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Kakudate N, Yokoyama Y, Tagliaferro EPDS, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Comparison of factors associated with the evidence-practice gap as perceived by Japanese and Brazilian dentists. J Dent 2024; 149:105255. [PMID: 39079315 DOI: 10.1016/j.jdent.2024.105255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/15/2024] [Accepted: 07/17/2024] [Indexed: 08/02/2024] Open
Abstract
OBJECTIVES To identify 1) factors of the evidence-practice gap (EPG) in Japan and Brazil as perceived by dentists and compare these factors between two countries, and 2) mechanisms to close this EPG. METHODS The study employed a cross-sectional design by administering a web-based questionnaire to 136 Japanese and 110 Brazilian dentists. The survey queried dentists' reports of which factors possibly cause an EPG, using a newly developed 20-item questionnaire. RESULTS An international comparison of 20 items related to factors of the EPG between Japan and Brazil revealed that "Dentists' own experiences are sometimes given priority over evidence" and "Dentists' own thoughts are sometimes given priority over evidence" were common factors to both countries, with over 80 % agreement. In logistic regression, "Insufficient opportunity to learn about evidence in dental education at universities", "Evidence-based treatments are sometimes not covered by the dental insurance system", and "Insufficient evidence which helps dentists choose an appropriate treatment for a patient after careful consideration of his/her own background" were significantly associated with the EPG in Japan (p < 0.05). In Brazil, "Insufficient case reports in which evidence-based dentistry (EBD) is applied to clinical practice" and "Image-based information and devices used for diagnosis vary depending on individual dentists" were significantly associated with the EPG (p < 0.05). CONCLUSIONS This study suggests that EPG could be improved in Japan: by promoting EBD education at universities, improving the dental insurance system, and accumulating evidence according to patient background; and in Brazil: by promoting EBD case reports and standardizing diagnostic information and devices. CLINICAL SIGNIFICANCE Two factors of EPG common to Japan and Brazil, namely the prioritization of dentists' own "experiences" and "thoughts" over evidence, are urgent issues for improving EPG. In addition, it will be necessary to address the country-specific factors of EPG that were identified in this study.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka 803-8580, Japan.
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa 252-0882, Japan
| | - Elaine Pereira da Silva Tagliaferro
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Futoshi Sumida
- Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido 066-0028, Japan
| | - Yuki Matsumoto
- Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi 444-0204, Japan
| | - Valeria V Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415, Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Takeshita L, Srinivasan M. Survey on the attitudes and perceptions of Swiss dental practitioners and dental students toward treating patients with disabilities and sensory impairments. SPECIAL CARE IN DENTISTRY 2024; 44:1260-1272. [PMID: 38483203 DOI: 10.1111/scd.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 07/18/2024]
Abstract
AIMS This study evaluated the attitudes and perceptions of private dental practitioners (PPs) and students on treating patients with disabilities and sensory impairments. METHODS AND RESULTS A multifaceted questionnaire was used to assess the participants' attitudes on providing care to persons with disabilities and sensory impairments [visual (VI) and hearing (HI)]. The survey evaluated different aspects of the participants' attitudes that included integrity, altruism, perceived barriers, and theory of planned behavior (TPB). One hundred twenty participants [students: n = 73, practitioners (PP): n = 47), with a mean-age of 27.7 ± 5.3 years, completed the survey (response rate: 100%). Fourth-year students scored better than the PP in integrity (p = .019). For altruism, the students scored better than PPs (vs. fourth-year: p = .009, vs. fifth-year: p = .031). There were no differences between the participant groups for the overall assessments of the TPB (p = .213), VI (p = .863), and HI (p = .261). CONCLUSION Dental practitioners and students revealed a positive attitude, with few barriers, towards treating individuals with disabilities/sensory impairments and considered the training in the field of special care dentistry as a necessary part of the dental education. Furthermore, a demand for an increase in the hands-on practical experience in treating individuals with disabilities/sensory impairments during the undergraduate study curriculum was identified.
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Affiliation(s)
- Lisa Takeshita
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Murali Srinivasan
- Clinic of General-, Special Care- and Geriatric Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Kakudate N, Yokoyama Y, da Silva Tagliaferro EP, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. The Evidence-practice Gap in Minimal Intervention Dentistry: An International Comparison Between Dentists in Japan and Brazil. Oper Dent 2024; 49:127-135. [PMID: 38196080 PMCID: PMC10984213 DOI: 10.2341/23-074-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES This study was designed to: 1) evaluate and compare the evidence-practice gap (EPG) in minimal intervention dentistry (MID) in Japan and Brazil by measuring concordance between dentists' clinical practice and published evidence; and 2) identify dentists' factors associated with the EPG in both countries. METHODS We performed a cross-sectional study using a web-delivered questionnaire among 136 Japanese and 110 Brazilian dentists. The questionnaire consisted of three questions concerning "restoration diagnosis and treatment," "deep caries diagnosis and treatment," and "caries risk assessment" regarding MID. A chi-square test was used to analyze differences in concordance among clinical practice and evidence from the literature between Japanese and Brazilian dentists. Logistic regression analyses were performed to analyze dentists' factors associated with overall concordance for all three questions. RESULTS Overall concordance was significantly higher in Brazil (55%) than in Japan (38%) (p<0.01). Concerning how evidence was obtained, textbooks, nonacademic journals, and seminars and workshops were used as information sources more frequently by Japanese than Brazilian dentists (p<0.001), whereas scientific journal articles in English were used more frequently by Brazilian dentists (p<0.001). On logistic regression analysis, overall concordance was higher for Japanese dentists who frequently obtained evidence from scientific journal articles in English (p<0.05), whereas Brazilian dentists who frequently obtained evidence from the Internet were associated with lower overall concordance (p<0.05). CONCLUSIONS Because overall concordance was significantly higher in Brazil than in Japan, Japan may have a greater EPG in MID practice. Specific characteristics of Japanese and Brazilian dentists showed significant associations with overall concordance.
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Affiliation(s)
- Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Elaine Pereira da Silva Tagliaferro
- Professor, Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V Gordan
- Professor and Interim Associate Dean for Research, Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Distinguished Professor, James R. Rosen Endowed Chair of Dental Research, & Chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Guo Y, Woodard J, Zhang Y, Staras SAS, Gordan VV, Gilbert GH, McEdward DL, Shenkman E. Patients' comfort with and receipt of health risk assessments during routine dental visits: Results from the South Atlantic region of the US National Dental Practice-Based Research Network. Community Dent Oral Epidemiol 2023; 51:854-863. [PMID: 35851866 PMCID: PMC10792993 DOI: 10.1111/cdoe.12773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 06/06/2022] [Accepted: 07/07/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To understand patients' comfort with health risk assessments (HRAs) and patient and dentist factors associated with the provision of HRAs. METHODS In this cross-sectional study, 857 patients seen by 30 dental practitioners in the United States National Dental Practice-Based Research Network reported their comfort receiving HRA for six risk factors (tobacco use, alcohol use, dietary sugar intake, human immunodeficiency virus risks, human papillomavirus risks and existing medical conditions) and whether they discussed any of the risk factors during their visits. Multi-level logistic models were used to examine the impacts of patient, practitioner, practice characteristics on the (1) number of risk factors patients were comfortable discussing and (2) number of risk factors assessed in the current dental visit. RESULTS Only a small percentage (4%) of patients reported being uncomfortable receiving any HRA during their dental visits. However, over half of the patients (53%) reported that they did not receive any HRAs during the current visit. In the regression analyses, patients who were older, male and from the suburban were more likely to be comfortable with more HRAs. Dentists were more likely to provide HRA if they were younger, not non-Hispanic white, less likely to feel that providing HRAs was beyond their scope of practice, yet more likely to feel occasional discomfort in providing HRA. CONCLUSIONS Interventions should focus on reducing dental practitioner perception that conducting HRAs is beyond their scope of practice and standardizing screening assessments for multiple risk factors.
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Affiliation(s)
- Yi Guo
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Jennifer Woodard
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Yahan Zhang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, 1225 Center Drive, Gainesville, FL, 32610
| | - Stephanie A. S. Staras
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
| | - Valeria V. Gordan
- Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Drive; Gainesville, FL 326010-0415
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama, 1919 7th Ave S, Birmingham, AL 35294
| | - Deborah L. McEdward
- National Dental Practice-Based Research Network, Restorative Dental Sciences, University of Florida, 1395 Center Drive; Gainesville, FL 326010-0415
| | - Elizabeth Shenkman
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 2004 Mowry Road; Gainesville, FL 32608
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Mahrous A, Botsko DL, Elgreatly A, Tsujimoto A, Qian F, Schneider GB. The use of artificial intelligence and game-based learning in removable partial denture design: A comparative study. J Dent Educ 2023. [PMID: 37186466 DOI: 10.1002/jdd.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 03/02/2023] [Accepted: 04/07/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE The purpose of this study was to compare student performance in removable partial denture (RPD) design during a pre-clinical RPD course with and without using a recently developed computer software named AiDental. Additionally, student perceptions associated with the use of this software were assessed. METHODS The AiDental software consists of a learning environment containing an RPD design system that automatically designs RPDs based on the user's input. The software also contains an RPD game component that compares the user's RPD Design to an automatically generated RPD ideal design. The study was conducted in two phases. In phase one, pre-clinical second-year dental students who participated in the study were randomly divided into two groups: The AiDental group with AiDental software access (n = 36), and the conventional group without software access (n = 37). Both groups received conventional RPD instruction and practice, however, the AiDental group had additional access to the AiDental software. After 2 weeks, both groups took a mock practical test, which was collected and graded by the principal investigator (PI). The PI was blinded from group assignment and no identifying information was used in the mock practical. In phase two, all students were granted access to the AiDental software for the remainder of the pre-clinical course duration. At the conclusion of the course, all students were given a survey to evaluate their perceptions of the AiDental software. Descriptive statistics were calculated and analyzed. Variables related to perceptions of both the AiDental designer and game were assessed using Spearman's rank correlation test, the chi-square test, Fisher's exact test, and the non-parametric Wilcoxon rank-sum test as appropriate. In addition, a thematic analysis of the responses to the optional comments section was conducted using the Braun and Clarke method. RESULTS Phase one results showed that subjects in the AiDental group were more likely than subjects in the conventional group to receive a final grade of A or B. Phase two results showed generally favorable student perceptions towards the software, and additionally, the results showed that age was significantly negatively correlated with ease of use of the software, improving decision-making, and critical thinking relative to RPD design choices. However, no correlation between age and using the software as a reference were noted. CONCLUSIONS The use of AiDental's automated feedback and gamification techniques in RPD education had a positive effect on student grades and it was well-liked by students. Thus, the results suggest that AiDental has the potential to be a useful adjunct to pre-clinical teaching.
