This letters was published in the journal Tuith Online in December 1999

Guidelines on the Sidelines

Last week we saw the consultative launch of the latest of the SIGN Guidelines which might strongly influence the rational practice of dentistry. "Towards Safer Sedation of Children" offers hope for a more prudent future when currently the commonest reason for general anaesthetic administration in under 12's in Scotland is dental extraction.

Surgery may be major or it may be minor we are often reminded, but a general anaesthetic is always a major physiological event, the unplanned sequellae of which are catastrophic. Strong and compelling reason for such evidence based practice currently advocated to be swiftly brought into practice. The strength of systematic review and the statistical might of meta-analysis leaves no doubt.

The impact of this Guideline is enhanced by the findings of the similarly potent SIGN document on "Preventing Caries in High caries Risk Children". Tough on caries: tough on the causes of caries. With these papers on our bracket tables we enter a new dawn in paediatric dentistry in a country where dental caries defines your socio-economic stratum. Empowered by systematically defined grades of clinical recommendation supported by rigorous definition of statements of evidence we might expect to reverse the dental aspects of the socially inequitable diseases of New Scotland.

In expectation of this dawning my alarm clock rings daily. There is already an eager group of dentists throughout the country who have attended the launches of all three dental Guidelines and who are prepared to support to evidence revolution. A study group at a recent national meeting debated "putting Guidelines into practice" with determination and conviction which suffered the inhibiting compromise that there are as yet no Guidelines on the bookstand. There are indeed drafts but as yet no winds of change. Yet every day the anaesthetic costs of our hospitals compete with the human costs of our children's well-being while the evidence based, systematically sieved solutions await the application in practical terms by a profession which has seen unguided capitation fail and has seen care indices falling.

What constitutes care? While our profession awaits the ratification of a strategy based on best evidence of prevention, the reality is that tomorrows anaesthetic lists will process with political pragmatism the failure of our inaction. The evidence is compelling and the professional motivation strong. How long can we now tolerate the cardiograph and capnograph within the daily routine of dental care? Back the researched science with the common sense of a properly funded NHS programme of audited activity and with every haste, put Guidelines into Practice.

Iain Hunter is a GDP with a practice in Hamilton