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
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.
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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.
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Scientific evidence supports the application of caries-preventive agents in children and adolescents, and this knowledge must be applied to the practice of dentistry. There are few multi-region data that allow for comparisons of practice patterns between types of dental practices and geographical regions. The objective of the present study was to characterise the use of specific caries-preventive agents for paediatric patients in a large multi-region sample of practising clinicians.
The present study surveyed clinicians from the Dental Practice-based Research Network who perform restorative dentistry in their practices. The survey consisted of a questionnaire that presented a range of questions about caries risk assessment and the use of preventive techniques in children aged 6 to 18 years.
Dental sealants (69%) or in-office fluoride (82%) were the most commonly used caries-preventive agents of the caries preventive regimens. The recommendation of at-home caries-preventive agents ranged from 36% to 7%,with the most commonly used agent being non-prescription fluoride rinse. Clinicians who practised in a large group practice model and clinicians who come from the Scandinavian region use caries risk assessment more frequently compared to clinicians who come from regions that had, predominantly, clinicians in private practice. Whether or not clinicians used caries risk assessment with their paediatric patients was poorly correlated with the likelihood of actually using caries-preventive treatments on patients.
Although clinicians reported the use of some form of in-office caries-preventive agent, there was considerable variability across practices. These differences could represent a lack of consensus across practising clinicians about the benefits of caries-preventive agents, or a function of differing financial incentives, or patient pools with differing levels of overall caries risk.