Title: An evaluation of routine preventive care in children based on public health England’s delivering better oral health toolkit
Abstract:
Introduction: Oral health is a significant part of a child’s development and wellbeing. Despite the overall decrease in caries prevalence over the years, childhood caries continues to be a present in the United Kingdom (UK). Dental professionals have an important role in the prevention of disease, and the current guidance in the United Kingdom is outlined in the Delivering Better Oral Health (DBOH) toolkit published by Public Health England.
Aim: The aim of this project was to improve the quality of preventive care in relation to the assessment, advice and treatment planning for children in dental practice. This would be achieved by evaluating paediatric patient records against the DBOH guidance and implementing changes in the practice to improve compliance. The standard was for 90% of records to be fully compliant in all domains of the guidelines.
Method: This was a two-cycle audit reviewing a total of 40 NHS paediatric patients. The first cycle was a retrospective analysis of 20 records. This was followed by changes implemented in the practice and a second audit cycle which prospectively assessed a further 20 records. The audit was designed around seven domains from the prevention pathway in the DBOH guidance. Domains 1-3 were on the quality of patient assessment, domains 3-6 on the quality of prevention advice and treatment planning, and domain 7 on whether contractual obligations were met. Each domain contained several criteria and were graded from 1 to 3 – grade 1 if all criteria were met, grade 2 if one criterion was missing, and grade 3 if two or more criteria were missing.
Results: In the first audit cycle, 2 out of 7 domains met the set standard, achieving grade 1 in 100% of the records. The remaining 5 domains achieved less than the standard. Following changes to practice, the second audit cycle showed an overall positive shift towards the standard, with the standard being met in 4 domains. There were also a higher proportion of grade 1s and lower proportion of grade 3s, indicating that more criteria were met in the records.
Conclusion: The changes in the practice have resulted in greater compliance with the DBOH toolkit and hence an improvement in the quality of preventive care provided to paediatric patients, although further audit cycles are still needed to address the remaining gaps in compliance. All dental practices would benefit from 6-monthly audits on compliance with the DBOH guidance. Through the provision of evidence-based care, patient education and support for behaviour change, the collective aim is to reduce oral health inequalities and disease on a national level.
