Childrens' Experiences of Pain in Conjunction With Tooth Extraction - a Grounded Theory Study
Condition: Attitude; Pain, Postoperative; Pain, Procedural; Child; Adolescent; Tooth Extraction
MeSH terms: Pain, Postoperative; Pain, Procedural
Study type: Observational

Summary: 
      This is a qualitative study, using Grounded Theory. The aim is to deepen our knowledge about
      how children perceive pain in conjunction with dental treatment; tooth extractions in
      particular. What increases, and what decreases, the risk of children experiencing pain; and
      how do they perceive dental treatments where pain might occur, either as procedural pain, or
      postoperatively?
    

Detailed description: 
      BACKGROUND: Pain in conjunction with dental treatment should be avoided as much as possible,
      when treating children. Many dental procedures may result in procedural and/or postoperative
      pain. There is a well-documented relationship between perceived pain during/after dental
      treatment, and the development of dental fear and anxiety. This may lead to suffering for the
      patient and accelerating treatment-costs for society. Despite this, research on children and
      pain is scarce. Systematic review shows a lack of studies on oral analgesics and their
      possibility to reduce/prevent pain. There is a need for randomized clinical trials regarding
      different treatments and effect of analgesics. However, before such research can be
      undertaken, one important piece is missing; an understanding on how children and adolescents
      perceive dental treatment and the possible pain afterwards. The aim of this study is to
      elucidate how children perceive dental treatment and pain after tooth extractions.

      METHODS: This is a qualitative study using Grounded Theory (GT). Children aged 10-15 years,
      who needs teeth extracted prior orthodontic treatment, will be consecutively enrolled if the
      legal guardians signs the informed consent-form and the child assents to participate. Tooth
      extractions will then be performed by another dentist than the one doing the interviews with
      the children. A treatment protocol, in accordance with today standardized practice, for the
      extractions will be followed. No extra dental treatment is performed, rather this is a part
      of the whole treatment plan for orthodontic treatment. In-depth interview will be performed
      with the children 1-2 weeks after tooth extraction, at a place convenient for the
      child/family. If the participant wishes to, they can be accompanied by their legal guardian
      during the interview. The questions will focus on their experiences of the tooth extraction,
      perceived pain, pain management, coping strategies, and previous experiences of pain and how
      they handled it then. Each interview is calculated to take approximately one hour. In
      Grounded Theory no sample size calculation is applicable. Participants will be included until
      saturation in data is reached, i.e. no new information can be obtained. In GT this is often
      achieved after 10-15 interviews, but when it involves children it is not unlikely that the
      number of participants will be closer to 20, since there is a risk of the interviews not
      being so "rich". All interviews will be tape recorded, and without further delay, the
      interviews will be transcribed. Data analyses and data collection will be done parallel with
      each other. The transcribed interviews will be analyzed, where codes will be identified.
      These codes will then merge into different preliminary categories. In the following axial
      coding process, each category will be further developed by identifying dimensions and
      characteristics (sub-categories). Relations between data and categories is sought for, and
      hereby a new whole is created. Selective coding will lead to data saturation and validation.
      Saturation can also be achieved by already retrieved data being re-coded.

      KNOWLEDGE GAINS: GT is a theory generating method. This is especially suitable for research
      areas where theories are scarce or completely lacking. A lot of research within the medical
      and dental field today, takes the perspective of the investigator, and far too seldom is
      those directly affected (i.e. the patient), involved. From an ethical point of view, it is
      important to include children and adolescents if the research is targeting this group. If
      knowledge about how children and adolescents perceive pain is gained, this will be an
      important piece in assembling the puzzle of research strategies related to pain.
    

Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Children aged 10-15 years of age, identified as eligable according to inclusion and
        exclusion criteria, during first visit to orthodontist, working in city of Malmö, Sweden.
      
Keywords: grounded theory; child; adolescent; postoperative pain; procedural pain; tooth extraction