Knowing which factors influence restoration longevity can help clinicians make sound treatment decisions. The authors analyzed data from The National Dental Practice-Based Research Network to identify predictors of early failures of amalgam and resin-based composite (RBC) restorations.
In this prospective cohort study, the authors gathered information from clinicians and offices participating in the network. Clinicians completed a baseline data collection form at the time of restoration placement and annually thereafter. Data collected included patient factors, practice factors and dentist factors, and the authors analyzed them by using mixed-model logistic regression.
A total of 226 practitioners followed up 6,218 direct restorations in 3,855 patients; 386 restorations failed (6.2 percent) during the mean (standard deviation) follow-up of 23.7 (8.8) months. The number of tooth surfaces restored at baseline helped predict subsequent restoration failure; restorations with four or more restored surfaces were more than four times more likely to fail. Restorative material was not associated significantly with longevity; neither was tooth type. Older patient age was associated highly with failure (P
Cites: J Am Dent Assoc. 2005 Jun;136(6):790-616022046
Practice-based research networks (PBRNs) aim to improve clinical practice by engaging dental practitioners in studies that are directly relevant to daily clinical practice. The Dental Practice-Based Research Network (DPBRN) consists of dentists from seven U.S. states and three Scandinavian countries. All DPBRN dentists complete an enrollment questionnaire about their practices and themselves; as of this writing, 1,086 have done so. To quantify the similarities between DPBRN dentists and U.S. dentists at large, this article compared DPBRN practice characteristics to those of dentists who responded to the 2004 ADA Survey of dental practice, which is not limited to ADA members. DPBRN dentists were similar to U.S. dentists in terms of gender, race, ethnicity, number of offices, percentage of patients with insurance coverage, number of operatories, patient visits per week, days for a new appointment, and waiting room time. DPBRN dentists were statistically more likely to be recent graduates. The commonalities should increase the likelihood that DPBRN studies will be applicable to U.S. practices, thereby fostering knowledge transfer in both research-to-practice and practice-to-research.
Cites: BMJ. 2001 Mar 10;322(7286):567-811238139
Cites: Ann Fam Med. 2007 May-Jun;5(3):242-5017548852
Cites: N Engl J Med. 2001 Jun 28;344(26):2021-511430334
Cites: J Am Dent Assoc. 2003 Jan;134(1):103-712555963
Cites: J Am Dent Assoc. 2003 May;134(5):621-712785498
Cites: N Engl J Med. 2003 Aug 28;349(9):868-7412944573
Cites: J Am Dent Assoc. 2003 Dec;134(12):1630-4014719761
Cites: Med Care. 2004 Apr;42(4 Suppl):III45-915026664
Cites: J Am Dent Assoc. 1998 Oct;129(10):1474-99787548
Cites: J Am Dent Assoc. 1997 May;128(5):651-39150651
Cites: Ann Fam Med. 2004 Sep-Oct;2(5):425-815506575
Cites: J Am Dent Assoc. 1998 Nov;129(11):1615-219818583
Cites: J Am Dent Assoc. 1999 Mar;130(3):424-3010085668
Cites: J Am Dent Assoc. 2004 Oct;135(10):1362, 1364, 136615551971
Cites: Ann Fam Med. 2005 May-Jun;3 Suppl 1:S12-2015928213
Cites: Ann Fam Med. 2005 May-Jun;3 Suppl 1:S5-1115928219
Cites: J Am Dent Assoc. 2005 Jun;136(6):728-3716022037
This study surveyed Dental Practice-Based Research Network (DPBRN) member dentists (from four regions in the U.S. and Scandinavia) who perform restorative dentistry in their practices. The survey asked a range of questions about caries risk assessment in patients aged 6 to 18. Among respondents, 73% of dentists reported performing caries risk assessment among these patients, while 14% assessed caries risk by using a special form. Regions in which most dentists were in a private practice model were the least likely to perform caries risk assessment, while regions where most dentists practiced in a large group practice model were the most likely to use a special form for caries risk assessment. Recent graduates from dental school were more likely to use a caries risk assessment compared to older graduates. Current oral hygiene, decreased salivary flow, and the presence of active caries were rated as the most important caries factors. Some differences by region were also evident for the risk factor ratings. These results suggest that not all community dentists assess caries risk. The results of this study also indicate considerable variability in dentists' views concerning the importance of specific caries risk factors in treatment planning and weak evidence that caries risk assessment is driving clinical practice when preventive treatment recommendations are being considered.
The growing availability of electronic data offers practitioners increased opportunities for reusing clinical data for research and quality improvement. However, relatively little is known about what clinical data practitioners keep on their computers regarding patients.
