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Mungia R, Funkhouser E, Cochran DL, Cunha-Cruz J, Gordan VV, Rindal DB, Meyerowitz C, Allareddy V, Fellows JL, Gilbert GH. Recruitment strategies and retention rates for five National Dental PBRN studies. J Clin Transl Sci 2024; 8:e56. [PMID: 38617061 PMCID: PMC11010183 DOI: 10.1017/cts.2024.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/23/2024] [Accepted: 03/11/2024] [Indexed: 04/16/2024] Open
Abstract
Background We describe a retrospective assessment of practitioner and patient recruitment strategies, patient retention strategies, and rates for five clinical studies conducted in the National Dental Practice-Based Research Network between 2012 and 2019, and practitioner and patient characteristics associated with retention. Methods Similar recruitment strategies were adopted in the studies. The characteristics of the practitioners and patients are described. The proportion of patients who either attended a follow-up (FU) assessment or completed an online assessment was calculated. For studies with multiple FU visits or questionnaire assessments, rates for completing each FU were calculated, as were the rates for completing any and for completing all FU assessments. The associations of practitioner and patient characteristics with all clinic FU visits, and with the completion of all assessments for a study were ascertained. Results Overall, 591 practitioners and 12,159 patients were included. FU rates by patients for any assessment varied from 91% to 96.5%, and rates for participating in all assessments ranged from 68% to 87%. The mean total number of patients each practitioner recruited was 21 (sd = 15); the mean number per study was 13 (sd = 7). For practitioners, practice type and patient enrollment were associated with greater clinic retention, while only race was associated with their patients completing post-visit online assessments. For patients, age was associated with clinic retention, while female gender, age, race, and education were all associated with greater completion of post-visit online assessments. Conclusion The Network efficiently recruited practitioners and patients and achieved high patient retention rates for the five studies.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics, School of Dentistry, The
University of Texas Health San Antonio, San Antonio,
TX, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine,
University of Alabama at Birmingham, Birmingham,
AL, USA
| | - David L. Cochran
- Department of Periodontics, School of Dentistry, The
University of Texas Health San Antonio, San Antonio,
TX, USA
| | - Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry,
University of Alabama at Birmingham, Birmingham,
AL, USA
| | - Valeria V. Gordan
- Director of Practice-based Research and Associate Dean for Research,
University of Florida, College of Dentistry,
Gainesville, FL, USA
| | - Donald B. Rindal
- Associate Dental Director for Research, HealthPartners Dental Group,
HealthPartners Institute, Minneapolis,
MN, USA
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester School of Medicine
and Dentistry, Rochester, NY,
USA
| | - Veerasathpurush Allareddy
- Brodie Craniofacial Endowed Chair, and Head of Department of Orthodontics,
University of Illinois Chicago College of Dentistry,
Chicago, IL, USA
| | | | - Gregg H. Gilbert
- Department of Clinical & Community Sciences, Distinguished Professor
and the James R. Rosen Chair of Dental Research Chair, School of Dentistry,
University of Alabama at Birmingham, Birmingham,
AL, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Thyvalikakath T, Siddiqui ZA, Eckert G, LaPradd M, Duncan WD, Gordan VV, Rindal DB, Jurkovich M, Gilbert GH. Survival analysis of posterior composite restorations in National Dental PBRN general dentistry practices. J Dent 2024; 141:104831. [PMID: 38190879 PMCID: PMC10866618 DOI: 10.1016/j.jdent.2024.104831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE Quantify the survival of posterior composite restorations (PCR) placed during the study period in permanent teeth in United States (US) general dental community practices and factors predictive of that survival. METHODS A retrospective cohort study was conducted utilizing de-identified electronic dental record (EDR) data of patients who received a PCR in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The final analyzed data set included 700,885 PCRs from 200,988 patients. Descriptive statistics and Kaplan Meier (product limit) estimator were performed to estimate the survival rate (defined as the PCR not receiving any subsequent treatment) after the first PCR was observed in the EDR during the study time. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. RESULTS The overall median survival time was 13.3 years. The annual failure rates were 4.5-5.8 % for years 1-5; 5.3-5.7 %, 4.9-5.5 %, and 3.3-5.2 % for years 6-10, 11-15, and 16-20, respectively. The failure descriptions recorded for < 7 % failures were mostly caries (54 %) and broken or fractured tooth/restorations (23 %). The following variables significantly predicted PCR survival: number of surfaces that comprised the PCR; having at least one interproximal surface; tooth type; type of prior treatment received on the tooth; Network region; patient age and sex. Based on the magnitude of the multivariable estimates, no single factor predominated. CONCLUSIONS This study of Network practices geographically distributed across the US observed PCR survival rates and predictive factors comparable to studies done in academic settings and outside the US. CLINICAL SIGNIFICANCE Specific baseline factors significantly predict the survival of PCRs done in US community dental practices.
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Affiliation(s)
- Thankam Thyvalikakath
- Office of Dental Informatics & Digital Health, Indiana University School of Dentistry, IUPUI, Research Scientist & Director, Dental Informatics, Center for Biomedical Informatics, Regenstrief Institute, Inc., OH 144A, 415 Lansing Street, Indianapolis, IN 46202, USA.
| | - Zasim Azhar Siddiqui
- West Virginia University School of Pharmacy, Morgantown, WV, USA; Department of Public Health and Dental Informatics, Indiana University School of Dentistry, IUPUI, Indianapolis, IN 46202, USA
| | - George Eckert
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, 340W 10th St, Indianapolis, IN 46202, USA
| | - Michelle LaPradd
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, 340W 10th St, Indianapolis, IN 46202, USA; Syneos Health, 1030 Sync St, Morrisville, NC 27560, USA
| | - William D Duncan
- Department of Community Dentistry, University of Florida, College of Dentistry, Gainesville, FL, USA; Biomedical Data Science and Shared Resource, Roswell Park Cancer Center, Buffalo, NY, USA
| | - Valeria V Gordan
- University of Florida, College of Dentistry, Gainesville, FL, USA
| | - D Brad Rindal
- 8170 33rd Avenue South | P.O. Box 1524, MS 23301A Minneapolis MN 55440, USA
| | - Mark Jurkovich
- HealthPartners Institute, Minneapolis MN, USA; 8170 33rd Ave S, Bloomington, MN 55440, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, SDB Room 109, University of Alabama at Birmingham, Birmingham, AL, USA; National Dental PBRN Collaborative Group, 1720 University Blvd, Birmingham, AL 35294, USA; University of Alabama at Birmingham, Birmingham, AL, USA
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da Silva Tagliaferro EP, Riley JL, Gilbert GH, da Silva SRC, Rosell FL, Junior AV, Gordan VV. EVIDENCE-PRACTICE GAP IN TREATMENT DECISIONS ABOUT DEFECTIVE COMPOSITE AND AMALGAM RESTORATIONS AMONG BRAZILIAN DENTISTS. Braz J Oral Sci 2023; 22:e231640. [PMID: 38077621 PMCID: PMC10702847 DOI: 10.20396/bjos.v22i00.8671640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Better understanding of dentists' decision-making about defective restorations is needed to close the evidence-practice gap (EPG). Aim: this study aimed to quantify the EPG about defective restorations and identify dentist factors associated with this EPG. Methods: 216 dentists from São Paulo State, Brazil, completed a questionnaire about three clinical case scenarios involving defective composite restorations with cementum-dentin margins (case 1) and enamel margins (case 2), and an amalgam (case 3) restoration. Dentists were asked what treatment, if any, they would recommend, including preventive treatment, polishing, re-surfacing, or repairing the restoration, or replacing the entire restoration. Replacing the entire restoration in any of these three scenarios was classified as inconsistent with the evidence, comprising an EPG. Bivariate analyses using Chi-square, ANOVA, or multiple comparison tests were performed (p<.05). Results: for defective composite restorations, 49% and 55% of dentists chose to replace the entire restoration for cases 1 and 2, respectively. Twenty-nine percent of dentists chose to replace the entire amalgam restoration. Dentists were significantly more likely to choose to replace the defective amalgam restoration than the composite restoration with a defect at the cementum-dentin margins or the enamel margins (both at p < .001). Female dentists were more likely to choose a conservative treatment than male dentists for cases 1 (p=.034) and 2 (p=.009). Dentists with a higher percentage of patients interested in individualized caries prevention were also more conservative in case 1 (p=.045). Conclusion: a substantial EPG regarding treatment decisions for defective restorations exists, especially for composite restorations. This study adds to the international evidence that an EPG exists in this clinical area and that global strategies need to be developed to close the gap.
