IADR Abstract Archives

GRADE Evidence-to-decision Framework For Developing Oral Health Policy

Objectives: To implement GRADE evidence-to-decision (EtD) framework tables and harmonize individual- and population-level perspectives for the development of oral health policies. This work was done in the context of an ADA clinical practice guideline on antibiotic use for pulpal and periapical conditions in collaboration with a guideline panel.
Methods: We developed two EtD framework tables using digital GRADEpro GDT templates; one was used to formulate recommendations for clinical settings where both antibiotics and dental treatment are available, and another for settings where only antibiotics are available. We used the following factors, detailed in each table, to inform systematic review and data collection efforts: problem, desirable effects, undesirable effects, patients’ values/preferences (PVPs), acceptability, feasibility, certainty in the evidence, and balance between benefits and harms, all related to antibiotic use for conditions of interest. When relevant, we considered both individual- and population-level perspectives for each factor.

Results: Evidence on eight factors was collected in EtD tables and presented during a guideline panel meeting to develop recommendations. See attached table detailing results of our experience.

Conclusions: This framework allowed for decision-makers to consider the magnitude of benefits, harms, and other relevant factors in a single location. Transparent judgments and a digital format also allow for easy sharing, adoption, or adaption of evidence contained in tables.

IADR/AADR/CADR General Session
2020 IADR/AADR/CADR General Session (Washington, D.C., USA)
Washington, D.C., USA
  • Tampi, Malavika  ( American Dental Association , Chicago , Illinois , United States )
  • Urquhart, Olivia  ( The American Dental Association , Chicago , Illinois , United States )
  • Pilcher, Lauren  ( American Dental Association , Chicago , Illinois , United States )
  • Pahlke, Sarah  ( American Dental Association , Chicago , Illinois , United States )
  • Carrasco-labra, Alonso  ( American Dental Association , Chicago , Illinois , United States )
  • NONE
    Poster Session
    Evidence-based Dentistry I
    ADA experience implementing EtD framework
    EtD factorsOur experience
    Is the problem a priority? Described individual- and population-level perspectives on why issue is a priority.
    Desirable effects (benefits)Included RCT data on benefits of antibiotics with/without dental treatment. Panel judged benefits to be negligible.
    Undesirable effects (harms)Included RCT and observational data indicating large harms at population-level. Panel placed a higher value on population-level harms when formulating recommendations.
    Balance between desirable and undesirable effectsSetting arbitrary thresholds for harms (e.g., how many population-level deaths due to antibiotic resistance is acceptable compared to potential benefit of antibiotics at an individual-level?) required us to be transparent about judgments related to balance between benefits and harms.
    Certainty in the evidence Panel judged certainty of evidence amongst all critical outcomes as low, but placed a higher value on large harms due to their likely underestimation.
    Acceptability to key stakeholdersPanel discussed feedback from clinicians, patient-advocacy groups, stakeholder organizations, and the general public, all of which overemphasized either individual- or population-level perspectives.
    PVPsIn the face of large harms, panel placed higher value on population-perspectives (from stakeholders and panel discussion), which conflicted with individual-level PVPs related to antibiotic use. This conflict forced the panel to judge this factor as having important variability.
    FeasibilityPanel judged antibiotics a feasible option, but identified access to dental care to be variable.