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Affiliation(s)
- Ahmed Mahrous
- Division of Prosthodontics, Arizona School of Dentistry and Oral Health, AT Still University, Mesa, Arizona, USA
- Department of Prosthodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | | | - Amira Elgreatly
- Division of Operative Dentistry, Arizona School of Dentistry and Oral Health, AT Still University, Mesa, Arizona, USA
| | - Akimasa Tsujimoto
- Department of Operative Dentistry Aichi Gakuin University School of Dentistry, Aichi, Nagoya, Japan
- Department of Operative Dentistry, University of Iowa College of Dentistry, Iowa City, Iowa, USA
- Department of General Dentistry, Creighton University School of Dentistry, Omaha, Nebraska, USA
| | - Fang Qian
- Division of Biostatistics and Computational Biology, Iowa Institute for Oral Health Research, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa, USA
| | - Galen B Schneider
- Department of Prosthodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
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Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Causes of the Evidence-practice Gap and Its Association with the Effects of Minimal Intervention Dentistry Education to Clinicians. Oper Dent 2023; 48:137-145. [PMID: 36745521 PMCID: PMC10792988 DOI: 10.2341/22-012-c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify causes of the evidence-practice gap (EPG) in dentistry in Japan and analyze whether these causes are associated with: (a) improvement of EPG in minimal intervention dentistry (MID) following an educational intervention and (b) specific dentist characteristics. METHODS We conducted a mixed-methods questionnaire survey among 197 Japanese dentists that integrated both quantitative and qualitative data. Causative factors for the EPG identified in the quantitative survey were clarified by qualitative analysis. We measured the EPG in a baseline survey using an EPG measurement tool based on MID. To examine how feedback using the latest scientific evidence affected change in the EPG, we measured the EPG again immediately after feedback was provided to participating dentists. RESULTS Qualitative analysis classified all dentists into one of four "EPG cause" groups, namely "evidence-", "dentist-", "patient-", and "health insurance system-related" causes. Quantitative analysis confirmed that improvement in the EPG following the feedback intervention was indeed associated with group classification. The highest concordance was found for the "evidence-related" group while the lowest concordance was in the "dentist-related" group (p=0.004). Concordance improved after evidence feedback in all groups but was lowest in the "dentist-related" group. More dentists reported practice busyness in the "dentist-related" group. CONCLUSIONS In this study, we identified four groups of causes of EPG among Japanese dentists. The degree of concordance between evidence and clinical practice was the lowest in the "dentist-related" group, and the results of this study are expected to provide useful information for the development of intervention methods for closing the EPG in the future.
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Affiliation(s)
- Yoko Yokoyama
- Project Senior Assistant Professor, Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Naoki Kakudate
- Professor & Division Director, Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
- Visiting Professor, University of Florida College of Dentistry, Gainesville, FL, USA P.O. Box 100415, Gainesville, FL 32610-0415, USA
| | - Futoshi Sumida
- Dentist, Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Director, Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Valeria V. Gordan
- Professor and Interim Associate Dean for Research, Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H. Gilbert
- Distinguished Professor & Chair, Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Feres MFN, Ruiz-Rodrigues L, Prado VDO, Vicioni-Marques F, Feres M, Nelson-Filho P, Flores-Mir C. Dentists' attitudes and practices toward evidence-based dentistry: a systematic review. JBI Evid Implement 2022; 22:02205615-990000000-00019. [PMID: 36378117 DOI: 10.1097/xeb.0000000000000326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND AIMS Considering that attitudes toward evidence-based dentistry (EBD) may predict implementation behaviors, the objective of this systematic review was to synthesize and evaluate the existing evidence related to dentists' attitudes and practices toward EBD. METHODS We included primary studies that collected information from interviews, questionnaires, or conversation sessions with dentists. The following sources were searched: Cochrane Central Register of Controlled Trials, Embase, PubMed, Scopus, and Web of Science, in addition to gray literature. The included studies were appraised according to the assessment tools recommended by the Joanna Briggs Institute for qualitative and quantitative observational studies. Descriptive data were collected in standardized tables and descriptively synthesized. RESULTS The selection process resulted in 36 included studies. Dentists share positive opinions about EBD and predominantly report willingness to learn or adopt these practices. Despite high methodological risks and significant heterogeneity, the results collected in this review indicated that scientific journals, clinical practice guidelines, and trusted colleagues are generally perceived as influential and useful by dentists, who highly consulted these information sources. CONCLUSION Despite supportive reported attitudes toward EBD, very low certainty exists about actual EBD-related practices.
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Affiliation(s)
| | - Larissa Ruiz-Rodrigues
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Viviane de Oliveira Prado
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Fernanda Vicioni-Marques
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Magda Feres
- Department of Periodontology, Dental Research Division, Guarulhos University, São Paulo, Brazil
- The Forsyth Institute, Cambridge, Massachusetts, USA
| | - Paulo Nelson-Filho
- Department of Pediatric Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, São Paulo, Brazil
| | - Carlos Flores-Mir
- Division of Orthodontics, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Takata T, Gordan VV, Gilbert GH. Web-based intervention to improve the evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2021; 115:103854. [PMID: 34688779 DOI: 10.1016/j.jdent.2021.103854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/26/2021] [Accepted: 10/14/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To determine whether: the evidence-practice gap (EPG) in minimal intervention dentistry (MID) can be improved by a tailored web-based intervention, and specific clinical situations might impede implementing MID. METHODS We conducted a before-after intervention study and a qualitative study. Two web-based questionnaire surveys were conducted among 197 Japanese dentists. In the first questionnaire, a baseline EPG was measured using six questionnaire items. Subsequently, feedback material about the EPG was electronically prepared, including results of the first questionnaire, international comparisons with a previous study from the US, and a summary of recent evidence on MID. In the second questionnaire, the EPG was re-measured after participants read the material. The primary outcome was mean overall concordance between published evidence and the dentist's clinical practice for all six questions. During the second questionnaire, we performed qualitative content analysis using free-text responses to a question about difficult situations encountered when conducting MID. RESULTS Regarding before and after comparisons of concordance between the first and second questionnaires, mean overall concordance improved significantly, from 66% to 89% (p<0.001). Qualitative content analysis identified five difficult situations: "cases where decision making for treatment and prognosis is difficult", "inadequate practice resources", "limitations on patient visit and treatment period", "discrepancy between MID and the patient's values", and "limitations on health insurance and social understanding". CONCLUSIONS These results suggest that it is possible to reduce the EPG in MID using a web-based educational intervention among Japanese dentists. Qualitative content analysis revealed five difficult situations that might hinder implementation of MID. CLINICAL SIGNIFICANCE Although this intervention demonstrated educational effects, perfect concordance was not achieved by all participants. This is possibly associated with the five situations that participants reported facing when conducting MID. Creating an environment to improve these situations may facilitate a reduction in the EPG.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan; University of Florida College of Dentistry, P.O. Box 100415, Gainesville, FL 32610-0415, USA.
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, 5322 Endo Fujisawa, Kanagawa, 252-0882, Japan
| | - Futoshi Sumida
- Daiich Dental Clinic, 5-5-7, Hanazono, Chitose, Hokkaido, 066-0028, Japan
| | - Yuki Matsumoto
- Matsumoto Dental Clinic, 24-3, Komanomai, Doimachi, Okazaki, Aichi, 444-0204, Japan
| | - Tomoka Takata
- School of Dentistry, Kyushu Dental University, 2-6-1, Manazuru, Kokura-kita, Kitakyushu, Fukuoka, 803-8580, Japan
| | - Valeria V Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Room D3-39 P.O. Box 100415 Gainesville, FL 32610-0415, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Room SDB 109, 1720 Second Avenue South, Birmingham, AL 35294-0007, USA
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Booth ET, Eckert GJ, Fontana M. Variability in caries management decision-making in a dental school setting. J Dent Educ 2021; 86:57-67. [PMID: 34405408 DOI: 10.1002/jdd.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/25/2021] [Accepted: 07/29/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess variability in caries management decision-making by faculty and dental students. Understanding sources of variability during training can aid in implementing evidence-based clinical decision-making in caries management. METHODS A voluntary, anonymous survey including clinical scenarios was distributed online to dental students in their first (D1) and third-year (D3) of training, and to faculty in the Department of Cariology, Restorative Sciences and Endodontics. RESULTS The response rate was 100% (108/108) for D1 students, 56% (73/130) for D3 students, and 39% (34/88; 12 full-time and 22 part-time) for faculty. D1 students, who were completing a cariology course, were in general more conservative in restorative thresholds for less severe caries lesions than D3 students and sometimes clinical faculty (e.g., for lesions at the DEJ, a significantly [p < 0.05] higher percentage of D3 students would restore these [53%] compared to D1 students and faculty [19% and 18%, respectively; p > 0.05]). For all groups, the threshold for doing restorative intervention was shifted toward less severe caries lesions as the caries risk increased (e.g., very few respondents would restore an occlusal lesion confined to enamel, with significantly [p < 0.05] less percentage of D1 students [lower risk scenario-LR = 4%; higher risk scenario-HR = 22%] compared to D3 students and faculty [LR = 15% and 18%; HR = 66% and 62%, respectively; p > 0.05]). Class lectures/preclinical instructors were the most important factor influencing decision-making for D1 students, versus clinical experiences/instructors for D3 students. CONCLUSION Although the majority of respondents used best-evidence deciding caries management, there was variability in how to manage less severe lesions, with caries risk influencing clinical thresholds, and clinical experiences influencing students' decision-making over time.
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Affiliation(s)
- Evan T Booth
- Class of 2021 from University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - George J Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine and Richard M. Fairbanks School of Public Health, Indianapolis, Indiana, USA
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences & Endodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Burgette JM, Isett KR, Rosenblum S, Doshi A, Melkers J. Association between predoctoral evidence-based practice training and later use of peer-reviewed journals: National dental PBRN. J Dent Educ 2021; 85:812-820. [PMID: 33598977 PMCID: PMC8197728 DOI: 10.1002/jdd.12564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We examined whether evidence-based practice (EBP) during dental school was associated with the increased use of peer-reviewed literature during subsequent clinical practice for National Dental Practice-Based Research Network (PBRN) dentists. We also sought to understand whether this association was moderated by being a dental specialist. METHODS We analyzed cross-sectional data from 1228 dentists participating in the PBRN. We used logistic regression to examine the association between self-reported EBP training during dental school and the use of peer-reviewed journals in clinical practice, controlling for the number of years since dental school graduation and dental practice type. We stratified the data by dental specialists and examined effect modification using the Breslow-Day test for homogeneity of the odds ratio. RESULTS The prevalence of peer-reviewed journal use by PBRN dentists in clinical practice was 87% (n = 1070) with no statistical evidence of effect modification by dental specialists on the EBP peer-reviewed journal use relationship (p > 0.05). After controlling for years since dental school graduation and dental practice type, dentists who self-reported EBP training during dental school had greater odds of using peer-reviewed journals in clinical practice than dentists who did not self-report EBP training during dental school (OR, 1.47; 95%CI = 1.01, 2.15). CONCLUSION The use of peer-reviewed published literature by PBRN dentists who had EBP predoctoral training is one important step in the EBP process by which practicing dentists can implement evidence-based findings, interventions, and policies into routine health care and public health settings. These findings add to the body of support for EBP curricula in dental education.
