'Toothache stories': a qualitative investigation of why and how people seek emergency dental care

Abstract

Objective: To understand from the patient's perspective the types of dental problem which present at weekends, how they affect people, and the care-seeking behaviour of emergency dental patients.

Basic design: Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis.

Setting: A community-based and a dental hospital emergency dental clinic.

Subjects: 44 emergency dental patients.

Results: Pain was the main presenting symptom, a key domain of quality of life and the underlying cause of most other quality of life effects. However, for patients deciding what symptoms mean--crucially whether they mean they need to see a dentist urgently--a wide range of other contextual factors come into play. These go beyond the individual patient's recent and current perception of symptom intensity. They encompass past experience of similar symptoms, past care-seeking experiences, anticipated effects on quality of life, anticipated service availability, joint decision-making and lay information from family and friends, professional opinions from non-dentists, expectations concerning what work dentists should do, and what symptoms distinguish "simple toothache" from more serious problems.

Conclusions: The effects of, and meanings which people attach to, acute dental symptoms are complex. Combined with poor awareness of the existence of emergency dental services it is not surprising that patients' pathways to care are correspondingly complicated. The planning of emergency dental services should be based on a broader, patient-derived understanding of the need for them.