Audit on the Use of Radiographs Prior to Stainless Steel Crown Placement

IF 1.9 3区 医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE
Jenna Shah, Caitlin Saunders, Danielle Grady
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Radiographs can be used in the assessment of contraindications to SSC placement [<span>1-3</span>] such as there being no sound band of dentine between carious lesions and the pulp [<span>2</span>] and evidence of radiographic pulpal involvement or infection [<span>3</span>].</p><p>To assess and improve compliance of clinicians within a community dental service in taking preoperative radiographs prior to placing stainless steel crowns.</p><p>UK national clinical guidelines for SSCs advise taking pre-operative radiographs prior to placement on primary molars [<span>1</span>]. 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The results of both cycles are summarised in Table 1.</p><p>Within the first cycle, there was no relevant medical history noted. Within the second cycle, there were three patients whose medical history was deemed to have contributed to issues with cooperation with radiographs prior to crown placement. Two of these patients had two crowns placed each, leading to a total of five crowns. This involved two crowns placed on a patient with autism, pathological demand avoidance and developmental delays, two crowns placed on a patient with autism and one crown placed on a patient with attention-deficit hyperactivity disorder (ADHD) and suspected autism.</p><p>Teaching was delivered on the importance of taking radiographs prior to placing stainless steel crowns, along with a presentation of the first cycle of audit data and its analysis at a peer review meeting within the community dental service. A clinical record keeping template for stainless steel crown treatment was created and emailed to clinicians. Finally, a label for the stainless steel crown box designed to remind the clinician to take a radiograph prior to placement of a SSC or to record the justification for not taking a radiograph was created and disseminated to all clinics within the service (Figure 1).</p><p>In the second cycle there was a slightly increased frequency of crowns placed; this could be due to the education provided within teaching on indications for and benefits of stainless steel crowns.</p><p>There was a marked improvement in results between the first and second cycles. This included both more pre-operative radiographs being taken and an improvement in record keeping when radiographs were not taken. 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引用次数: 0

Abstract

Stainless steel crowns (SSC) are a valuable restorative option in paediatric patients due to their high clinical effectiveness [1-3]. Literature has suggested reduced failure rates in SSC placed with hall and conventional techniques for primary molars versus restorations such as glass ionomer cement (GIC), composite and amalgam [1]. In order to appropriately plan treatment, teeth need to be assessed for suitability for SSC placement, which includes pre-operative radiographs [2]. Radiographs can be used in the assessment of contraindications to SSC placement [1-3] such as there being no sound band of dentine between carious lesions and the pulp [2] and evidence of radiographic pulpal involvement or infection [3].

To assess and improve compliance of clinicians within a community dental service in taking preoperative radiographs prior to placing stainless steel crowns.

UK national clinical guidelines for SSCs advise taking pre-operative radiographs prior to placement on primary molars [1]. This standard has been adapted to account for the patient groups (e.g., pre-cooperative patients) treated in the community dental service where radiographs may not be possible.

In assessing Question 3, the relevant medical history was reviewed for factors that could have affected the ability to take radiographs, including learning disabilities, autism spectrum disorder and behavioural or mental health conditions. When assessing Question 4, possible written justification for not attempting radiographs included if the patient was a pre-cooperative child or if the teeth being crowned were hypomineralised non-carious teeth.

Individual clinician data for the first cycle was collected in order to allow for individual feedback to be provided to staff members if required, and this was emailed across if the staff member asked for their data but was anonymised for analysis and presentation of results.

Data collection for both cycles was conducted using an electronic Audit Management and Tracking (AMAT) proforma. Between the first and second cycle of the audit, an action plan was implemented. A retrospective second cycle audit was conducted between 25 February 2023 and 25 February 2024 using the same methods as the first cycle.

In the first cycle of the audit, 11 clinicians and 161 crowns were audited, while in the second cycle, 11 clinicians and 174 crowns were audited. The results of both cycles are summarised in Table 1.

