Page 36 - RADC Bulletin 2019

Managing Military Tooth Surface Loss: An Audit of Practitioner Effectiveness
Defence Primary Health Care
Major Kate Porter, Primary Care Dental Practitoner,
Surg Cdr (D) Graeme Bryce, Consultant in Restorative Dentistry
Introduction
Defence Primary Health Care (DPHC) is responsible for the dental welfare of UK Armed Forces military personnel. Although previous research1 recognised that Tooth Surface Loss (TSL) has increased steadily within the military population since 2008, the effectiveness of DPHC Clinician diagnosis and management of this condition is yet to be realised.
Aim
This audit aimed to evaluate the effectiveness of DPHC Dentists clinical assessment and management of patients’ suffering from TSL within the UK military.
Standards and Inclusion Criteria
Gold Standards were set using clinical guidelines adapted from the BSRD and published clinical papers2,3,4. A total of 70 patients, affected by TSL, were randomly selected for cycle 1.
Gold Standards:
1. For 100% of TSL to be accurately charted.
2. For 100% of patients to have had the aetiology investigated.
3. For 100% of patients to have been informed of their TSL.
4. For 100% of patients to have had preventative advice/
treatment provided.
Method
Results
A Comparison of Gold Standards Between Cycle 1 & Cycle 2
100
Cycle 1
Cycle 2
90 80 70 60 50 40 30 20 10
0
Mean Accuracy of Charting
All Investigations Carried Out
% Investigations Carried Out
Aetiology Recorded
BEWE Patients Informed
of TSL
Cycle 1
Minimum of 1 Preventative Treatment
Cycle 2
Interventions Carried Out With Cycle 1 & 2
70 60 50 40 30 20 10
0 Fluoride
Temporary
restoration restoration restoration
Soft splint
Hard splint
Medical Intervetion
Referral
Review appointment
Cycle 2
Cycle 1
n=70
Calibrated Auditor
70 sets of Patient 70 individual Electronic Models Assessed Healthcare Record (iEHR)
Cycle One Results Analysis and Recommendations
Local Training & Education of GDPs on assessment and Management of TSL
A Comparison of BEWE in Relation to Management of TSL
35 30 25 20 15 10
5 0
Cycle 1
Direction
Indirect
Cycle 2
n=30
30 sets of Patient 30 individual Electronic Models Assessed Healthcare Record (iEHR) Results Analysis
34 RADC BULLETIN 2019
High Cycle 1 n=21 Cycle 2 n=10
Medium
Cycle 1 n=29 Cycle 2 n=17
Low
Cycle 1 n=20 Cycle 2 n=3
CLINICAL
Informed Investigated 1 3
19
10
n=19
47.64% 60.3%
Prevention/Treatment Restoration Referral Informed Investigated Prevention/Treatment Restoration Referral Informed Investigated
n=2
n=17
n=1
Prevention/Treatment 2 3 Restoration 1 2 Referral 4
n=2
7
7
n=1 n=0
4 3
n=2 n=0
9
9 15 2
n=10 n=15
11
n=13
14
10
n=2
15
17
n=0 n=0
n=22
16 8
14
n=27
n=1 n=1
n=33
n=13
n=9
n=40
n=27
n=30
n=13
n=19
n=37
n=27
n=28