# Safety first! An audit to improve airway protection during student placement of preformed metal crowns

## TL;DR

This paper shows how implementing a safety protocol improved student compliance with airway protection during preformed metal crown placement in children.

## Contribution

A new airway protection protocol was introduced and integrated into dental training to enhance safety during crown placement.

## Key findings

- In Cycle 1, only 15 out of 50 PMCs met the airway protection standard.
- After introducing a new protocol, 46 out of 50 PMCs met the standard in Cycle 2.
- A 62% improvement in compliance was observed, though further training is needed to reach 100%.

## Abstract

Introduction The Hall technique is an evidenced-based approach to managing primary caries. Airway protection (AP) is essential when placing preformed metal crowns (PMCs), preventing aspiration/ingestion.

Aim Assess undergraduates' compliance in AP when placing PMCs.

Standard Conforming with guidance from the University of Dundee, 100% of undergraduates will use the following AP during PMC placement: 1) child seated upright (not reclined greater than 45o); 2) use of a gauze swab square or Micro-Stix applicator for the entire procedure.

Methods Data were obtained prospectively via a standardised pro forma completed by calibrated clinical teachers observing student placement of PMCs. Clinical teachers were advised to intervene if they had safety concerns. Data were collected via convenience sample of 50 PMCs per cycle.

Results In Cycle 1, 15 PMC placements met the standard, with nine episodes of intervention. A new AP protocol was introduced and embedded within the curriculum. In Cycle 2, 46 PMCs met the standard, with three episodes of intervention.

Discussion Despite an improvement in AP of 62%, further changes are recommended to reach the 100% standard set.

Conclusion A comprehensive action plan including an AP protocol and teaching can improve compliance with guidance on PMC placement. Further training is proposed to meet the standard.

Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-025-8493-x für autorisierte Leser zusätzliche Dateien abrufbar.

Highlights the importance of airway protection during placement of preformed metal crowns.Demonstrates how an airway protection protocol can improve student compliance with safety precautions during placement of preformed metal crowns.Outlines a whole team approach to addressing a clinical challenge.

Highlights the importance of airway protection during placement of preformed metal crowns.

Demonstrates how an airway protection protocol can improve student compliance with safety precautions during placement of preformed metal crowns.

Outlines a whole team approach to addressing a clinical challenge.

Zusatzmaterial online: Zu diesem Beitrag sind unter 10.1038/s41415-025-8493-x für autorisierte Leser zusätzliche Dateien abrufbar.