Cassie H, Treweek S, McKee L, Ramsay C, Young L, Clarkson J. 'Well, in dentistry the dentist is always the boss': a multi-method exploration of which organisational characteristics of dental practices most influence the implementation of evidence-based guidance. BMJ Open 2022; DOI: 10.1136/bmjopen-2021-059564.

Evidence-based dental recommendations are not routinely translated into practice so guidelines should aim to tailor recommendations and implementation strategies to reflect the complexities and varying contexts that exist in primary care dentistry.

This study investigated which organisational characteristics of primary care dental practices influence the implementation of evidence-based guidance. A multi-method study set within primary care dentistry in Scotland comprised of semi-structured interviews with dental teams as well as a questionnaire-based survey and case studies. Survey data revealed compliance with recommendations from three topics of dental guidance to be variable, with only 41% (emergency dental care), 19% (oral health assessment and review) and 4% (drug prescribing) of respondents reporting full compliance. Analysis revealed no significant relationship between practice characteristics and compliance with emergency dental care or drug prescribing recommendations. Positive associations were observed between compliance with oral health assessment and review recommendations and having a practice manager, as well as with the type of treatment offered, with fully private practices more likely, and fully NHS practices less likely, to comply, when compared with those offering a mixture of treatment. Synthesis of the data identified leadership and context as key drivers of guidance uptake. The authors concluded that evidence-based dental recommendations are not routinely translated into practice.