Polk Deborah E, Shah Nilesh H, Dawson Tim, Gruß Inga, Pihlstrom Daniel J, Kaplan Charles D, Guerrero Erick G, Fellows Jeffrey L
University of Pittsburgh School of Dental Medicine, Pittsburgh, PA, USA.
The Art of Democracy, Pittsburgh, PA, USA.
Sci Rep. 2025 May 25;15(1):18180. doi: 10.1038/s41598-025-03236-9.
Dental sealants, an evidence-based clinical practice, can arrest occlusal non-cavitated carious lesions (NCCLs); however, U.S. oral health providers rarely provide this treatment. To increase providers' adoption of the practice, clinic leaders need to identify implementation strategies to deploy. Using a stepped wedge design across 16 cluster-randomized dental clinics, we examined whether small-group deliberative engagement enabled 680 oral health providers and staff to endorse implementation strategies and to increase placement of dental sealants on occlusal NCCLs. Participants deliberated about two barriers and eight implementation strategies. Sealant placement for occlusal NCCLs was extracted from the electronic health record. After deliberating, 49% of participants endorsed the first barrier and 37% endorsed the second barrier. Of those, 26% indicated a strategy was needed for the first barrier and 28% indicated a strategy was needed for the second. Consistent with this perceived lack of need for strategies, leaders did not deploy implementation strategies. Compared with the non-intervention period (98 clinic-months), in the intervention period (101 clinic-months), providers did not increase placement of sealants on occlusal NCCLs. Deliberative engagement may help clinic leaders efficiently evaluate support for implementation strategies, but future research is needed to determine how to increase guideline adoption.Trial Registration: This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 18/12/2020. https://clinicaltrials.gov/ct2/show/NCT04682730.
牙齿窝沟封闭是一种基于证据的临床实践，可阻止咬合面非龋性龋损（NCCLs）；然而，美国的口腔健康服务提供者很少提供这种治疗。为了提高服务提供者对该实践的采用率，诊所负责人需要确定要部署的实施策略。我们采用阶梯楔形设计，在16个整群随机牙科诊所进行研究，以检验小组审议参与是否能使680名口腔健康服务提供者和工作人员认可实施策略，并增加对咬合面NCCLs进行牙齿窝沟封闭的操作。参与者审议了两个障碍和八个实施策略。从电子健康记录中提取了针对咬合面NCCLs的窝沟封闭操作数据。审议后，49%的参与者认可第一个障碍，37%的参与者认可第二个障碍。其中，26%的人表示第一个障碍需要一种策略，28%的人表示第二个障碍需要一种策略。与这种认为不需要策略的看法一致，负责人没有部署实施策略。与非干预期（98个诊所月）相比，在干预期（101个诊所月），服务提供者并未增加对咬合面NCCLs进行窝沟封闭的操作。审议参与可能有助于诊所负责人有效评估对实施策略的支持，但需要未来的研究来确定如何提高指南的采用率。试验注册：该项目已在ClinicalTrials.gov上注册，ID为NCT04682730。该试验于2020年12月18日首次注册。https://clinicaltrials.gov/ct2/show/NCT04682730 。
