Pharmacy, not dentist, is 1st stop when kids have oral pain

Less than a third of children with oral pain saw a dentist before their parents went to a pharmacy for pain medication in a recent U.K. survey. In addition, about the same percentage of children saw a physician or other healthcare practitioner rather than a dentist for a diagnosis of their oral pain, researchers found.

The results highlight the underutilization of dental services for children and the additional costs incurred by the National Health Service (NHS) in the U.K. The survey results were published in BMJ Open (February 28, 2018).

"The fact that only 30% of children with oral pain had seen a dentist before going to a pharmacy highlights a concerning underuse of dental services," lead researcher Vanessa Muirhead, BDS, PhD, noted in a statement issued by Queen Mary University of London.

Dr. Muirhead is a clinical senior lecturer and honorary consultant in dental public health at the Institute of Dentistry at Queen Mary University.

Pharmacy visits

The researchers wanted to find out how many parents and caregivers went to pharmacies to purchase medication for their children's pain, specifically for oral pain. They also wanted to find out which, if any, healthcare practitioners or services these pediatric patients visited before the pharmacy purchase. Their third goal was to estimate the cost to the NHS when children with oral pain initially saw healthcare professionals other than dentists.

Dental care is free in the U.K. for children age 18 and younger, and guidelines recommend dental visits at least every year, according to the study authors. However, about only 60% of children in England and 49% of children in London had visited a dentist in 2016, they reported.

The researchers conducted a cross-sectional survey of parents, caregivers, and adolescents who visited community pharmacies in London during a 10-week period from November 2016 to January 2017. More than 950 pharmacies participated by administering the online survey to the parents and caregivers, gathering information from almost 7,000 customers who were seeking children's pain medication.

Most of the respondents (65%) reported that the purpose of their visit was to purchase medication to relieve their child's oral pain. The survey also asked about the cause of the pain:

• A toothache was reported by 41% of respondents.
• A newly erupting tooth was reported by 20%.
• A painful mouth ulcer was reported by 15%.

In addition, the survey included a question on whether the child had seen a dentist before the pharmacy visit, with 30% of respondents answering positively. However, 28% of the children, while not seeing a dentist, had seen between one and four healthcare professionals, including general physicians, school nurses, and others.

Saturdays and Sundays were the peak days of the week for pharmacy visits, which, combined with limited weekend urgent dental care services, could partly explain why some children had not seen a dentist, according to the study authors.

The researchers estimated that the additional cost to the NHS of children seeing health professionals outside dentistry was nearly 37,000 pounds ($50,000) during the 10-week survey period:

• Visits with a general physician cost the NHS nearly 17,000 pounds ($23,000).
• Visits to walk-in and urgent care centers cost more than 3,000 pounds ($4,000).
• Multiple visits to other healthcare practitioners added more than 4,000 pounds ($6,000) to the cost.

Finally, when the researchers calculated the additional cost to the NHS for a period of a full year and to all pharmacies in England, the estimated total came to more than 2.3 million pounds ($3.2 million).

Cost savings

The researchers noted two possible limitations around their cost estimates. They assumed that minimal seasonal variations in pharmacy visits would occur across a year and that the pharmacies that did not participate in the study saw a similar pattern of parent visits.

Nevertheless, the survey authors concluded that parents tended to underuse dental services while contacting multiple healthcare professionals outside dentistry in both primary and secondary care. Reducing children's inappropriate contact with multiple healthcare services when they have oral pain could have significant cost savings for the NHS, they noted.

"We need to develop integrated systems and referral processes where [general physicians], community pharmacists, and dentists talk to each other to make sure that children with toothache see a dentist as soon as possible for treatment," Dr. Muirhead stated.