Dental Practice-Based Research Network

Literature Watch

Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network
Wednesday, January 11, 2012

The December 2011 issue of The Journal of the American Dental Association features an article entitled "Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network".

The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The DPBRN and to assess the tooth, patient and dentist characteristics associated with those reasons.

The authors did this by collecting data provided by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used.

The authors found that dentists most often placed restorations to treat lesions caused by abrasion, abfraction or erosion (AAE) (46 percent) and tooth fracture (31 percent). Patients 41 years or older received restorations mainly because of AAE. Premolars and anterior teeth were restored mostly owing to AAE; molars were restored mostly owing to tooth fracture. Dentists used directly placed resin-based composite (RBC) largely to restore AAE lesions and fractured teeth.

The authors concluded that among DPBRN practices, AAE and tooth fracture were the main reasons for restoring noncarious tooth surfaces. Pre-molars and anterior teeth of patients 41 years and older are most likely to receive restorations owing to AAE; molars are most likely to receive restorations owing to tooth fracture. Dentists restored both types of NCTDs most often with RBC.

Click here to view the abstract on the JADA website.

Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: Executive summary of recommendations from the American Dental Association Council on Scientific Affairs
Friday, December 02, 2011

The November 2011 issue of The Journal of the American Dental Association features an article entitled "Managing the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: Executive summary of recommendations from the American Dental Association Council on Scientific Affairs". This article provides a narrative review of osteonecrosis of the jaw (ONJ) in patients with low bone mass receiving treatment with antiresorptive agents and is based on an appraisal of the literature by an advisory committee of the American Dental Association Council on Scientific Affairs. It updates the committee's 2008 advisory statement.

The authors searched MEDLINE for literature published between May 2008 (the end date of the last search) and February 2011 and included the CONDOR ONJ study. This report contains recommendations based on the findings of the literature search and on expert opinion that relate to general dentistry; periodontal disease management; implant placement and maintenance; oral and maxillofacial surgery; endodontics; restorative dentistry and prosthodontics; orthodontics; and C-terminal telopeptide testing and drug holidays.

The authors concluded that the highest reliable estimate of antiresorptive agent-induced osteonecrosis of the jaw (ARONJ) prevalence is approximately 0.10 percent. Osteoporosis is responsible for considerable morbidity and mortality. Therefore, the benefit provided by antiresorptive therapy outweighs the low risk of developing osteonecrosis of the jaw.

The clinical implications are that an oral health program consisting of sound hygiene practices and regular dental care may be the optimal approach for lowering ARONJ risk. No validated diagnostic technique exists to determine which patients are at increased risk of developing ARONJ. Discontinuing bisphosphonate therapy may not lower the risk but may have a negative effect on low-bone-mass-treatment outcomes.

Click here to view the PubMed abstract.

Sealants and dental caries: dentists' perspectives on evidence-based recommendations
Wednesday, November 02, 2011

The September 2011 issue of The Journal of the American Dental Association features an article entitled "Sealants and dental caries: dentists' perspectives on evidence-based recommendations". The authors of this article conducted a study to survey the perspectives of dentists regarding the 2010 American Dental Association (ADA) recommendation to seal non-cavitated carious lesions (NCCLs) in children and young adults.

They did this by mailing a questionnaire to a randomly selected sample of 2,400 general dentists (GDs) and pediatric dentists (PDs) in the United States. The questionnaire included two photographs of NCCLs (permanent first molar and premolar) in a 12-year-old child. Respondents were provided with radiographic findings and asked to choose from several management options.

The authors found that in the absence of radiographic evidence of caries, 37.4 percent and 42.3 percent of GDs and PDs, respectively, indicated that they would seal the NCCL in the molar. For the premolar, a significantly lower percentage of GDs than of PDs indicated that they would seal the NCCL. With radiographic evidence of caries in dentin, less than 4 percent of all dentists surveyed indicated that they would seal the NCCLs, and more than 90 percent indicated that they would remove the caries and place restorations. Less than 40 percent of dentists indicated that they sealed NCCLs in their practice.

The authors concluded that the U.S. dentists surveyed have not adopted evidence-based clinical recommendations regarding the sealing of NCCLs.

Click here to view the PubMed abstract.

Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity
Tuesday, October 04, 2011

The October issue of The Journal of the American Dental Association features an article entitled “Development of a brief and effective temporomandibular disorder pain screening questionnaire: reliability and validity”. In this article, the authors conducted a study to develop and assess the validity of a self-report instrument in screening patients for pain-related TMDs.

They did this by using a short (three-item) and long (six-item) version of the questionnaire and evaluated them for validity among 504 participants.

The authors found that internal reliability was excellent, with coefficient α values of 0.87 and 0.93 for the short and long versions, respectively. When the authors dichotomized instrument scores at optimal thresholds, both versions had a sensitivity of 99 percent and a specificity of 97 percent for correct classification of the presence or absence of TMD. The specificity was at least 95 percent in the correct identification of people with nonpainful TMJ disorders or headahce without TMD pain.

The authors concluded that with use of appropriate psychometric methodology, the selected items exhibited excellent content validity. The excellent levels of reliability, sensitivity and specificity demonstrate the validity and usefulness of this instrument.

Using this instrument will allow clinicians to identify more readily—and cost-effectively—most patients with painful TMD conditions for whom early and reliable identification would have a significant effect on diagnosis, treatment and prognosis.

Click here to view the article.

Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network.
Tuesday, September 06, 2011

"Dentists' use of caries risk assessment and individualized caries prevention for their adult patients: findings from The Dental Practice-Based Research Network" will be featured in the upcoming issue of Community Dentistry Oral Epidemiology.

There have been few studies to examine dentists' subjective ratings of importance of caries risk factors or tested whether dentists use this information in treatment planning. This study tested several hypotheses related to caries risk assessment (CRA) and individualized caries prevention (ICP). They accomplished this by collecting data using a questionnaire entitled 'Assessment of Caries Diagnosis and Caries Treatment', completed by 547 DPBRN practitioners.

The results showed that 69% of DPBRN dentists perform CRA on their patients. Recently graduated dentists, dentists with busier practices, and those who believe a dentist can predict future caries were the most likely to use CRA. The association between CRA and ICP was weaker than expected (r=0.21). Dentists who perform CRA provide ICP to 57% of their patients, compared with 42% for dentists who do not perform CRA. Based on their responses to radiographic and clinical scenarios in the questionnaire, dentists who use CRA appear to use this information in restorative decisions.

The results showed that a substantial percentage of DPBRN dentists do not perform CRA, and there is not a strong linkage between its use and use of individualized preventive regimens for adult patients. More progress in the implementation of current scientific evidence in this area is warranted.

Click here to view the PubMed abstract.

