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.