An audit of the implementation of guidelines in relation of the prevention of dental caries

Aim: To determine the implementation of national clinical guidelines in relation to the targeted prevention of dental caries in the permanent teeth of 6-16-year-olds presenting for dental care amongst training grade staff working within the Hospital Dental Service. Methods: Patient records were reviewed prospectively with regard to caries risk assessment, behaviour modification and tooth protection. Following dissemination of the results and reinforcement of fundamental points from the guideline, a second audit was conducted one month later. The results were assessed by chi² (X²) analysis. Results: One hundred patient records were reviewed in both Audit One (M:52; F:48) and Audit Two (M:61; F:39). Caries risk assessment was poorly recorded in both Audits One and Two (13% and 17%, respectively). There was an improvement in radiographic reporting between the first and second audit, from 53% to 80% (X² = 16.36, P = 0.001). Dietary advice and toothbrushing instruction were recorded in 36% and 41% of records in Audit One, whilst in Audit Two this had improved to 68% and 92%, respectively (X² = 20.51, P = 0.001 and X² = 58.38, P = 0.001). There was a statistically significant improvement in the prescription of fissure sealants in Audit Two (X² = 38.97, P = 0.001), although not in the prescription of topical fluoride application (X² = 1.71, P = 0.192). Conclusion: Amongst training grade staff, there appears to be failure of implementation of certain aspects of SIGN guidelines for caries prevention. Clinical audit, however, would appear to improve guideline implementation.