Nighttime-breathing Treatments Backed by Strongest Evidence among Options To Treat Sleep Apnea
Thursday, August 11, 2011

The Agency for Helathcare and Research Quality (AHRQ) recently sent out a press release entitled "Nighttime-Breathing Treatments Backed by Strongest Evidence Among Options to Treat Sleep". Among the treatments for obstructive sleep apnea, the effectiveness of a nighttime-breathing machine called a “CPAP” was backed by the strongest evidence, and a mouthpiece worn at night was also shown to be effective, according to a new AHRQ-funded report. Sleep apnea is a disorder that disrupts sleep for an estimated 12 million Americans, with millions more likely undiagnosed. The report found that the continuous positive airway pressure (CPAP) machine, which pumps air through a mask while the patient is asleep, is highly effective in improving sleep and related symptoms of obstructive sleep apnea by improving airflow. Another treatment, a mouthpiece called a mandibular advancement device, can also be very effective. Weight loss and surgery may also be effective, although the evidence behind these treatments is not as strong, according to a comparative effectiveness review prepared by the Tufts Medical Center Evidence-based Practice Center for AHRQ's Effective Health Care Program. The report does note that all treatments have possible side effects.

To highlight the findings of the report, AHRQ also published guides for consumers and clinicians that summarize the latest evidence for treating obstructive sleep apnea, a disorder that can lead to heart disease, diabetes, and multiple other health problems. The report and the companion guides are available on AHRQ's Effective Health Care Program Web site (click here). The consumer guide, Treating Sleep Apnea: A Review of the Research for Adults, defines sleep apnea for patients and their families, summarizes treatment options, offers a list of questions to discuss with a doctor and contains basic cost information (click here). The clinician guide, Comparative Effectiveness of Diagnosis and Treatment of Obstructive Sleep Apnea in Adults, covers these topics, provides "confidence ratings" for existing scientific evidence, and offers a "clinical bottom line" to give clinicians tools to discuss treatment options with their patients (click here). Click here to read the press release.

Practitioner, patient and carious lesions characteristics associated with type of restorative material: findings from The Dental Practice-Based Research Network
Wednesday, July 06, 2011

"Practitioner, patient and carious lesions characteristics associated with type of restorative material: findings from The Dental Practice-Based Research Network" appeared in the June 2011 issue of The Journal of the American Dental Association.

In this study, the authors conducted a study to identify factors associated with the materials that dentists in DPBRN use when placing the first restoration on permanent posterior tooth surfaces.

They accomplished this by recruiting 182 DPBRN practitioner-investigators who provided data on 5,599 posterior teeth with caries.

Practitioner-investigators completed an enrollment questionnaire that included the dentist's age, sex, practice workload, practice type and number of years since graduation. When patients who had provided informed consent to participate in the investigation sought treatment for a previously unrestored carious surface, the practitioner-investigator recorded patient and tooth characteristics.

The results showed that practitioner-investigators used amalgam more often than they used direct resin-based composite (RBC) for posterior carious lesions. Practitioner and practice characteristics (years since graduation and type of practice); patient characteristics (sex, race, age and dental insurance status); and lesion characteristics (tooth location and surface, preoperative and postoperative lesion depth) were associated with the type of restorative material used.

The authors concluded that several practitioner, practice, and patient lesion characteristics were associated significantly with the use of amalgam and RBC: geographical region, years since dentist's graduation, patient's dental insurance status, tooth location and surface, and preoperative and postoperative lesion depth.

Click here to read the article. Click here to view the abstract on the PubMed website.

Methods Used by Dental Practice-based Research Network (DPBRN) Dentists to Diagnose Dental Caries
Monday, June 06, 2011

"Methods Used by Dental Practice-based Research Network (DPBRN) Dentists to Diagnose Dental Caries" appeared in the March 2011 issue of the Operative Dentistry.

In this study, the authors (1) identified the methods that dentists in The DPBRN use to diagnose dental caries; (2) quantified their frequency of use and (3) tested the hypothesis that certain dentist and dental practice characteristics are significantly associated with their use.

They accomplished this by sending out a questionnaire about methods used for caries diagnosis to DPBRN dentists who reported doing some restorative dentistry; 522 dentists participated. Questions included the use of dental radiographs, the dental explorer, laser fluorescence, air-drying and fiber-optic devices and magnification as used when diagnosing primary, secondary/recurrent or non-specific caries lesions. Variations on the frequency of their use were tested using multivariate analysis and Bonferroni tests.

The results showed that, overall, the dental explorer was the instrument most commonly used to detect primary occlusal caries and caries at the margins of existing restorations. In contrast, laser fluorescence was rarely used to help diagnose occlusal primary caries. For proximal caries, radiographs were used to help diagnose 75%-100% of lesions by 96% of the DPBRN dentists. Dentists who use radiographs most often to assess proximal surfaces of posterior teeth were significantly more likely to also report providing a higher percentage of patients with individualized caries prevention and seeing a higher percentage of pediatric patients.

The authors concluded that the use of specific diagnostic methods varied substantially. The dental explorer and radiographs are still the most commonly used diagnostic methods.

Click here to read the article. Click here to view the abstract on the PubMed website.

Differences in male and female dentists' practice patterns regarding diagnosis and treatment of dental caries: Findings from The Dental Practice-Based Research Network
Monday, May 09, 2011

"Differences in male and female dentists' practice patterns regarding diagnosis and treatment of dental caries: Findings from The Dental Practice-Based Research Network" appeared in the April 2011 issue of the Journal of the American Dental Association.

In this study, the authors surveyed DPBRN general dentists who practiced within the United States. The survey included questions about dentists', practices' and patients' characteristics, as well as prevention, assessment and treatment of dental caries. The authors adjusted the statistical models for differences in years since dental school graduation, practice model, full-time versus part-time status, and practice owner or employee status before making conclusions about sex differences.

The results illustrated that three hundred ninety-three male (84%) and 73 female (16%) dentists participated. Female dentists recommended at-home fluoride to a significantly larger number of their patients than did male dentists, whereas male dentists had a preference for using in-office fluoride treatments with pediatric patients. Female dentists also chose to use preventive therapy more often at earlier stages of dental caries. There were few differences between the sexes in terms of diagnostic methods, time spent on or charges for restorative dentistry, and busyness of the practice.

The authors concluded that female DPBRN dentists differ from their male counterparts in some aspects of the prevention, assessment and treatment of dental caries, even with significant covariates taken into account. Practice Implications. The practice patterns of female dentists suggest a treatment philosophy with a greater focus on caries prevention. Although there have been articles that have addressed differences in productivity between male and female dentists, little is known about differences between the sexes in practice patterns regarding caries management.

Click here to view the article on the ADA website. Click here to view the abstract on the PubMed website.

Lessons learned during the conduct of clinical studies in The Dental PBRN
Tuesday, April 12, 2011

Lessons learned during the conduct of clinical studies in The Dental PBRN" appeared in the April 2011 issue of the Journal of Dental Education. The authors describe lessons learned from conducting DPBRN studies that effectively address challenges of conducting research in nonacademic settings. The studies are conducted by clinicians in community settings who may be doing their first research study. To date, twenty-one studies have been completed or are in implementation. These include a broad range of topic areas, enrollment sizes, and study designs. A total of 1,126 practitioner-investigators have participated in at least one study. After excluding one study because it involved electronic records queries only, these studies included more than 70,000 patient/participant units. Because the DPBRN is committed to being both practitioner- and patient-driven, all studies must be approved by its Executive Committee and a formal study section of academic clinical scientists. As a result of interacting with a diverse range of institutional and regulatory entities, funding agencies, practitioners, clinic staff, patients, academic scientists, and geographic areas, twenty-three key lessons have been learned. Patients' acceptance of these studies has been very high, judging from high participation rates and their completion of data forms. Early studies substantially informed later studies with regard to study design, practicality, forms design, informed consent process, and training and monitoring methods. Although time-intensive and complex, these solutions improved acceptability of practice-based research to patients, practitioners, and university researchers.

