Selecting effective implementation strategies to support guideline-concordant dental care is a complex process. For this research project, an online deliberative forum brought together staff from dental clinics to discuss the strengths and weaknesses of implementation strategies and barriers to implementation of a component of a dental (pit-and-fissure) guideline. The goal was to determine whether deliberative engagement enabled participants\' sharing of promotive and prohibitive voice about implementation strategies to promote guideline-concordant care.
Qualitative analysis of online chat transcripts of facilitated deliberations from 31 small group sessions.
Kaiser Permanente Dental (KP Dental) in the USA.
All staff from 16 dental offices.
The directed content analysis revealed that participants shared prohibitive and promotive voice when offering critique of the barriers and the implementation strategies suggested by the researchers. The analysis also revealed that the focus of the deliberations often was not on the aspect of the pit-and-fissure guideline intended by the research team for deliberation.
The deliberative forum discussions were a productive venue to ask staff in dental clinics to share their perspectives on strategies to promote guideline-concordant care as well as barriers. Participants demonstrated prohibitive voice and engaged critically with the materials the research team had put together. An important limitation of the deliberation was that the discussion often centred around an aspect of the pit-and-fissure guideline that already was implemented well. To ensure a deliberation oriented towards resolving challenging aspects of the pit-and-fissure guideline, greater familiarity with the guideline would have been important, as well as more intimate knowledge of the current discrepancies in guideline-concordant care.
This project is registered at ClinicalTrials.gov with ID NCT04682730. The trial was first registered on 18 December 2020. https://clinicaltrials.gov/ct2/show/NCT04682730.

Medical emergencies are an unavoidable reality affecting dental practices. This review synthesizes and examines the guidelines offered by governmental and professional organizations.
Licensing agencies and professional associations were chosen as organizations of focus based on legal authority, high professional regard, or both. International and interprofessional organizational counterparts were chosen as points of comparison. In total, 11 organizations were examined. Guidelines reported were compiled by examination of documents published on official agency websites and in associated peer-reviewed journals.
Guidelines for the handling of medical emergencies in the dental clinic vary in level of detail and scope among sources. Licensing agencies provide basic requirements for training, encouraging oral health care providers to develop and integrate their own emergency response plans. Professional associations provide extensive detail on instruction in medical emergency management. Both licensing agencies and professional associations provide lists of emergency medications and equipment, with varying levels of instruction on drug maintenance and organization. Professional associations emphasize regular review of training and office emergency drills.
Oral health care professionals are provided with basic and required elements of medical emergency training by licensing agencies. They may seek out recommended, but not required, instruction from professional associations. Although guidance is provided, literature on protocol instituted in dental practices is limited. Further research is necessary to determine the oral health care community\'s approach to emergency management.
Providers must be prepared to handle medical emergencies that they encounter. Accessible and understandable guidelines are crucial to safe dental practice.

In this study we evaluated the effect of a multicomponent intervention to implement the Public Health Service (PHS) guideline Treating Tobacco Use and Dependence in six randomly selected dental clinics in New York University\'s College of Dentistry. The main outcome measure-provider adherence to tobacco use treatment guidelines-was assessed by auditing a random selection of patient charts pre (698) and post (641) intervention. The intervention components included a chart reminder and referral system, free nicotine replacement therapy (NRT), and provider training and feedback. The results showed that rates of screening for tobacco use did not change between pre and post test chart audits. However, providers were significantly more likely to offer advice (28.4 percent pre, 49 percent post), assess readiness to quit (17.8 percent pre, 29.9 percent post), and offer assistance (6.5 percent pre and 15.6 percent post) in the post test period. Increases in NRT distribution were associated with booster training sessions but declined in the time periods between those trainings. Research is needed to further define sustainable strategies for implementing tobacco use treatment in dental clinics. The results of this study suggest the feasibility and effectiveness of using a tailored multicomponent approach to implement tobacco use treatment guidelines in dental clinics.

In this paper, the extent to which practice guidelines using cost-effectiveness data can be used to inform programme decisions is analysed. In particular it is shown that guidelines aimed at informing individual patient-provider decisions are unable to reflect the economic concepts that are required to inform public decisions concerned with making best (i.e., most productive) use of the resources available to serve defined populations. The research on which practice guidelines are based represents an important but incomplete source of information for taking decisions about which clients to serve, with which services, and when in the disease process, in the context of provision of services to groups or populations. Moreover, the inappropriate use of \'individually focused\' guidelines to inform \'collectively-focused\' decisions can lead to more harm than good. An alternative approach for dealing with the difficult choices faced by decision makers involved in public programmes is identified. An illustration of the proposed approach is presented concerning the provision of pit and fissure sealants to children served by a public health clinic.

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The emergence of acquired immune deficiency syndrome as a new and devastating communicable disease has led to concern among health care workers as to their risk of acquiring human immunodeficiency virus (HIV) in the workplace. Centres for Disease Control, and Health and Welfare Canada guidelines seek to prevent HIV transmission through modification of work practices. A study was performed in the authors\' institution to quantitate health care worker compliance with such practice modifications as outlined in the researchers\' institutional infection control procedures and to evaluate administrative and engineering controls related to this policy. An infection control program to educate health care workers and modify practices was being implemented prior to commencement of this study. Three areas were studied: emergency room, dental clinic and plastic surgery clinic. Adherence to established procedures was judged as compliant, noncompliant and interpretive compliant. Of 806 observations made on 24 health care workers in the three areas, 31.3% were compliant, 28% were noncompliant and 40.7% were interpretive complaint. The most serious non-compliance was noted in handling and disposal of needles. Use of gloves, eyewear, gowns or masks varied among the three sites. Administrative and engineering controls were lacking for eyewear, gowns, puncture-resistant containers and a written policy in some sites. The lack of compliance with institutional infection control procedures needs to be confirmed in other institutions. If there is generalized compliance failure, then a re-evaluation of the present strategies to reduce risk of HIV infection in health care workers is essential.