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Table 2 Data analysis chart

From: Dental neglect as a marker of broader neglect: a qualitative investigation of public health nurses’ assessments of oral health in preschool children

Main theme

Sub-theme

Theme dimensions

# Cited

Question 1: How do public health nurses assess oral health?

Observation

Child’s teeth

 

15

  

Opportunistic look in mouth

10

  

Do not look directly in mouth routinely

9

  

As part of holistic assessment

9

  

Look in mouth if asked

9

  

Look in mouth if concerned

7

  

Observe decayed front teeth

6

 

Family teeth

  
  

Parents teeth

11

  

Siblings teeth

4

Assessing parental attitudes

Gauge parental interest in oral health

 

9

  

If parental concern e.g. pain

7

  

Parental dental phobia

6

 

Parental feeding and weaning practices

  
  

Use of feeding bottles/dummies/juice/sweets

14

Communication

With parents

  
  

Ask if registered with dentist (routinely)

15

  

Ask about teeth brushing

13

  

Mention dental health services

10

  

Use of assessment framework

7

  

Ask about recent attendance with dentist

6

 

Other communication channels

  
  

Knowledge of family/family history (e.g. through records)

7

  

Through information from other professionals

4

Question 2: What are the potential barriers to assessment?

 

Public health nurse role

  
  

Not likely to be aware of problems further back in child’s mouth

7

  

Public health nurses’ role is advisory

5

  

Public health nurses not qualified to look in children’s mouths

4

  

Not top of public health nurses’ agenda

4

 

Parental expectation

  
  

Parents do not expect public health nurses to assess dental health

7

  

Parents might consider it intrusive to look in child’s mouth

4

  

Dental health - a very ‘sensitive’ subject

3

  

Tension between choice and protection

3

Question 3: What threshold levels of dental decay are used by public health nurses as an indicator of the need for targeted public health nurse support?

Threshold levels for support

   
 

Concerns about other social issues

  
  

Homelessness/drugs/domestic abuse

10

 

Concerns about dental health

  
  

Concerns about child’s teeth

5

  

Concerns about parent’s teeth

4

Responses to identified need

   
 

Issue dental packs

  
  

Additional issuing of dental pack

6

 

Referral

  
  

Referral to dental services

10

Question 4: What are the factors relating to dental neglect beyond which public health nurses initiate child protection intervention?

Threshold levels for concern

   
 

Concerns about other social issues

  
  

Dental decay alone is not a child protection issue

12

  

Dental decay is a marker of broader neglect

11

 

Concerns about dental health

  
  

Untreated dental caries or pain

10

  

Not taking child to dentist

7

Responses to concern

   
 

Referral to dental services

  
  

Facilitate further dental appointment / attendance at appointment

7

  

Repeated referrals to dentist

2

 

Notifying another agency of concern /sharing information

  
  

Include or consider including information within child protection reports / risk assessments

8

  

Notify (or consider notification) to social work of concern

2

Barriers to intervention

   
 

Communication and Feedback

  
  

Poor liaison between services

6