Click here to visit the ADEA website.

Risk Factors for Osteonecrosis of the Jaws: a Case-control Study from the CONDOR Dental PBRN and ONJ in Two Dental Practice-Based Research Network Regions
Monday, March 21, 2011

The Journal of Dental Research has 2 articles in their upcoming issue on osteonecrosis of the jaw (ONJ). These articles, written by DPBRN investigators, feature some of the largest published studies to date on ONJ patients.

In the article entitled "Risk Factors for Osteonecrosis of the Jaws: a Case-control Study from the CONDOR Dental PBRN", the authors conducted a case-control study to determine the risk associated with bisphosphonates and identify other risk factors for ONJ, including dental diseases and procedures. Researchers enrolled 191 ONJ cases and 573 controls from 119 dental practices and found that bisphosphonate use was strongly associated with ONJ. Click here to view the PubMed abstract.

In the second article entitled "ONJ in Two Dental Practice-Based Research Network Regions", the authors conducted a DPBRN study that estimated ONJ incidence and odds ratios from bisphosphonate exposure and other risk factors using patients' electronic records. The researchers identified 572,606 health plan members and of those patients, approximately 25,000 had a diagnosis or procedure code that suggested a necrotic bone lesion, including inflammatory jaw condition, cyst of bone, aseptic necrosis of the bone and open wound of the jaw. Patients with oral bisphosphonates were 15.5 times more likely to have ONJ than non-exposed patients. Click here to view the PubMed abstract.

The effect of xylitol on the composition of the oral flora: a pilot study
Friday, February 18, 2011

The January 2011 issue of European Journal of Dentistry features an article entitled “The effect of xylitol on the composition of the oral flora: a pilot study”. In it, they discussed the effect of short-term xylitol consumption on the microbial composition of plaque and saliva. They did this by enrolling twelve participants who had mutans streptococci (MS). The experimental chewing gum contained 65% xylitol while the control gum contained 63% sorbitol and 2% maltitol. Stimulated saliva and plaque samples were collected before and after the two four-week test periods. The samples were cultured for MS, total streptococci, lactobacilli, and total facultatives. The results showed that the MS counts of the plaque samples collected from "caries-prone" tooth sites decreased significantly (P<.01) in the xylitol gum group but not in the sorbitol gum group. Also the plaque MS percentage decreased significantly in the xylitol gum group (P<.01). The salivary MS counts did not decrease either in the xylitol or in the sorbitol gum groups. The authors concluded that xylitol consumption reduced MS counts in plaque but appeared not to affect the microbial composition of plaque or saliva in general. Click here to view the PubMed abstract.

Dental caries: A complete changeover, PART III: Changeover in the treatment decisions and treatments
Tuesday, January 18, 2011

The October 2010 issue of Journal of Conservative Dentistry features an article entitled “Dental caries: A complete changeover, PART III: Changeover in the treatment decisions and treatments”. In it, they discuss the decision-making process of diagnosing and treating caries lesions. Currently, the decision-making process is influenced by numerous factors such as the size/ depth/ activity of the carious lesion and age/ the caries risk status of the patient. Treatment decisions should involve planning the non-operative/ preventive treatment for non-cavitated or early cavitated lesions and also formulating operative treatment for cavitated lesions. The clinician should also be knowledgeable enough to decide when not to interfere in the caries dynamics and how frequently to recall the patient for follow-ups. The non-operative treatment prescriptions vary in dose, intensity and mode of delivery according to the caries risk status. Minimal invasion and maximal conservation of tooth structure has become the essence of current operative treatments. This part of the series elaborates on the paradigm shift in the management of dental caries. Click here to view the PubMed abstract

Methods dentists use to diagnose primary caries lesions prior to restorative treatment: findings from The Dental PBRN
Monday, December 20, 2010

The December 2010 issue of Journal of Dentistry features an article entitled "Methods dentists use to diagnose primary caries lesions prior to restorative treatment: findings from The Dental PBRN". The purpose of this article was to quantify the diagnostic techniques used by DPBRN dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use. A total of 228 DPBRN dentists recorded information on 5676 consecutive restorations inserted due to primary caries lesions on 3751 patients. Practitioner-investigators placed a mean of 24.9 (SD=12.4) restorations. Lesions were categorized as posterior proximal, anterior proximal, posterior occlusal, posterior smooth, or anterior smooth. Techniques used to diagnose the lesion were categorized as clinical assessment, radiographs, and/or optical. They found that, by lesion category, the diagnostic technique combinations used most frequently were clinical assessment plus radiographs for posterior proximal (47%), clinical assessment for anterior proximal (51%), clinical assessment for posterior occlusal (46%), clinical assessment for posterior smooth (77%), and clinical assessment for anterior smooth (80%). Diagnostic technique was significantly associated with lesion category after adjusting for clustering in dentists (p<0.0001). These results - obtained during actual clinical procedures rather than from questionnaire-based hypothetical scenarios - quantified the diagnostic techniques most commonly used during the actual delivery of routine restorative care. Diagnostic technique varied by lesion category and with certain practice and patient characteristics. Click here to view the PubMed abstract.

Change in stated clinical practice associated with participation in The Dental Practice-Based Research Network
Thursday, December 02, 2010

"Change in stated clinical practice associated with participation in The Dental Practice-Based Research Network" appeared originally in the November/December 2010 issue of General Dentistry (Published with permission by the Academy of General Dentistry. © 2010 by the Academy of General Dentistry. All rights reserved).

DPBRN dentists completed a detailed questionnaire about how they diagnose and treat dental caries. They next received a customized report that compared their answers to those from all other practitioner-investigators. Of the DPBRN dentists who completed the questionnaire, 126 of them attended DPBRN's first network-wide meeting of practitioner-investigators from all five of its regions. During that meeting, certain questions were repeated and new ones were asked about the dentist's intention to change the way that he or she diagnosed or treated dental caries. The results indicated that less than one-third of practitioner-investigators intended to change how they diagnosed or treated caries as a result of receiving the customized report. However, as a result of the meeting, the majority of these same practitioner-investigators stated an intention to change toward a more conservative, less surgically invasive approach. These findings are consistent with the idea that a highly interactive meeting with fellow practitioner-investigators may be an effective means to translate scientific findings into clinical practice. Practitioner-investigators are open to changing how they treat patients as a result of engaging fellow practitioner-investigators in the scientific process.

Click here to read the article.

Click here to visit the AGD website.

