Participants
Overall, 44 participants were recruited: 35 for interviews and nine for the focus group. Of these, 39% (n = 17) identified as female, 57% (n = 25) as male and 4% (n = 2) as non-binary. Participants’ age groups ranged from 18-24 (n = 4), 25-34 (n = 18), 35-44 (n = 4), 45-54 (n = 7), 55-64 (n = 4), 65-74 (n = 5), to 75-84 (n = 2), with the largest proportion in the 25-34 age group. Participants came from all seven health boards in Wales and represented diverse backgrounds regarding disability status, educational attainment, employment status and personal income (see Supplementary Table 1). A total of 77% (n = 34) were currently registered with an NHS dentist, 16% (n = 7) were not, and 7% (n = 3) were unsure. Ethnic backgrounds included white (n = 26), Black, African, Caribbean or Black British (n = 12), multiple ethnic group (n = 4), Asian or Asian British (n = 1), and one participant who preferred not to disclose their ethnicity.
Self-reported digital literacy varied, including participants’ abilities to use applications, set up video calls and resolve basic technical issues. A total of 38 participants (86%) agreed or strongly agreed that they could independently use applications or programs (such as Zoom) on devices like mobile phones, computers, or tablets without needing assistance. Regarding video calls, 37 participants (84%) agreed or strongly agreed that they could set up video calls on their electronic devices without seeking help. Similarly, 37 participants (84%) reported confidence in their ability to solve or figure out basic technical issues independently.
Key findings
Three key themes (and eight sub-themes) emerged during data analysis. Exemplary quotes are included below; further quotes are included in Supplementary Table 2.
Awareness and understanding of the general dental service team
Participants reflected on their awareness of the different members of the dental team, their understanding of their roles and how this compares to their understanding of other healthcare teams and professionals.
Limited awareness of dental team roles
Most participants demonstrated a limited understanding of the broader dental team and were unaware of all key roles (see Table 1). The most mentioned roles were the dentist, dental nurse and dental hygienist. However, around one-third of participants reported limited understanding of the team beyond the role of ‘dentist’:
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‘I heard about the dentist. It’s all about the dentists to me’ (P33)
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‘So, I feel apart from a dentist, the dental specialist. I don’t know. It is your dentist, and the dental specialist should be able to look after my dental care’ (P35).
Only a few participants mentioned roles such as ‘dental technicians’ (one participant) and ‘orthodontists’ (two participants). Despite being a key role highlighted in NHS skill mix guidance,9 no participants identified or expressed awareness of the ‘dental therapist’ role. Some participants referenced ‘dental surgeons’ and ‘specialists,’ acknowledging that these professionals typically provide care in specialised settings and often require referrals.
Although not formally recognised as part of the general dental service team, many participants perceived administrative staff as integral to the ‘dental team.’ These staff members play a crucial role in coordinating appointments, assisting patients in navigating their care, and facilitating communication between patients and dental professionals:
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‘So this and also the receptionist…I would regard them as, you know, a core member of the team. Because they are the ones responsible for receiving patients and then communication with the dentist’ (P134).
One participant felt that patients were also a core part of the ‘dental team’:
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‘I mean, those who are involved, like the patients, the community support groups…so, to me, when we talk about teams, it shall be not just the service providers, but the service users as well‘ (P75).
Limited understanding of dental team roles
Most participants seemed aware that the different team members performed different roles and described tasks that would be done by a dental hygienist (e.g., scale and polish), a therapist (e.g., x-rays or teeth impressions) or a dental technician (e.g., making bridges or dentures). However, they were uncertain who performed them and what their role was called:
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‘Okay, I think the dental team consists of a couple of, number of, people ranging from the dentist and, and the [dental] hygienist and we do not know how to name them, but I know that they have different roles. Yeah, they do not do the same thing’ (P37)
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‘My understanding is the dental assistant can either be the dental technician or the dental nurse. I think it depends on the practice‘ (P34).
Many participants used the term ‘dental assistant’ to refer to anyone present during their appointment other than the dentist, regardless of their specific qualifications or job title. This label was often applied broadly, encompassing various roles, indicating a lack of distinction between different qualified roles within the dental team:
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‘So thinking about the dental team, I would usually refer to the dentist, who is really a core part of the dental team. And also there is the dental assistants that help the dentist when he is about to perform a procedure’ (P4).
One participant did not feel that the team members had different titles or provided different services, instead seeing them all as ‘dental service providers’:
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‘They’re still dentists, they’re still part of the dental services. So although you’ve listed them out separately, for me, and for most laypeople, they see them as one family…they don’t see them as different…they might be different individuals, but they’re not different service care providers‘ (P75).
