Developing an Original Evidence Synthesis Methodology for Dental Clinical Guidelines in Low-Resource Settings

Evidence synthesis for dental clinical guidelines in low-resource settings requires methodological adaptations that account for sparse, contextually restricted primary evidence, indirect evidence from higher-resource contexts, and resource constraint considerations that standard guideline development methods do not accommodate. This study developed an original evidence synthesis methodology for dental clinical guidelines in low-resource settings, with application to three dental clinical questions relevant to Nigerian dental practice. A methodology development approach integrating health technology assessment, guideline methodology research, and original application was employed. The three clinical questions addressed were: fluoride varnish frequency for high-risk children in PHC settings, antibiotic choice for dentoalveolar abscess in primary care, and caries management decisions in the absence of dental radiography. For each clinical question, a structured literature search, GRADE evidence assessment adapted for resource constraints, a health economic analysis framework for low-resource settings, and a contextualisation panel of Nigerian dental and public health specialists were applied. The original Low-Resource Dental Guideline Synthesis Methodology (LR-DGSM) formalises seven adaptations to standard GRADE methods, including a resource feasibility dimension for each recommendation and a context-transfer validity assessment for evidence from high-resource settings. Expert review by 16 guideline development and dental public health specialists confirmed the methodology's original contribution. The study recommends the LR-DGSM be used by the National Oral Health Programme for all future Nigerian evidence-based dental guidelines.

Keywords: evidence synthesis methodology, dental clinical guidelines, low-resource settings, GRADE, Nigeria