.
authors.affiliation: Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK. Ahmad.aljafari@kcl.ac.uk.
authors.forename: Ahmad K
authors.initials: AK
authors.lastname: Aljafari
authors.affiliation: Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK. jenny.gallagher@kcl.ac.uk.
authors.forename: Jennifer Elizabeth
authors.initials: JE
authors.lastname: Gallagher
authors.affiliation: Division of Population and Patient Health, King's College London Dental institute, Bessemer Road, London, SE5 9RS, UK. m.t.hosey@kcl.ac.uk.
authors.forename: Marie Therese
authors.initials: MT
authors.lastname: Hosey
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002648:Child; D002652:Child Behavior; D003299:Cooperative Behavior; D003731:Dental Caries / Q000517:prevention & control; D003733:Dental Caries Susceptibility; D003815:Dentists / Q000523:psychology*; D054242:Emigrants and Immigrants; D005260:Female; D005792:General Practice, Dental; D006293:Health Promotion; D054625:Healthcare Disparities; D006801:Humans; D008131:London; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009909:Oral Health; D010290:Parents / Q000193:education / Q000523:psychology; D011320:Primary Health Care; D036301:Qualitative Research; D013218:State Dentistry / Q000458:organization & administration