The authors conducted a web-based survey of 991 U.S. and Scandinavian practitioner-investigators (P-Is) in The Dental Practice-Based Research Network to determine the extent of their use of computers to manage clinical information; the type of patient information they kept on paper, a computer or both; and their willingness to reuse electronic dental record (EDR) data for research.
A total of 729 (73.6 percent) of 991 P-Is responded.A total of 73.8 percent of U.S. solo practitioners and 78.7 percent of group practitioners used a computer to manage some patient information, and 14.3 percent and 15.9 percent, respectively, managed all patient information on a computer. U.S. practitioners stored appointments, treatment plans, completed treatment and images electronically most frequently, and the periodontal charting, diagnosis, medical history, progress notes and the chief complaint least frequently.More than 90 percent of Scandinavian practitioners stored all information electronically.A total of 50.8 percent of all P-Is were willing to reuse EDR data for research, and 63.1 percent preferred electronic forms for data collection.
The results of this study show that the trend toward increased adoption of EDRs in the United States is continuing, potentially making more data in electronic form available for research. Participants appear to be willing to reuse EDR data for research and to collect data electronically.
The rising rates of EDR adoption may offer increased opportunities for reusing electronic data for quality improvement and research.
Cites: J Dent Educ. 2011 Apr;75(4):453-6521460266
Cites: BMJ. 2003 May 17;326(7398):107012750210
Cites: Med Care Res Rev. 2010 Oct;67(5):503-2720150441
Cites: Gen Dent. 2009 May-Jun;57(3):270-519819818
Cites: Ann Intern Med. 2009 Sep 1;151(5):338-4019638402
The feasibility of a clinical trial of pain related to temporomandibular muscle and joint disorders: the results of a survey from the Collaboration on Networked Dental and Oral Research dental practice-based research networks.
The authors conducted a survey to characterize the strategies used by general dentists to manage pain related to temporomandibular muscle and joint disorders (TMJDs) and to assess the feasibility of conducting a randomized controlled trial (RCT) to determine the effectiveness of these strategies.
Dentists from three dental practice-based research networks (PBRNs) (The Dental Practice-Based Research Network, Practitioners Engaged in Applied Research and Learning Network and Northwest Practice-based REsearch Collaborative in Evidence-based DENTistry) agreed to participate in this survey.
Of 862 dentists surveyed, 654 were general dentists who treated TMJDs; among these, 80.3 percent stated they would participate in a future RCT. Dentists treated an average of three patients with TMJD-related pain per month. Splints or mouthguards (97.6 percent), self-care (85.9 percent) and over-the-counter or prescribed medications (84.6 percent) were the treatments most frequently used. The treatments dentists preferred to compare in an RCT were splint or mouthguard therapy (35.8 percent), self-care (27.4 percent) and medication (17.0 percent).
Most general dentists treat TMJD-related pain, and initial reversible care typically is provided. It is feasible to conduct an RCT in a dental PBRN to assess the effectiveness of splint or mouthguard therapy, self-care or medication for the initial management of painful TMJD.
There is an opportunity to do an RCT in a dental PBRN, which could lead to the development of evidence-based treatment guidelines for the initial treatment of TMJD-related pain by primary care dentists.
In this study, the authors tested the frequency of dentists' recommendations for and use of caries-preventive agents for children as compared with adults.
The authors surveyed 467 general dentists in the Dental Practice-Based Research Network who practice within the United States and treat both pediatric and adult patients. They asked dentists to identify the percentage of their patients for whom they had administered or recommended dental sealants, in-office and at-home fluoride, chlorhexidine rinse and xylitol gum.
Dentists were less likely to provide adult patients than pediatric patients with in-office caries-preventive agents. However, the rate at which they recommended at-home preventive regimens for the two groups of patients was similar. Dentists with a conservative approach to caries treatment were the most likely to use and recommend the use of caries-preventive agents at similar rates in adults as in children. In addition, dentists in practices with a greater number of patients who had dental insurance were significantly more likely to provide in-office fluoride or sealants to adult patients than to pediatric patients.
General dentists use in-office caries-preventive agents more commonly with their pediatric patients than with their adult patients.
General dentists should consider providing additional in-office caries-preventive agents for their adult patients who are at increased risk of experiencing dental caries.
Effectively addressing regulatory and human participant protection issues with Institutional Review Boards (IRBs, or ethics committees) and grants administration entities is an important component of conducting research in large collaborative networks. A dental practice-based research network called "DPBRN" (http://www.DPBRN.org) comprises dentists in two health maintenance organizations, several universities, seven US states, and three Scandinavian countries. Our objectives are to describe: a) the various human participants and regulatory requirements and solutions for each of DPBRN's five regions; b) their impact on study protocols and implementation; and c) lessons learned from this process.