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Affiliation(s)
- Jacqueline M Burgette
- Departments of Dental Public Health and Pediatric Dentistry, School of Dental Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberley R Isett
- Biden School of Public Policy and Administration, the University of Delaware, Newark, Delware, USA
| | - Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Ameet Doshi
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Julia Melkers
- School of Public Policy, Georgia Institute of Technology, Atlanta, Georgia, USA
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Staras SAS, Guo Y, Gordan VV, Gilbert GH, McEdward DL, Manning D, Woodard J, Shenkman EA. Dental practitioners' use of health risk assessments for a variety of health conditions: Results from the South Atlantic region of The National Dental Practice-Based Research Network. J Am Dent Assoc 2020; 152:36-45. [PMID: 33276954 DOI: 10.1016/j.adaj.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 08/10/2020] [Accepted: 09/02/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND An important step in integrating dental and medical care is improving understanding of the frequency and characteristics of dental practitioners who conduct health risk assessments (HRAs). METHODS From September 2017 through July 2018, active dentist and hygienist members of the South Atlantic region of The National Dental Practice-Based Research Network (N = 870) were invited to participate in a survey evaluating their HRA practices (screening, measuring, discussing, referring patients) for 6 health conditions (obesity, hypertension, sexual activities, diabetes, alcohol use, tobacco use). For each health condition, the authors used ordinal logistic regression to measure the associations among the practitioner's HRA practices and the practitioner's characteristics, barriers, and practice characteristics. RESULTS Most of the 475 responding practitioners (≥ 72%) reported they at least occasionally complete 1 or more HRA steps for the health conditions except sexual activities. Most practitioners screened (that is, asked about) and gave referral information to affected patients for diabetes (56%) and hypertension (63%). Factors associated with each increased HRA practice for 2 or more outcomes were non-Hispanic white compared with Hispanic practitioner (cumulative odds ratio [COR] obesity, 0.4; 95% confidence interval [CI], 0.2 to 0.8; and COR diabetes, 0.3; 95% CI 0.2 to 0.8), male compared with female practitioner (COR tobacco, 0.3; 95% CI, 0.2 to 0.7; and COR hypertension, 0.4; 95% CI 0.2 to 0.8), and practitioner discomfort (COR, obesity and alcohol use, 0.7; 95% CI, 0.6 to 0.9; and COR, sexual activities 0.6; 95% CI 0.5 to 0.8). CONCLUSIONS AND PRACTICAL IMPLICATIONS Dental practitioners are conducting HRA practices for multiple conditions. Interventions should focus on reducing practitioner discomfort and target non-Hispanic white, male practitioners.
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Prophylactic antibiotic prescribing in dental practice: Findings from a National Dental Practice-Based Research Network questionnaire. J Am Dent Assoc 2020; 151:770-781.e6. [PMID: 32979956 DOI: 10.1016/j.adaj.2020.04.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/30/2020] [Accepted: 04/30/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Little is known about antibiotic prescribing practices of dentists. The objective of this study was to gain a better understanding of dentists' beliefs and behaviors regarding the use of antibiotic prophylaxis (AP) before invasive dental procedures. METHODS A multidisciplinary team developed and disseminated a questionnaire to 3,584 dentist members of the National Dental Practice-Based Research Network. RESULTS Overall, 2,169 network dentists (61%) responded. Respondents saw patients at risk of developing infective endocarditis (IE) and prosthetic joint infection (PJI) at least once per week (35% and 65%, respectively). Although 78% of dentists agreed that the 2007 American Heart Association guidelines for the prevention of IE are well-defined and clear, only 49% agreed concerning PJI guidelines. Differences for the IE and PJI patient populations also existed for questions regarding dentists' understanding of the specific patient groups at risk, the recommended antibiotic regimens, and the need to consult with a patient's cardiologist or orthopedic surgeon. CONCLUSIONS The survey results indicate that decision making regarding the use of AP occurs frequently among dentists. Moreover, dentists reported uncertainty about the appropriate use of AP as defined by both IE and PJI guidelines, which may have resulted in a lack of concordance between dentists' beliefs and their practice behaviors. PRACTICAL IMPLICATIONS The results reported by the authors highlight the need to develop better educational programs that address antimicrobial stewardship in AP for patients at risk of developing IE and PJI and target the dental profession.
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Abstract
Despite evidence strongly supporting use of non-invasive or minimally invasive procedures in caries management, there is still a large gap between evidence-based recommendations and application of these concepts in practice, with the practice of dentistry still largely dominated by invasive procedures in the US. This paper describes efforts in education and clinical practice in the US in the last decade to promote evidence-based cariology strategies, which support a minimum intervention dentistry (MID) philosophy. These include, for example: a competency-based core cariology curriculum framework which has been developed and disseminated. National education accreditation standards supporting caries management are likely to soon be changed to support assessment of best evidence in cariology. There are several ongoing efforts by organised dentistry and other groups involving dental educators, researchers and clinical practitioners to promote cariology concepts in practice, such as the development of evidence-based clinical practice guidelines for caries management by the American Dental Association. Within each of these strategies there are challenges, but also opportunities to expand the implementation of MID in the US, which create optimism for future improvements over time.
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Evidence-practice gap in minimal intervention dentistry: Findings from a dental practice-based research network. J Dent 2020; 102:103469. [PMID: 32916232 DOI: 10.1016/j.jdent.2020.103469] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES This study aimed to 1) quantify the evidence-practice gap (EPG) between dental clinical practice and published evidence on Minimal Intervention Dentistry (MID) among dentists in Japan; and 2) examine the hypothesis that dentist characteristics have a significant association with the EPG. METHODS We conducted a cross-sectional study via use of a web-based questionnaire survey of dentists who were affiliated with the Dental Practice-based Research Network Japan (n = 297). To quantify the EPG on MID, we used a questionnaire that included 10 clinical questions or scenarios to assess concordance between dental practice and published evidence on MID. We evaluated concordance by coding responses to each question as consistent or inconsistent with the evidence. An overall concordance was then determined as percent of responses that were consistent with published evidence for 10 questions. Subsequently, multiple logistic regression analysis was conducted to examine the associations between dentist characteristics and higher overall concordance (≥median) with published evidence. RESULTS Mean and median overall dentist-level concordance were both 60 % (SD: 18, interquartile range: 50-75 %). Logistic regression analysis showed that "gender of dentist", "city population", and "frequency of obtaining evidence from the scientific journal articles in English" were significantly associated with high concordance, with odds ratios (95 % CIs) of 2.33 (1.01-5.39), 2.01 (1.02-3.96), and 2.45 (1.08-5.59), respectively. CONCLUSIONS Japanese dentists demonstrated medium concordance with published evidence, indicating that an EPG on MID exists in Japanese dental clinical practices. Dentist-specific characteristics had significant associations with high concordance with published evidence. CLINICAL SIGNIFICANCE Despite the establishment and dissemination of the concept of MID, the EPG on MID exists in Japanese dental clinical practices. A high concordance was significantly associated with the following dentist characteristics: "female dentist", "dental clinic location in a government-ordinance-designated city", and "frequently obtaining evidence from the English-language scientific journal articles".
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16
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Practitioner Engagement in Activities of the National Dental Practice-Based Research Network (PBRN): 7-Year Results. J Am Board Fam Med 2020; 33:687-697. [PMID: 32989063 PMCID: PMC7895471 DOI: 10.3122/jabfm.2020.05.190339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/16/2020] [Accepted: 01/21/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To 1) quantify practitioner activities of the National Dental Practice-Based Research Network (Network) for which Continuing Education (CE) credits were received (study training, videos, webinars, meetings, and symposia); 2) quantify practitioner coauthoring Network publications and presentations; and 3) test whether practitioner characteristics were associated with participation in these activities. METHODS A retrospective analysis of 4361 practitioners who enrolled in the Network between April 12, 2012 and October 12, 2018. RESULTS Overall, 59% (n = 2586) of practitioners earned CE credit from the Network; among these, 68% (n = 1757) from a video, 38% (n = 993) attended an annual Network meeting, 31% (n = 798) due to training for a Network clinical study, 9% (n = 226) attended a national symposium, and 7% (n = 170) participated in a Network webinar. Members of 2 large group practices earned on average more CEs than practitioners from other practice settings. Four percent (n = 159) of practitioners coauthored a Network presentation or publication. Practitioners who received their dental degree before 2000, were general practitioners, or were members of 2 large group practices, were more likely to have coauthored a publication or presentation. CONCLUSION This Network used a broad range of activities to engage community practitioners. These activities were successful in sustaining a high level of practitioner engagement in clinical research and its relevance to everyday clinical practice.
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Thyvalikakath TP, Duncan WD, Siddiqui Z, LaPradd M, Eckert G, Schleyer T, Rindal DB, Jurkovich M, Shea T, Gilbert GH. Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices. Appl Clin Inform 2020; 11:305-314. [PMID: 32349142 DOI: 10.1055/s-0040-1709506] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES The aim of this study is to determine the feasibility of conducting clinical research using electronic dental record (EDR) data from U.S. solo and small-group general dental practices in the National Dental Practice-Based Research Network (network) and evaluate the data completeness and correctness before performing survival analyses of root canal treatment (RCT) and posterior composite restorations (PCR). METHODS Ninety-nine network general dentistry practices that used Dentrix or EagleSoft EDR shared de-identified data of patients who received PCR and/or RCT on permanent teeth through October 31, 2015. We evaluated the data completeness and correctness, summarized practice, and patient characteristics and summarized the two treatments by tooth type and arch location. RESULTS Eighty-two percent of practitioners were male, with a mean age of 49 and 22.4 years of clinical experience. The final dataset comprised 217,887 patients and 11,289,594 observations, with the observation period ranging from 0 to 37 years. Most patients (73%) were 18 to 64 years old; 56% were female. The data were nearly 100% complete. Eight percent of observations had incorrect data, such as incorrect tooth number or surface, primary teeth, supernumerary teeth, and tooth ranges, indicating multitooth procedures instead of PCR or RCT. Seventy-three percent of patients had dental insurance information; 27% lacked any insurance information. While gender was documented for all patients, race/ethnicity was missing in the dataset. CONCLUSION This study established the feasibility of using EDR data integrated from multiple distinct solo and small-group network practices for longitudinal studies to assess treatment outcomes. The results laid the groundwork for a learning health system that enables practitioners to learn about their patients' outcomes by using data from their own practice.
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Affiliation(s)
- Thankam Paul Thyvalikakath
- Dental Informatics Core, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, Indiana, United States.,Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States
| | - William D Duncan
- Environmental Genomics and Systems Biology, Lawrence Berkeley National Laboratory, Berkeley, California, United States
| | - Zasim Siddiqui
- Dental Informatics Core, Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, IUPUI, Indianapolis, Indiana, United States
| | - Michelle LaPradd
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - George Eckert
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Inc., Indianapolis, Indiana, United States.,Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | | | - Mark Jurkovich
- HealthPartners Institute, Minneapolis, Minnesota, United States
| | - Tracy Shea
- HealthPartners Institute, Minneapolis, Minnesota, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States
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McCracken MS, Litaker MS, Thomson AES, Slootsky A, Gilbert GH. Laboratory Technician Assessment of the Quality of Single-Unit Crown Preparations and Impressions as Predictors of the Clinical Acceptability of Crowns as Determined by the Treating Dentist: Findings from the National Dental Practice-Based Research Network. J Prosthodont 2020; 29:114-123. [PMID: 31893566 DOI: 10.1111/jopr.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE In-laboratory assessment by laboratory technicians may offer insight to increase clinical success of dental crowns, and research in this area is lacking. MATERIALS AND METHODS Dentists in the National Dental Practice-Based Research Network enrolled patients in a study about single-unit crowns; laboratory technicians evaluated the quality of tooth preparations and impressions. The primary outcome for each crown was clinical acceptability (CAC), as judged by the treating dentist. A secondary outcome was "Goodness of Fit (GOF)," a composite score of several aspects of clinical fit, also judged by the study dentist. A mixed-effects logistic regression was used to analyze associations between laboratory technician ratings and the CAC and GOF. RESULTS Dentists (n = 205) evaluated 3731 crowns. Technicians ranked the marginal detail of impressions as good or excellent in 92% of cases; other aspects of the impression were ranked good or excellent 88% of the time. Regarding tooth preparation, about 90% of preparations were considered adequate (neither excessive nor inadequate reduction). Factors associated with higher CAC were more preparation taper, and use of optical imaging. Factors associated with better GOF were higher impression quality, greater occlusal reduction, more preparation taper, and optical imaging. CONCLUSIONS Overall quality of preparations and impressions was very high, as evaluated by laboratory technicians. Several clinical parameters were associated with higher CAC and GOF. Clinicians who struggle with crown remakes might consider less conservative tooth preparation, as well as using digital impression technology.