Invasive dental treatment and risk for vascular events: a self-controlled case series
Monday, November 08, 2010

The October 2010 issue of Annals of Internal Medicine features an article entitled “Invasive dental treatment and risk for vascular events: a self-controlled case series”. In it, they discuss whether invasive dental treatment transiently increases the risk for vascular events. To answer this question, they looked at self-controlled case series from the U.S. Medicaid claims database. Their patient-based looked at all persons exposed to invasive dental treatment with a primary hospital discharge diagnosis of ischemic stroke (n = 650) or myocardial infarction (n = 525) from 2002 to 2006.The incidence of ischemic stroke and myocardial infarction in periods immediately after invasive dental treatment was compared with the incidence in all other observed time periods. Incidence ratios and 95% CIs were calculated. They found that the rate of vascular events significantly increased in the first 4 weeks after invasive dental treatment (incidence ratio, 1.50 [95% CI, 1.09 to 2.06]) and gradually returned to the baseline rate within 6 months. The positive association remained after exclusion of persons with diabetes, hypertension, or coronary artery disease or persons with prescriptions for antiplatelet or salicylate drugs before treatment. Invasive dental treatment may be associated with a transient increase in the risk for vascular events. However, the absolute risks are minimal, and the long-term benefits on vascular health will probably outweigh the short-lived adverse effects. Click here to view the PubMed abstract.

A psychosocial approach to dentistry for the underserved: incorporating theory into practice
Monday, November 01, 2010

Dr. Paul Benjamin, DPBRN Executive Committee Member and practitioner-investigator from Florida, co-authored an article entitled “A psychosocial approach to dentistry for the underserved: incorporating theory into practice” in the Fall 2010 issue of Journal of Health Care Finance. In it, they discuss the value of access to quality dentistry as an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. They tackle the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? They found that a theoretical approach to dentistry employing the health belief model, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. Click here to view the PubMed abstract.

General practitioners' use of caries-preventive agents in adult patients versus pediatric patients: findings from The Dental Practice-Based Research Network
Thursday, October 07, 2010

The June 2010 issue of Journal of the American Dental Association features an article entitled "General practitioners' use of caries-preventive agents in adult patients versus pediatric patients: findings from The Dental Practice-Based Research Network". The purpose of this article was to test the frequency of dentists' recommendations for and use of caries-preventive agents for children as compared with adults. They did this by surveying 467 general dentists in the DPBRN who practice within the United States and treat both pediatric and adult patients. They asked dentists to identify the percentage of their patients for whom they had administered or recommended dental sealants, in-office and at-home fluoride, chlorhexidine rinse and xylitol gum. The results illustrated that dentists were less likely to provide adult patients than pediatric patients with in-office caries-preventive agents. However, the rate at which they recommended at-home preventive regimens for the two groups of patients was similar. Dentists with a conservative approach to caries treatment were the most likely to use and recommend the use of caries-preventive agents at similar rates in adults as in children. In addition, dentists in practices with a greater number of patients who had dental insurance were significantly more likely to provide in-office fluoride or sealants to adult patients than to pediatric patients. The authors concluded that general dentists use in-office caries-preventive agents more commonly with their pediatric patients than with their adult patients.

Click here to view the PubMed abstract.

Click here to visit the ADA website.

Rubber dam use during routine operative dentistry procedures: findings from The Dental PBRN
Wednesday, September 08, 2010

The September 2010 issue of Operative Dentistry features an article entitled "Rubber dam use during routine operative dentistry procedures: findings from The Dental PBRN". The purpose of this study was to determine how commonly the rubber dam is used during operative dentistry procedures and to test the hypothesis that certain dentist, restoration and patient-level factors are associated with its use. A total of 229 DPBRN practitioner-investigators collected data on 9,890 consecutive restorations done in previously unrestored tooth surfaces from 5,810 patients. Most dentists (63%) did not use a rubber dam for any restoration in this study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With regions accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance and age. These results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of the rubber dam during operative dentistry procedures. Usage varied with certain dentist, restoration and patient-level characteristics.

Click here to view the article.

Reflections of Practice-based Researchers
Monday, August 09, 2010

The July/August 2010 issue of the Journal of the American Board of Family Medicine features an article entitled “Voices from Left of the Dial: Reflections of Practice-based Researchers”. The purpose of this article is to assess factors motivating PBRN clinicians to participate and stay involved in practice-based research in their primary care office setting.

They did this by inviting practicing clinicians across the United States who are affiliated with a PBRN to share their stories regarding motivations to participate in practice-based research. They categorized the stories into the main motivation for participation and the perceived impact of participation.

A total of 37 stories were collected from clinicians affiliated with 12 PBRNS located in 14 states. Motivations for participation in practice-based research included themes associated with personal satisfaction, improving local clinic-based care, and contributing to community- and system-level improvements. These stories from PBRN clinicians describe the values, motivations, and unique paths that clinicians took as they chose to participate and stay active in a PBRN. Their voices have the potential to influence others to participate in practice-based research.

Click here to view the article.

Preferences for caries prevention agents in adult patients: findings from The Dental Practice-Based Research Network.
Wednesday, July 14, 2010

The May issue of Community Dentistry and Oral Epidemiology features an article entitled "Preferences for caries prevention agents in adult patients: findings from The Dental Practice-Based Research Network". The purpose of this article was to identify factors that were significantly associated with dentists' use of specific caries preventive agents in adult patients, and whether dentists who use one preventive agent are also more likely to use certain others. The data were collected from 564 practitioners who participated in DPBRN. The results indicated that in-office topical fluoride was the method most frequently used. Regarding at-home preventive agents, there was little difference in preference between nonprescription fluoride, prescription fluoride, or chlorhexidine rinse. Dentists who most frequently used caries prevention were also those who regularly perform caries risk assessment and individualize caries prevention at the patient level. Higher percentages of patients with dental insurance were significantly associated with more use of in-office prevention modalities. Female dentists and dentists with more-recent training were more likely to recommend preventive agents that are applied by the patient. Dentists who reported more-conservative decisions in clinical treatment scenarios were also more likely to use caries preventive agents. Groups of dentist who shared a common preference for certain preventive agents were identified. One group used preventive agents selectively, whereas the other groups predominately used either in-office or at-home fluorides. Caries prevention is commonly used with adult patients. However, these results suggest that only a subset of dentists base preventive treatments on caries risk at the individual patient level. Click here to view the PubMed abstract.

Dentists’ use of caries risk assessment in children: findings from The Dental Practice-Based Research Network
Wednesday, June 16, 2010

"Dentists’ use of caries risk assessment in children: findings from The Dental Practice-Based Research Network" appeared originally in the May/June 2010 issue of General Dentistry (© Academy of General Dentistry). The purpose of this article was to survey DPBRN dentists (from four regions in the U.S. and Scandinavia) who perform restorative dentistry in their practices. The survey asked a range of questions about caries risk assessment in patients aged 6–18. Among respondents, 73% of dentists reported performing caries risk assessment among these patients, while 14% assessed caries risk by using a special form. Regions in which most dentists were in a private practice model were the least likely to perform caries risk assessment, while regions where most dentists practiced in a large group practice model were the most likely to use a special form for caries risk assessment. Recent graduates from dental school were more likely to use a caries risk assessment compared to older graduates. Current oral hygiene, decreased salivary flow, and the presence of active caries were rated as the most important caries factors. Some differences by region were also evident for the risk factor ratings. These results suggest that not all community dentists assess caries risk. The results of this study also indicate considerable variability in dentists’ views concerning the importance of specific caries risk factors in treatment planning and weak evidence that caries risk assessment is driving clinical practice when preventive treatment recommendations are being considered. Click here to read the article. Click here to visit the AGD website.

