An investigation of West Sussex general dental practitioners' awareness, attitudes and adherence to NICE dental recall guidelines

Abstract

Aims: The overall aim of this study was to determine whether general dental practitioners (GDPs) in West Sussex were aware of and followed National Institute for Health and Clinical Excellence (NICE) guidelines on dental recalls. The study also aimed to identify factors in the GDPs' practice of dentistry that could affect their adherence to NICE guidelines and to gain some insight into their views on this topic and how these might affect their adherence.

Methods: A postal questionnaire, which had previously been piloted, and an explanatory letter were sent to a random sample of 195 GDPs representing 50% of the GDPs contracted to the West Sussex Primary Care Trust. Those who did not respond were sent the questionnaire and letter for a second time. The questionnaire consisted of 50 questions that covered awareness of, attitudes towards and adherence to the NICE guidelines on dental recalls, risk factors, and the GDPs' practising profile. Resulting data were entered into a database and, where appropriate, statistically tested with the chi-square test, with the level of statistical probability set at P<0.5.

Results: Data were obtained from the 50 questions in the questionnaires. Only key results are presented in this abstract. Ten of the 195 GDPs had either moved away from the area or were orthodontists. The final sample was therefore 185, of whom 117 returned questionnaires, a response rate of 63%. Seventy-three per cent of the respondents had qualified in United Kingdom. Sixty-five per cent were male. The mean age of respondents was 43 years. Seventy-one per cent worked as GDPs within the General Dental Services (GDS) or Personal Dental Services. Concerning NICE recall guidelines, 94% stated that they were aware of them, 61% said they agreed with them, and 64% that they adhered to them. Female GDPs were statistically far more likely to state that they followed NICE guidelines ( P =0.0043). Seventy per cent of GDPs reported that they still recalled their patients at six-month intervals and only 3% that they recalled their patients according to need. Eighty-five per cent reported taking radiographs at two-year intervals and/or according to patient need, and 68% that they gave oral hygiene advice six monthly or at every recall. Risk assessments were reported as being always carried out by 65% of responding GDPs for caries, 83% for periodontal disease, and 81% for oral cancer. Ninety per cent reported that they thought risk factors were relevant when setting the recall interval and 82% thought that six-monthly recalls allowed appropriate screening to take place.

Conclusions: Only 3% of responding GDPs recalled their patients according to patient need, in line with NICE recall guidelines, although the majority of GDPs agreed with the guidelines and stated that they adhered to them; however, this was in contrast to the 70% of GDPs who continued to recall at six-month intervals. The majority of GDPs thought that less frequent recalls would not allow for early caries, periodontal disease and oral malignancy diagnosis, and did not think that access to NHS dentistry would be improved. They also did not believe that excessive NHS money was spent on over-frequent dental examinations. There would appear to be significant obstacles to altering the recall habits of dentists because of the way that dentists practise.