Following numerous discussions with IRB and grants administrative personnel for each region, some practitioner-investigators are attached to their respective IRBs and contracting entities via sub-contracts between their organizations and the network's administrative site. Others are attached via Individual Investigator Agreements and contractually obligated via Memoranda of Agreement.
IRBs approve general operations under one approval, but specific research projects via separate approvals. Various formal IRB and grants administrative agreements have been arranged to customize research to the network context. In some instances, this occurred after feedback from patients and practitioners that lengthy written consent forms impeded research and raised suspicion, instead of decreasing it.
Instead of viewing IRBs and institutional administrators as potentially adversarial, customized solutions can be identified by engaging them in collegial discussions that identify common ground within regulatory bounds. Although time-intensive and complex, these solutions improve acceptability of practice-based research to patients, practitioners, and university researchers.
Effectively addressing challenges of conducting research in nonacademic settings is crucial to its success. A dental practice-based research network called The Dental Practice-Based Research Network (DPBRN) is comprised of practitioner- investigators in two health maintenance organizations, several universities, many U.S. states, and three Scandinavian countries. Our objective in this article is to describe lessons learned from conducting studies in this research context; the studies are conducted by clinicians in community settings who may be doing their first research study. To date, twenty-one studies have been completed or are in implementation. These include a broad range of topic areas, enrollment sizes, and study designs. A total of 1,126 practitioner-investigators have participated in at least one study. After excluding one study because it involved electronic records queries only, these studies included more than 70,000 patient/participant units. Because the DPBRN is committed to being both practitioner- and patient-driven, all studies must be approved by its Executive Committee and a formal study section of academic clinical scientists. As a result of interacting with a diverse range of institutional and regulatory entities, funding agencies, practitioners, clinic staff, patients, academic scientists, and geographic areas, twenty-three key lessons have been learned. Patients' acceptance of these studies has been very high, judging from high participation rates and their completion of data forms. Early studies substantially informed later studies with regard to study design, practicality, forms design, informed consent process, and training and monitoring methods. Although time-intensive and complex, these solutions improved acceptability of practice-based research to patients, practitioners, and university researchers.
Cites: Acad Med. 2010 Mar;85(3):476-8320182121
Cites: J Am Dent Assoc. 2010 Apr;141(4):441-820354094
Cites: Exp Biol Med (Maywood). 2010 Mar;235(3):290-920404046
Cites: J Public Health Dent. 2010 Winter;70(1):19-2719694937
Cites: Child Care Health Dev. 2010 May;36(3):385-9120507330
The authors conducted a study to identify factors associated with the materials that dentists in The Dental Practice-Based Research Network (DPBRN) use when placing the first restoration on permanent posterior tooth surfaces.
A total of 182 DPBRN practitioner-investigators provided data regarding 5,599 posterior teeth with caries. Practitioner-investigators completed an enrollment questionnaire that included the dentist's age, sex, practice workload, practice type and number of years since graduation. When patients who had provided informed consent to participate in the investigation sought treatment for a previously unrestored carious surface, the practitioner-investigator recorded patient and tooth characteristics.
Practitioner-investigators used amalgam more often than they used direct resin-based composite (RBC) for posterior carious lesions. Practitioner and practice characteristics (years since graduation and type of practice); patient characteristics (sex, race, age and dental insurance status); and lesion characteristics (tooth location and surface, preoperative and postoperative lesion depth) were associated with the type of restorative material used.
Several practitioner and practice, patient and lesion characteristics were associated significantly with use of amalgam and RBC: geographical region, years since dentist's graduation, patient's dental insurance status, tooth location and surface, and preoperative and postoperative lesion depth.
Despite advances in esthetic dentistry, U.S. dentists still are placing amalgam on posterior teeth with carious lesions. Amalgam was used more often than RBC in older patients, who may have had deeper carious lesions.
Cites: Qual Health Care. 1999 Sep;8(3):202-710847878
Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study
A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices.
Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P
Cites: J Am Dent Assoc. 2000 Feb;131(2):223-3110680391
Cites: J Am Dent Assoc. 2000 Jun;131 Suppl:13S-19S10860340
Cites: J Am Dent Assoc. 2001 Jun;132(6):762-911433855
Cites: J Am Dent Assoc. 2002 Dec;133(12):1643-5112512664
Cites: Gen Dent. 2002 Jul-Aug;50(4):346-5012640851