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Affiliation(s)
- Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | | | - Alan Slootsky
- Department of Prosthodontics, Nova Southeastern University, College of Dental Medicine, Davie, FL.,Private Practice of Dentistry, Pompano Beach, FL
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Clinical acceptance of single-unit crowns and its association with impression and tissue displacement techniques: Findings from the National Dental Practice-Based Research Network. J Prosthet Dent 2019; 123:701-709. [PMID: 31590974 DOI: 10.1016/j.prosdent.2019.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 05/06/2019] [Accepted: 05/22/2019] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM The definitive impression for a single-unit crown involves many material and technique factors that may affect the success of the crown. PURPOSE The purpose of this prospective cohort study was to determine whether impression technique (tray selection), impression material, or tissue displacement technique are associated with the clinical acceptability of the crown (CAC). MATERIAL AND METHODS Dentists in the National Dental Practice-Based Research Network documented details of the preparation, impression, and delivery of 3730 consecutive single-unit crowns. Mixed-effects logistic regression analyses were performed to evaluate associations between impression techniques and materials and the CAC and to assess associations between the presence of a subgingival margin with the displacement technique and the outcome variables CAC and number of impressions required. RESULTS Of the 3730 crowns, 3589 (96.2%) were deemed clinically acceptable. A significant difference in the CAC was found with different impression techniques (P<.001) and different impression materials (P<.001). The percentage of the CAC for digital scans was 99.5%, 95.8% for dual-arch trays, 95.2% for quadrant trays, and 94.0% for complete-arch impression trays. Although no statistically significant difference was found in the CAC produced with dual-arch trays without both mesial and distal contacts, crowns fabricated under these conditions were less likely to achieve excellent occlusion. The percentage of the CAC for digital scans was 99.5%, 97.0% for polyether impressions, 95.5% for polyvinyl siloxane impressions, and 90.5% for other impression materials. Accounting for the location of the margin, the use of a dual-cord displacement technique was significantly associated with lower rates of requiring more than 1 impression (P=.015, odds ratio=1.43). CONCLUSIONS Dual-arch trays produced clinically acceptable crowns; however, if the prepared tooth was unbounded, the occlusal fit was more likely to have been compromised. Digital scans produced a slightly higher rate of CAC than conventional impression materials. The use of a dual-cord technique was associated with a decreased need to remake impressions when the margins were subgingival.
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McCauley JL, Nelson JD, Gilbert GH, Gordan V, Durand SH, Mungia R, Meyerowitz C, Leite RS, Fillingim RB, Brady KT. Prescription Drug Abuse Among Patients in Rural Dental Practices Reported by Members of the National Dental PBRN. J Rural Health 2019; 36:145-151. [PMID: 31385367 DOI: 10.1111/jrh.12386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/28/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE This study compared rural to nonrural dentists with respect to opioid prescribing practices, perceptions about prescription drug abuse among patients, and training relevant to pain management and addictions. METHODS A web-based, cross-sectional questionnaire was administered to practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822) and linked with network enrollment questionnaire data regarding practitioner demographics and practice characteristics. Pain management prescribing practices and perceptions regarding relevance and scope of addiction and drug diversion among patients were assessed. Rural practice was defined as a practice whose ZIP Code has more than 50% of its population in either a nonmetropolitan county and/or a rural Census tract. FINDINGS Rural dentists were significantly more likely than their nonrural counterparts to recommend nonsteroidal anti-inflammatory agents/acetaminophen in combination with prescribing an opioid [F (1,820) = 4.59, P = .03]. Compared to nonrural dentists, rural dentists were more likely to report that opioid abuse/diversion was a problem in their practices [χ2 [1, n = 807] = 6.85, P < .001], were more likely to have suspected a patient of abuse or diversion [χ2 [1, n = 807] = 10.12, P = .001], and were more likely to have refrained from prescribing due to suspicions of abuse or diversion [χ2 [1, n = 807] = 12.49, P < .001]. CONCLUSION Rural dentists may be disproportionately impacted by patients' opioid abuse and represent a viable target for educational outreach that encourages screening, identification, and referral of patients in need of drug abuse treatment.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Joni D Nelson
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama
| | - Valeria Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida
| | | | - Rahma Mungia
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas
| | - Cyril Meyerowitz
- University of Rochester, Eastman Institute for Oral Health, Rochester, New York
| | - Renata S Leite
- Department of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina
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- The National Dental PBRN Collaborative Group includes practitioner, faculty, and staff investigators who contributed to this activity. A list is available at:, http://nationaldentalpbrn.org/collaborative-group.php
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Litaker MS, Kopycka-Kedzierawski DT, Rindal DB, Fellows JL, Heft MW, Meyerowitz C, Chonowski S, Gilbert GH. Concordance between practitioner questionnaire responses and observed clinical treatment recommendations for treatment of dentin hypersensitivity: findings from the National Dental Practice-Based Research Network. BMC Oral Health 2019; 19:112. [PMID: 31200689 PMCID: PMC6570951 DOI: 10.1186/s12903-019-0772-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners' questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations. METHODS A total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen's kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated. RESULTS For individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner's top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low. CONCLUSIONS Concordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen's kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration. Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.
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Affiliation(s)
- Mark S Litaker
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL, 35294-0007, USA.
| | | | - D Brad Rindal
- Health Partners Institute for Education and Research, 8170 33rd Avenue South, Mail Stop 21111R, PO Box 1524, Bloomington, MN, 55440-1524, USA
| | - Jeffrey L Fellows
- Kaiser Permanente Center for Health Research, 3800 N Interstate Avenue, Portland, OR, 97227, USA
| | - Marc W Heft
- Department of Oral & Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL, 32610-0416, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14620, USA
| | - Sidney Chonowski
- Private Practice of General Dentistry, 66 Maple Ave, Morristown, NJ, 07960, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, University of Alabama at Birmingham, 1919 7th Avenue South, Birmingham, AL, 35294-0007, USA
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Lawson NC, Litaker MS, Ferracane JL, Gordan VV, Atlas AM, Rios T, Gilbert GH, McCracken MS. Choice of cement for single-unit crowns: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2019; 150:522-530. [PMID: 31030937 PMCID: PMC6538426 DOI: 10.1016/j.adaj.2019.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In this article, the authors present clinical factors associated with the type of cement practitioners use for restoration of single-unit crowns. METHODS A total of 202 dentists in The National Dental Practice-Based Research Network recorded clinical details (including cement type) used for 3,468 single-unit crowns. The authors classified crowns as bonded if the dentist used a resin cement. The authors used mixed-model logistic regression to assess the associations between various clinical factors and the dentist's decision to bond. RESULTS A total of 38.1% of crowns were bonded, and 61.9% were nonbonded; 39.1% (79 of 202) of dentists never bonded a crown, and 20.3% (41 of 202) of dentists bonded every crown in the study. Crowns with excessive occlusal reduction (as judged by laboratory technicians) were more likely to be bonded (P = .02); however, there was no association with bonding and excessive taper (P = .15) or axial reduction (P = .08). Crowns were more likely to be bonded if they were fabricated from leucite-reinforced glass ceramic (76.5%) or lithium disilicate (70.8%) than if they were fabricated from layered zirconia (38.8%), full-contour zirconia (30.1%), full metal (14.7%), or porcelain-fused-to-metal (13.8%) (P < .01) restorative material. There was no significant association between choice to bond and crown margin location (P = .35). Crowns in the anterior maxilla were more likely to be bonded (P < .01). CONCLUSIONS Excessive occlusal tooth preparation, anterior location of a crown, and the use of glass ceramic crowns were associated significantly with the decision to bond. PRACTICAL IMPLICATIONS In this study, the authors identified factors significantly associated with the clinical decision made by practicing dentists when selecting a cement for restoration of single-unit crowns.
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Affiliation(s)
- Nathaniel C Lawson
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7 Ave S, Birmingham, AL, 35294, 205-975-8302,
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7 Ave S, Birmingham, AL, 35294, 205-934-1179,
| | - Jack L Ferracane
- Professor and Chair, Department of Restorative Dentistry, Oregon Health & Science University, 2730 S.W. Moody Avenue, Portland, OR 97201, 503-494-4327,
| | - Valeria V Gordan
- Professor, Department of Restorative Dental Sciences, College of Dentistry, University of Florida, 1395 Center Dr, Gainesville, FL 32610, 352-273-5846,
| | - Alan M Atlas
- Private practice, Department of Endodontics and Department of Preventive/Restorative Sciences, School of Dental Medicine, University of Pennsylvania, 240 S 40th St, Philadelphia, PA 19104, 215-545-3111,
| | - Tara Rios
- Private practice, 1205 E Alton Gloor Blvd, Brownsville, TX 78526, 956-542-1956,
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7 Ave S, Birmingham, AL, 35294, 205-934-5423,
| | - Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, 1919 7 Ave S, Birmingham, AL, 205-934-1947,
| | - National Dental PBRN Collaborative Group
- The National Dental PBRN Collaborative Group includes practitioner, faculty, and staff investigators who contributed to this activity. A list is available at http://nationaldentalpbrn.org/collaborative-group.php
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Dentists' practice patterns of treatment for deep occlusal caries: Findings from a dental practice-based research network. J Dent 2019; 84:76-80. [PMID: 30935965 DOI: 10.1016/j.jdent.2019.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 03/26/2019] [Accepted: 03/28/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study quantified and compared practice patterns of treatment for deep occlusal carious lesions among Japanese dentists, and tested the hypothesis that dentist characteristics are significantly associated with the decision to choose an indirect pulp capping (IPC), a form of selective carious tissue removal that involves leaving a thin layer of demineralized tissue over the pulp, that is then covered with a protective liner. METHODS This cross-sectional study was conducted using a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (n = 297). Dentists were asked to indicate what percentage of time they use three treatment options when treating patients with deep occlusal caries and possible mild pulpitis on a posterior tooth. Response options were "1. Stop before removing all caries and perform an IPC", "2. Remove all caries and proceed with a direct pulp cap", and "3. Remove all caries and proceed with endodontic-related procedures". Percentages of options 1-3 were compared by multiple comparison. Associations between dentist characteristics and a higher percentage of IPC provision (option 1) were analyzed via logistic regression. RESULTS Responses were obtained from 206 dentists. Median percentages (interquartile ranges) of options 1, 2 and 3 were 30% (10-59%), 10% (0-30%), and 40% (19-80%), respectively. The differences between option 3 and options 1 and 2 were significant (p < 0.001). In logistic regression analysis, a higher frequency of obtaining evidence from English-language scientific articles was significantly associated with a higher percentage of IPC, with an odds ratio of 2.28 (95%CI: 1.14-4.54). CONCLUSIONS Endodontic-related procedures remain the most frequent treatment option for deep occlusal caries. Frequent use of evidence-based information in English-language scientific articles was associated with Japanese dentists' preference toward IPC. CLINICAL SIGNIFICANCE Japanese dentists would most frequently choose endodontic-related procedures, followed by IPC and direct pulp capping for treatment of patients with deep occlusal caries with possible mild pulpitis on posterior teeth. Significant association was identified between use of evidence-based information in the English-language scientific literature and Japanese dentists' preference for IPC.