Within the first cycle, there was no relevant medical history noted. Within the second cycle, there were three patients whose medical history was deemed to have contributed to issues with cooperation with radiographs prior to crown placement. Two of these patients had two crowns placed each, leading to a total of five crowns. This involved two crowns placed on a patient with autism, pathological demand avoidance and developmental delays, two crowns placed on a patient with autism and one crown placed on a patient with attention-deficit hyperactivity disorder (ADHD) and suspected autism.

Teaching was delivered on the importance of taking radiographs prior to placing stainless steel crowns, along with a presentation of the first cycle of audit data and its analysis at a peer review meeting within the community dental service. A clinical record keeping template for stainless steel crown treatment was created and emailed to clinicians. Finally, a label for the stainless steel crown box designed to remind the clinician to take a radiograph prior to placement of a SSC or to record the justification for not taking a radiograph was created and disseminated to all clinics within the service (Figure 1).

In the second cycle there was a slightly increased frequency of crowns placed; this could be due to the education provided within teaching on indications for and benefits of stainless steel crowns.

There was a marked improvement in results between the first and second cycles. This included both more pre-operative radiographs being taken and an improvement in record keeping when radiographs were not taken. In the second cycle, there were more attempts to take radiographs; therefore, there was an overall increase in both the proportion of crowns placed with pre-operative radiographs present (Question 1) as well as evidence of unsuccessful attempts to take radiographs (Question 2). There was a focus on good documentation in the actions implemented after the first cycle; therefore, in the second cycle, the standard was met in 94% of cases where crowns were placed (Question 5).

A limitation of the audit is that there was sometimes subjectivity as to whether certain words meant that a radiograph had been attempted but unsuccessful or not attempted at all as the patient was deemed pre-cooperative, for example the interpretation of the word ‘uncooperative’, therefore these were included as ‘other written justifications’ (Question 4).

Another limitation is that the second cycle sample period commenced 3 months after the action plan had been implemented when clinicians were more acutely aware of the standards.

As there was high compliance against the standard with 94% compliance against a target of 100%, no further changes were recommended for implementation. A follow-up audit at 12 months was recommended to determine if a high compliance was maintained.

Overall, this project was successful. This is the first time this topic has been audited within this NHS Foundation Trust, and after the second cycle, there was a large increase in the number of pre-operative radiographs taken prior to stainless steel crown placement. Clinicians are now more knowledgeable on the reasons for taking pre-operative radiographs during treatment planning for stainless steel crowns and are able to make informed decisions with their patients on which primary molars would benefit from this treatment.

The authors declare no conflicts of interest.

