Implementation of Evidence-Based Pain Assessment in Pediatric Dentistry

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PROJECT SUMMARY Dental procedures are one of the most common sources of acute pain in children. Painful childhood dental experiences are distressing. Moreover, they are related to development of dental fear, future dental care avoidance, and associated oral health problems. Use of evidence-based pain measurement tools is an integral part of acute pain management, and such tools are available for use with children in the dental setting. These tools are recommended by professional groups as part of routine clinical practice. However, dentists are unlikely to consistently use standardized pain assessment protocols. This K23 project aims to identify the barriers to and facilitators of evidence-based pain assessment in pediatric dentistry and to develop and pilot an intervention that will increase dentists’ adherence to evidence-based guidelines on pain management. The career development award will provide training to advance the candidate’s research program in behavioral dentistry. A carefully devised training plan will allow the candidate to gain expertise in implementation science, qualitative research methods, pediatric pain, and pediatric dentistry, as well as additional experience in multidisciplinary collaboration and grant writing. Training goals will be achieved through rigorous mentorship from experts, graduate-level coursework, and advanced professional development activities. The proposed research project is congruent with the training goals. The first phase will include three studies: (1) a survey of all US pediatric dentistry residency directors to determine which approaches to dental pain assessment are taught, and how; (2) a large, nationally-representative survey of dentists to identify barriers to and facilitators of use of evidence-based assessment of acute pediatric dental pain in clinical practice; and, (3) qualitative interviews with dentists to refine the understanding of these barriers and facilitators and identify final targets for intervention. The second phase will involve development of an implementation intervention targeting barriers and facilitators identified in the first phase to improve adherence to assessment recommendations. Intervention development will be informed by feedback from an advisory group of key stakeholders, and the implementation strategy will subsequently be pilot tested with dentists for appropriateness, acceptability, and feasibility. The long-term objective of this research is to improve pain management in pediatric dentistry as a means to prevent patient distress, development of dental fear, and related health consequences. The work will take place at a research-intensive public university with noteworthy strengths in behavioral dentistry, implementation science, and pediatric pain. The award will complement the candidate’s existing strengths by providing training in new domains and will prepare him for an independent research career using health psychology to improve oral health.