Evidence-based dentistry – overcoming the challenges for the UK's dental practitioners

Health professionals' recommendations on the use of fluoride varnish for caries prevention in preschool children

BACKGROUND

Fluoride varnish (FV) is widely recommended for caries prevention in preschool children, despite its anticaries benefits being uncertain and modest. Dentists often report using clinical practice guidelines (CPGs) as a source of scientific information.

AIM

To identify and analyze recommendations for clinical practice on the use of FV for caries prevention in preschool children and to assess the methodological quality of the CPG on this topic.

DESIGN

Two researchers independently used 12 search strategies and searched the first five pages of Google Search™ and three guideline databases for recommendations freely available to health professionals on the use of FV for caries prevention in preschoolers. Then, they retrieved and recorded recommendations that met the eligibility criteria and extracted the data. A third researcher resolved disagreements. Each included CPG was appraised using the AGREE II instrument.

RESULTS

Twenty-nine documents were included. Recommendations varied according to age, patients' caries risk, and application frequency. Of the six CPGs, only one scored above 70% in the AGREE II overall assessment.

CONCLUSION

Recommendations on the use of FV lacked scientific evidence, and CPGs were of poor quality. Application of FV is widely recommended despite recent evidence showing an uncertain, modest, and possibly not clinically relevant anticaries benefit. Dentists should be aware that it is necessary to critically appraise CPGs since they may be of poor quality.

Knowledge and attitudes toward evidence-based cariology and restorative dentistry among Egyptian dental practitioners: a cross-sectional survey

BACKGROUND

This is the first study to assess Egyptian dental practitioners' knowledge about conservative caries management approaches and investigate whether this knowledge transfers into clinical practice and the barriers to translating research into evidence-based practice.

METHODS

A sample of dental practitioners was surveyed using an online questionnaire. Convenience and snowball sampling were used to collect data from February to June 2022. We included graduated dentists from Egyptian universities who practiced in Egypt. Data were analyzed with descriptive statistics, and the associations between variables were checked using Kruskal Wallis and Chi-Square tests.

RESULTS

This study included 396 participants from throughout Egypt. There were significant correlations between specialty and participants' knowledge and behaviors toward evidence-based caries management (p = 0.002) and between specialization and tools used to detect carious lesions (p < 0.001). Most participants (59.1%) used G.V Black's classification, and (80.8%) removed caries based on the feature of dentin hardness and color, whereas (67%) removed caries until hard dentine remained. The participants' primary hurdle to staying up-to-date was their belief that the newly gained information would not be clinically applicable due to a lack of equipment or working in low-economic areas. Patient-related barriers were the major obstacles for participants in implementing evidence-based practice.

CONCLUSION

Egyptian dentists did not fully embrace minimal invasive approaches for caries management, and practitioners' experiences continue to shape decision-making. It emphasizes the imperative to practically educate dentists using effective knowledge translation dissemination to promote evidence adoption in daily practice and advocate value-based dental care to address the economic crisis's impact on Egypt's healthcare.

Dental educators' attitudes towards the teaching of dental amalgam

OBJECTIVE

To ascertain dental educators' attitudes towards the teaching of dental amalgam at dental schools in Australia and identify preferred curricular approaches in a potentially "amalgamless" profession.

METHODS

A mixed methods analysis was employed based on an open-ended response survey followed by a closed-ended questionnaire. Identification of key issues from the survey helped frame the questionnaire. Participants included those with expertise in operative and restorative dentistry, with direct involvement in curriculum development or delivery, at Australian dental schools.

RESULTS

Participants numbered fifteen and represented seven of the nine dental schools in Australia. Key themes identified and explored included the following: (in)consistency of approach to teaching restorative dentistry; a perceived disconnect between undergraduate study and the "real world"; a need for a focus on teaching of alternatives to dental amalgam (80 per cent (strongly) agreeing); the contradictory nature of the evidence base and literature that is not readily understood; the need for more post-graduate education relating to adhesive restorative materials (86 per cent (strongly) agreeing); the need for dental amalgam to continue to be available; formal understandings (guidelines) as to the use of dental amalgam; dental schools in Australia being heard on these issues; and the relevance of this issue (100 per cent (strongly) agreeing the issue is topical and important).

CONCLUSION

There is a broad consensus of dental educators at Australian dental schools as how best to approach the teaching of amalgam if a phase-down is to occur and the issues any such approach may face.

Willingness of general dental practices in South East London to engage with research

This study assessed the willingness of general dental practices (GDPs) to participate in research. All 263 GDPs in South East London that provide dental care under National Health Service (NHS) contracts were invited. The survey instrument was adapted from previous studies and piloted before administration. Geographical factors and practice characteristics associated with willingness to participate in research were explored in logistic regression models. A total of 77 responses were received (response rate: 29%). Of them, 40 (53%) expressed interest in being involved in primary care research. They saw their main role as collecting data and facilitating access to patients. Time, bureaucracy and lack of energy were the main reasons behind a decision not to engage with research. Those spending more time in NHS services were more likely to be willing to participate in research. Other possible indicators were single-handed GDPs, participation in the dental foundation training programme and location in more affluent areas.

Community-based preventive activities in the Public Dental Service in Norway

OBJECTIVES

The purpose of this study was to describe community-based preventive interventions undertaken by the dental team outside the dental clinics in Norway, from the dental hygienists' and the dentists' perspective, with the main focus on target groups and existing guidelines and routines for these activities. A secondary aim was to identify the personnel responsible for developing the local guidelines and the knowledge sources for the guidelines.

METHODS

With the assistance of the Chief Dental Officers in 15 Public Dental Service (PDS) regions, questionnaires were emailed to the local clinics (n = 421). In each, the most experienced dental hygienist and dentist were asked to respond; 215 dentists and 166 and dental hygienists responded (60%).

RESULTS

Almost 40% of the respondents reported that their clinic had guidelines on community-based activities conducted outside the clinics. Dental hygienists and local chief dentists were responsible for planning them. The main target groups were young children and the dependent elderly; the majority of the activities were carried out at child welfare centres and for personnel at nursing homes or for home care nurses.

CONCLUSION

At the regional and local level, a more strategic and coordinated approach to the provision of community-based activities is needed, including assessment of oral health needs among population groups. Continuous documentation and evaluation of results are necessary for optimal use of available resources and to facilitate an evidence-based approach.

Contemporary views of dental practitioners' on patient safety

BACKGROUND

There is little known about general dental practitioners' (GDPs) views on patient safety in dentistry; we believe this to be the first paper describing their opinions and ideas for maintaining or improving safe practices.

METHODS

Focus groups were used to gather the views of 12 GDPs (who also hold university teaching contracts) on the following topics: Defining patient safety, the important issues in patient safety, safeguards and tools for maintaining safe care, never events and research priorities. Thematic analysis was performed on the verbatim transcripts.

RESULTS

Key themes from the practitioners included: Medical history (polypharmacy and co-morbidities), competence and skill level, the use of safeguards and tools to ensure safety, the importance of effective communication (including working with a chaperone) and the role of reflective practice. Suggestions for improvement included: effective sharing of information with other healthcare professionals, easy access to guidelines and educational tools, adoption of practice protocols, team working and the use of universal charting systems to limit ambiguity.

CONCLUSIONS

GDPs are well versed in the concept of patient safety and are keen to implement evidence based tools and/or interventions designed to improve safety for their patients.