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Affiliation(s)
- 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
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki Junior
- Department of Community Dentistry, São Paulo State University (Unesp), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Valeria Veiga Gordan
- University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Riley JLI, Rindal DB, Velly AM, Anderson GC, Johnson KS, Gilbert GH, Schiffman EL. Practitioner/Practice- and Patient-Based Factors Contributing to Dental Practitioner Treatment Recommendations for Patients with Pain-Related TMDs: Findings from the National Dental PBRN. J Oral Facial Pain Headache 2023; 37:195-206. [PMID: 37975783 PMCID: PMC10664701 DOI: 10.11607/ofph.3263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 04/16/2023] [Indexed: 11/19/2023]
Abstract
AIMS To document National Dental Practice-Based Research Network (PBRN) practitioner treatment recommendations for patients with painful temporomandibular disorders (TMDs) and to identify practitioner/practice- and patient-related factors contributing to treatment recommendations made at the initial clinical visit. METHODS This prospective single-sample cohort study formed groups based on treatment recommendations made by 185 dental practitioners who treated 1,901 patients with painful TMDs. At the baseline visit, which this article describes, practitioners provided patients with their diagnoses and a treatment plan and then completed a comprehensive questionnaire. RESULTS Self-care, an intraoral appliance, medication, and practitioner-recommended jaw exercises were the most frequently recommended treatments. Practitioners recommended multiple treatments to most patients. TMD signs, symptoms, and diagnoses were primary considerations in treatment planning, but the practitioner's expectations for improvement were only significant for intraoral appliances and self-care. Female practitioners and those with expertise in TMDs more frequently recommended patient-directed and multidisciplinary treatments compared to their counterparts. CONCLUSIONS Practitioners used a wide range of treatments for patients with few consistent patterns. The propensity to use TMD signs, symptoms, and diagnoses when making treatment recommendations suggests a tendency to conceptualize patients using the biomedical model. Infrequent referral to nondental providers suggests a lack of availability of these providers, a misunderstanding of the complexity of TMDs, and/or discomfort with assessment of psychosocial factors. Implications include the need for comprehensive training in the assessment and management of TMD patients during dental school and participation in TMD continuing education courses following evidence-based guidelines.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Cunha-Cruz J, Gilbert GH, Allareddy V, Cochran DL, Fellows J, Kopycka-Kedzierawski DT, McBurnie M, Meyerowitz C, Mungia R, Rindal DB, Gordan VV. Characteristics of dentists in the National Dental Practice-Based Research Network. J Dent 2023; 137:104653. [PMID: 37572986 PMCID: PMC10528504 DOI: 10.1016/j.jdent.2023.104653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/08/2023] [Indexed: 08/14/2023] Open
Abstract
OBJECTIVES Our aims are to describe the characteristics of dentists, members of the US National Dental practice-based research network (PBRN) in the United States, and determine how often these dentists provide specific dental procedures. METHODS Dentists completed a questionnaire when they enrolled in the Network about their demographic and training characteristics and characteristics of their practices and patients. Dentists also reported the frequency of providing specific dental procedures. Data were analyzed using descriptive statistics. RESULTS Of 4,483 dentists in active clinical practice, 34% identified as females, 70% as white, and 73% as general dentists. Most dentists practiced in large metropolitan areas (87%) and in solo or small practices (72%). On average, they reported about one-half of their patients were children or older adults, a third were from historically underrepresented racial and ethnic groups, and one-quarter were covered by public insurance. Most dentists routinely performed restorations and fixed prosthetics (78%), extractions (59%), removable (44%) and implant (40%) prosthetics, and endodontics on incisor and premolar teeth (44%). CONCLUSIONS Dentists participating in the National Dental PBRN have much in common with dentists at large. The network has a broad representation of dentists, practice types, patient populations, and treatments offered, including diversity regarding race/ethnicity, gender, insurance, and geography of its practitioners and patients. CLINICAL SIGNIFICANCE Characteristics of National Dental PBRN dentists suggest that a broad range of dentists is interested in participating in national-level research studies, thereby enabling an array of clinical study settings and topics that can optimize the generalizability of study findings.
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Affiliation(s)
- Joana Cunha-Cruz
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States.
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Medical Towers Suite 402, 1717 11th Avenue South, Birmingham, AL 35205, United States
| | - Veerasathpurush Allareddy
- University of Illinois Chicago College of Dentistry, 801 S. Paulina Street, Chicago, Illinois 60612, United States
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States
| | - Jeffrey Fellows
- Center for Health Research, Kaiser Permanente, 3800N. Interstate Avenue, Portland, OR 97227-1098, United States
| | - Dorota T Kopycka-Kedzierawski
- Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Ave, PO Box 683, Rochester, NY 14620, United States
| | - MaryAnn McBurnie
- Kaiser Permanente Center for Health Research, 3800N. Interstate Avenue, Portland, OR 97114, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester. 601 Elmwood Avenue, Box 686, Rochester, NY 14642, United States.
| | - Rahma Mungia
- Department of Periodontics, The University of Texas Health San Antonio, 8403 Floyd Curl Drive; MC 8258; Suite 300.29, San Antonio, TX 78229, United States
| | - D Brad Rindal
- HealthPartners Institute, HealthPartners Dental Group, 8170 33rd Avenue South | P.O. Box 1524, MS 21112R, Minneapolis MN 55440-1524, United States
| | - Valeria V Gordan
- University of Florida College of Dentistry, Restorative Dental Sciences Department, PO Box 100415, Gainesville FL 32610-0415, United States
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Mungia R, Lobbezoo F, Funkhouser E, Glaros A, Manfredini D, Ahlberg J, Taverna M, Galang-Boquiren MT, Rugh J, Truong C, Boone H, Cheney C, Verhoeff MC, Gilbert GH. Dental practitioner approaches to bruxism: Preliminary findings from the national dental practice-based research network. Cranio 2023:1-9. [PMID: 37016587 PMCID: PMC11011247 DOI: 10.1080/08869634.2023.2192173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Bruxism is a repetitive masticatory muscle activity. This study investigates dental practitioners' approaches to bruxism assessment and treatment in practices. METHODS A brief 5 question questionnaire ("Quick Poll") on bruxism was conducted. RESULTS A total of 397 practitioners responded. More than half (55%) initiated treatment for bruxism on one to three patients per month. The majority believed that stress (97%) and sleep patterns (82%) affected bruxism in their patients. Interestingly, 96% offered an occlusal guard/appliance and 46% made occlusal adjustments. CONCLUSION This study highlights inconsistencies in practitioner approaches to bruxism assessment and management in clinical settings, suggesting gaps in practitioner knowledge evidenced by the varied responses. ABBREVIATIONS PBRN - Practice-Based Research NetworkMMA - Masticatory muscle activitySB - Sleep bruxismAB - Awake bruxismTMJ - Temporomandibular jointOSA - Obstructive sleep apnea.
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Affiliation(s)
- Rahma Mungia
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at San Antonio, Texas, USA
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ellen Funkhouser
- Department of Medicine, School of Medicine, University of Alabama at Birmingham
| | - Alan Glaros
- School of Dentistry, The University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - Daniele Manfredini
- Department of Medical Biotechnologies, Università degli Studi di Siena, Siena, Italy
| | - Jari Ahlberg
- Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Melanie Taverna
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at San Antonio, Texas, USA
| | | | - John Rugh
- Department of Developmental Dentistry, School of Dentistry, The University of Texas Health Science Center at San Antonio, Texas, USA
| | - Clarisse Truong
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at San Antonio, Texas, USA
| | - Honesty Boone
- Department of Periodontics, School of Dentistry, The University of Texas Health Science Center at San Antonio, Texas, USA
| | | | - Merel C. Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Jurasic MM, Gillespie S, Sorbara P, Clarkson J, Ramsay C, Nyongesa D, McEdward D, Gilbert GH, Vollmer WM. Deep caries removal strategies: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2022; 153:1078-1088.e7. [PMID: 36175201 PMCID: PMC10787323 DOI: 10.1016/j.adaj.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 07/28/2022] [Accepted: 08/04/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The International Caries Consensus Collaboration (ICCC) has published recommendations on carious tissue removal to treat cavitated carious lesions in a manner that preserves hard tissue and retains teeth long term. This study quantifies The National Dental Practice-Based Research Network dentists' use of selective caries removal. METHODS This cross-sectional questionnaire study assessed reported use of selective caries removal when treating deep caries in asymptomatic and symptomatic teeth in response to clinical case scenarios. Statistical methods included the proportion of respondents concordant with ICCC guidelines at various thresholds and logistic regression to model factors associated with concordance. RESULTS A total of 500 dentists responded. The study sample was 57% male, mean (SD) age was 50.9 (12.6) years, and 60% worked in private practice settings. Higher levels of concordance for choosing selective caries removal 50% or greater of the time were found for asymptomatic (62.4%; 95% CI, 57.6 to 67.2) than for symptomatic caries (49.3%; 95% CI, 44.4 to 54.2). These differences were significantly associated with type of practice setting. CONCLUSIONS The National Dental Practice-Based Research Network dentists reported using selective caries removal strategies when managing deep carious lesions more often than in previous US and Japanese practice-based research network studies and from results of a systematic review and meta-analysis. Nonetheless, substantive discordance with the ICCC guidelines was seen by the authors of this study. PRACTICAL IMPLICATIONS More dissemination and continuing education activities, as well as implementation studies, may further encourage use of selective caries removal to soft or firm dentin when indicated.
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Therese Galang-Boquiren M, Mungia R, Allareddy V, Santana-Rivera Y, Gilbert GH. Dental Sleep Medicine among dental practitioners: Preliminary findings from the National Dental Practice-Based Research Network. J Dent Sleep Med 2022; 9:2. [PMID: 36304172 PMCID: PMC9595117 DOI: 10.15331/jdsm.7264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives/Introduction Dental sleep medicine (DSM) focuses on oral appliance therapy (OAT) to manage sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA). This brief poll aimed to assess the interest and practices of dental practitioners in DSM. To this day lack of data exists regarding how DSM practices function in the clinical setting. Therefore, identifying knowledge gaps in DSM among dental practitioners may improve patient outcomes. Methods A preliminary brief questionnaire ("Quick Poll") on DSM was conducted through the National Dental Practice-Based Research Network (Network) members (n=311). The poll contained five questions about DSM. Results Results showed that 66% of practitioners have involvement in DSM patient care. A total of 44% of practitioners who answered the Quick Poll do not screen for snoring or SDBs. About 40% of respondents are either interested in continuing education courses on the topic or had already taken multiple courses on DSM. The top three topics of DSM research of interest to practitioners were various DSM practice models, response to OAT, and compliance with OAT. Conclusion Network dental practitioner respondents face challenges regarding the treatment of SDBs. Despite these challenges, most practitioners are interested in engaging in DSM. Based on these preliminary findings, there are informational needs regarding the current state of clinical care, side effects of OAT, choice of OAT, titration protocols, and patient outcomes.