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McCauley JL, Reyes S, Meyerowitz C, Gordan VV, Rindal DB, Gilbert GH, Leite RS, Fillingim RB, Brady KT. Training experiences regarding pain management, addiction, and drug diversion of dentists enrolled in the National Dental Practice-Based Research Network. Subst Abus 2019; 40:344-349. [PMID: 30829128 DOI: 10.1080/08897077.2019.1576085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: The purpose of this study was to describe dentists' training experiences relevant to pain management, addiction, and prescription opioid drug diversion and examine associations between these training experiences and dentists' opioid prescribing practices. Methods: A Web-based, cross-sectional survey was conducted among practicing dentist members of the National Dental Practice-Based Research Network (PBRN; N = 822). The survey assessed pain management prescribing practices and training experiences related to pain management and assessment for addiction and drug diversion. Survey data were linked with National Dental PBRN Enrollment Questionnaire data regarding practitioner demographics and practice characteristics. Results: The majority of dentists (67%) reported prior training in pain management; however, a minority of dentists reported prior training regarding identification and assessment of drug abuse or addiction (48%) or identification of prescription drug diversion (25%). The majority of training experiences across all topics occurred through continuing dental education participation. Dental school training relevant to pain management, addiction, and identification of drug diversion was more prevalent among more recent dental school graduates. Training experiences were associated with prescribing practices. Conclusions: Results suggest that across multiple levels of training, many dentists are not receiving training specific to addiction assessment and identification of drug diversion. Such training is associated with greater consistency of risk mitigation implementation in practice.
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Affiliation(s)
- Jenna L McCauley
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie Reyes
- Department of Periodontics, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, Gainesville, Florida, USA
| | - D Brad Rindal
- HealthPartners Institute, Bloomington, Minnesota, USA
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Renata S Leite
- Department of Stomatology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Sciences, University of Florida, Gainesville, Florida, USA
| | - Kathleen T Brady
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA
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Minyé HM, Gilbert GH, Litaker MS, Mungia R, Meyerowitz C, Louis DR, Slootsky A, Gordan VV, McCracken MS. Preparation Techniques Used to Make Single-Unit Crowns: Findings from The National Dental Practice-Based Research Network. J Prosthodont 2018; 27:813-820. [PMID: 30311319 PMCID: PMC6283672 DOI: 10.1111/jopr.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To: (1) determine which preparation techniques clinicians use in routine clinical practice for single-unit crown restorations; (2) test whether certain practice, dentist, and patient characteristics are significantly associated with these techniques. MATERIALS AND METHODS Dentists in the National Dental Practice-Based Research Network participated in a questionnaire regarding preparation techniques, dental equipment used for single-unit crown preparations, scheduled chair time, occlusal clearance determination, location of finish lines, magnification during preparation, supplemental lighting, shade selection, use of intraoral photographs, and trimming dies. Survey responses were compared by dentist and practice characteristics using ANOVA. RESULTS Of the 2132 eligible dentists, 1777 (83%) responded to the survey. The top two margin configuration choices for single-unit crown preparation for posterior crowns were chamfer/heavy chamfer (65%) and shoulder (23%). For anterior crowns, the most prevalent choices were the chamfer (54%) and the shoulder (37%) configurations. Regarding shade selection, a combination of dentist, assistant, and patient input was used to select anterior shades 59% of the time. Photographs are used to communicate shade selection with the laboratory in about half of esthetically demanding cases. The ideal finish line was located at the crest of gingival tissue for 49% of respondents; 29% preferred 1 mm below the crest; and 22% preferred the finish line above the crest of tissue. Average chair time scheduled for a crown preparation appointment was 76 ± 21 minutes. Practice and dentist characteristics were significantly associated with margin choice including practice type (p < 0.001), region (p < 0.001), and years since graduation (p < 0.001). CONCLUSIONS Network dentists prefer chamfer/heavy chamfer margin designs, followed by shoulder preparations. These choices were related to practice and dentist characteristics.
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Affiliation(s)
- Helena M Minyé
- Private practice of general dentistry, Odessa and Fort Worth, TX
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Rahma Mungia
- Department of Periodontics University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - David R Louis
- Private practice of general dentistry with HealthPartners, Woodbury, MN
| | - Alan Slootsky
- Private practice of general dentistry, Pompano Beach, FL
| | - Valeria V Gordan
- Restorative Dental Sciences Department, Operative Dentistry Division, College of Dentistry, University of Florida, Gainesville, FL
| | - Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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McCracken MS, Litaker MS, Gordan VV, Karr T, Sowell E, Gilbert GH. Remake Rates for Single-Unit Crowns in Clinical Practice: Findings from The National Dental Practice-Based Research Network. J Prosthodont 2018; 28:122-130. [PMID: 30412320 DOI: 10.1111/jopr.12995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Some crowns returned from the laboratory are clinically unacceptable, and dentists must remake them. The objectives of this study were to: (1) quantify the remake rate of single-unit crowns; and (2) identify factors significantly associated with crown remakes and intraoral fit. MATERIALS AND METHODS Dentists participating in the National Dental Practice-Based Research Network recruited patients needing crowns and documented fabrication techniques, patient characteristics, and outcomes. Crowns were considered clinically acceptable or rejected. Also, various aspects of the clinical fit of the crown were graded and categorized as 'Goodness of Fit (GOF).' Dentist and patient characteristics were tested statistically for associations with crown acceptability and GOF. RESULTS More than 200 dentists participated in this study (N = 205) and evaluated 3750 single-unit crowns. The mean age (years) of patients receiving a crown was 55. The remake rate for crowns was 3.8%. The range of rejection rates among individual practitioners was 0% to 42%. Most clinicians (118, or 58%) did not reject any crowns; all rejections came from 42% of the clinicians (n = 87). The most common reasons for rejections were proximal misfit, marginal errors, and esthetic failures. Fewer years in practice was significantly associated with lower crown success rates and lower fit scores. GOF was also associated with practice busyness and patient insurance status, patient gender (dentists reported better fit for female patients), and patient ethnicity. CONCLUSIONS The crown remake rate in this study was about 4%. Remakes and crown GOF were associated with certain dentist and practice characteristics.
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Affiliation(s)
- Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Valeria V Gordan
- Restorative Dental Sciences Department, Operative Dentistry Division, College of Dentistry, University of Florida, Gainesville, FL
| | | | - Ellen Sowell
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Opinions and Treatment Decisions for Dental Erosive Wear: A Questionnaire Survey among Icelandic Dentists. Int J Dent 2018; 2018:8572371. [PMID: 30515214 PMCID: PMC6236703 DOI: 10.1155/2018/8572371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/24/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023] Open
Abstract
Dental erosive wear (DEW) is common among children and adolescents, and a survey of Icelandic children showed that 30.7% of 15-year-olds were diagnosed with the condition. Objective. To gain knowledge about dental practitioners' experiences, opinions, and treatment decisions. Materials and Methods. A precoded questionnaire, previously used among Norwegian dentists, was sent electronically to all dentists in Iceland (n = 341). Results. The response rate was 64.2%, and 58% of dentists were male. More than half of the clinicians (54%) thought that prevalence had increased the last 10-15 years, and 67% reported it to be more common in male. Most (96%) recorded presence of DEW, but only 4% used a detailed scoring system. Lesions were mostly on occlusal surfaces of first mandibular molars (73%), on palatal in upper anterior teeth (61%), and on occlusal of maxillary first molars (36%). Most dentists (74%) reported a probable cause, e.g., high consumption of carbonated beverages (98%), acidic juices (68%), sport drinks (58%), reflux (54%), and eating disorders (20%). Dietary history was often recorded by 38%, and 65% never measured saliva. Most of the dentists (88%) treated patients themselves, and half of them preferred prevention with high fluoride and resin sealants. While some dentists wanted to restore teeth more invasively, most considered to restore with a filling. Conclusion. Icelandic dentists seem to be well educated for diagnosis and treatment of dental erosion, and dentists are aware of a minimally invasive approach. Clinical Significance. It is challenging for dentists to make the best treatment decision for patients with DEW, both in a short perspective and long perspective. At present, little is known about their knowledge and treatment approach, and there is no standard treatment which can be recommended. Therefore, the present study investigated dental practitioners' treatment decisions, as well as knowledge, experiences, and awareness of DEW.
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Practitioner Participation in National Dental Practice-based Research Network (PBRN) Studies: 12-Year Results. J Am Board Fam Med 2018; 31:844-856. [PMID: 30413541 PMCID: PMC6936735 DOI: 10.3122/jabfm.2018.06.180019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 06/01/2018] [Accepted: 06/11/2018] [Indexed: 01/11/2023] Open
Abstract
PURPOSE This study examines practitioner participation over 12 years in the National Dental Practice-Based Research Network (PBRN) studies and practitioner meetings, average length of participation, and association of practitioner- and practice-level characteristics with participation. Little information exists about practitioners' long-term participation in PBRNs. METHODS The network conducted a retrospective analysis of practitioner participation in 3 main network activities during 2005 to 2017. Practitioners who completed an enrollment questionnaire, practiced in the United States, and either attended a network meeting or received an invitation to complete a questionnaire or clinical study were included in the analysis. Practitioners (n = 3669) met inclusion criteria. The network implemented 38 studies (28 clinical and 10 questionnaire), 23 of which (15 clinical and 8 questionnaire) met the criteria for the current analysis. RESULTS Overall, 86% (N = 3148) participated in at least 1 network activity during 2005 to 2017. Questionnaire studies had the highest rate with 81% (N = 2963) completing at least 1, 21% (N = 762) completed at least 1 clinical study and 19% (N = 700) attended at least 1 network meeting. Among 1578 practitioners enrolled in the first 5 years of the Network launch, 20% (N = 320) participated in multiple network activities over 5 to 9 years, and 14% (N = 238) for 10 to 12 years. Practitioner characteristics associated with participation varied depending on the activity assessed. CONCLUSION The network engaged practitioners in its research activities with relatively high participation rates over a 12-year period. Strategies employed by the network to engage practitioners may serve as a model for PBRN networks for other allied health professions.