Less understanding of the ‘dental team’ compared to other healthcare teams
Some participants reported that they had much less understanding of the dental team roles and how they work together as a team when compared to other healthcare teams that they interact with:
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‘I would say I have a much greater understanding of other teams than a dental team. I didn’t realise there was so much available to a dental team because I’ve never been offered it. And I’ve never experienced it. And I’ve never noticed these other positions exist’ (P73)
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‘I definitely have less understanding of what a dental team comprises of and their roles, compared to like you say, a GP [general medical practitioner] practice. I’d have far more understanding if I was to go to a GP practice and they said “you’re best off speaking to the physiotherapist who comes here once a week rather than the GP”. Whereas, a kind of similar example for the dentist I wouldn’t know why or who I’d be seeing and why I wouldn’t be seeing the dentist’ (P174).
Importance of understanding in supporting skill mix
When discussing their lack of awareness and understanding of the different dental team members, many participants expressed a need for better information about the different roles and expertise available in the general dental setting:
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‘It’s kind of all tied together really, you know, making people really aware of what these different roles do and their expertise…they might have been through the same kind of training, and letting people know that’ (P174).
Most of these participants reflected that if they had this information and a better understanding of the different roles, they would be more receptive to seeing different members of the dental team:
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‘Sometimes, at the doctors, it’s very appropriate to see a nurse, a physiotherapist. You don’t always have to see the GP…if we were properly educated as to who can do what, and then we think “oh, well, that’s okay, I’m seeing the dental nurse. I’m not actually seeing the dentist today, but dental nurses know about and do this”’ (P74).
Understanding of urgent and emergency dental services
Participants reflected on their understanding of urgent dental care (UDC) and emergency dental services (EDSs). They described what their actions would be in urgent or emergency dental situations, including who they would contact, where they would seek care and how they would determine the appropriateness of UDC or EDSs for the issue they were experiencing.
Deciding when something is a dental emergency
Despite many participants not knowing who to contact or where to go in a dental emergency, many participants reflected on various factors that would help them identify if their situation was a dental emergency.
These factors included constant bleeding, severe pain that cannot be managed by regular painkillers, post-oral surgery complications, unexpected injury (e.g., life-threatening accidents, domestic violence), when there might be an infection and a risk of sepsis, and if they feel that they needed support or treatment within less than 24 hours.
However, some participants reported feeling unsure about what an emergency is:
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‘And also, I don’t really know what, what constitutes an emergency’ (P74)
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‘Not really, but I know that in, in an emergency dental care, you have to, you know, book an appointment, probably sometimes a few days before’ (P37).
Uncertainty on how to access emergency dental services
Many participants reported uncertainty about who to contact or where to go if they had an urgent or emergency dental situation:
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‘Oh, now you’re going into a very complicated area…I mean, that’s a whole can of worms…emergency dental services is still not clearly defined or understood by the patients and members of the public, and I suspect even the dental professions themselves between one dental profession and another dental profession‘ (P75).
Several participants reported that they would contact their dentist in the first instance. This was often because of trust and their established relationship with the dentist. This was also seen as a sign-posting opportunity to access the correct EDS service:
Only a few participants said that they would use the NHS 111 service (telephone triage and advice) to access EDSs; this was usually a back-up option when the dental practice was closed:
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‘If it is out of hours, if it is on the weekend, or when my dental practice is closed, then I will go into 111 services to get access to emergency dental care’ (P75).
Some participants said that they would attend A&E (accident and emergency) with a dental emergency:
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‘Well, for me, I think our first point of call would be A&E at the hospital, and from there, they would…I think from there they would direct us to the actual section that we are supposed to be at’ (P52).
Information needs
When describing their awareness and understanding of general services and EDSs, participants also identified key information gaps and needs and explained how this information could be delivered.
What do the public need more information on?
There was a strong need for improved communication and information. This includes: a) better information about different general dental service team members and their roles; b) better information about what constitutes a dental emergency versus urgent or routine dental care; c) better information about who to contact and where to go in a dental emergency situation.
How should this information be delivered?
Participants made various suggestions for how this information could be delivered to the public and the format of this information. This included: a) government/NHS campaigns; b) community outreach; c) school and youth programmes; d) traditional advertising methods; and e) personal involvement in raising dental care awareness. Throughout, participants were mindful of ensuring all materials were accessible and inclusive and of the personal role they could play in actively engaging in promoting dental care awareness e.g., within their families or communities.
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