Institutional review board and regulatory solutions in The Dental PBRN
Wednesday, May 19, 2010

The Winter 2010 issue of Journal of Public Health Dentistry features an article entitled "Institutional review board and regulatory solutions in The Dental PBRN". The objectives of this article were to describe: a) the various human participants and regulatory requirements and solutions for each of DPBRN's five regions; b) their impact on study protocols and implementation; and c) lessons learned from this process. The authors found that following numerous discussions with IRB and grants administrative personnel for each region, some practitioner-investigators were attached to their respective IRBs and contracting entities via sub-contracts between their organizations and the network's administrative site. Others were attached via Individual Investigator Agreements and contractually obligated via Memoranda of Agreement. IRBs approve general operations under one approval, but specific research projects via separate approvals. Various formal IRB and grants administrative agreements were arranged to customize research to the network context. In some instances, this occurred after feedback from patients and practitioners that lengthy written consent forms impeded research and raised suspicion, instead of decreasing it. The authors concluded that instead of viewing IRBs and institutional administrators as potentially adversarial, customized solutions can be identified by engaging them in collegial discussions that identify common ground within regulatory bounds. Although time-intensive and complex, these solutions improve acceptability of practice-based research to patients, practitioners, and university researchers. Click here to view the article. Click here to visit the American Association of Public Health Dentistry website.

Reasons for placement of restorations on previously unrestored tooth surfaces by dentists in The Dental Practice-Based Research Network
Wednesday, April 07, 2010

The April issue of Journal of the American Dental Association features an article entitled "Reasons for placement of restorations on previously unrestored tooth surfaces by dentists in The Dental Practice-Based Research Network". The purpose of this article was to identify and quantify the reasons used by dentists in the DPBRN for placing restorations on unrestored permanent tooth surfaces and the dental materials they used in doing so. A total of 229 DPBRN practitioner-investigators provided data from their practices regarding 9,890 consecutive restorations in 5,810 patients. Information the practitioner-investigators provided included their reasons for restoring the teeth, the specific teeth and surfaces they restored and the restorative materials they used. The results showed that primary caries (85 percent of teeth, 8,351 of 9,890) and noncarious defects (15 percent, 1,479 of 9,890) were the main reasons participants gave for placing restorations. Participants placed restorations necessitated by caries most frequently on occlusal surfaces (49 percent, 4,091 of 8,351). They used amalgam for 47 percent of the molar restorations and 45 percent of the premolar restorations. They used directly placed resin-based composite (RBC) for 48 percent of the molar restorations, 50 percent of the premolar restorations and 93 percent of the anterior restorations. DPBRN practitioner-investigators cited dental caries on occlusal and proximal surfaces of molar teeth as the main reasons for placing restorations on previously unrestored tooth surfaces. RBC was the material they used most commonly for occlusal and anterior restorations. Amalgam remains the material of choice to restore posterior teeth with proximal caries, although the authors noted significant differences in the use of amalgam and RBC by dentists in various regions of the DPBRN Click here to view the PubMed abstract.

Pay-for-performance in dentistry: what we know
Wednesday, March 17, 2010

The January/February issue of Journal for Healthcare Quality features an article entitled "Pay-for-performance in dentistry: what we know". This article focuses on the pay-for-performance system (P4P). The authors investigate the current experience of P4P in primary medical care that has relevance to dentistry and discuss the dental performance-based programs to date. Taking into consideration these lessons, the structure of dental service delivery in the United States, and the paucity of evidence-based quality indicators in dentistry, the authors provide several guidelines for the design of P4P pilot programs for dental services. The authors conclude that large-scale implementation of P4P for dentistry may not be a realistic option before significant progress is achieved in quality of dental care indicators. Click here to view the PubMed abstract.

Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis
Wednesday, February 24, 2010

The February 2010 issue of Journal of Endodontics features an article entitled “Frequency of persistent tooth pain after root canal therapy: a systematic review and meta-analysis”. The purpose of this article was to research the frequency of persistent pain after endodontic procedures through a systematic review. Persistent tooth pain was defined as pain present > or = 6 months after endodontic treatment. Endodontic procedures included in the review were pulpectomy, nonsurgical root canal treatment, surgical root canal treatment, and retreatment. Using subgroup analyses, they explored the influence of treatment approach (surgical/nonsurgical), longitudinal study design (prospective/retrospective), follow-up rate, follow-up duration, initial treatment versus retreatment, and quality of reporting on the pain frequency estimate. Of 770 articles retrieved and reviewed, 26 met the inclusion criteria. A total of 5,777 teeth were enrolled, and 2,996 had follow-up information regarding pain status. 168 teeth were identified with pain and derived a frequency of 5.3% for persistent all-cause tooth pain. Prospective studies had a higher pain frequency (7.6%) than retrospectives studies did (0.9%). The frequency of all-cause persistent tooth pain after endodontic procedures was estimated to be 5.3%, with higher report quality studies suggesting >7%. Click here to view the article. Click here to visit the Journal of Endodontics homepage.

Outcomes of root canal treatment in Dental Practice-Based Research Network practices
Wednesday, February 03, 2010

"Outcomes of root canal treatment in Dental Practice-Based Research Network practices" appeared originally in the January/February 2010 issue of General Dentistry (© Academy of General Dentistry). The purpose of this article was to quantify the incidence of root canal treatment (RCT) failure and identify its predictors in root canals that were performed or referred by general dentistry practices in a PBRN. This study involved 174 endodontically treated teeth with a mean follow-up time of 8.6 years. Permanent restorations were placed in 89% of the teeth, with 18% of teeth resulting in an extraction. Patients who did not receive a permanent restoration were more likely to experience RCT failure. Click here to read the article. Click here to visit the AGD website.

Restorative treatment thresholds for interproximal primary caries based on radiographic images: findings from the Dental Practice-Based Research Network
Wednesday, January 13, 2010

"Restorative treatment thresholds for interproximal primary caries based on radiographic images: findings from the Dental Practice-Based Research Network" appeared originally in the November/December 2009 issue of AGD Impact (© Academy of General Dentistry). The purpose of this article was to quantify the depths of proximal caries lesions that lead dentists in regular clinical practice to intervene restoratively, based on hypothetical scenarios that included both radiographic images and patient background information. This article also identified characteristics associated with restorative intervention in early enamel lesions. Dentists were asked to indicate the depth at which they would restore a lesion, based on a series of radiographic images depicting interproximal caries at increasing lesion depths in a mandibular premolar with two caries risk scenarios: one involving a patient with low caries risk and another involving a patient at higher risk. For a high caries risk patient, 66% of respondents indicated that they would restore a proximal enamel lesion, while 24% would do so once the lesion had reached into the outer third of the dentin. For a low caries risk patient, 39% of respondents reported that they would restore an enamel lesion, and 54% would do so once the lesion had reached into the outer third of the dentin. Dentists in large group practices were less likely to intervene surgically for enamel caries, regardless of patient's caries risk. Click here to read the article. Click here to visit the AGD website.