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Affiliation(s)
| | - Rahma Mungia
- University of Texas Health Science Center, San Antonio, Texas, USA
| | | | | | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, Alabama, USA
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Jeffery MM, Ahadpour M, Allen S, Araojo R, Bellolio F, Chang N, Ciaccio L, Emanuel L, Fillmore J, Gilbert GH, Koussis P, Lee C, Lipkind H, Mallama C, Meyer T, Moncur M, Nuckols T, Pacanowski MA, Page DB, Papadopoulos E, Ritchie JD, Ross JS, Shah ND, Soukup M, St Clair CO, Tamang S, Torbati S, Wallace DW, Zhao Y, Heckmann R. Acute pain pathways: protocol for a prospective cohort study. BMJ Open 2022; 12:e058782. [PMID: 35790333 PMCID: PMC9258513 DOI: 10.1136/bmjopen-2021-058782] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Opioid analgesics are often used to treat moderate-to-severe acute non-cancer pain; however, there is little high-quality evidence to guide clinician prescribing. An essential element to developing evidence-based guidelines is a better understanding of pain management and pain control among individuals experiencing acute pain for various common diagnoses. METHODS AND ANALYSIS This multicentre prospective observational study will recruit 1550 opioid-naïve participants with acute pain seen in diverse clinical settings including primary/urgent care, emergency departments and dental clinics. Participants will be followed for 6 months with the aid of a patient-centred health data aggregating platform that consolidates data from study questionnaires, electronic health record data on healthcare services received, prescription fill data from pharmacies, and activity and sleep data from a Fitbit activity tracker. Participants will be enrolled to represent diverse races and ethnicities and pain conditions, as well as geographical diversity. Data analysis will focus on assessing patients' patterns of pain and opioid analgesic use, along with other pain treatments; associations between patient and condition characteristics and patient-centred outcomes including resolution of pain, satisfaction with care and long-term use of opioid analgesics; and descriptive analyses of patient management of leftover opioids. ETHICS AND DISSEMINATION This study has received approval from IRBs at each site. Results will be made available to participants, funders, the research community and the public. TRIAL REGISTRATION NUMBER NCT04509115.
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Affiliation(s)
- Molly Moore Jeffery
- Emergency Medicine and Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mitra Ahadpour
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Summer Allen
- Knowledge and Evaluation Research Unit; Department of Family Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Richardae Araojo
- Office of the Commissioner, Office of Minority Health and Health Equity, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Fernanda Bellolio
- Emergency Medicine and Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy Chang
- Center for Drug Evaluation and Research, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Laura Ciaccio
- Division of Population Health and Genomics, University of Dundee School of Medicine, Dundee, UK
| | - Lindsay Emanuel
- Division of Health Care Delivery Research, Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Jonathan Fillmore
- Department of Surgery, Mayo Clinic Division of Oral and Maxillofacial Surgery, Rochester, Minnesota, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, The University of Alabama at Birmingham School of Dentistry, Birmingham, Alabama, USA
| | - Patricia Koussis
- Center for Drug Evaluation and Research, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Christine Lee
- Office of the Commissioner, Office of Minority Health and Health Equity, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Heather Lipkind
- Department of Obstetrics, Gynecology, & Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut, USA
| | - Celeste Mallama
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Tamra Meyer
- Center for Drug Evaluation and Research, Office of Surveillance and Epidemiology, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Megan Moncur
- Center for Drug Evaluation and Research, Office of New Drugs, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Teryl Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael A Pacanowski
- Center for Drug Evaluation and Research, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - David B Page
- Department of Emergency Medicine, Department of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Elektra Papadopoulos
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Jessica D Ritchie
- Center for Outcomes Research and Evaluation, Yale University Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Joseph S Ross
- Internal Medicine, Yale University Center for Outcomes Research and Evaluation, New Haven, Connecticut, USA
| | - Nilay D Shah
- Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
| | - Mat Soukup
- Center for Drug Evaluation and Research, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Christopher O St Clair
- Center for Drug Evaluation and Research, Office of New Drugs, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Stephen Tamang
- Department of Family Medicine, Monument Health, Rapid City, South Dakota, USA
| | - Sam Torbati
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Douglas W Wallace
- Department of Emergency Medicine, Department of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine, The University of Alabama, Birmingham, Alabama, USA
| | - Yueqin Zhao
- Center for Drug Evaluation and Research, Office of Translational Sciences, US Food and Drug Administration, Silver Spring, Maryland, USA
| | - Rebekah Heckmann
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
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Funkhouser E, Ferracane JL, Hilton TJ, Gordan VV, Gilbert GH, Mungia R, Burton V, Meyerowitz C, Kopycka-Kedzierawski DT. Onset and resolution of pain among treated and untreated posterior teeth with a visible crack: Three-year findings from the national dental practice-based research network. J Dent 2022; 119:104078. [PMID: 35227834 PMCID: PMC8988449 DOI: 10.1016/j.jdent.2022.104078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cracked teeth may be associated with pain, especially biting pain, and to a lesser degree cold and spontaneous pain. Described are how commonly these pains remain constant, develop, or resolve over time, none of which have been well-described, especially among untreated cracked teeth. METHODS Cracked teeth from the Cracked Tooth Registry (CTR) study were followed for 3 years. Assessments of cold, biting, and spontaneous pain and treatments performed were completed at enrollment (Y0) and at each annual recall visit. RESULTS 209 practitioners enrolled 2,858 patients, each with a visible crack on a posterior tooth; 2601 (91%) patients attended at least one recall visit. Overall, 960 (37%) were treated, primarily with crowns. Among both treated and untreated cracked teeth with biting pain or spontaneous pain at Y0, the vast majority (92-99%) had their pain resolved by the time of a recall visit and 85-93% remained pain-free after initial resolution. The observations for cold pain were similar: 68% (untreated) and 78% (treated) became free of cold pain at some point during follow-up, and 84% of these stayed free of cold pain after initial resolution. Few teeth developed biting or spontaneous pain (4-8%) and 44-67% of these had pain resolution during the follow-up period. CONCLUSION In this study, treatment resolved a preponderance of pain associated with a cracked tooth. Pain was also resolved for most untreated cracked teeth, especially biting pain, and to a lesser degree spontaneous and cold pain, although not to the same degree as with the treated cracked teeth.
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Affiliation(s)
- Ellen Funkhouser
- School of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States.
| | - Jack L Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave. Portland, OR 97201-5042, United States
| | - Thomas J Hilton
- Alumni Centennial Professor in Operative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave. Portland, OR 97201-5042, United States
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd. Gainesville, FL 32610, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive; MC 8258, San Antonio, TX 78229, United States
| | - Vanessa Burton
- HealthPartners, 5901 John Martin Dr. Brooklyn Center, MN 55430, United States
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 686. Rochester, NY 14642, United States
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Ferracane JL, Hilton TJ, Funkhouser E, Gordan VV, Gilbert GH, Mungia R, Burton V, Meyerowitz C, Kopycka-Kedzierawski DT. Outcomes of treatment and monitoring of posterior teeth with cracks: three-year results from the National Dental Practice-Based Research Network. Clin Oral Investig 2022; 26:2453-2463. [PMID: 34628545 PMCID: PMC8898304 DOI: 10.1007/s00784-021-04211-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe treatment and monitoring outcomes of posterior teeth with cracks at baseline followed in the National Dental Practice-Based Research Network for up to three years. MATERIALS AND METHODS Two hundred and nine dentists enrolled a convenience sample of 2,858 patients, each with a posterior tooth with at least one visible crack and followed them for three years. Characteristics at the patient, tooth, and crack level were recorded at baseline and at annual recall visits. Data on all teeth referred for extraction were reviewed. Data on all other teeth, treated or monitored, seen at one or more recall visits were reviewed for evidence of failure (subsequent extraction, endodontics, or recommendation for a re-treatment). RESULTS The survival rate for teeth with cracks at baseline exceeded 98% (only 37 extractions), and the failure rate for teeth that were treated restoratively was only 14%. Also, only about 14% of teeth recommended at baseline for monitoring were later recommended to be treated, and about 6.5% of teeth recommended for monitoring at baseline were later treated without a specific recommendation. Thus, about 80% of teeth recommended at baseline for monitoring continued with a monitoring recommendation throughout the entire three years of the study. Treatment failures were associated with intracoronal restorations (vs. full or partial coverage) and male patients. CONCLUSIONS In this large 3-year practice-based study conducted across the USA, the survival rate of posterior teeth with a visible crack exceeded 85%. Clinical relevance Dentists can effectively evaluate patient-, tooth-, and crack-level characteristics to determine which teeth with cracks warrant treatment and which only warrant monitoring.
