Report finds ADA clinical practice guidelines provide high-quality guidance for clinicians

Authors measured methodological rigor, transparency

A report published in JDR Clinical & Translational Research found the  American Dental Association's clinical practice guidelines collectively provide high-quality guidance for clinicians.

Developed by multidisciplinary panels, the guidelines critically appraise, summarize and interpret relevant evidence to provide recommendations that can be applied to patient care. The 10 guidelines address nonrestorative caries management, fluoride toothpaste for young children, non fluoride caries preventive agents, oral cancer detection, periodontitis treatment, sealants for caries prevention, and topical fluoride for caries prevention, as well as antibiotics to manage dental pain and swelling, prevent infective endocarditis, and prevent prosthetic joint infection.

The purpose of the report, titled “Assessment of the Quality of Current American Dental Association Clinical Practice Guidelines,” was to measure the methodological rigor and transparency of the guidelines. It was published in April by the International Association for Dental Research and American Association for Dental, Oral, and Craniofacial Research’s journal.

The authors assessed each guideline using standardized criteria for evaluating the quality of guidelines in six domains: scope and purpose, stakeholder involvement, rigor of development, clarity of presentation, applicability, and editorial independence, as well as overall quality. They used a score of 75% as the threshold to determine if a guideline was high quality.

"I was very pleased to see that the high quality of the ADA's clinical practice guidelines has been supported by an external evaluation in this recent paper using a comprehensive approach," said Margherita Fontana, D.D.S., Ph.D., co-author of the guideline on nonrestorative caries management. "Rigorous, high-quality guidelines, informed by a systematic review of the evidence and assessment of the benefits and harms of alternative care solutions, are essential to drive evidence-based clinical decision-making to optimize patient care."

Six guidelines met the threshold for overall quality, including sealants for caries prevention, oral cancer detection, antibiotics to manage dental pain and swelling, nonrestorative caries management, periodontitis treatment, and topical fluoride for caries prevention. Non fluoride caries preventive agents scored slightly below the threshold, and the scores for antibiotics to prevent infective endocarditis, antibiotics to prevent prosthetic joint infection, and fluoride toothpaste for young children were considered marginal.

More recent guidelines received higher scores, as the ADA began using the assessment criteria to develop guidelines in 2016. The overall quality scores for the guidelines published since 2016 were between 83% and 92%. While the authors found the quality of the older guidelines to be somewhat lower, they still considered them to be acceptable overall and stated ADA guidelines "may be used with confidence to inform practitioners of treatment options supported by rigorous evidence-based dentistry standards."

"Clinical practice guidelines are intended to optimize patient care by contextualizing evidence obtained from high-quality systematic reviews," said Vineet Dhar, B.D.S., Ph.D., chair of the ADA Council on Scientific Affairs' Clinical Excellence Subcommittee and co-author of the guideline on sealants for caries prevention. "I am pleased to see that the ADA's work in this area has received external validation in this report. It is no surprise that the authors found the guidelines, especially those published since 2016, to be of high quality. I attribute the success to the knowledgeable staff members who have led the guideline development work in the past few years."