Promoting evidence-based dentistry through "The Dental Practice-Based Research Network"
Monday, December 21, 2009

The December issue of The Journal of Evidence-Based Dental Practice features an article entitled "Promoting evidence-based dentistry through 'The Dental Practice-Based Research Network'". This article was written by one of the members of our DPBRN Executive Committee, Dr. Paul Benjamin of Miami, FL. It focuses on dental practice-based research networks as one of the solutions to the oftentimes slow and inefficient process of translating research evidence into clinical practice. This article identifies two major issues that are faced when setting up a dental practice-based research network. Using his role as a DPBRN practitioner-investigator as an example, Dr. Benjamin discusses what is involved in undertaking a research project in his office. Also discussed are the types of projects being done in this new setting and how Dr. Benjamin believes these studies will be one of the bridges toward developing evidenced based dentistry in private practice. Click here to read the article.

How Dentists Diagnose and Treat Defective Restorations: Evidence from The Dental Practice-Based Research Network
Tuesday, December 01, 2009

The November/December issue of Operative Dentistry features an article entitled "How Dentists Diagnose and Treat Defective Restorations: Evidence from The Dental Practice-Based Research Network." A questionnaire was sent to all DPBRN practitioner-investigators who reported doing some restorative dentistry. Questions included clinical case scenarios that used text and clinical photographs of defective restorations. Dentists were asked what type of treatment, if any, they would use in each scenario. Dentists were more likely to intervene surgically when the restoration was an existing composite, compared to an amalgam restoration. Click here to read the article.

Missing posterior teeth and risk of temporomandibular disorders
Tuesday, November 24, 2009

The October 2009 issue of Journal of Dental Research features an article entitled “Missing posterior teeth and risk of temporomandibular disorders”. The purpose of this article was to investigate whether the number of missing posterior teeth, their distribution, age, and gender were associated with temporomandibular disorders (TMD). Seven hundred and forty-one individuals, aged 21-60 years, with missing posterior teeth, 386 with and 355 without TMD, were included in the study. The results indicate that individuals who lost posterior teeth, with fewer missing posterior teeth but in more quadrants, have a higher prevalence of TMD, especially young women. Click here to view the PubMed abstract.

Practices participating in a dental PBRN have substantial and advantageous diversity even though as a group they have much in common with dentists at large
Tuesday, October 27, 2009

This article from the October 2009 issue of BMC: Oral Health compared DPBRN practice characteristics across the five regions. The results showed there were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations. Click here to view the abstract and click here to view the article.

Long-term performance of resin based fissure sealants placed in a general dental practice
Wednesday, October 21, 2009

The September 2009 issue of Journal of Dentistry features an article entitled “Long-term performance of resin based fissure sealants placed in a general dental practice”. The purpose of the paper is to evaluate the long-term performance of resin based fissure sealants. 1204 sealants were placed on posterior non-discolored permanent teeth and followed for an average of 11 years. At follow-up, 41% of the sealants were fully retained and 11.4% were replaced with a restoration. The restorations and failed sealants were found significantly more often in the molars and on patients with a history of restorations. Click here to view the PubMed abstract.

Dentists' attitudes and practices related to diabetes in the dental setting
Friday, October 02, 2009

One of the DPBRN studies, "Blood sugar testing in dental practice", investigates the prevalence of hyperglycemia in dental patients of DPBRN practitioner-investigators. The September 2009 issue of Journal of Public Health Dentistry contains an article entitled "Dentists' attitudes and practices related to diabetes in the dental setting". The authors surveyed 265 general dentists in three states. The results illustrated that sixty-one percent of the dentists believed addressing diabetes was important to their role as a dentist, 86 percent advised patients with diabetes about periodontal risks, 18 percent provided diabetic-related services, 47 percent reported they knew how to assess for diabetes, and 42 percent felt well prepared to intervene with patients with diabetes. With hyperglycemia increasing and its link as a potential risk factor for periodontal disease, disease infection, and poor response to treatment, it is important for the dentist to be informed if their patient is hyperglycemic. Click here to view the PubMed abstract.

Updated information for clinicians regarding the H1N1 flu
Wednesday, September 09, 2009

The ADA has posted information on their website regarding the H1N1 flu in dental practice. It has also included updated frequently asked questions from dental providers. Click here to view this important information.

A Study of Flare-ups Following Single-Visit Root Canal Treatment in Endodontic Patients
Wednesday, August 19, 2009

One of the DPBRN studies, "Peri-operative pain and root canal therapy", involves understanding the factors related to the development of endodontic flare-up pain. The July 2009 issue of The Journal of the College of Physicians and Surgeons contains an article entitled "A Study of Flare-ups Following Single-Visit Root Canal Treatment in Endodontic Patients". In it, they follow 100 patients for a period of one month to determine if they experienced any flare-ups after single visit endodontic treatment. The study found that the single-visit root canal treatment was safe in terms of endodontic flare-ups (among their patients). Click here to view the PubMed abstract.

Practice-based Research is Community Engagement
Monday, July 20, 2009

The July-August 2009 issue of The Journal of the American Board of Family Medicine is the 4th annual PBRN theme issue. One of the feature articles is entitled "Practice-based research is community engagement". The article investigates the definition of “community” and how it is involved in practice-based research. The authors concluded that PBRNs have solved many research hurdles by engaging different communities and therefore making the conclusions drawn relevant to a broader population. Click here to go to The Journal of the American Board of Family Medicine website.

Association between chronic dental infection and acute myocardial infarction
Wednesday, July 08, 2009

The May 2009 issue of The Journal of Endodontics features an article entitled "Association between chronic dental infection and acute myocardial infarction". The article investigated the risk of chronic dental infection in persons with a history of acute myocardial infarction. The authors concluded that those with a history of acute myfacardial infarction had an increased number of missing teeth, less endodontically treated teeth, and more radiographic apical lesions compared to those with no significant medical history. Due to copyright constraints, only the abstract can be viewed. Click here to go to the PubMed website.

Caries risk in formerly sealed teeth
Thursday, June 18, 2009

The April 2009 issue of The Journal of the American Dental Association features an article entitled "Caries risk in formerly sealed teeth". The article investigated the risk of caries development in teeth with partially or fully lost sealants relative to the risk in teeth that never received sealants. The authors concluded that partially or fully lost sealants were not at a higher risk for developing caries compared to the teeth that never received sealants. Due to copyright constraints, only the abstract can be viewed. Click here to go to the PubMed website.

Dentists in practice-based research networks have much in common with dentists at large Evidence from the Dental Practice-Based Research Network
Tuesday, June 02, 2009

This article from the May/June 2009 issue of General Dentistry compared DPBRN practice characteristics to those of dentists who responded to the 2004 ADA Survey of Dental Practice. Click here to view the article.