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Affiliation(s)
- Jack L. Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Thomas J. Hilton
- School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007
| | - Valeria V. Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health Science Center at San Antonio
| | - Vanessa Burton
- HealthPartners, 5901 John Martin Dr., Brooklyn Center, MN 55430
| | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, 601 Elmwood Avenue, Box 686, Rochester, NY 14642
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Lockhart PB, Thornhill MH, Zhao J, Baddour LM, Gilbert GH, McKnight PE, Stephens C, Mougeot JL. Factors that affect dentists’ use of antibiotic prophylaxis. J Am Dent Assoc 2022; 153:552-562. [DOI: 10.1016/j.adaj.2021.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/26/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022]
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Velly AM, Anderson GC, Look JO, Riley JL, Rindal DB, Johnson K, Wang Q, Fricton J, Huff K, Ohrbach R, Gilbert GH, Schiffman E. Management of painful temporomandibular disorders: Methods and overview of The National Dental Practice-Based Research Network prospective cohort study. J Am Dent Assoc 2022; 153:144-157. [PMID: 34973705 PMCID: PMC8799528 DOI: 10.1016/j.adaj.2021.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients often seek consultation with dentists for temporomandibular disorders (TMDs). The objectives of this article were to describe the methods of a large prospective cohort study of painful TMD management, practitioners' and patients' characteristics, and practitioners' initial treatment recommendations conducted by The National Dental Practice-Based Research Network (the "network"). METHODS Participating dentists recruited into this study treated patients seeking treatment for painful TMDs. The authors developed self-report instruments based on well-accepted instruments. The authors collected demographics, biopsychosocial characteristics, TMD symptoms, diagnoses, treatments, treatment adherence, and painful TMDs and jaw function outcomes through 6 months. RESULTS Participating dentists were predominately White (76.8%) and male (62.2%), had a mean age of 52 years, and were general practitioners (73.5%) with 23.8% having completed an orofacial pain residency. Of the 1,901 patients with painful TMDs recruited, the predominant demographics were White (84.3%) and female (83.3%). Patients' mean age was 44 years, 88.8% self-reported good to excellent health, and 85.9% had education beyond high school. Eighty-two percent had pain or stiffness of the jaw on awakening, and 40.3% had low-intensity pain. The most frequent diagnoses were myalgia (72.4%) and headache attributed to TMDs (51.0%). Self-care instruction (89.4%), intraoral appliances (75.4%), and medications (57.6%) were recommended frequently. CONCLUSIONS The characteristics of this TMD cohort include those typical of US patients with painful TMDs. Network practitioners typically managed TMDs using conservative treatments. PRACTICAL IMPLICATIONS This study provides credible data regarding painful TMDs and TMD management provided by network practitioners across the United States. Knowledge acquired of treatment recommendations and patient reports may support future research and improve dental school curricula.
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Affiliation(s)
- Ana Miriam Velly
- McGill University, Faculty of Dental Medicine and Oral Health Sciences, Research Department of Dentistry SMBD - Jewish General Hospital; Network for Canadian Oral Health Research (NCOHR); Orofacial Pain Working Group, NCOHR
| | - Gary C. Anderson
- Department of Developmental and Surgical Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - John O. Look
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
| | - Joseph L. Riley
- College of Dentistry, University of Florida; Pain Clinical Research Unit, University of Florida Clinical and Translational Science Institute, Gainesville, FL
| | | | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - James Fricton
- School of Dentistry, University of Minnesota, Minneapolis, MN; HealthPartners Institute, Bloomington, MN; Minnesota Head and Neck Pain Clinic, Minneapolis, MN
| | | | - Richard Ohrbach
- Department of Oral and Diagnostic Sciences, School of Dental Medicine, State University of New York, University at Buffalo, Buffalo, NY
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | - Eric Schiffman
- Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Lam EWN, Law AS, Nguyen RHN, Basile S, Austah O, Gilbert GH, Lindauer PA, Romano MJ, Nixdorf DR, Fellows JL. Interexaminer Agreement in the Radiologic Identification of Apical Periodontitis/Rarefying Osteitis in the National Dental Practice-Based Research Network PREDICT Endodontic Study. J Endod 2021; 47:1575-1582. [PMID: 34280432 DOI: 10.1016/j.joen.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Periapical images are routinely made in endodontics to support diagnosis and treatment decisions, but conventional imaging may not readily demonstrate inflammatory changes. This study aims to quantify disagreement in the radiologic interpretation of apical periodontitis/rarefying osteitis between 2 expert examiners and to determine if differences exist based on anatomic location. METHODS We used 1717 pretreatment periapical images made before orthograde endodontic treatment as part of the Predicting Outcomes of Root Canal Treatment (PREDICT) study conducted within the National Dental Practice-Based Research Network. Periapical changes were assessed independently by 2 board-certified specialists, an oral and maxillofacial radiologist and an endodontist, blinded to other clinical information. If the examiners disagreed about whether a diagnosis of apical periodontitis/rarefying osteitis was justified, an adjudication was made by a third examiner. RESULTS The overall prevalence of this radiologic diagnosis in the periapical images was 55%, and interexaminer agreement measured with the Cohen kappa statistic was calculated to be 0.56 (95% confidence interval, 0.52-0.60). Diagnostic disagreements between the 2 examiners occurred for 377 teeth (22%), with disagreements more frequent for jaw location (P = .038) and tooth type (P = .021). Differences between root number (P = .058) and jaw location and tooth groups (P = .069) were found not to be statistically significant. CONCLUSIONS The variability of diagnostic disagreements across anatomic location and tooth type may reflect the inability of periapical images to reveal bone changes masked by the complexity and density of overlying anatomic structures, a limitation that could potentially be overcome with the use of 3-dimensional imaging.
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Affiliation(s)
- Ernest W N Lam
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.
| | - Alan S Law
- Department of Endodontics, The Dental Specialists, Lake Elmo, Minnesota; School of Dentistry, University of Minnesota, Minneapolis, Minnesota
| | - Ruby H N Nguyen
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sarah Basile
- Health Partners Research Foundation, Bloomington, Minnesota
| | - Obadah Austah
- Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Paul A Lindauer
- Division of Endodontics, East Carolina School of Dental Medicine, Greenville, North Carolina
| | - Michael J Romano
- Department of Endodontics, Summit Dental Group, Liverpool, New York
| | - Donald R Nixdorf
- School of Dentistry, University of Minnesota, Minneapolis, Minnesota
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Rosenblum S, Isett KR, Melkers J, Funkhouser E, Hicks D, Gilbert GH, Melkers MJ, McEdward D, Buchberg-Trejo M. The association between professional stratification and use of online sources: Evidence from the National Dental Practice-Based Research Network. J Inf Sci 2021; 47:373-386. [PMID: 34177010 PMCID: PMC8221114 DOI: 10.1177/0165551519890519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of online information sources in most professions is widespread, and well researched. Less understood is how the use of these sources vary across the strata within a single profession, and how question context affects search behaviour. Using the dental profession as a case of a highly stratified discipline, we examine search preferences for sources by professional strata among dentists in a practice-based network. Results show that variation exists in information search behaviour across professional strata of dental clinicians. This study highlights the importance of addressing information literacy across different levels of a profession. Findings also underscore that search behaviour and source preference vary with perceived question relevance.
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Affiliation(s)
- Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Julia Melkers
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Ellen Funkhouser
- Division of Preventive Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Deborah McEdward
- South Atlantic Region, National Dental Practice-Based Research Network, Gainesville, FL, USA
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21
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Gilbert GH, Allen GJ, Burton VA, Calnon WR, Cochran DL, Fellows JL, Gordan VV, Meyerowitz C, Rindal DB. Addressing Knowledge Gaps. J Am Dent Assoc 2021; 152:258-259. [PMID: 33775284 DOI: 10.1016/j.adaj.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Gregg H Gilbert
- Distinguished Professor and Chair, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
| | | | - Vanessa A Burton
- Chief of Professional Services, HealthPartners Dental Group, Minneapolis, MN
| | - William R Calnon
- Clinical Professor of Dentistry, University of Rochester Medical Center, Rochester, NY; General Dentistry Private Practice, Rochester, NY
| | - David L Cochran
- Professor and Chair, School of Dentistry, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Jeffrey L Fellows
- Senior Investigator, Kaiser Permanente Northwest Center for Health Research, Portland, OR
| | - Valeria V Gordan
- Professor, Interim Associate Dean for Research, College of Dentistry, University of Florida, Gainesville, FL
| | - Cyril Meyerowitz
- Professor, University of Rochester Medical Center, Rochester, NY
| | - D Brad Rindal
- Senior Investigator, HealthPartners Dental Group and HealthPartners Institute, Minneapolis, MN
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22
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Tagliaferro EPDS, Valsecki Júnior A, Rosell FL, Silva SRCD, Riley JL, Gilbert GH, Gordan VV. Methods for Caries Prevention in Children Reported by Dentists from a Brazilian Community. Pesqui Bras Odontopediatria Clín Integr 2021. [DOI: 10.1590/pboci.2021.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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23
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Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Gordan VV, Kopycka-Kedzierawski DT, Meyerowitz C, Mungia R, Burton V. Baseline characteristics as 3-year predictors of tooth fracture and crack progression: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2020; 152:146-156. [PMID: 33358237 DOI: 10.1016/j.adaj.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The authors of this practice-based study estimated the risk of experiencing tooth fractures and crack progression over 3 years and correlated baseline patient-, tooth-, and crack-level characteristics with these outcomes. METHODS Two-hundred-and-nine National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2,601 participants with a cracked vital posterior tooth that had been examined for at least 1 recall visit over 3 years. Data were collected at the patient, tooth, and crack levels at baseline, annual follow-up visits, and any interim visits. Associations between these characteristics and the subsequent same-tooth fractures and crack progression were quantified. RESULTS Of the 2,601 teeth with a crack or cracks at baseline, 78 (3.0%; 95% confidence interval, 2.4% to 3.7%) subsequently developed a fracture. Of the 1,889 patients untreated before year 1, 232 (12.3%; 95% confidence interval, 10.9% to 13.8%) had some type of crack progression. Baseline tooth-level characteristics associated with tooth fracture were the tooth was maxillary and had a wear facet through enamel and a crack was detectable with an explorer, on the facial surface, and in a horizontal direction. Crack progression was associated with males and teeth with multiple cracks at baseline; teeth with a baseline facial crack were less likely to show crack progression. There was no commonality between characteristics associated with tooth fracture and those associated with crack progression. CONCLUSIONS Development of tooth fractures and crack progression over 3 years were rare occurrences. Specific characteristics were associated with the development of tooth fracture and crack progression, although none were common to both. PRACTICAL IMPLICATIONS This information can aid dentists in assessing factors that place posterior cracked teeth at risk of experiencing adverse outcomes.
