skip to Main Content

Recruiting, Ongoing, Upcoming, Completed

Studies for which we are currently recruiting

Dental caries is a preventable disease; however, it still affects large numbers of people globally and in the US. The expectation is that untreated caries will continue to rise as the aging population increases and the edentulous rate decreases.  Current evidence suggests that less invasive treatment should be employed that can preserve hard tissue and retain teeth long term. Nevertheless, disparity in the management of deep carious lesions remains.  The purpose of this study is to survey National Dental PBRN dentists regarding their treatment practices for managing deep carious lesions and assess their willingness and ability to participate in a randomized controlled trial evaluating deep caries removal strategies in permanent teeth in adults (18+).

Précis:

Pain is a common, and unwelcome aftermath of seeing the dentist. Indeed, pain has been deemed the fifth vital sign and many describe it as an adverse event (AE). After the effects of the most commonly-used local anesthetic diminishes, dental patients must rely on themselves and their own understanding for pain management following dental procedures. This has led to an over-reliance on prescribed opioids as there are no means to actively track patients’ pain once they leave the clinic. To understand effective/appropriate pain management, we need to examine the pain levels experienced by patients caused by which dental procedures. Such an inventory will allow providers to anticipate and better manage their patients’ post-operative pain.

Innovative mobile applications and connected health technologies that allow real-time tracking of patients’ symptoms, functional status and quality of life, provide healthcare professionals with data that were previously unavailable, and have fostered patient engagement, shared decision-making and adherence to treatment plans. We propose to explore an innovative solution to dental pain monitoring and management by implementing mobile phone technology to monitor patients’ pain during the critical acute post-operative phase.

We believe that by tracking patient reported outcomes (PROs) using mobile phones, patients with sub-optimal pain experiences will be easily identified. This study will demonstrate that PROs provide actionable data. This study can also serve as a model for implementing new health IT (mHealth) within dental practices to improve patient engagement.

This observational study will be conducted at the National Dental Practice-based Research Network (the Network) sites, which we believe are ideal for the development of this practical and focused post-operative pain management study. We will recruit up to 50 Network practices and 4050 patients who will receive push notifications through text messages using FollowApp.Care on their mobile phones at designated time intervals following their dental procedure. This innovative approach of implementing an existing and tested mHealth system technology (FollowApp.Care) into the real-world dental office setting of the Network will actively track pain and other complications following dental procedures. By patients using their mobile phones, we expect to promptly and precisely identify specific levels of pain for surgical dental procedures.

During the UG3 phase of the study (Yr 1-2) we will develop all study materials in UG3-Aim1, and in UG3-Aim 2 develop the design features and workflow for implementation of the study. During the UH3 phase (Yr 3-6) we will in UH3-Aim1, pilot test procedures to streamline data collection and workflow in the Network dental office. In UH3- Aim 2 we will assess post-operative pain intensity by procedure type; in UH3-Aim 3 we will assess provider and patient post-op management strategies and in UH3-Aim 4, we will evaluate patients’ and providers’ acceptance of the mHealth technology.

Dental intervention-related oral bleeding is an important consideration when treating patients on anticoagulants (ACs). The literature reports of extensive bleeding complications in patients on warfarin affecting 1.5-26% of the patients. The prevalence of minor bleeding is reported within the range of 3-9.7%. Several societies have published guidelines on how to minimize the risk for bleeding in patients receiving ACs, however, the rapidly emerging new anticoagulants pose new challenges with limited clinical data from the US.

The overall goal of the study is to assess the current understanding and approach of dental practitioners about the management of patients on anticoagulants, including conventional and direct oral anticoagulants (DOACs) in practice.

By surveying approximately 1,650 members of the National Dental Practice-Based Research Network, the survey will look into common tendencies and practices regarding dental treatment for patients on anticoagulants by practitioners across the United States. The information generated from the study will help in understanding the gaps in clinical practice regarding the management of anticoagulated patients, which will assist in development and implementation of guidelines for the treatment of patients on ACs, particularly DOACs, in the dental practice.

