Dental care for looked after children and adolescents: evidence synthesis and qualitative exploration

Background

Children and adolescents in care in the UK are at risk of extremely poor oral health due to the lack of access to dental services (related to both routine oral care and emergency visits relating to pain) and the context of their living circumstances (e.g., entering the care system with poor health because of poverty, abuse and parental neglect, also frequent relocation within the care system).

Children in statutory care tend to have relatively high levels of poor oral care and disease, little or no regular dental attendance before they enter care, and higher treatment needs when they attend a dental surgery. They experience higher caries levels than children not subject to a protection plan and have considerably higher prevalence of traumatic dental injuries and dental pain. They are less likely than their peers to access dental services.

However, relevant research on this subject is limited. There are no reviews collating evidence on the factors that influence oral hygiene behaviours and/or access to dental care for this population. Nor are there primary studies that explore the views of relevant stakeholders about the factors influencing oral health behaviours and dental care.

Aims

The aims of the research are to:

1. Provide insights into and evidence regarding the oral health behaviours, dental experience and access to dental services of children and adolescents in care

2. Generate evidence-informed recommendations for how these can be improved

Specific objectives are to:

1. Synthesise available evidence and enhance understanding pertaining to the oral health and dental care of children and adolescents in care

2. Identify and understand the factors influencing oral health behaviours and dental care access for children and adolescents in care

3. Identify and understand the factors influencing the provision of dental care to children and adolescents in care by dental health professionals

4. Produce validated recommendations for improving dental care access and provision for children and adolescents in care

Activity

We will:

1. Undertake a scoping review to synthesise available research evidence in relation to the dental health of children and adolescents in care (including oral health and behaviours of children and adolescents, their access to oral healthcare, and the content and outcomes of relevant interventions)

2. Conduct semi-structured interviews with oral healthcare providers, children and adolescents in care, young people who recently left the care system, foster carers and support staff (i.e., specialist nurses and social workers supporting foster families). These interviews will seek to explore experiences of adopting good oral health behaviours and accessing and providing dental care, and identify recommendations on optimising dental care for children in care

3. Organise a workshop with our PPI group, stakeholder representatives and a group of external experts to reach consensus on recommendations for improving the dental care and experiences of children and adolescents in care.

Anticipated Outputs

We will disseminate findings through conferences, presentations and reports to various stakeholders (e.g., healthcare organisations, local authorities, policy makers, Chief Dental Officer) and other relevant dental and third sector organisations. Easy-to-read reports will be made available. Results of the scoping review, the qualitative study and the workshop will be submitted as articles to peer-reviewed journals. A blog (co-produced with our PPI and stakeholder group) on engaging vulnerable groups in health research will also be published.

Funding

This project is funded by The Borrow Foundation