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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] [What about the content of this article? (0)] [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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da Silva Tagliaferro EP, da Silva SRC, Rosell FL, Valsecki A, Riley JL, Gilbert GH, Gordan VV. METHODS FOR CARIES PREVENTION IN ADULTS AMONG DENTISTS FROM A BRAZILIAN COMMUNITY: Adult' caries prevention among Brazilian dentists. Braz J Oral Sci 2020; 19. [PMID: 32461752 DOI: 10.20396/bjos.v19i0.8656224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Little is known about dental practice patterns of caries prevention in adults among Brazilian dentists. OBJECTIVE To quantify procedures used for caries prevention for adult patients among dentists from a Brazilian community. METHODS Dentists (n=197) who reported that at least 10% of their patients are more than 18 years old participated in the first Brazilian study that used a translated version of the "Assessment of Caries Diagnosis and Caries Treatment" from the U.S. National Dental Practice-Based Research Network. A questionnaire about characteristics of their practice and patient population were also completed by the dentists. Generalized linear regression models and a hierarchal clustering procedure were used (p<0.05). RESULTS In-office fluoride application was the preventive method most often reported. The main predictors for recommending some preventive agent were: female dentist (dental sealant; in-office fluoride; non-prescription fluoride) and percentage of patients interested in caries prevention (dental sealant; in-office fluoride; non-prescription fluoride). Other predictors included private practice (dental sealant), percentage of patients 65 years or older (in-office fluoride), graduation from a private dental school (non-prescription fluoride), years since dental school graduation (chlorhexidine rinse) and using a preventive method (recommending sealant/fluoride/chlorhexidine rinse/sugarless, xylitol gum). Cluster analysis showed that dentists in the largest subgroup seldom used any of the preventive agents. CONCLUSION Dentists most often reported in-office fluoride as a method for caries prevention in adults. Some practitioner, practice and patients' characteristics were positively associated with more-frequent use of a preventive agent.
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Affiliation(s)
- 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
| | - Silvio Rocha Correa da Silva
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Fernanda Lopez Rosell
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Aylton Valsecki
- Department of Community Dentistry, São Paulo State University (UNESP), School of Dentistry, Araraquara, Rua Humaitá, 1680, Centro - 14801-903 - Araraquara, SP, Brazil
| | - Joseph L Riley
- University of Florida College of Dentistry, Director, Pain Clinical Research Unit, UF CTSI, Deputy Director, South Atlantic Region, Dental Practice-based Research Network, Clinical and Translational Research Building (CTRB), Room 2227, 2004 Mowry Road, Box 100404, Gainesville, FL 32610-0404, The United States of America
| | - Gregg H Gilbert
- Department of Clinical & Community Sciences, Room SDB 109, School of Dentistry, University of Alabama at Birmingham, 1720 Second Avenue South, Birmingham, AL 35294-0007, The United States of America
| | - Valeria Veiga Gordan
- Dental Practice-Based Research, University of Florida, College of Dentistry, Room D9-6 P.O. Box 100415, Gainesville, FL 32610-0415, The United States of America
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Sadasivam RS, Kamberi A, DeLaughter K, Phillips B, Williams JH, Cutrona SL, Ray MN, Gilbert GH, Houston TK. Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks. J Med Internet Res 2020; 22:e13289. [PMID: 32374266 PMCID: PMC7240437 DOI: 10.2196/13289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/24/2019] [Accepted: 01/28/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. OBJECTIVE This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. METHODS We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. RESULTS Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers' messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). CONCLUSIONS Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation.
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Affiliation(s)
| | - Ariana Kamberi
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Kathryn DeLaughter
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Barrett Phillips
- Veterans Affairs Central Western Massachusetts Healthcare System, Leeds, MA, United States
| | | | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Midge N Ray
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gregg H Gilbert
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Thomas K Houston
- University of Massachusetts Medical School, Worcester, MA, United States
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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: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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29
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Hilton TJ, Funkhouser E, Ferracane JL, Gilbert GH, Gordan VV, Bennett S, Bone J, Richardson PA, Malmstrom H. Symptom changes and crack progression in untreated cracked teeth: One-year findings from the National Dental Practice-Based Research Network. J Dent 2019; 93:103269. [PMID: 31899264 DOI: 10.1016/j.jdent.2019.103269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/27/2019] [Accepted: 12/28/2019] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES The study objective was to: (1) quantify symptom (pain) and crack changes during one year of follow-up, among teeth that had at least one visible crack at baseline but which did not receive treatment for those cracks; (2) identify any patient traits/behaviors and external tooth/crack characteristics correlated with these changes. METHODS In this observational study, 209 National Dental Practice-Based Research Network dentists enrolled a convenience sample of 2858 subjects, each with a single, vital posterior tooth with at least one observed external crack; 1850 teeth remained untreated after one year of follow-up and were the cohort for analyses. Data were collected at the patient-, tooth-, and crack-level at baseline, one-year follow up (Y1), and interim visits. Associations between changes in symptoms and cracks were identified, as were changes in symptoms associated with baseline treatment recommendations. RESULTS Changes in pain symptoms were observed in 32% of patients; decreases were twice as common as increases (23% vs. 10%). More changes were observed in cold pain than in biting pain and spontaneous pain combined; 2% had increases in biting pain and 2% in spontaneous pain. Only 6% had an increase in the number of cracks. Changes in pain symptoms were not associated with an increase in the number of cracks, but were associated with baseline treatment recommendations. Specifically, pain symptom changes (especially decreases) were more common when the tooth was recommended for treatment at baseline. CONCLUSIONS Cracked teeth that have not received treatment one year after baseline do not show meaningful progression as measured by increased symptoms or number of cracks during follow-up. CLINICAL SIGNIFICANCE Untreated cracked teeth, most of which were recommended for monitoring at baseline and some of which were recommended for treatment but did not receive treatment, remained relatively stable for one year with little progression of cracks or symptoms.
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Affiliation(s)
- Thomas J Hilton
- School of Dentistry, Oregon Health &, Science University, 2730 S.W. Moody Ave, Portland, OR 97201-5042, United States.
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, Birmingham, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States
| | - Jack L Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave, Portland, OR 97201-5042, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, United States
| | - Sandra Bennett
- Private Practice, 22400 SE Stark Street, Gresham, OR 97030, United States
| | - Jennifer Bone
- Private Practice, 710 Hill Country Drive, Suite 1, Kerrville, TX 78028, United States
| | - Peggy A Richardson
- Private Practice, 7060 Centennial Drive, Suite 103, Tinley Park, IL 60477, United States
| | - Hans Malmstrom
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, 625 Elmwood Avenue, Rochester, NY 14620, United States
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Stoops WW, Johnson MF, Strickland JC, Knudsen HK, Gilbert GH, Massingale SD, Ray MN, Studts CR, Atchley L, Reynolds G, Slade E, Studts JL. Feasibility of Collecting Saliva for Biological Verification of Tobacco Use Status in Dental Practices and Patients' Homes: Results from the National Dental PBRN. Community Dent Health 2019; 36:187-189. [PMID: 31436924 DOI: 10.1922/cdh_4474stoops03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the feasibility of collecting and analyzing saliva samples from dental practices and patients' homes for biochemical verification of tobacco use status. BASIC RESEARCH DESIGN Sub-study within single-arm, multi-center, longitudinal clinical study. CLINICAL SETTING Dental practices in the South Central region of the United States National Dental Practice-Based Research Network and patients' homes. PARTICIPANTS Fifty-five patients recruited from 30 dental practices. INTERVENTIONS Participants in the sub-study were instructed on saliva collection for cotinine analysis in dental practices where they enrolled in the primary study. Saliva was collected at the practices and then from patients' homes. MAIN OUTCOME MEASURES Feasibility for dental practice collection was define as 80% of enrolled participants having analyzable samples. For patients' home collection, feasibility was defined as 70%. RESULTS Forty-seven samples (i.e., 86% of those enrolled) collected in dental practices were analyzable. Twenty-one samples (i.e. 38% of those enrolled) collected in patients' homes were analyzable. CONCLUSIONS Collecting saliva samples for cotinine analysis from dental practices, but not from patients' homes, was feasible. Dental practices may provide an advantageous setting for biochemically verifying tobacco use status as part of clinical trials for tobacco cessation.
