Translating current evidence into practice in paediatric dentistry with clinical practice guidelines

Abstract

A review of available oral epidemiological studies among children in Hong Kong was conducted to evaluate trends in their oral health status. Since the 1960s, a decline in the prevalence and extent of dental caries experience was observed among school children and adolescents. However, among pre-school children, dental caries experience remains common and it appears that the extent of dental caries has increased. Over 90% of the dental caries experience among pre-school children is untreated. This high unmet treatment need suggests barriers to access of appropriate oral health care and this urgently warrants consideration.

A random sample of 476 (~25% of all) general dental practitioners (GDPs) and all 28 paediatric dentists (PDs) were recruited to participate in a survey in Hong Kong. Beliefs and attitudes towards providing care to pre-school children were determined using the Barriers to Childhood Caries Treatment (BaCCT) measure. In addition, dentists’ treatment preferences for caries of different severities were determined. The response rate was 61.5% (310/504). There was a significant difference in BaCCT scores between GDPs and PDs (P<0.05). GDPs reported more barriers to providing dental care than PDs. Furthermore, there were significant differences between GDPs and PDs in relation to their preferred treatment of pre-school children with caries (P<0.05). Wide variation in their views about the best way to treat dental caries existed among both groups. These findings highlighted the need for clinical guidelines relating to childhood caries in Hong Kong.

In collaboration with the Hong Kong Society of Paediatric Dentistry (HKSPD), clinical guidelines for ‘Dental caries prevention and management by caries risk assessment for pre-school children in Hong Kong’ were developed using the ADAPTE process and the Delphi consensus technique. The draft guidelines were reviewed by 36 members of HKSPD with a response rate of 52.9% (36/68). Seventy out of 91 draft recommendations were retained where there was consensus among members. The HKSPD adopted the guidelines.

At a teaching hospital, the feasibility of implementing the guidelines and the effectiveness in changing clinical practice was determined over a 6-month period. Clinical records of preschool children treated at the hospital over a 3-month period prior to implementing the guidelines were reviewed (N = 237). The guidelines were implemented over a one month period and clinical records for the following 3-month period were reviewed (N = 147). There was a significant increase in mean guideline adherence scores from x̅ = 14.86 (SD = 6.11) to x̅ = 28.88 (SD = 8.75), P<0.001. There were significant improvements in a range of aspects related to the guidelines (P<0.01), but not in all aspects. The developed guidelines were effective in translating evidence into best practice with potential for widespread implementation.