Abstract Image

不锈钢冠置入前x光片使用审核
不锈钢牙冠(SSC)因其高临床疗效而成为儿科患者一种有价值的修复选择[1-3]。文献表明,与玻璃离子水泥(GIC)、复合材料和汞合金[1]等修复体相比,采用霍尔和传统技术放置SSC的初级磨牙失败率降低。为了适当地计划治疗,需要评估牙齿是否适合放置SSC,其中包括术前x线片[2]。x线片可用于评估SSC放置的禁忌症[1-3],例如在龋齿病变和牙髓[2]之间没有良好的牙本质带,以及x线片上有牙髓受损伤或感染[3]的证据。评估和提高社区牙科服务的临床医生在放置不锈钢牙冠之前进行术前x线片的依从性。英国国家ssc临床指南建议在第一磨牙放置前进行术前x线片检查。本标准已被修改,以考虑在社区牙科服务中治疗的患者群体(例如,合作前患者),这些患者可能无法进行x光检查。在评估问题3时,审查了可能影响拍摄x光片能力的相关病史,包括学习障碍、自闭症谱系障碍和行为或精神健康状况。在评估问题4时,不尝试x光片的可能书面理由包括:如果患者是一个未合作的儿童,或者如果正在冠的牙齿是低矿化的非龋齿。收集了第一个周期的个人临床医生数据,以便在需要时向工作人员提供个人反馈,如果工作人员要求提供他们的数据,则通过电子邮件发送这些数据,但为了分析和展示结果,这些数据是匿名的。两个周期的数据收集使用电子审计管理和跟踪(AMAT)形式进行。在审计的第一个周期和第二个周期之间,执行了一项行动计划。在2023年2月25日至2024年2月25日期间,采用与第一次周期相同的方法进行了回顾性第二周期审计。在第一轮审计中,审计了11名临床医生和161名冠,而在第二轮审计中,审计了11名临床医生和174名冠。表1总结了这两个周期的结果。在第一个周期内,没有相关的病史记录。在第二个周期内,有三名患者的病史被认为与冠植入前的x线片配合问题有关。其中两名患者每人安置了两个冠,总共安置了五个冠。这包括给一个患有自闭症、病理性需求回避和发育迟缓的病人戴上两个皇冠,给一个患有自闭症的病人戴上两个皇冠,给一个患有注意力缺陷多动障碍(ADHD)和疑似自闭症的病人戴上一个皇冠。教授了在放置不锈钢牙冠之前拍摄x光片的重要性,并在社区牙科服务的同行评审会议上介绍了第一轮审计数据及其分析。创建了不锈钢冠治疗的临床记录保存模板,并通过电子邮件发送给临床医生。最后,为不锈钢冠盒设计了一个标签,提醒临床医生在放置SSC之前拍摄x光片,或记录不拍摄x光片的理由,并分发给该服务的所有诊所(图1)。在第二个周期中,冠的放置频率略有增加;这可能是由于在教学中提供了关于不锈钢牙冠的适应症和益处的教育。在第一个和第二个周期之间,结果有明显的改善。这包括术前拍摄更多的x光片,以及在不拍摄x光片时改善记录保存。在第二个周期,有更多的人试图拍x光片;因此,术前有x光片在场的冠放置比例(问题1)以及尝试拍摄x光片不成功的证据(问题2)总体上都有所增加。在第一个周期后实施的行动中注重良好的文件;因此,在第二个周期中,94%的放置冠的病例达到了标准(问题5)。审计的一个限制是,有时对于某些词是否意味着尝试了x光片但不成功或根本没有尝试,因为患者被认为是预先合作的,例如对“不合作”一词的解释,因此这些被包括在“其他书面理由”中(问题4)。 另一个限制是,第二周期样本期开始于行动计划实施后3个月,此时临床医生对标准有了更敏锐的认识。由于对标准有很高的遵从性,对100%的目标有94%的遵从性,因此不建议对实现进行进一步的更改。建议在12个月进行后续审计,以确定是否保持高度遵守。总的来说,这个项目是成功的。这是NHS基金会信托第一次对这一主题进行审计,在第二个周期之后,在不锈钢冠放置之前拍摄的术前x线片数量大幅增加。临床医生现在更了解在不锈钢牙冠的治疗计划中采取术前x线片的原因,并且能够与患者一起做出明智的决定,决定哪些初级磨牙将从这种治疗中受益。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
5.50
自引率
2.60%
发文量
82
审稿时长
6-12 weeks
期刊介绍: The International Journal of Paediatric Dentistry was formed in 1991 by the merger of the Journals of the International Association of Paediatric Dentistry and the British Society of Paediatric Dentistry and is published bi-monthly. It has true international scope and aims to promote the highest standard of education, practice and research in paediatric dentistry world-wide. International Journal of Paediatric Dentistry publishes papers on all aspects of paediatric dentistry including: growth and development, behaviour management, diagnosis, prevention, restorative treatment and issue relating to medically compromised children or those with disabilities. This peer-reviewed journal features scientific articles, reviews, case reports, clinical techniques, short communications and abstracts of current paediatric dental research. Analytical studies with a scientific novelty value are preferred to descriptive studies. Case reports illustrating unusual conditions and clinically relevant observations are acceptable but must be of sufficiently high quality to be considered for publication; particularly the illustrative material must be of the highest quality.
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