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McCauley JL, Gilbert GH, Cochran DL, Gordan VV, Leite RS, Fillingim RB, Brady KT. Prescription Drug Monitoring Program Use: National Dental PBRN Results. JDR Clin Trans Res 2018; 4:178-186. [PMID: 30931705 DOI: 10.1177/2380084418808517] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The American Dental Association recommends that dentists use a prescription drug monitoring program (PDMP) prior to prescribing an opioid for acute pain management. OBJECTIVE The objective of this study was to examine dentists' experiences using their state PDMP, as well as the impact that state-mandated registration policies, mandated use policies, and practice characteristics had on the frequency with which dentists used their PDMP. METHODS We conducted a web-based cross-sectional survey among practicing dentist members of the National Dental Practice-Based Research Network ( n = 805). The survey assessed prescribing practices for pain management and implementation of risk mitigation strategies, including PDMP use. Survey data were linked with network Enrollment Questionnaire data to include practitioner demographics and practice characteristics. RESULTS Nearly half of respondents ( n = 375, 46.6%) reported having never accessed a PDMP, with the most common reasons for nonaccess being lack of awareness ( n = 214, 57.1%) and lack of knowledge regarding registration and use ( n = 94, 25.1%). The majority of PDMP users reported the program to be very helpful (58.1%) or somewhat helpful (31.6%). Dentists reported that PDMP use most often did not change their intended prescribing behavior (40.2%), led them not to prescribe an opioid (33.5%), or led them to prescribe fewer opioid doses (25.5%). Presence of a mandated use policy was significantly associated with increased frequency of PDMP use across a variety of situations, including prior to 1) prescribing any opioid for pain management, 2) issuing refills, 3) prescribing to new patients, and 4) prescribing to patients deemed high risk. CONCLUSION Findings suggest that the majority of dentists find PDMPs helpful in informing their opioid-prescribing practices. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study. KNOWLEDGE TRANSFER STATEMENT Findings from this national survey suggest that the majority of practicing dentists find PDMPs helpful in informing their opioid-prescribing practices; however, consistent PDMP use was not common. Whereas the existence of a state-mandated use policy is a consistent predictor of dentists' PDMP use, outreach and education efforts may overcome key barriers to use identified in this study.
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Affiliation(s)
- J L McCauley
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - G H Gilbert
- 2 Department of Clinical and Community Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - D L Cochran
- 3 Department of Periodontics, UT Health San Antonio, San Antonio, USA
| | - V V Gordan
- 4 Department of Restorative Dental Sciences, University of Florida, Gainesville, FL, USA
| | - R S Leite
- 5 Department of Stomatology, Medical University of South Carolina, Charleston, SC, USA
| | - R B Fillingim
- 6 Department of Restorative Dental Sciences, University of Florida, USA
| | - K T Brady
- 1 Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA.,7 Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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- 8 National Dental PBRN Collaborative Group, which includes practitioner, faculty, and staff investigators who contributed to this activity ( http://nationaldentalpbrn.org/collaborative-group.php )
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Moreira NC, Leonardi-Dutra K, Feres MF, Colangelo EA, Balevi B, Matthews D, Flores-Mir C. Impact of Evidence-Based Dentistry Workshops on Educators’ Use of Evidence in Teaching and Practice: A Pilot Study. J Dent Educ 2018; 82:581-590. [DOI: 10.21815/jde.018.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 12/10/2017] [Indexed: 11/20/2022]
Affiliation(s)
| | | | | | | | - Ben Balevi
- Faculty of Medicine; University of British Columbia; Canada
| | - Debora Matthews
- Academic Affairs, Faculty of Dentistry; Dalhousie University; Canada
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Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. J Am Dent Assoc 2018; 149:353-362. [PMID: 29550022 DOI: 10.1016/j.adaj.2017.11.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 10/26/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Minimal information exists regarding the consistency and correlates of dentists' implementation of risk mitigation strategies when prescribing opioids, including risk screening, prescription drug monitoring program (PDMP) use, and patient education. METHODS The authors conducted a Web-based, cross-sectional survey among practicing dentist members of The National Dental Practice-Based Research Network. The authors used the survey to assess pain management prescribing practices and risk mitigation implementation. The authors linked survey data with network enrollment questionnaire data to include practitioner demographic and practice characteristics. RESULTS A total of 822 dentists completed the survey. A minority of dentists reported prescribing opioids only (11%) or opioids in combination with a recommendation for nonsteroidal anti-inflammatory drugs or acetaminophen (18%) to one-half or more of their patients needing management of acute pain. Higher levels of opioid prescribing were associated significantly with less consistent implementation of PDMP use (r = -0.20) and patient education (r = -0.11). CONCLUSIONS Most dentists reported infrequent PDMP use and counseling patients regarding risks, storage, and disposal of opioids. Higher frequency of opioid prescribing was associated with less consistent risk mitigation implementation. PRACTICAL IMPLICATIONS When opioid prescribing is indicated, risk of misuse and diversion may be mitigated by consistent PDMP use and provision of patient education. Dental education in this arena is needed.
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Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2017; 148:922-929. [PMID: 29055504 DOI: 10.1016/j.adaj.2017.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/25/2017] [Accepted: 08/07/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically. METHODS Ninety-three dentists participated in the study. When a consenting patient had an SOCL, information was recorded about the tooth, lesion, treatment provided, and, if the SOCL was opened surgically, its lesion depth. The Rao-Scott cluster-adjusted χ2 test was used to evaluate associations between lesion depth and color, roughness, patient risk, and luster. RESULTS The authors analyzed 1,593 SOCLs. Lesion color varied from yellow/light brown (40%) to dark brown/black (47%), with 13% other colors. Most (69%) of SOCLs had a rough surface when examined with an explorer. Over one-third of the SOCLs (39%) were treated surgically. Of the 585 surgically treated SOCLs, 61% had dentinal caries. There were statistically significant associations between lesion depth and color (P = .03), luster (P = .04), and roughness (P = .01). The authors classified 52% of the patients as being at elevated caries risk. The authors found no significant associations between lesion depth and patient risk (P = .07). CONCLUSIONS Although statistically significant, the clinical characteristics studied do not provide accurate guidance for making definitive treatment decisions and result in high rates of false positives. PRACTICAL IMPLICATIONS Given that 39% of the opened lesions did not have dentinal caries or were inactive, evidence-based preventive management is an appropriate alternative to surgical intervention.
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Jones JA, Snyder JJ, Gesko DS, Helgeson MJ. Integrated Medical-Dental Delivery Systems: Models in a Changing Environment and Their Implications for Dental Education. J Dent Educ 2017; 81:eS21-eS29. [PMID: 28864800 DOI: 10.21815/jde.017.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/28/2017] [Indexed: 12/16/2022]
Abstract
Models and systems of the dental care delivery system are changing. Solo practice is no longer the only alternative for graduating dentists. Over half of recent graduates are employees, and more than ever before, dentists are practicing in groups. This trend is expected to increase over the next 25 years. This article examines various models of dental care delivery, explains why it is important to practice in integrated medical-dental teams, and defines person-centered care, contrasting it with patient-centered care. Systems of care in which teams are currently practicing integrated oral health care delivery are described, along with speculation on the future of person-centered care and the team approach. Critical steps in the education of dental and other health care professionals and the development of clinical models of care in moving forward are considered. This article was written as part of the project "Advancing Dental Education in the 21st Century."
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Affiliation(s)
- Judith A Jones
- Dr. Jones is Professor and Associate Dean for Academic Administration, University of Detroit Mercy School of Dentistry; Dr. Snyder is Dental Director and CEO, Permanente Dental Associates in Oregon; Dr. Gesko is Dental Director and Senior Vice President, HealthPartners in Minnesota; and Dr. Helgeson is CEO, Apple Tree Dental in Minnesota.
| | - John J Snyder
- Dr. Jones is Professor and Associate Dean for Academic Administration, University of Detroit Mercy School of Dentistry; Dr. Snyder is Dental Director and CEO, Permanente Dental Associates in Oregon; Dr. Gesko is Dental Director and Senior Vice President, HealthPartners in Minnesota; and Dr. Helgeson is CEO, Apple Tree Dental in Minnesota
| | - David S Gesko
- Dr. Jones is Professor and Associate Dean for Academic Administration, University of Detroit Mercy School of Dentistry; Dr. Snyder is Dental Director and CEO, Permanente Dental Associates in Oregon; Dr. Gesko is Dental Director and Senior Vice President, HealthPartners in Minnesota; and Dr. Helgeson is CEO, Apple Tree Dental in Minnesota
| | - Michael J Helgeson
- Dr. Jones is Professor and Associate Dean for Academic Administration, University of Detroit Mercy School of Dentistry; Dr. Snyder is Dental Director and CEO, Permanente Dental Associates in Oregon; Dr. Gesko is Dental Director and Senior Vice President, HealthPartners in Minnesota; and Dr. Helgeson is CEO, Apple Tree Dental in Minnesota
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Chiang HK, Best AM, Sarrett DC. Concordance Between Clinical Practice and Published Evidence: Findings From Virginia Commonwealth University School of Dentistry. J Evid Based Dent Pract 2017; 17:169-176. [PMID: 28865813 DOI: 10.1016/j.jebdp.2017.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/06/2017] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the concordance between clinical practice and published evidence by dental faculty and graduating students of the Virginia Commonwealth University School of Dentistry. METHODS A questionnaire previously developed by the National Dental Practice-Based Research Network with 12 clinical scenarios was administered to VCU faculty and graduating students. Responses were scored as either consistent or inconsistent with published evidence and then analyzed for differences between dental faculty, graduating students, and the national results. RESULTS There were 43 dental faculty members with at least half-time student contact who responded to the survey. Faculty concordance ranged from 33% to 100%, and general practice faculty had the highest concordance (82%). Eighty-five of the graduating class of 98 responded to the survey, and student concordance ranged from 18% to 92% and averaged 67%. General practice faculty had higher concordance with published evidence than recently graduated dental students. CONCLUSIONS Graduating students and dental faculty demonstrated higher concordance with evidence-based practice than practitioners in the National Dental Practice-Based Research Network. General practice dental faculty demonstrated adequate concordance, but students demonstrated only a medium-level concordance. Practitioners involved in teaching dental students are better able to keep up with evolving evidence and are better able to demonstrate evidence-based practice.
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Affiliation(s)
- Harmeet K Chiang
- Department of General Practice, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA.
| | - Al M Best
- Department of Periodontics, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA; Department of Biostatistics, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - David C Sarrett
- School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
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McCracken MS, Litaker MS, George AJ, Durand S, Malekpour S, Marshall DG, Meyerowitz C, Carter L, Gordan VV, Gilbert GH. Impression evaluation and laboratory use for single-unit crowns: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2017; 148:788-796.e4. [PMID: 28822536 DOI: 10.1016/j.adaj.2017.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 05/11/2017] [Accepted: 06/12/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Objectives were to determine the likelihood that a clinician accepts an impression for a single-unit crown and document crown remake rates. METHODS The authors developed a questionnaire that asked dentists about techniques used to fabricate single-unit crowns. The authors showed dentists photographs of 4 impressions and asked them to accept or reject each impression. The authors correlated answers with dentist and practice characteristics. Other questions pertained to laboratory use and crown remake rates. RESULTS The response rate was 83% (1,777 of 2,132 eligible dentists). Of the 4 impressions evaluated, 3 received consistent responses, with 85% agreement. One impression was more equivocal; 52% accepted the impression. The likelihood of accepting an impression was associated significantly with the clinician's sex, race, ethnicity, and practice busyness. Clinicians produced 18 crowns per month on average, and 9% used in-office milling. Most dentists (59%) reported a remake rate of less than 2%, whereas 17% reported a remake rate greater than 4%. Lower remake rates were associated significantly with more experienced clinicians, optical impressions, and not using dual-arch trays. CONCLUSIONS Although dentists were largely consistent in their evaluation of impressions (> 85%), nonclinical factors were associated with whether an impression was accepted or rejected. Lower crown remake rates were associated with more experienced clinicians, optical impressions, and not using dual-arch trays. PRACTICAL IMPLICATIONS These results provide a snapshot of clinical care considerations among a diverse group of dentists. Clinicians can compare their own remake rates and impression evaluation techniques with those in this sample when developing best practice protocols.
