IADR Abstract Archives
Barriers to Sealant Use for NCCL: The DISGO Study
Objectives: The American Dental Association’s pit-and-fissure sealant guideline was released in 2008 and updated in 2016. However, few U.S. dentists adhere to this guideline when treating non-cavitated occlusal carious lesions (NCCL). This study characterized adherence to NCCL guideline recommendations in a salaried, large group practice and identified adoption barriers.
Methods: We collected data from 6 interviews, 5 focus groups, a survey of 270 providers and staff, including dentists, dental hygienists (DHs), expanded function dental assistants (EFDAs), dental assistants (DAs), and front-of-the-house staff, and two years of data from the electronic health record (EHR).
Results: According to the survey, 79% of dentists said they “sometimes,” “regularly,” or “always” include sealants for NCCLs in their treatment plans. This was consistent with results from the EHR: over the two-year period, 68% of dentists sealed at least one NCCL. However, most applied only 1-2 sealants. Thus, only 3% of lesions were sealed (EHR). Barriers to guideline adoption occurred at the leadership, clinic, and provider levels. Although at the leadership level there is a dedicated committee responsible for guideline implementation (interview), committee members lack training in implementation (interview). At the clinic level, adoption of guidelines is left to the discretion of the provider (focus group). At the provider level, providers are not familiar with the content of the guideline (interview, survey). Additionally, 66% of dentists and 62% of DHs, EFDAs, and DAs believe caries may progress under a sealant (survey). Finally, only 47% of dentists and 26% of DHs, EFDAs, and DAs believe placing sealants to arrest caries is within the standard of care (survey).
Conclusions: Although a majority of dentists had sealed NCCLs, most had placed only 1-2 sealants, resulting in only 3% of lesions receiving a sealant. Barriers occurred at multiple levels. To address this quality/implementation gap, future research should identify ways to overcome these barriers.
Methods: We collected data from 6 interviews, 5 focus groups, a survey of 270 providers and staff, including dentists, dental hygienists (DHs), expanded function dental assistants (EFDAs), dental assistants (DAs), and front-of-the-house staff, and two years of data from the electronic health record (EHR).
Results: According to the survey, 79% of dentists said they “sometimes,” “regularly,” or “always” include sealants for NCCLs in their treatment plans. This was consistent with results from the EHR: over the two-year period, 68% of dentists sealed at least one NCCL. However, most applied only 1-2 sealants. Thus, only 3% of lesions were sealed (EHR). Barriers to guideline adoption occurred at the leadership, clinic, and provider levels. Although at the leadership level there is a dedicated committee responsible for guideline implementation (interview), committee members lack training in implementation (interview). At the clinic level, adoption of guidelines is left to the discretion of the provider (focus group). At the provider level, providers are not familiar with the content of the guideline (interview, survey). Additionally, 66% of dentists and 62% of DHs, EFDAs, and DAs believe caries may progress under a sealant (survey). Finally, only 47% of dentists and 26% of DHs, EFDAs, and DAs believe placing sealants to arrest caries is within the standard of care (survey).
Conclusions: Although a majority of dentists had sealed NCCLs, most had placed only 1-2 sealants, resulting in only 3% of lesions receiving a sealant. Barriers occurred at multiple levels. To address this quality/implementation gap, future research should identify ways to overcome these barriers.