Answering clinical questions using the principles of evidence-based dentistry
Wednesday, May 27, 2009

The March 2009 issue of The Journal of Evidence-Based Dental Practice features an article "Answering clinical questions using the principles of evidence-based dentistry". The article describes the use of electronic clinical decision support to enable dentists to implement the foundational elements of evidence-based dentistry and evidence-based decision making into clinical care. Due to copyright constraints, only the abstract can be viewed. Click here to go to the PubMed website.

New study finds higher cancer risk from x-rays
Thursday, December 11, 2008

The September 5th 2008 issue of DrBicuspid.com wrote a news item regarding dental x-rays and cancer risks, citing the September issue of the Journal of the American Dental Association (September 2008, Vol. 139:9, pp. 1237-1243) article which found that dental x-rays cause much more cancer than previously assumed and that dentists should change the way they do radiography. For example, take only the images you need, taking into consideration the patient’s caries risk; using F speed or digital radiography; or using rectangular collimation. Click here to view this article on DrBicuspid.com.

Contamination from Removing Personal Protective Equipment
Friday, August 29, 2008

This August 2008 article from Emerging Infectious Diseases discusses the evaluation of personal protective equipment removal protocol designed to minimize wearer contamination with pathogens. They found that following this protocol often resulted in virus transfer to hands and clothing. Click here to view the abstract.

Hand hygiene among general practice dentists: a survey of knowledge, attitudes and practices
Friday, August 29, 2008

This July 2008 article from Journal of the American Dental Association involves a study conducted to examine the self-reported knowledge, attitudes and practices of general practice dentists regarding hand hygiene and factors associated with hand hygiene and skin condition. Click here to view the abstract and comments from the Dental Evaluation and Consulting Service.

The Evidence-Based Dentistry Champions: a Grassroots Approach to the Implementation of EBD
Monday, July 07, 2008

The June 2008 issue of The Journal of Evidence-Based Dental Practice features an article "The Evidence-Based Dentistry Champions: a Grassroots Approach to the Implementation of EBD". The article describes the use of Champions, influential individuals to support the transfer of knowledge among their peers, as one effective approach used by others in the health care field to successfully implement science into clinical care. Due to copyright constraints, only the abstract can be viewed. Click here to go to the PubMed website.

January 2008 issue of JADA features 2 articles and editorial regarding bisphosphonate-associated osteonecrosis of the jaws (ONJ)
Friday, January 11, 2008

January 2008 edition of JADA has published two articles, as well as an editorial, that address the issue of bisphosphonate-associated ONJ. The first article, "Bisphosphonate Use and the Risk of Adverse Jaw Outcomes: A medical claims study of 714,217 people", used a retrospective review to identify osteoporosis and specific cancer patients and divide them into bisphosphonate (BP) exposed and non-exposed patients. Results showed that both osteoporosis and cancer patients treated with IVBP had a significantly higher number of inflammatory conditions of the jaws and higher number of surgical procedures. Osteoporosis patients treated with oral BP had a significantly lower number of inflammatory jaw conditions. All other analyses showed no statistical differences. The authors concluded that IVBP constitutes a risk for ONJ while oral BP may be protective.

This study has significant limitations, including a retrospective design and use of surrogate markers for ONJ. The authors also assume that all patients who were prescribed oral BP were compliant with their treatment, which is contrary to other published results. No effort was made in this study to confirm claims data against medical charts. It is also highly unlikely that cancer patients and osteoporosis patients treated with highly different amounts of IVBP will have the same association with ONJ. These findings contradict previous reports. Due to copyright restraints, only the abstract can be viewed. Click here to view the abstract on the PubMed website.

The second article, "Incidence of Osteonecrosis of the Jaw in Women With Postmenopausal Osteoporosis in the Health Outcomes and Reduced Incidence With Zoledronic Acid Once Yearly Pivotal Fracture Trial", was sponsored by NOVARTIS (the maker of zoledronic acid). These are results of a study previously published elsewhere, which did not have ONJ as one of its studied outcomes. Osteoporosis patients were treated with 5mg zoledronic acid IV yearly or placebo. About half of the patients received two drug administrations while the other half got all three doses during the 3 year study duration. The main study outcome was the number of bone fractures, which was significantly lower in the BP treated group. A review of the adverse effects uncovered one ONJ case in the BP-treated group and one in the control group. The authors concluded that there is no increased risk of ONJ from 5mg zoledronic acid IV administered yearly.

The limitations here are: no information on dental treatment is presented and the patients were followed for a very brief period of time. Given the frequency of ONJ reported in the literature for osteoporosis patients and the average time to development of jaw necrosis in this group, two to three doses of drug would not be expected to produce significant results. These findings contradict results published by Cartsos et al in the article discussed above. Due to copyright restraints, only the abstract can be viewed. Click here to view the abstract on the PubMed website.

The design of these two studies substantially limit their ability to inform daily clinical practice. An editorial, "Closing in on the Puzzle of ONJ", about these two articles by Michael Glick, JADA’s Editor–in-Chief, notes that “these studies do not help clarify the potential adverse effects of dental treatment in patients taking bisphosphonates.” DPBRN has two ONJ studies ongoing (DPBRN Study 7 and 12) that are designed to inform daily clinical practice. Results from these studies should be released in late 2008. Click here to view the editorial on the JADA website.

The Creation and Development of the Dental Practice-Based Research Network
Monday, January 07, 2008

The January 2008 issue of JADA features an article DPBRN entitled "The Creation and Development of the Dental Practice-Based Research Network". The article describes the creation and development of DPBRN, which originally began as the Alabama Dental Practice-Based Research Network in 2002. The article also explains the administrative and study development process within the network. Due to copyright constraints, only the abstract can be viewed. Click here to view the abstract on the PubMed website.

Intravenous Bisphosphonate Therapy and Inflammatory Conditions of the Jaw: A Population-based Analysis
Tuesday, December 04, 2007

This article from the July 2007 issue of The Journal of the National Cancer Institute investigates the association between intravenous bisphosphonate use and ONJ. Click here to view the article.

Economic Impact of Regulating the Use of Amalgam Restorations
Friday, August 10, 2007

An article on the economic impact of regulating the use of amalgams is in the September-October 2007 issue of Public Health Reports. In it, they discuss the financial impact of a ban on amalgam.

Click here to view the article.

Food and Drug Administration Toothpaste Alert
Monday, July 09, 2007

The U.S. Food and Drug Administration issued a warning to consumers to avoid using tubes of toothpaste labeled as made in China. The agency issued alert to prevent toothpaste containing the poisonous chemical diethylene glycol (DEG) from entering the country. DEG is used in antifreeze and as a solvent.

Click here to read this important information.

Study links chronic periodontitis to tongue cancer
Tuesday, May 29, 2007

The ADA recently published an article that links chronic periodontitis to an increased risk in tongue cancer in men.

To read more about the study, click here.

Overview of Osteonecrosis of the Jaw (ONJ)
Thursday, May 17, 2007

The ADA recently published a news article regarding Bisphosphonate medications and their link to ONJ. Included are the list of medications associated with ONJ and treatment guidlines.

Click here to read the overview.

Click here to read the treatment guidelines.

Updated guidelines recommend antibiotic prophylaxis for fewer dental patients
Monday, April 30, 2007

This news story from the ADA news posted April 19, 2007, discusses the revised guidelines for antibiotic prohylaxis in the dental office. The new guidelines include reducing the number of patients who have to be pre-medicated.