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Kopycka-Kedzierawski DT, Meyerowitz C, Litaker MS, Heft MW, Tasgaonkar N, Day MR, Porter-Williams A, Gordan VV, Yardic RL, Lawhorn TM, Gilbert GH. Management of dentin hypersensitivity by practitioners in The National Dental Practice-Based Research Network. J Am Dent Assoc 2017. [PMID: 28629602 DOI: 10.1016/j.adaj.2017.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Dentin hypersensitivity (DH) is a condition commonly encountered in clinical dental practice. The authors conduct a study to identify the treatments recommended to manage DH among dentists in the United States. METHODS The authors conducted a multicenter study of 1,862 patients with DH who received a diagnosis and were treated by 171 dentists with The National Dental Practice-Based Research Network. RESULTS The most common treatment recommended was desensitizing over-the-counter (OTC) potassium nitrate toothpaste (alone or in combination with other treatments) for 924 of 1,862 patients (50%). This was followed by an application of fluoride varnish (FV) for 516 patients (28%) and a prescription for fluoride toothpaste for 314 patients (17%). Restorative treatments were recommended to 151 patients (8%). The most common single treatment recommendation was desensitizing OTC potassium nitrate toothpaste, recommended to 335 patients (18%). The most frequent combination of 2 treatment modalities was FV and desensitizing OTC potassium nitrate toothpaste, recommended to 100 patients (5%). A total of 890 of 1,862 patients (48%) with DH received a recommendation for 1 treatment modality, and 644 of 1,862 patients (35%) received a recommendation for a combination of 2 treatment modalities, most frequently an application of FV along with desensitizing OTC potassium nitrate toothpaste (100/1,862; 5%). CONCLUSIONS Desensitizing OTC potassium nitrate toothpaste and fluoride products were the most widely recommended products to manage DH in the practice setting. PRACTICAL IMPLICATIONS Our results suggest that most network clinicians preferred noninvasive treatment modalities when treating DH.
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Kopperud S, Rukke H, Kopperud H, Bruzell E. Light curing procedures – performance, knowledge level and safety awareness among dentists. J Dent 2017; 58:67-73. [DOI: 10.1016/j.jdent.2017.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/19/2017] [Accepted: 02/04/2017] [Indexed: 01/11/2023] Open
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Repair or replacement of restorations: A prospective cohort study by dentists in The National Dental Practice-Based Research Network. J Am Dent Assoc 2017; 146:895-903. [PMID: 26610834 DOI: 10.1016/j.adaj.2015.05.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/15/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND A prospective cohort study that included dentists in The National Dental Practice-Based Research Network was conducted to quantify 12-month failures of restorations that were repaired or replaced at baseline. The study tested the hypothesis that no significant differences exist in failure percentages between repaired and replaced restorations after 12 months. It also tested the hypothesis that certain dentist, patient, and restoration characteristics are significantly associated with the incidence of restoration failure. METHODS Dentists recorded data for 50 or more consecutive defective restorations. The restorations that were either repaired or replaced were recalled after 12 months and characterized for developing defects. RESULTS Dentists (N = 195) recorded data on 5,889 restorations; 378 restorations required additional treatment (74 repaired, 171 replaced, 84 teeth received endodontic treatment, and 49 were extracted). Multivariable logistic regression analysis indicated that additional treatment was more likely to occur if the original restoration had been repaired (7%) compared with replaced (5%) (odds ratio [OR], 1.6; P < .001; 95% confidence interval [CI], 1.2-2.1), if a molar was restored (7%) compared with premolars or anterior teeth (5% and 6%, respectively) (OR, 1.4; P = .010; 95% CI, 1.1-1.7), and if the primary reason was a fracture (8%) compared with other reasons (6%) (OR, 1.3; P = .033; 95% CI, 1.1-1.6). CONCLUSIONS An additional treatment was more likely to occur within the first year if the original restoration had been repaired (7%) compared with being replaced (5%). However, repaired restorations were less likely to need an aggressive treatment (replacement, endodontic treatment, or extraction) than replaced restorations. PRACTICAL IMPLICATIONS One year after repair or replacement of a defective restoration, the failure rate was low. However, repaired restorations were less likely to need an aggressive treatment than replaced restorations.
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Kopycka-Kedzierawski DT, Meyerowitz C, Litaker MS, Chonowski S, Heft MW, Gordan VV, Yardic RL, Madden TE, Reyes SC, Gilbert GH. Management of Dentin Hypersensitivity by National Dental Practice-Based Research Network practitioners: results from a questionnaire administered prior to initiation of a clinical study on this topic. BMC Oral Health 2017; 17:41. [PMID: 28086862 PMCID: PMC5237301 DOI: 10.1186/s12903-017-0334-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 01/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Dentin hypersensitivity (DH) is a common problem encountered in clinical practice. The purpose of this study was to identify the management approaches for DH among United States dentists. Methods One hundred eighty five National Dental Practice-Based Research Network clinicians completed a questionnaire regarding their preferred methods to diagnose and manage DH in the practice setting, and their beliefs about DH predisposing factors. Results Almost all dentists (99%) reported using more than one method to diagnose DH. Most frequently, they reported using spontaneous patient reports coupled with excluding other causes of oral pain by direct clinical examination (48%); followed by applying an air blast (26%), applying cold water (12%), and obtaining patient reports after dentist’s query (6%). In managing DH, the most frequent first choice was desensitizing, over-the-counter (OTC), potassium nitrate toothpaste (48%), followed by fluorides (38%), and glutaraldehyde/HEMA (3%). A total of 86% of respondents reported using a combination of products when treating DH, most frequently using fluoride varnish and desensitizing OTC potassium nitrate toothpaste (70%). The most frequent predisposing factor leading to DH, as reported by the practitioners, was recessed gingiva (66%), followed by abrasion, erosion, abfraction/attrition lesions (59%) and bruxism (32%). Conclusions The majority of network practitioners use multiple methods to diagnose and manage DH. Desensitizing OTC potassium nitrate toothpaste and fluoride formulations are the most widely used products to manage DH in dental practice setting.
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Affiliation(s)
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, Rochester, NY, 14620, USA
| | - Mark S Litaker
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | | - Stephanie C Reyes
- University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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McCracken MS, Louis DR, Litaker MS, Minyé HM, Oates T, Gordan VV, Marshall DG, Meyerowitz C, Gilbert GH. Impression Techniques Used for Single-Unit Crowns: Findings from the National Dental Practice-Based Research Network. J Prosthodont 2017; 27:722-732. [PMID: 28076661 DOI: 10.1111/jopr.12577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2016] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To: (1) determine which impression and gingival displacement techniques practitioners use for single-unit crowns on natural teeth; and (2) test whether certain dentist and practice characteristics are significantly associated with the use of these techniques. MATERIALS AND METHODS Dentists participating in the National Dental Practice-Based Research Network were eligible for this survey study. The study used a questionnaire developed by clinicians, statisticians, laboratory technicians, and survey experts. The questionnaire was pretested via cognitive interviewing with a regionally diverse group of practitioners. The survey included questions regarding gingival displacement and impression techniques. Survey responses were compared by dentist and practice characteristics using ANOVA. RESULTS The response rate was 1777 of 2132 eligible dentists (83%). Regarding gingival displacement, most clinicians reported using either a single cord (35%) or dual cord (35%) technique. About 16% of respondents preferred an injectable retraction technique. For making impressions, the most frequently used techniques and materials are: poly(vinyl siloxane), 77%; polyether, 12%; optical/digital, 9%. A dental auxiliary or assistant made the final impression 2% of the time. Regarding dual-arch impression trays, 23% of practitioners report they typically use a metal frame tray, 60% use a plastic frame, and 16% do not use a dual-arch tray. Clinicians using optical impression techniques were more likely to be private practice owners or associates. CONCLUSIONS This study documents current techniques for gingival displacement and making impressions for crowns. Certain dentist and practice characteristics are significantly associated with these techniques.
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Affiliation(s)
- Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - David R Louis
- Private practice of general dentistry with HealthPartners, Woodbury, MN
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Helena M Minyé
- Private practice of general dentistry, Odessa and Fort Worth, TX
| | - Thomas Oates
- School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Valeria V Gordan
- Restorative Dental Sciences Department, Operative Dentistry Division, College of Dentistry, University of Florida, Gainesville, FL
| | | | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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- The National Dental PBRN Collaborative Group includes practitioner, faculty, and staff investigators who contributed to this activity
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Coleman BG, Johnson TM, Erley KJ, Topolski R, Rethman M, Lancaster DD. Preparing Dental Students and Residents to Overcome Internal and External Barriers to Evidence-Based Practice. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.10.tb06198.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Brandon G. Coleman
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon Georgia
| | - Thomas M. Johnson
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon Georgia
| | - Kenneth J. Erley
- U.S. Army Advanced Education Program in Periodontics; Fort Gordon Georgia
| | | | - Michael Rethman
- Baltimore College of Dental Surgery; University of Maryland; College of Dentistry; The Ohio State University
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Makhija SK, Lawson NC, Gilbert GH, Litaker MS, McClelland JA, Louis DR, Gordan VV, Pihlstrom DJ, Meyerowitz C, Mungia R, McCracken MS. Dentist material selection for single-unit crowns: Findings from the National Dental Practice-Based Research Network. J Dent 2016; 55:40-47. [PMID: 27693778 DOI: 10.1016/j.jdent.2016.09.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Dentists enrolled in the National Dental Practice-Based Research Network completed a study questionnaire about techniques and materials used for single-unit crowns and an enrollment questionnaire about dentist/practice characteristics. The objectives were to quantify dentists' material recommendations and test the hypothesis that dentist's and practice's characteristics are significantly associated with these recommendations. METHODS Surveyed dentists responded to a contextual scenario asking what material they would use for a single-unit crown on an anterior and posterior tooth. Material choices included: full metal, porcelain-fused-to-metal (PFM), all-zirconia, layered zirconia, lithium disilicate, leucite-reinforced ceramic, or other. RESULTS 1777 of 2132 eligible dentists responded (83%). The top 3 choices for anterior crowns were lithium disilicate (54%), layered zirconia (17%), and leucite-reinforced glass ceramic (13%). There were significant differences (p<0.05) by dentist's gender, race, years since graduation, practice type, region, practice busyness, hours worked/week, and location type. The top 3 choices for posterior crowns were all-zirconia (32%), PFM (31%), and lithium disilicate (21%). There were significant differences (p<0.05) by dentist's gender, practice type, region, practice busyness, insurance coverage, hours worked/week, and location type. CONCLUSIONS Network dentists use a broad range of materials for single-unit crowns for anterior and posterior teeth, adopting newer materials into their practices as they become available. Material choices are significantly associated with dentist's and practice's characteristics. CLINICAL SIGNIFICANCE Decisions for crown material may be influenced by factors unrelated to tooth and patient variables. Dentists should be cognizant of this when developing an evidence-based approach to selecting crown material.
