Factors that influence the dental attendance of children under thirteen years of age at two community dental clinics in the Western Cape, South Africa.
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AIMS AND OBJECTIVES: Most children presenting to dental clinics have pain of varying intensity that usually, has been endured for long periods of time. A study done at Cardiff in the United Kingdom, found that only 15% of children that had dental pain visited the dentist. Therefore, understanding the motivations of patients in seeking health care is vital to the quality of life in the family and community and to the success of any oral health planning process. This study explored factors influencing the time between the initial pain experience and definitive dental treatment, that is, the time lapse. It assessed how factors such as pain, individual and community characteristics affect the timing of dental visits. METHOD: Parents or guardians accompanying children visiting two community dental clinics in Guguletu and Mitchells Plain in the Western Cape were asked to indicate how factors such as severity and duration of pain, efficacy of self-treatment, and impact on parents affected the decision to seek treatment. A total of one hundred and twenty six parents were interviewed using a structured questionnaire. The English questionnaire was translated into Xhosa and Afrikaans and used with the help of interpreters when necessary. Children attending these community dental clinics for treatment on a particular morning were included in the study sample. Children up to thirteen years of age (primary, mixed, and early permanent dentition) comprised the study sample. Only children that had a dental problem were included in the study. Children that were not accompanied by a parent or guardian were excluded. RESULTS: Close to half the children (43 - 45%) had never been to the dentist before. Parents from Mitchells Plain knew earlier of their children's dental problems (most knew14 days before visit) than those from Guguletu where most knew within the last 7 days. However, Guguletu children were presented to the dentist sooner after the painful experience (69.2% within 7 days) than Mitchells Plain where only 48.3% were presented within the same period. It was found that for these communities, the distance from the clinic, the mode of transport, and the fares charged greatly influenced dental attendance. Most families lived within 3km, and walked (more prevalent in Guguletu) or rode a taxi (more prevalent in Mitchells Plain). With taxi the most prevalent mode of transport, money was an important factor of dental attendance. Long queues at the clinic and waiting long for appointments, were cited by parents as the major hindrances to attendance. While a worsening of pain, loss of sleep and sensitivity to chewing hastened dental attendance, parental work commitment and the child's school delayed it. Most families (79%) tried some treatment at home prior to the dental visit. The remedies offered such as Disprin®, direct placement of crushed Disprin® and Panado® were a concern because they were potentially harmful. Both communities were in the low socio-economic class with Guguletu consistently the poorer of the two. They both had disrupted family life as reflected by the low rates of married parents. CONCLUSION: In the presence of pain Guguletu children were presented to the dentist sooner than those of Mitchells Plain. Accessibility of the clinics was a real concern especially in Guguletu. There was rampant inappropriate use of medications such as aspirin and antibiotics. The greatest impact of the child's pain on the parents was on affected sleep. The non-regular attendance pattern of the children closely followed that of the parents.