General practitioners' use of caries-preventive agents in adult patients versus pediatric patients: findings from the dental practice-based research network

A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon

ISSUE ADDRESSED

Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon.

METHODS

Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis.

RESULTS

In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained.

CONCLUSION

Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.

Evidence-Based Practice Knowledge, Perceptions, and Behavior: A Multi-Institutional, Cross-Sectional Study of a Population of U.S. Dental Students

The aim of this study was to help inform faculty and curriculum leaders in academic dental institutions about the knowledge, skills, perceptions, and behavior of an institutionally diverse population of dental students with respect to evidence-based practice (EBP). A survey utilizing the validated Knowledge, Attitudes, Access, and Confidence Evaluation instrument developed by Hendricson et al. was conducted in 2012 with fourth-year dental students at seven geographically dispersed U.S. dental schools. The survey addressed elements of EBP knowledge, attitudes toward EBP, behavior in accessing evidence, and perceptions of competence in statistical analysis. A total of 138 students from the seven schools participated. A slight majority of these students correctly responded to the knowledge of critical appraisal questions. While the students demonstrated positive attitudes about EBP, they did not report high levels of confidence in their critical appraisal skills. The findings also showed that the students accessed various sources of evidence with differing frequencies. The most frequently accessed resources were colleagues, the Internet (excluding Cochrane Database of Systematic Reviews), and textbooks. The results of this study help to identify areas for improvement in EBP education in order to advance dental students' preparation to become evidence-based practitioners.

Concordance between clinical practice and published evidence: findings from The National Dental Practice-Based Research Network

BACKGROUND

Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network").

METHODS

Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors. The authors coded responses to each scenario/clinical practice behavior as consistent ("1") or inconsistent ("0") with published evidence, summed the coded responses and divided the sum by the number of total responses to create an overall concordance score. The overall concordance score was calculated as the mean percentage of responses that were consistent with published evidence.

RESULTS

The authors limited analyses to participants in the United States (N = 591). The study results show a mean concordance at the practitioner level of 62 percent (SD = 18 percent); procedure-specific concordance ranged from 8 to 100 percent. Affiliation with a large group practice, being a female practitioner and having received a dental degree before 1990 were independently associated with high concordance (≥ 75 percent).

CONCLUSION

Dentists reported a medium-range concordance between practice and published evidence.

PRACTICAL IMPLICATIONS

Efforts to bring research findings into routine practice are needed.

Edentulism in high poverty rural counties

PURPOSE

To examine the differences in oral health status among residents of high-poverty counties, as compared to residents of other rural or urban counties, specifically on the prevalence of edentulism.

METHODS

We used the 2005 Behavioral Risk Factor Surveillance System (BRFSS) and the 2006 Area Resource File (ARF). All analyses were conducted with SAS and SAS-callable SUDAAN, in order to account for weighting and the complex sample design.

FINDINGS

Characteristics significantly related to edentulism include: geographic location, gender, race, age, health status, employment, insurance, not having a usual source of care, education, marital status, presence of chronic disease, having an English interview, not deferring care due to cost, income, and dentist saturation within the county.

CONCLUSIONS

Significant associations between high-poverty rural and other rural counties and edentulism were found, and other socioeconomic and health status indicators remain strong predictors of edentulism.