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Affiliation(s)
- Sonia K Makhija
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States.
| | - Nathaniel C Lawson
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mark S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - David R Louis
- HealthPartners Dental Group, Woodbury, MN, United States
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, Operative Dentistry Division, University of Florida, Gainesville, FL, United States
| | | | - Cyril Meyerowitz
- University of Rochester, Eastman Institute for Oral Health, Rochester, NY, United States
| | - Rahma Mungia
- Department of Periodontics, University of Texas Health Science Center at San Antonio, United States
| | - Michael S McCracken
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
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Staxrud F, Tveit A, Rukke H, Kopperud S. Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 2016; 52:50-4. [DOI: 10.1016/j.jdent.2016.07.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 07/08/2016] [Accepted: 07/11/2016] [Indexed: 11/28/2022] Open
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McCracken MS, Louis DR, Litaker MS, Minyé HM, Mungia R, Gordan VV, Marshall DG, Gilbert GH. Treatment recommendations for single-unit crowns: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2016; 147:882-890. [PMID: 27492046 DOI: 10.1016/j.adaj.2016.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND The objectives of this study were to quantify practitioner variation in likelihood to recommend a crown and test whether certain dentist, practice, and clinical factors are associated significantly with this likelihood. METHODS Dentists in The National Dental Practice-Based Research Network completed a questionnaire about indications for single-unit crowns. In 4 clinical scenarios, practitioners ranked their likelihood of recommending a single-unit crown. The authors used these responses to calculate a dentist-specific crown factor (range, 0-12). A higher score implied a higher likelihood of recommending a crown. The authors tested certain characteristics for statistically significant associations with the crown factor. RESULTS A total of 1,777 of 2,132 eligible dentists (83%) responded. Practitioners were most likely to recommend crowns for teeth that were fractured, cracked, or endodontically treated or had a broken restoration. Practitioners overwhelmingly recommended crowns for posterior teeth treated endodontically (94%). Practice owners, practitioners in the Southwest, and practitioners with a balanced workload were more likely to recommend crowns, as were practitioners who used optical scanners for digital impressions. CONCLUSIONS There is substantial variation in the likelihood of recommending a crown. Although consensus exists in some areas (posterior endodontic treatment), variation dominates in others (size of an existing restoration). Recommendations varied according to type of practice, network region, practice busyness, patient insurance status, and use of optical scanners. PRACTICAL IMPLICATIONS Recommendations for crowns may be influenced by factors unrelated to tooth and patient variables. A concern for tooth fracture-whether from endodontic treatment, fractured teeth, or large restorations-prompted many clinicians to recommend crowns.
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Kopperud SE, Tveit AB, Opdam NJM, Espelid I. Occlusal Caries Management: Preferences among Dentists in Norway. Caries Res 2016; 50:40-7. [PMID: 26839953 DOI: 10.1159/000442796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/26/2015] [Indexed: 11/19/2022] Open
Abstract
The aim was to measure variations in the threshold for operative treatment of occlusal caries in permanent teeth and the use of dental materials, compared with results from a similar study conducted in Norway in 1995. In 2009, a precoded questionnaire was sent electronically to 3,654 dentists with E-mail addresses in the member register of the Norwegian Dental Association. The questions were related to caries, treatment strategies and choice of dental materials. Replies were obtained from 61.3% respondents after two reminders. Restorative treatment of occlusal lesions confined to enamel was proposed by 12% of the dentists, compared with 18% in 1995 (p < 0.01). Older dentists more often than younger dentists would operatively treat enamel lesions (p < 0.01). Most dentists preferred to drill only the carious part of the fissure rather than the whole fissure both in 2009 (78.8%) and 1995 (68.3%; p < 0.01). In 2009, 91.9% preferred composite as the restorative material of choice, compared to only 39.1% in 1995. Logistic regression analyses identified higher age of the dentist as the only variable significantly associated with higher risk of restoring occlusal enamel lesions operatively. The authors conclude that especially young dentists appear to be more reluctant to remove tooth substance in 2009 compared with 1995. Composite is the dominating material of choice in 2009 and seems to have substituted the use of most other filling materials in occlusal restorations in permanent teeth.
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Funkhouser E, Vellala K, Baltuck C, Cacciato R, Durand E, McEdward D, Sowell E, Theisen SE, Gilbert GH. Survey Methods to Optimize Response Rate in the National Dental Practice-Based Research Network. Eval Health Prof 2016; 40:332-358. [PMID: 26755526 DOI: 10.1177/0163278715625738] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Surveys of health professionals typically have low response rates, and these rates have been decreasing in the recent years. We report on the methods used in a successful survey of dentist members of the National Dental Practice-Based Research Network. The objectives were to quantify the (1) increase in response rate associated with successive survey methods, (2) time to completion with each successive step, (3) contribution from the final method and personal contact, and (4) differences in response rate and mode of response by practice/practitioner characteristics. Dentist members of the network were mailed an invitation describing the study. Subsequently, up to six recruitment steps were followed: initial e-mail, two e-mail reminders at 2-week intervals, a third e-mail reminder with postal mailing a paper questionnaire, a second postal mailing of paper questionnaire, and staff follow-up. Of the 1,876 invited, 160 were deemed ineligible and 1,488 (87% of 1,716 eligible) completed the survey. Completion by step: initial e-mail, 35%; second e-mail, 15%; third e-mail, 7%; fourth e-mail/first paper, 11%; second paper, 15%; and staff follow-up, 16%. Overall, 76% completed the survey online and 24% on paper. Completion rates increased in absolute numbers and proportionally with later methods of recruitment. Participation rates varied little by practice/practitioner characteristics. Completion on paper was more likely by older dentists. Multiple methods of recruitment resulted in a high participation rate: Each step and method produced incremental increases with the final step producing the largest increase.
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Affiliation(s)
| | | | | | | | - Emily Durand
- 5 HealthPartners Institute for Education and Research, Minneapolis, MN, USA
| | - Deborah McEdward
- 6 College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Ellen Sowell
- 1 University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sarah E Theisen
- 7 University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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- 1 University of Alabama at Birmingham, Birmingham, AL, USA
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Polk DE, Nolan BA, Shah NH, Weyant RJ. Policies and Procedures That Facilitate Implementation of Evidence-Based Clinical Guidelines in U.S. Dental Schools. J Dent Educ 2016. [DOI: 10.1002/j.0022-0337.2016.80.1.tb06054.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Beth A.D. Nolan
- University of Pittsburgh Graduate School of Public Health at the time of this study
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Eleazer PD, Gilbert GH, Funkhouser E, Reams GJ, Law AS, Benjamin PL. Techniques and materials used by general dentists during endodontic treatment procedures: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2015; 147:19-27. [PMID: 26562726 DOI: 10.1016/j.adaj.2015.05.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/22/2015] [Accepted: 05/27/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Little is known about which materials and techniques general dentists (GDs) use during endodontic procedures. The objectives were to quantify GDs' use of specific endodontic tools, quantify inappropriate use, and ascertain whether inappropriate use is associated with GDs' practice characteristics. METHODS GDs in The National Dental Practice-Based Research Network reported in a questionnaire materials and techniques they use during endodontic procedures. RESULTS Among eligible GDs, 1,490 (87%) participated. Most (93%; n = 1,383) used sodium hypochlorite to irrigate. The most commonly used sealers were zinc oxide eugenol (43%) and resin (40%), followed by calcium hydroxide (26%). Most (62%; n = 920) used a compaction obturation technique; 36% (n = 534) used a carrier-based method. Most (96%; n = 1,423) used gutta-percha as a filler; 5% used paste fillers. Few used irrigants (n = 46), techniques (n = 49), or fillers (n = 10) that investigators classified as inappropriate. CONCLUSIONS GDs use a broad range of endodontic techniques and materials, often adapting to newer technologies as they become available. Few GDs use tools that the investigators classified as inappropriate. PRACTICAL IMPLICATIONS GDs use many types of endodontic techniques and materials, but only a small percentage of them are inappropriate.
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Allen KD, DiBartolo MC, Welsh DL, Brown V. Design of a Medical Triage Evidence-Based Clinical Management Protocol and Implementation of Medical Triage On-Line Training for Use by Mission of Mercy Volunteers. J Community Health Nurs 2015; 32:218-30. [PMID: 26529107 DOI: 10.1080/07370016.2015.1087273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evidence-based protocols in safety net settings can help standardize care practices, increase organizational workflow, and enhance quality outcomes for those receiving services. The purpose of this quality improvement project is two-fold: to design an evidence-based medical triage clinical management protocol, and, to influence adherence to that protocol by safety net medical triage volunteers through an on-line volunteer orientation. Leadership skills were required to help translate evidence-based practice recommendations into useful tools to assist in directing practice. Project outcomes included successful multidisciplinary practice change, significantly improved volunteer knowledge surrounding medical triage protocol parameters, increased organizational workflow, and enhanced quality client outcomes.
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Affiliation(s)
- Kimberly D Allen
- a Department of Nursing , Salisbury University , Salisbury , Maryland
| | - Mary C DiBartolo
- a Department of Nursing , Salisbury University , Salisbury , Maryland
| | | | - Voncelia Brown
- a Department of Nursing , Salisbury University , Salisbury , Maryland
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Lawson NC, Gilbert GH, Funkhouser E, Eleazer PD, Benjamin PL, Worley DC. General Dentists' Use of Isolation Techniques during Root Canal Treatment: From the National Dental Practice-based Research Network. J Endod 2015; 41:1219-25. [PMID: 26015159 DOI: 10.1016/j.joen.2015.04.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/24/2015] [Accepted: 04/19/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION A preliminary study done by a National Dental Practice-Based Research Network precursor observed that 44% of general dentists (GDs) reported always using a rubber dam (RD) during root canal treatment (RCT). This full-scale study quantified the use of all isolation techniques, including RD use. METHODS Network practitioners completed a questionnaire about isolation techniques used during RCT. Network enrollment questionnaire data provided practitioner characteristics. RESULTS One thousand four hundred ninety of 1716 eligible GDs participated (87%); 697 (47%) reported always using an RD. This percentage varied by tooth type. These GDs were more likely to always use an RD, do not own a private practice, perform less than 10 RCTs/month, and have postgraduate training. CONCLUSIONS Most GDs do not use an RD all the time. Ironically, RDs are used more frequently by GDs who do not perform molar RCT. RD use varies with tooth type and certain dentist, practice, and patient characteristics.
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Affiliation(s)
- Nathaniel C Lawson
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama.
| | - Ellen Funkhouser
- Division of Preventive Medicine, Department of Medicine, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul D Eleazer
- Department of Endodontics, School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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