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Title: Evidence-based guidelines in dentistry
Author: Glenny, Anne-Marie
ISNI:       0000 0001 2445 4160
Awarding Body: The University of Manchester
Current Institution: University of Manchester
Date of Award: 2005
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Background: Clinical guidelines have an important role to play in helping to close the gap between research evidence and clinical practice. In order to fulfill this role, guidelines need to be valid, relevant and comprehensive. Despite advances in chemotherapy and radiotherapy, cancer treatment still remains associated with clinically important oral complications that can impact severely on a patient's quality of life. No clear guidelines exist outlining the optimal oral care strategy for children, teenagers and young adults treated for cancer. Aims: (i) To assess the quality of current clinical guidelines for those working within dentistry; (ii) To develop evidence-based guidelines on mouth care for children, teenagers and young adults being treated for cancer; (iii) To compare the quality of published guidelines and their recommendations in light of supporting research evidence. Methods: (i) Dental guidelines, published in English between 1997-2004, were appraised using the Appraisal of Guidelines Research and Evaluation (AGREE) instrument; (ii) A telephone survey of UK cancer centres was undertaken to establish current practice with regard to mouth care for children treated for cancer. National, evidence-based guidelines were developed following, where appropriate, the established methodology of the Scottish Intercollegiate Guidelines Network (SIGN); (iii) A qualitative assessment of previously published guidelines on mouth care for cancer patients was undertaken. Results: (i) The AGREE instrument identified few examples of good quality dental guidelines; (ii) There is diversity in the mouth care provided to children being treated for cancer in the UK, particularly with regard to the use of routine, preventative oral care therapies. The guideline development process required a combination of an evaluation of research evidence and a formal opinion gathering process. A variety of interventions have been used for the management of oral mucositis, candidiasis, xerostomia and herpes simplex virus; few are supported by the research evidence; (iii) Variation exists in the methods used to produce previously published guidelines on mouth care for cancer patients. Recommendations vary irrespective of the supporting evidence-base. Conclusion: Guidelines need to be assessed for quality before being applied in practice. The guideline development process needs to be transparent, with clear links between recommendations and supporting evidence. There is currently variation in the mouth care provided to children, teenagers and young adults being treated for cancer in the UK. National, evidence-based guidelines may help to reduce this variation. Further research is required into the most effective methods of dissemination and implementation, exploring the role of psychological models of behavioural change.
Supervisor: Not available Sponsor: Not available
Qualification Name: School of Dentistry Qualification Level: Doctoral
EThOS ID:  DOI: Not available