Quality Data Registry in Dentistry

Recently on this site there was a discussion of using an outcomes data registry for dentistry to help assess surgical outcomes, complications, and possible gaps in treatment.  The goal with such a data registry is to better monitor what is going on in clinical practice to help improve the quality of care that patients receive. Such efforts have been limited in dentistry although present in other aspects of healthcare for many years. According to the “Quality Measurement in Dentistry A Guidebook” produced by the Dental Quality Alliance in June 2019, retrospective claims data are the only data currently collected in dentistry.

In an article titled “Swedish Quality Registry for Caries and Periodontal Diseases – a framework for quality development in dentistry,” by Bultzingslowen et al. appearing in the International Dental Journal in 2019, the authors discuss an automatic data retrieval concept for use in dentistry from patient records. The data warehouse is an SQL (Structured Query Language) relational database, which allows for efficient addition of new items to the data structure. Information stored includes more than 400 variables including gender, age, risk assessment for caries and periodontal diseases, and dental status based on tooth/tooth site levels. Data is validated and secured on a regular and continuous basis to ensure that data quality is maintained and data is not altered from that in the original patient records.

The registry in Sweden has been in place since 2008. Over 1,000 public dental clinics in Sweden have had their dental data included. The total number of patients included in the registry has increased from approximately 261,000 in 2009 to over 6.9 million in 2018. About 90% of the Swedish population ages 0 to 19 is represented while only about 47% of the Swedish population ages 20 and older is included. Patients are given the option to have their data removed and not included in the registry but only 28 patients so far have done so. The Swedish Quality Registry for Caries and Periodontal Diseases has also developed their own Manual for Quality Development in Dentistry.

medical record chart patient - Quality Data Registry in Dentistry
This image is from the NIH on Flickr and has a Creative Commons license

In the article by Bultzingslowen et al. several charts and figures are present which shows examples of what can be gleaned from the data. For example there is a bar chart which shows the mean number of decayed or filled surfaces broken down into age groups and years (excluding wisdom teeth). This shows that the mean number of tooth surfaces with caries or fillings remained stable in those 20 years old, decreased in those ages 35, 50, and 65, and increased in those aged 80 and 95 over the years from 2010 to 2016. Another example is a bar chart which shows the percentage of patients 20 years and older who received a comprehensive oral examination with periodontal pocket depth assessment in 2012 and 2016. The general trend shows that there was an increased percentage in 2016 when compared to 202 and thus an improved quality of care with regard to periodontal diagnosis. However, this trend did not hold for two out of the 21 dental care organizations in Sweden and thus these dental care organizations could work towards improving the skills of their dentists. Another example is a figure which illustrates the percentage distribution of reasons for tooth extraction in 2016 from patients 20 to 90 years old into six categories: Endodontic, Dental caries, Periodontal diseases, Dental fracture, Orthodontics, and Other reasons. The reasons for extracting a tooth in younger patients was most commonly for caries and then for other reasons. However, in patients older than 50 the most common reason for extracting a tooth was periodontal diseases.

The authors state

“National quality registries [NQR] are considered powerful tools in support of quality development of healthcare, promoting patient in favour of patient safety and health, and as sources for valuable and valid information for clinical research….[this] is the first NQR in dentistry solely based on automatic retrieval and delivery of data from patient records.”

The authors also mention that 25% of the adult population Sweden does not seek out dental care, which can help better explain while less than 50% of adult Swedish patients are in the registry. Even so the authors still feel longitudinal and cross-sectional epidemiological data produced by the registry can describe oral health conditions among the population in Sweden. The authors do point out a few problems with data quality from the registry. The first is that data quality controls revealed some shortcomings in the patient record systems but the authors feel once these were identified they were corrected. However, they do feel that continuous development of new parameters and close collaboration with the providers of the dental record system is necessary. Further the authors point out that non-calibrated examiners generate the diagnostic data but believe because of using over 10,000 clinicians that the risk of systematic errors is low. The bottom line is the authors feel that the concepts of the registry can be applied to the scientific and dental communities to help lead for improvement of oral health and quality of dental care.

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