Methodology

Guidance development methodology

SDCEP uses a methodology for guidance development that aims to be transparent, systematic and to adhere as far as possible to international standards set out by the Appraisal of Guidelines Research and Evaluation (AGREE) Collaboration (www.agreetrust.org). Details of the guidance development methodology used by SDCEP to produce guidance are available at www.sdcep.org.uk/how-we-work/guidance-development-process.

Development of the first edition

The 2013 first edition of the Management of Acute Dental Problems (MADP) guidance was developed by a multidisciplinary group, building on SDCEP’s Emergency Dental Care guidance,⁹ the experience of managing dental calls within NHS 24 and evidence on treatment of the wide range of conditions that may present.

Following the TRiaDS framework for translating guidance recommendations into practice,⁵⁸ the views of general dental practitioners, general medical practitioners and pharmacists on current practice, attitudes to the management of patients with acute dental problems and preferred content of the guidance were obtained via questionnaire surveys. This was used to inform both the scope of the guidance and the strategy for identifying evidence.

The guiding principle for developing guidance within SDCEP is to first source existing guidelines, policy documents, legislation or other recommendations. Relevant systematic reviews are also initially identified. These are appraised for their quality of development, evidence base and applicability to the remit of the guidance under development. In the absence of these sources or when supplementary information is required, other published literature and unpublished work may be sought. For the first edition of this guidance, an evidence overview was carried out to appraise and summarise evidence on relevant oral conditions and the interventions recommended to manage these conditions.

A search of Medline, Embase, Cinahl and Web of Science Proceedings was conducted in July 2011. The results of this were supplemented from the Cochrane Database of Systematic Reviews (CDSR) by scrutinising all published reviews in the Cochrane Oral Health Group’s database, and conducting a simple search of the CDSR database for relevant disease terms for conditions not exclusive to the oral health collection. Two reviewers identified potentially eligible articles from the list of titles and abstracts and where agreement could not be reached on the eligibility of an article, a third reviewer was involved in settling the discrepancy. The AMSTAR checklist was used to assess the methodological quality of the retrieved articles.⁵⁹ Additional sources of evidence and other references identified by GDG members were considered, taking relevance and methodological quality into account.

Information was collected from the sources and presented to GDG members as summary tables to inform development of the guidance. Where authoritative evidence was unavailable, the advice was informed by expert opinion. Decisions were reached through informal consensus.

A consultation draft of the first edition was sent to individuals and bodies with a specific interest in the management of patients with acute dental problems in a variety of healthcare settings, and to those involved in the organisation of dental services and education in Scotland. To obtain feedback from the end-users of the guidance, dentists, general medical practitioners and pharmacists in Scotland were notified that the consultation draft was available and invited to comment. The consultation feedback was reviewed and considered to inform further development of the guidance prior to targeted peer review. Similarly, all peer reviewer comments were considered and the guidance amended before publication. 

Development of the second edition

In 2018 the SDCEP Steering Group agreed not to prioritise extensive review and updating and the MADP guidance remained extant. In 2023 a review of the guidance commenced to determine the need for, and extent of, any updating required. Preliminary scoping work identified clinical details in the guidance that were outdated, and a more comprehensive review and updating was initiated.

Relevant authoritative sources, including the British National Formulary (BNF; https://bnf.nice.org.uk/) and NICE Clinical Knowledge Summaries (CKS; https://cks.nice.org.uk) were searched for current advice relating to each clinical condition in the guidance. Where advice from these sources was unavailable or insufficient, recent systematic reviews and guidelines were identified by searching the Cochrane Database of Systematic Reviews and the Epistemonikos database, and by checking guideline provider websites and conducting internet searches, using search terms based on each oral condition. Additional sources of evidence identified by GDG members were considered, taking relevance and methodological quality into account.

Systematic reviews and guidelines relating to the clinical conditions were appraised for their quality of development and evidence base, with precedence given to the most recent articles. Systematic reviews were assessed for methodological quality using AMSTAR criteria,^60,61 and relevant information extracted. Cochrane Systematic Reviews were not subject to formal appraisal due to Cochrane’s well established and accepted robust and transparent methodology. The AGREE II instrument was used to assess the methodological quality of guidelines (www.agreetrust.org).

Updates to the guidance were based on the identified sources and expert opinion, with clinical input provided by individual GDG members, before consideration by the wider GDG. Decisions on the guidance content were reached by consensus or majority voting.

Targeted external peer review of the draft updated guidance was carried out in November 2025. All peer reviewer comments were considered, and the guidance amended accordingly prior to publication.

An assessment of the potential impact of this guidance on equality target groups was conducted during the updating.

Further details of the methodology used for the development of the first and second editions of the guidance will be made available via this website.

Review and updating

For this guidance, a further review of the topic will take place five years after publication of this edition, and if there are significant changes the guidance will be updated accordingly.