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Affiliation(s)
- W W Stoops
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Department of Psychiatry, College of Medicine, University of Kentucky, KY USA.,Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - M F Johnson
- Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA
| | - J C Strickland
- Department of Psychology, College of Arts and Sciences, University of Kentucky, KY USA
| | - H K Knudsen
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA
| | - G H Gilbert
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - S D Massingale
- Department of Clinical & Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL USA
| | - M N Ray
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL USA
| | - C R Studts
- Department of Health, Behavior & Society, College of Public Health, University of Kentucky, Lexington, KY US
| | - L Atchley
- General Dentist, Phenix City, AL USA
| | - G Reynolds
- Health Decision Technologies LLC, Oakland, CA USA
| | - E Slade
- Department of Biostatistics, College of Public Health, University of Kentucky, KY USA
| | - J L Studts
- Department of Behavioral Science, College of Medicine, University of Kentucky, KY USA.,Behavioral and Community-Based Research Shared Resource Facility, University of Kentucky Markey Cancer Center, KY USA.,Cancer Prevention and Control Program, University of Kentucky Markey Cancer Center, KY USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kopycka-Kedzierawski DT, Cacciato R, Hennessey R, Meyerowitz C, Litaker MS, Heft MW, Johnson KS, Reyes SC, Johnson JD, Baltuck CT, Gilbert GH. Electronic and paper mode of data capture when assessing patient-reported outcomes in the National Dental Practice-Based Research Network. ACTA ACUST UNITED AC 2019; 10:e12427. [PMID: 31155859 DOI: 10.1111/jicd.12427] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/11/2019] [Indexed: 11/27/2022]
Abstract
AIM Our objectives were to describe the approach used in the National Dental Practice-Based Research Network to capture patient-reported outcomes and to compare electronic and paper modes of data capture in a specific network study. METHODS This was a prospective, multicenter cohort study of 1862 patients with dentin hypersensitivity. Patient-reported outcomes were assessed based on patients' perception of pain using Visual Analog Scales and Labeled Magnitude scales at baseline and at 1, 4 and 8 weeks post-baseline. RESULTS Eighty-five percent of study patients chose to complete follow-up assessments via an electronic mode; 15% completed them via a paper mode. There was not a significant difference in the proportions of patients who completed the 8-week assessment when comparing the electronic mode to the paper mode (92% vs. 90.8%, P = 0.31, Rao-Scott clustered χ2 -test). CONCLUSION The electronic mode of data capture was as operational as the traditional paper mode, while also providing the advantage of eliminating data entry errors, not involving site research coordinators in measuring the patient-reported outcomes, and not incurring cost and potential delays due to mailing study forms. Electronic data capture of patient reported outcomes could be successfully implemented in the community dental practice setting.
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Affiliation(s)
| | - Rita Cacciato
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | | | - Cyril Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, New York
| | - Mark S Litaker
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marc W Heft
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Stephanie C Reyes
- University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - James D Johnson
- College of Dentistry, University of Florida, Gainesville, Florida
| | | | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, Alabama
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Hicks D, Melkers M, Barna J, Isett KR, Gilbert GH. Comparison of the accuracy of CBCT effective radiation dose information in peer-reviewed journals and dental media. Gen Dent 2019; 67:38-46. [PMID: 31199743 PMCID: PMC7189219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Accessible sources of clinical information have proliferated over the past decade. Although these new sources that contextualize information for practice are user friendly, there are questions about their accuracy because much of the material is not peer reviewed. On the other hand, traditional peer-reviewed material can be somewhat removed from the needs of practicing dentists, and recently questions have been raised about the accuracy of journals. This study assessed the accuracy of cone beam computed tomography (CBCT) radiation safety information in both professional media and peer-reviewed journals. Articles introducing CBCT technology to dentists and published in peer-reviewed journals were compared to articles appearing in professional magazines, clinically oriented news sites, and blogs written by clinicians for clinicians. The reported radiation doses of CBCT and conventional dental radiographs were recorded, as were conclusions about the comparative doses of these 2 imaging modalities. The proportion of articles reporting CBCT dose to be greater than, equal to, or less than that of conventional dental radiographs was not different between the peer-reviewed and professional media articles during the period 2003-2016. There is weak evidence that the conclusions of peer-reviewed journal articles, but not professional media sources, became more conservative after the 2010 publication of an article in The New York Times that was critical of misinformation concerning the safety and efficacy of CBCT in dentistry. Professional media articles that were not peer reviewed were as accurate as peer-reviewed journals for this topic and during the time period assessed. However, the method used here necessitated a narrow focus, and more studies are needed to broaden understanding.
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Affiliation(s)
- Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 20332-0345
| | | | | | - Kimberley R. Isett
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA 20332-0345
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Melkers J, Hicks D, Isett KR, Kopycka-Kedzierawski DT, Gilbert GH, Rosenblum S, Burton V, Mungia R, Melkers MJ, Ford G. Preferences for peer-reviewed versus other publication sources: a survey of general dentists in the National Dental PBRN. Implement Sci 2019; 14:19. [PMID: 30823931 PMCID: PMC6397483 DOI: 10.1186/s13012-019-0854-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/07/2019] [Indexed: 11/21/2022] Open
Abstract
Background Medical professionals have access to a broad range of resources to address clinical information needs. While much attention is given to new sources of data such as those available on the internet, it is less clear how clinicians choose between peer-reviewed research literature and other publication-based sources. This analysis distinguishes between possible drivers of publication type preference (namely, practice setting, advanced training, professional development experiences). Dentists enrolled in the National Dental Practice-Based Research Network (PBRN) are the population for this study. Theories of human and intellectual capital and institutional logics theory are used to understand how advanced training and other clinical experiences may explain the choices that dentists make when faced with clinical questions. Methods An online questionnaire was implemented with general dentists in the US National Dental PBRN. A series of logistic and Ordinary Least Squares (OLS) regression models were used to explain the use of peer-reviewed and other publications. Measures of knowledge-based human capital distinctions (advanced clinical training and research engagement, advanced professional status, personal motivation for professional advancement) were used to explain preferences for research literature as a clinical resource. Results General dentists with advanced training, as well as those with a skill advancement motivation, show a preference for peer-reviewed materials. General dentists who have been practicing longer tend to favor other dental publications, preferring those sources as a resource when faced with clinical challenges. Human capital and professional motivation distinguish the information preferences among general dentists. Further, these factors explain more variance in use of peer-reviewed materials than practice setting does. Few differences by demographic groups were evident. Conclusions Results point to a distinct variation in the general dentistry professional community. Advanced training among general dentists, as well as the types of procedures typically conducted in their practice, distinguishes their information preferences from other general dentists, including those with more years of clinical experience.
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Affiliation(s)
- Julia Melkers
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA.
| | - Diana Hicks
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | - Kimberley R Isett
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Gregg H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Simone Rosenblum
- School of Public Policy, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Rahma Mungia
- University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, TX, USA
| | | | - George Ford
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA.,, Lawrenceville, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Gilbert GH, Cochran DL, Fellows JL, Gordan VV, Makhija SK, Meyerowitz C, Rindal DB. Engaging clinicians in research. J Am Dent Assoc 2018; 149:1007-1008. [DOI: 10.1016/j.adaj.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Isett KR, Rosenblum S, Barna JA, Hicks D, Gilbert GH, Melkers J. Missed Opportunities for Detecting Alternative Nicotine Product Use in Youth: Data From the National Dental Practice-Based Research Network. J Adolesc Health 2018; 63:587-593. [PMID: 30348281 PMCID: PMC7249256 DOI: 10.1016/j.jadohealth.2018.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/27/2018] [Accepted: 06/07/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE With growing rates of youth e-cigarette and hookah use, and the fact that use of these products is difficult to detect, surveillance and early detection efforts need to be reassessed. Physicians and pediatricians both report that their level of knowledge about these products is low. Given that over 80% of youth have had dental visits in the past year and that the effects of nicotine use are visible early in routine dental examinations, it is likely that dental professionals are well positioned to play a critical role in detection. Currently, the knowledge about alternative nicotine among practicing dental clinicians is unknown. METHODS One thousand seven hundred and twenty-two dental professionals in community practice in the United States National Dental Practice-Based Research Network responded to a survey in the summer/fall of 2016. These data were supplemented with network membership enrollment data, and the American Community Survey, and were analyzed using descriptive statistics, measures of association, and logistic regression. RESULTS Only 25%-36% of dental professionals feel knowledgeable about the most common types of alternative nicotine products, including e-cigarettes and hookahs. Thirty-eight percent of respondents reported not screening at all for e-cigarettes. CONCLUSIONS A substantial percentage of dental professionals do not have a working understanding of alternative nicotine products, nor are aware of their patients' use rates. Better access to information and training on alternative nicotine products could provide an opportunity to improve surveillance for early use of these products in youth populations.