Click here to view the news story.

Practice-Based Research-"Blue Highways" on the NIH Roadmap
Wednesday, February 14, 2007

An article on practice-based research is in the January issue of JAMA. In it, they discuss the importance of practice-based research networks. Some of the benefits of PBRNs are: (1) their ability to identify problems that arise in daily clinical practice; (2) their ability to more quickly translate research into daily clinical practice that can improve clinical practice for the benefit of the patients; and (3) their ability to access a large number of patients. Practice-based research is the final common pathway for improving individual patient care and outcomes. Click here to view the article.

The evidence supporting alternative management strategies for early occlusal caries and suspected occlusal dentinal caries
Tuesday, January 09, 2007

This article from the March 2006 issue of The Journal of Evidence-Based Dental Practice assesses the strength of the evidence describing the effectiveness of alternative strategies to the detection and management of early occlusal caries and suspected occlusal dentinal caries. Click here to view the abstract of the article. Due to copyright restraints, only the abstract can be viewed.

Practicing dentistry using findings from clinical research: You are closer than you think
Tuesday, January 09, 2007

The November 2006 issue of JADA features a commentary regarding the 3 Dental Practice-Based Research Networks (DPBRN, PEARL, PRECEDENT) receiving funding from NIH-NIDCR. The commentary focuses on the importance of this research, the benefits of participating in a dental practice-based research network, as well as the knowledge gained from the results of the studies. To view the entire commentary, please visit the JADA website at www.jada.ada.org.

Diagnostic tools for early caries detection
Thursday, December 21, 2006

This article from the December 2006 issue of JADA reviews diagnostic tools for early caries detection. Click here to view the abstract of the article. Due to copyright restraints, only the abstract can be viewed. In order to retrieve the full article, please go to the JADA website (www.ada.org).

Research as a Career Option for Dental Hygienists
Monday, December 04, 2006

The November 2006 issue of Access published an article citing the various options that research has to offer for dental hygienists. Among them are the 3 Dental Practice-Based Research Networks, including DPBRN. Click here to view the article in its entirety.

Charles CH, Cugini M. Research as a career option for dental hygienists.Access 2006; 20(9):27-31. Reprinted by permission of the American Dental Hygienists' Association.

Information on cracked tooth syndrome
Thursday, October 26, 2006

One of the most requested topics of discussion is related to cracked teeth. In the June 2006 issue of Dental Truamatology, the aim of the study was to analyze the cases of tooth cracks in a dental hospital in a year, and to find out the characteristic features of cracks of teeth. Click here to read the abstract.

ADA Evidence-based clinical recommendations
Thursday, July 20, 2006

The ADA recently made available the evidence-based clinical recommendations for professionally-applied topical fluoride. These recommendations were developed through evidence-based assessments. Click here to view the Evidence-based Clinical Recommendations report of the Council on Scientific Affairs on the JADA website. In addition to the full report, an executive summary is also available through JADA. Click here to view the summary.

Journal of the Canadian Dental Association's "Point of Care" article
Wednesday, April 19, 2006

The Journal of the Canadian Dental Association has begun a “Point of Care” section that is designed to answer “everyday clinical questions by providing practical information that aims to be useful at the point of patient care.” DPBRN practitioner-investigators may find this Point of Care section useful. Click here to access this month's issue.

Making Sense of Evidence-Based Dentistry
Monday, February 20, 2006

One of the practitioner-investigators in the DPBRN, Dr. Brad Rindal, and a colleague at the University of Minnesota, Dr. Gary Anderson, wrote an article entitled "Making Sense of Evidence-Based Dentistry" in Northwest Dentistry, the journal of the Minnesota Dental Association. In it they discuss the role of scientific evidence in daily clinical practice, address concerns that some dentists may have about evidence-based dentistry, and discuss opportunities for the future of dentistry. Click here to read the article.

Clinical diagnosis of recurrent caries
Thursday, November 17, 2005

This article from the October 2005 issue of JADA reviews practice-based literature regarding the diagnosis of recurrent caries. Click here to view the abstract of the article. Due to copyright restraints, only the abstract can be viewed. In order to retrieve the full article, please go to the JADA website (www.ada.org).

Research in general dental practice
Monday, August 15, 2005

This article, by four DPBRN investigators, found in the Feb 2005 issue of Acta Odontologica Scandinavica, presents the need for a change in clinical dental research towards practice-based research. Click here to view the abstract. Click here to view the full paper.

Primary Care Practice-Based Research Networks: Working at the Interface between Research and Quality Improvement
Monday, August 15, 2005

This May/June 2005 issue of Annals of Famliy Medicine describes the emerging role of primary care practice-based research, quality improvement, and translation of research into practice. Click here to view the article.

The National Institute of Dental and Craniofacial Research Research for the practicing dentist
Wednesday, June 01, 2005

This article from the June 2005 issue of JADA discusses the new NIDCR initiative in general dentistry practice-based research. It also highlights research supported by the NIDCR and its implications for dental practices in restorative dentistry. Click here to view the abstract of the article. Due to copyright restraints, only the abstract can be viewed. In order to retrieve the full article, please go to the JADA website (www.ada.org).

"The integration of clinical research into therapeutic research: the role of the astute clinician"
Wednesday, March 30, 2005

This article reviews the strategies needed to engage clinicians in the process of therapeutic intervention through clinical research. Click here to view the abstract of the article, which appeared in the November 2004 edition of the Journal of the American Dental Association. Due to copyright restraints, only the abstract can be viewed. In order to retrieve the full article, please go to the JADA website (www.ada.org).

"The health insurance portability and accountability act privacy rule: a practical guide for researchers"
Wednesday, March 30, 2005

This article reviews the HIPPA guide for researchers. Click here to bring up the abstract of the article, which appeared in the April 2004 edition of Medical Care. Due to copyright restraints, only the abstract can be viewed.

"A primer for the HIPPA privacy rule for practice-based researchers"
Wednesday, March 30, 2005

This article reviews the HIPPA for practice-based researchers. Click here to bring up an Adobe pdf file of the article, which appeared in the November-December 2004 edition of the Journal of the American Board of Family Practice.

"A systematic review of the performance of a laser fluorescence device for detecting dental caries"
Monday, November 08, 2004

This article reviews the diagnostic performance of the DIAGNOdent device. Click here to bring up the abstract of the article, which appeared in the October 2004 edition of the Journal of the American Dental Association. Due to copyright restraints, only the abstract is available. For the full text, please visit the JADA website (www.ada.org).

"Are we ready to move from operative to non-operative/preventive treatment of dental caries in clinical practice?"
Monday, November 08, 2004

This article reviews the current state of patient care for dental caries. Click here to bring up an Adobe pdf file of the article, which appeared in Caries Research in 2004, published by S. Karger AG, Basel.

"Modern Concepts of Caries Measurement"
Monday, November 08, 2004

This article reviews the state of the science on the clinical management of dental caries. Click here to bring up an Adobe pdf file of the article, which appeared in a 2004 Special Issue of the Journal of Dental Research.