Emergency and Sequalae Management of Traumatic Dental Injuries: A Quality Assessment of Clinical Practice Guidelines

The prevalence and consequences of traumatic dental injuries (TDI) make them a public health problem. Trustworthy TDI Clinical Practice Guidelines (CPGs) can assist clinicians in making a proper diagnosis, and guide them to the most appropriate therapy for every case. The aim of this study was to identify and evaluate the quality of CPGs for the diagnosis, emergency management and follow-up of TDIs. A systematic search was carried out in MEDLINE, EMBASE, Epistemonikos, Trip database, CPG websites, and dental societies to identify documents providing recommendations for the emergency and sequelae management of TDIs. Reviewers assessed the included guidelines independently and in duplicate, using the AGREE II instrument. T-student or ANOVA tests were used to determine the attributes of CPGs associated with the total score in AGREE II. Ten CPGs published between 2010 and 2020 were included, mostly from Europe (n=6). The overall agreement between reviewers was very good (0.94; 95%CI 0.91-0.97). The mean scores for each domain were as follows: Scope and purpose 78.0 {+/-} 18.9%; Stakeholder involvement 46.9 {+/-} 29.6%; Rigour of development 41.8 {+/-} 26.7%; Clarity of presentation 75.8 {+/-} 17.6%; Applicability 15.3 {+/-} 18.8% and Editorial independence 41.7 {+/-} 41.7%. The overall mean rate was 4 {+/-} 1.3 out of a maximum score of 7. Only two guidelines were recommended by the reviewers and rated as high quality. The CPGs developed by governments showed a significantly higher overall score. The overall quality of CPGs on TDI was suboptimal. Therefore, the CPGs developers need to use a methodology that allows them to formulate recommendations in a structured, transparent, and explicit way.