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Affiliation(s)
- Kimberley R Isett
- Georgia Institute of Technology School of Public Policy, Atlanta, Georgia.
| | - Simone Rosenblum
- Georgia Institute of Technology School of Public Policy, Atlanta, Georgia
| | | | - Diana Hicks
- Georgia Institute of Technology School of Public Policy, Atlanta, Georgia
| | - Gregg H Gilbert
- University of Alabama at Birmingham, School of Dentistry, Birmingham, Alabama
| | - Julia Melkers
- Georgia Institute of Technology School of Public Policy, Atlanta, Georgia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Kakudate N, Yokoyama Y, Sumida F, Matsumoto Y, Riley JL, Gordan VV, Gilbert GH. Practice-based research agenda priorities selected by patients: findings from a dental practice-based research network. Int Dent J 2018; 69:183-191. [PMID: 30350855 DOI: 10.1111/idj.12447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aimed to identify (i) which practice-based research agendas had the highest priority among patients and (ii) whether priorities varied significantly with patient age and gender. METHODS We conducted a cross-sectional questionnaire survey of 482 patients from 11 outpatient dental practices. The patients were shown 31 items concerning practice-based research questions and asked to select the three items in which they were most interested. We generated a rank order of the 31 items. Subsequently, the 31 items were categorised into 10 groups, and we performed subgroup analyses according to age and gender using chi-square tests. RESULTS "Age-specific care to maintain oral health (n = 86)" was rated as the most interesting research question. When data were analysed according to age, patients less than 40 years old rated "Orthodontic treatment", "Esthetic dental care" and "Topical fluoride application" as interesting questions significantly more frequently than did patients 40 years old or older (P < 0.01)?, while patients 40 years old or older rated "Regular dental check-ups", "Dental implant", "Diet and food" and "Social health insurance" as more interesting than did patients less than 40 years old (P < 0.05). When data were analysed according to gender, female patients rated the questions on aesthetic dental care as more interesting than did male patients (P < 0.01), whereas male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05). CONCLUSIONS Patients assessed "Age-specific care to maintain oral health" as the highest priority among a broad range of research topics. This study also quantified patient priorities for research agendas according to age and gender group. Designing future research with these priorities in mind will promote patient-centred evidence.
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Affiliation(s)
- Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, Kitakyushu, Japan.,University of Florida College of Dentistry, Gainesville, FL, USA
| | - Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, Fujisawa-city, Japan
| | | | | | - Joseph L Riley
- Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Valeria V Gordan
- Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, FL, USA
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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Tagliaferro E, Junior AV, Rosell FL, Silva S, Riley JL, Gilbert GH, Gordan VV. Caries Diagnosis in Dental Practices: Results From Dentists in a Brazilian Community. Oper Dent 2018; 44:E23-E31. [PMID: 30212272 DOI: 10.2341/18-034-c] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to assess practices related to diagnosis of dental caries among dentists (n=217) from Araraquara, São Paulo State, Brazil. Data on sociodemographic information and practitioner characteristics were collected using a pretested questionnaire, and data on practices related to caries diagnosis were gathered by using a translated and culturally adapted questionnaire from the US National Dental Practice-Based Research Network. Descriptive statistics and regression analyses were used for data analysis. Respondents reported using in most of their patients radiographs (Rx) to diagnose proximal caries (59%), explorer (Ex) for the diagnosis of occlusal caries (64%) and on the margins of existing restorations (79%), as well as air jet (AJ) with drying (92%). Magnification (M) (25%), fiber optic transillumination (FOTI; 14%), and laser fluorescence (LF) (3%) were used in the minority of patients. Regression analysis revealed that the following dentists' characteristics were significantly associated (p<0.05) with the use of diagnostic methods on a greater percentage of their patients: advanced degree (Rx, FOTI), higher percentage of patients with individualized caries prevention (Rx, FOTI, M), more years since dental school graduation (Ex, M), and work in an exclusively private practice model (LF). In conclusion, most Brazilian dentists from Araraquara reported they most commonly use visual, tactile, and radiographic imaging for the diagnosis of dental caries. Some dentists' characteristics, such as time from dental school graduation and having a postgraduation course, were associated with the use of certain diagnostic methods.
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Ferracane JL, Funkhouser E, Hilton TJ, Gordan VV, Graves CL, Giese KA, Shea W, Pihlstrom D, Gilbert GH. Observable characteristics coincident with internal cracks in teeth: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2018; 149:885-892.e6. [PMID: 30121122 DOI: 10.1016/j.adaj.2018.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 05/29/2018] [Accepted: 06/03/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND This study determined if there are observable patient-, tooth- and crack-level characteristics markedly associated with whether a tooth with an external crack also has an internal crack. METHODS Two hundred nine dentists in The National Dental Practice-Based Research Network enrolled 2,858 adults with a vital permanent posterior tooth having at least 1 observed external crack. Presence and characteristics of internal cracks were recorded for 435 cracked teeth that were treated. Generalized estimating equations were used to identify significant (P < .05) independent odds ratios associated with the tooth having internal cracks. RESULTS Overall, 389 teeth (89%) had at least 1 internal crack, with 46% of these teeth having 2 or more internal cracks. Sixty-nine percent of treated cracked teeth were associated with 1 or more types of pain assessed before treatment; 53% were associated with cold testing, 37% with bite testing, and 26% with spontaneous pain. In the final model, biting pain, having an external crack that connected with a restoration, or an external crack that extended onto the root was each associated with more than a 2-fold increased odds of having an internal crack. CONCLUSIONS Essentially 9 of 10 teeth that had at least 1 external crack also had at least 1 internal crack. PRACTICAL IMPLICATIONS The external cracks that a dental practitioner should be most concerned about, because they are most likely to be associated with internal cracks in the tooth, are those in which the patient experiences biting pain, is connected with a restoration of some type, or extends onto the root.
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Williams JH, DeLaughter K, Volkman JE, Sadasivam RS, Ray MN, Gilbert GH, Houston TK. Exploring Online Asynchronous Counseling With Tobacco Treatment Specialists in the QUIT-PRIMO and National Dental PBRN HI-QUIT Studies: Who Uses It and What Do They Say? Am J Health Promot 2018; 32:1170-1177. [PMID: 29848011 PMCID: PMC5986085 DOI: 10.1177/0890117116670972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To describe the content of messages sent by smokers through asynchronous counseling within a Web-based smoking cessation intervention. DESIGN Qualitative. SETTING National community-based setting of patients who had been engaged by the medical or dental practices at which they attended or via Google advertisements. PARTICIPANTS Adults older than 19 years who were current smokers and interested in quitting. Participants throughout the United States referred to a Web-based cessation intervention by their medical or dental provider or by clicking on a Google advertisement. METHODS We conducted a qualitative review of 742 asynchronous counseling messages sent by 270 Web site users. Messages were reviewed, analyzed, and organized into qualitative themes by the investigative team. RESULTS The asynchronous counseling feature of the intervention was used most frequently by smokers who were white (87%), female (67%), aged 45 to 54 (32%), and who had at least some college-level education (70%). Qualitative analysis yielded 7 basic themes-Talk about the Process of Quitting, Barriers to Quitting, Reasons to Quit, Quit History, Support and Strategies for Quitting, Quitting with Medication, and Quit Progress. The most common theme was Support and Strategies for Quitting with 255 references among all messages. CONCLUSION We found rich communication across the spectrum of the quit process, from persons preparing to quit to those who had successfully quit. Asynchronous smoking cessation counseling provides a promising means of social support for smokers during the quit process.
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Affiliation(s)
- Jessica H Williams
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kathryn DeLaughter
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
| | - Julie E Volkman
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 5 Department of Communication, Bryant University, Smithfield, RI, USA
| | - Rajani S Sadasivam
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
| | - Midge N Ray
- 1 Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gregg H Gilbert
- 6 Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas K Houston
- 2 VA eHealth Quality Enhancement Research Initiative, Bedford VAMC, Bedford, MA, USA
- 3 Division of Health Informatics and Implementation Science, University of Massachusetts Medical School, Worcester, MA, USA
- 4 VA Center for Healthcare Organization and Implementation Research (CHOIR), Bedford and Boston, MA, USA
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Makhija SK, Bader JD, Shugars DA, Litaker MS, Nagarkar S, Gordan VV, Rindal DB, Pihlstrom DJ, Mungia R, Meyerowitz C, Gilbert GH. Influence of 2 caries-detecting devices on clinical decision making and lesion depth for suspicious occlusal lesions: A randomized trial from The National Dental Practice-Based Research Network. J Am Dent Assoc 2018; 149:299-307.e1. [PMID: 29475554 DOI: 10.1016/j.adaj.2017.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/04/2017] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin. METHODS Eighty-two dentists participated. In phase 1 of the study, dentists identified approximately 20 SOCLs, obtained patient consent, and recorded information about the lesion, treatment or treatments, and depth, if opened. Dentists were then randomly assigned into 1 of 3 groups: no device, DIAGNOdent (KaVo), and Spectra (Air Techniques). In phase 2, dentists enrolled approximately 20 additional patients and recorded the same phase 1 information while using the assigned device to help make their treatment decisions. A mixed-model logistic regression was used to determine any differences after randomization in the proportion of lesions opened and, if opened, the proportion of lesions that penetrated into dentin. RESULTS A total of 1,500 SOCLs were enrolled in each phase. No statistically significant difference was found in the change in proportion of lesions receiving invasive treatment from phase 1 to phase 2 across the 3 groups (P = .33) or in the change in proportion of percentage of opened lesions that extended into dentin (P = .31). CONCLUSION Caries-detecting devices in the study did not change substantially dentists' decisions to intervene or the accuracy of the intervention decision in predicting lesion penetration into dentin. PRACTICAL IMPLICATIONS The caries-detecting devices tested may not improve dentists' clinical decision making for SOCLs.
