A Framework to Improve the Quality of Management of Traumatic Dental Injuries at a Tertiary Dental Hospital

Appropriate early management, as well as early diagnosis and interceptive management of adverse outcomes, is essential in managing Traumatic Dental Injuries (TDIs) to minimize the incidence and impact of negative sequelae. Barriers to optimal management include inadequate clinician knowledge and experience, poor adherence to established guidelines, time constraints, and the complex nature of TDIs. These barriers can potentially be addressed by adopting a multipronged approach that integrates education and administrative support. The aim of this study was to evaluate the improvements in the quality of TDI management and review at the National University Centre for Oral Health Singapore after implementing a framework consisting of a series of targeted interventions.

Interventions included a refresher lecture, standardized recording templates, and improved access to resources such as international guidelines. Clinical records and radiographs of patients who had received acute management for TDI or received dental review as follow-up for TDIs between 1st May 2023 and 30th June 2024 were reviewed. The quality of baseline management and follow-up review was scored based on a scoring rubric, with a score of 100% deemed as "appropriate" management. The quality of baseline management and follow-up review of TDI in the pre- and post-implementation phases was compared using Chi-squared, Fisher's exact, and Mann-Whitney U tests.

247 patients were seen for TDI baseline management or review. The quality of TDI baseline and review management improved significantly, with median (interquartile range) scores increasing from 62.5% (27.9%) and 100% (66.6%), respectively, to 100% (0%, p < 0.001). The proportion of cases deemed appropriately managed at both baseline and review significantly improved from 3.64% and 54.3% to 82.9% and 93.8%, respectively (p < 0.001).

A framework consisting of refresher lectures, standardized recording templates, and enhanced access to resources significantly improves the quality of TDI management and review.