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Yokoyama Y, Kakudate N, Sumida F, Matsumoto Y, Gordan VV, Gilbert GH. Dentist's distress in the management of chronic pain control: The example of TMD pain in a dental practice-based research network. Medicine (Baltimore) 2018; 97:e9553. [PMID: 29505535 PMCID: PMC5943127 DOI: 10.1097/md.0000000000009553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We aimed to obtain greater understanding of dentists' distress when they diagnose and treat patients with temporomandibular disorders (TMD), and to explore ways in which TMD can be better treated.We conducted a cross-sectional study based on a questionnaire survey of dentists (n = 148). Dentists were queried using an open-ended questionnaire about distress they experienced when treating patients with TMD. Survey responses were analyzed using mixed methods. Associations between specific dentist and patient characteristics and types of distress were analyzed by one way analysis of variance and residual analysis.One hundred thirteen clinicians responded to the questionnaire, giving a 76% response rate. Thematic analysis identified 6 major themes: difficulty in predicting therapeutic effect and prognosis; difficulty in diagnosis; difficulty in the decision about whether to do occlusal adjustment; difficulty in specifying a cause; difficulty in communicating with patients and mental factors; and health insurance system barriers. Clinicians who reported difficulty in deciding whether to do occlusal adjustment saw significantly more patients who experienced shoulder stiffness and headache (P = .008 and P = .022, respectively). Dentists' knowledge of TMD guidelines was associated with a lower percentage of difficulty in predicting therapeutic effect and prognosis (residual analysis; P = .010).These findings provide important insights into clinician's perception of difficulties with patients experiencing TMD-related pain. Knowledge of the existence of TMD clinical practice guidelines may lower dentist distress, particularly with regard to prognosis. Further studies are needed to decrease dentist's distress and to overcome the evidence-practice gap in TMD treatment.
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Affiliation(s)
- Yoko Yokoyama
- Graduate School of Media and Governance, Keio University, Fujisawa City, Kanagawa
| | - Naoki Kakudate
- Division of Clinical Epidemiology, Kyushu Dental University, Kitakyushu, Fukuoka, Japan
- University of Florida College of Dentistry, Gainesville, FL
| | - Futoshi Sumida
- Mikami Dental and Orthodontics Clinic, Tomakomai, Hokkaido
| | | | - Valeria V. Gordan
- Department of Restorative Dental Sciences at the University of Florida College of Dentistry, Gainesville, FL
| | - Gregg H. Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL
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Hilton TJ, Funkhouser E, Ferracane JL, Gordan VV, Huff KD, Barna J, Mungia R, Marker T, Gilbert GH. Associations of types of pain with crack-level, tooth-level and patient-level characteristics in posterior teeth with visible cracks: Findings from the National Dental Practice-Based Research Network. J Dent 2017; 70:67-73. [PMID: 29289728 DOI: 10.1016/j.jdent.2017.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 12/01/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES The objective of this study was to determine which patient traits, behaviors, external tooth and/or crack characteristics correlate with the types of symptoms that teeth with visible cracks exhibit, namely pain on biting, pain due to cold stimuli, or spontaneous pain. METHODS Dentists in the National Dental Practice-Based Research Network enrolled a convenience sample of subjects each of whom had a single, vital posterior tooth with at least one observable external crack (cracked teeth); 2858 cracked teeth from 209 practitioners were enrolled. Data were collected at the patient-, tooth-, and crack-level. Generalized estimating equations were used to obtain significant (p < .05) independent odds ratios (OR) associated with teeth that were painful for 10 outcomes based on types of pain and combinations thereof. RESULTS Overall, 45% of cracked teeth had one or more symptoms. Pain to cold was the most common symptom, which occurred in 37% of cracked teeth. Pain on biting (16%) and spontaneous pain (11%) were less common. Sixty-five percent of symptomatic cracked teeth had only one type of symptom, of these 78% were painful only to cold. No patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Positive associations for various combinations of pain symptoms were present with cracks that: (1) were on molars; (2) were in occlusion; (3) had a wear facet through enamel; (4) had caries; (5) were evident on a radiograph; (6) ran in more than one direction; (7) blocked transilluminated light; (8) connected with another crack; (9) extended onto the root; (10) extended in more than one direction; or (11) were on the distal surface. Persons who were <65 yo or who clench, grind, or press their teeth together also were more likely to have pain symptoms. Pain was less likely in teeth with stained cracks or exposed roots, or in non-Hispanic whites. CONCLUSIONS Although pain to cold was the most commonly noted pain associated with symptomatic cracked teeth, no patient-, tooth- or crack-level characteristic was significantly associated with pain to cold alone. Characteristics were only associated with pain on biting and/or spontaneous pain with or without pain to cold. CLINICAL SIGNIFICANCE Although often considered the most reliable diagnosis for a cracked tooth, pain on biting is not the most common symptom of a tooth with a visible crack, but rather pain to cold.
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Affiliation(s)
- Thomas J Hilton
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042, United States.
| | - Ellen Funkhouser
- School of Medicine, University of Alabama, 1720 2nd Avenue South, Birmingham, AL 35294-0007, United States
| | - Jack L Ferracane
- Department of Restorative Dentistry, School of Dentistry, Oregon Health & Science University, 2730 S.W. Moody Ave., Portland, OR 97201-5042, United States
| | - Valeria V Gordan
- Dept of Restorative Dental Sciences, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32610, United States
| | - Kevin D Huff
- Private Practice, 217 W 4th St, Dover, OH 44622, United States
| | - Julie Barna
- Private Practice, 222 JPM Rd, Lewisburg, PA 17837, United States
| | - Rahma Mungia
- Department of Periodontics, School of Dentistry, University of Texas Health San Antonio, 7703 Floyd Curl Drive, MC 8258, San Antonio, TX, 78229-3900, United States
| | - Timothy Marker
- Private Practice, 2210 Kulshan View Rd., Mount Vernon, WA 98273, United States
| | - Gregg H Gilbert
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama, Birmingham, AL, United States
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Heft MW, Litaker MS, Kopycka-Kedzierawski DT, Meyerowitz C, Chonowski S, Yardic RL, Gordan VV, Mungia R, Gilbert GH. Patient-Centered Dentinal Hypersensitivity Treatment Outcomes: Results from the National Dental PBRN. JDR Clin Trans Res 2017; 3:76-82. [PMID: 29276777 DOI: 10.1177/2380084417742099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Dentinal hypersensitivity (DH) can have a significant impact on oral health and functioning, and it is a clinical symptom commonly managed by dentists during routine clinical practice. DH symptoms are typically elicited by otherwise innocuous, nonpainful stimuli applied to exposed dentin (e.g., tactile stimuli, warming or cooling temperatures or air puffs). Treatment approaches have sought to directly target the dentinal pulp tissues or close dentinal tubules via dental office care and treatment services (fluoride varnishes, glutaraldehydes, bonding agents, sealants, oxalates, or lasers) or home care services (toothpastes or dentifrices containing fluoride or potassium nitrate compounds). The purpose of this prospective multicenter cohort study was to assess how community-based dentists from the National Dental Practice-Based Research Network (National Dental PBRN) manage DH and whether the effectiveness of DH treatments can be assessed in those settings. A total of 171 dentists recruited 1862 subjects with DH from their existing patients. Dentists then recommended and provided DH treatment as appropriate. Treatment choice was at the discretion of the dentists. Patients rated their DH pain at baseline and 1, 4, and 8 wk during the course of their treatments. They used pain intensity and unpleasantness visual analog scales and 4 labeled magnitude scales and rated their satisfaction with treatment after 8 wk. Patients were provided reminders postbaseline via email, texting, or voice mail. These patient-centered outcomes served as the principal measures for the assessment of treatment because treatments sought to alleviate DH symptoms. The patients with DH who reported pain reduction from dentist-provided treatments (glutaraldehyde/HEMA [hydroxyethyl methacrylate] compounds, oxalates, and bonding agents), dentists' advice and counseling regarding oral habits and diet, and patient-applied fluoride toothpaste reported a concomitant positive rating of satisfaction with DH treatments. The results from this study support the feasibility of engaging network practices to assess the effectiveness of clinical DH treatments. Knowledge Transfer Statement: National Dental PBRN dentists provide a range of procedures to treat dentinal hypersensitivity. In this large nonrandomized study designed to assess clinical care and to capture patient-reported outcomes, about 60% of patients reported improvement in pain. This study demonstrated the feasibility of engaging network dentists and their patients to assess treatment effectiveness. Future studies will explore the feasibility of imposing randomization and measuring patient compliance with treatment in the manner that this treatment is provided.
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Affiliation(s)
- M W Heft
- Department of Oral and Maxillofacial Surgery, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - M S Litaker
- Department of Clinical and Community Sciences, School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - C Meyerowitz
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY, USA
| | - S Chonowski
- Private practice, general dentistry, Morristown, NJ, USA
| | - R L Yardic
- HealthPartners Apple Valley Dental Clinic, Apple Valley, MN, USA
| | - V V Gordan
- College of Dentistry, University of Florida, Gainesville, FL, USA
| | - R Mungia
- Department of Periodontology, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - G H Gilbert
- School of Dentistry, University of Alabama at Birmingham, Birmingham, AL, USA
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