The Occupational Health and Safety Administration (OSHA) places dental healthcare providers (DHCP) in the very high exposure risk category for being exposed to SARS-CoV-2, the virus that causes COVID-19. However, data regarding the transmission dynamics of infectious agents in dental settings is limited, and studies evaluating methods to prevent organism transmission in dentistry are urgently needed. DHCPs regularly interact with patient saliva, which has high viral loads of SARS-CoV-2 in infected patients. Although it is discouraged to perform procedures on individuals with active COVID-19, epidemiologic data indicates that there are individuals who asymptomatically carry SARS-CoV-2. Thus, appropriate personal protective equipment (PPE) is necessary to protect DHCPs from SARS-CoV-2. However, data regarding the transmission of infectious agents when utilizing PPE in the dental setting is limited. Most transmission dynamics studies regarding PPE use were performed in the hospital setting; however, DHCPs have different and specific needs than that of a hospital healthcare provider. The purpose of this proposal is to identify potential routes of self-contamination during PPE donning and doffing by DHCPs using a fluorescent marker as a surrogate for pathogen transmission, and pilot an educational video focused on improving PPE donning and doffing techniques.

Amid the COVID-19 outbreak, dentistry urgently needs modified dental examination regimens that render quality care and ensure the safety of patients and the dental health care personnel (DHCP). Traditional dental examinations – more than 300 million per year in the US – rely on person-to-person visual-tactile examination, posing challenges to infection control and consuming large quantity of advanced level personal protective equipment (PPE).

Our long-term goal is to develop an innovative mDentistry (mDent) model. This model supplements the traditional practice of dentistry with virtual visits supported by mobile devices such as mobile phones, tablets, personal digital assistants, and the wireless infrastructures. The mDent leverages advantages of virtual dental visits and digital mHealth tools, such as intraoral cameras, to deliver virtual oral examinations, treatment planning, and interactive oral health management on a broad population basis.

This mDentistry (mDent) eHygiene study is the first step of utilizing the mDentistry model, which will access the rich resources of the National Dental Practice-Based Research Network, recruit 48 DHCP (Dentists and Hygienists) and 192 patients from practices across regions of the Network, and assess the acceptance of virtual dental examinations by patients and the dental health care personnel. The mDentistry eHygiene model has the potential of empowering patients with mhealth tools and engaging them in oral health care delivery.

Study results will inform of immediate modification of the dental service system, provide safe care delivery, and preserve PPEs amid COVID-19 pandemic.

In modern dental care procedures, aerosols and droplets are generated from the use of high speed handpieces, ultrasonic scalers, and other dental care equipment. This naturally puts both the patients and the dental care providers at a higher risk of respiratory infection due to the presence of higher levels of potentially contaminated droplets and particulate matters in dental offices. In this experimental study, we propose to develop a robust platform to fully assess the air quality in dental settings and develop recommendations for immediate and long-term adjustments necessary to minimize the transmission of highly infectious respiratory diseases such as COVID-19.

This project is designed to achieve three specific aims. First, we develop a respiratory patient simulator to generate and characterize a physiologically accurate cloud of droplets and aerosols. The experimental simulator will be furnished with particle image velocimetry capabilities as well as pressure, temperature, humidity, and particle sizer/counter sensors. This portable and versatile rig will enable us to carry out a benchmark study under well controlled laboratory conditions in order to generate and characterize the behavior of expelled particles resulting from the most common dental procedures as well as expiratory events. Second, we characterize the particle topography and size distribution during various dental procedures using air-turbine handpieces and air-water syringe sprays while a dentist performs these procedures on the patient simulator. We will fully characterize the particle distribution as a function of a large parameter space including the common dental treatments, patient’s posture, office layout, and air conditioning system settings, all in the absence of human subjects but with a dentist operating on the dental typodont of the respiratory simulator. Third, we quantify the map of particle topography and size distribution under modified work conditions. We will use barriers such as flexible face shields and an external oral suction device among other respiratory droplet protective/preventive equipment to reduce the transport of aerosols and droplets in dental offices. Imaging and point measurements will be performed under the altered/modified work conditions in the same parameter domain as in the second aim to characterize the change in particle concentration, accumulation, and dissipation over time.

This study will identify the most hazardous particle concentration locations with respect to the patient/dentist and will reveal the most effective operation conditions and room layouts (open semi-open/closed) to provide specific recommendations for the reduction of aerosol/droplet transmission. We will investigate the spatio-temporal correlation of the particle size and concentration in different locations of the testing area over time. In a broader scope, this project provides us the opportunity to improve our understanding of the transport of dense clouds of particulate matters (in both liquid and solid forms) applicable to a wider array of respiratory related questions. In addition, this platform enables us to develop and test respiratory protective equipment using a range of physiologically accurate aerosols and droplets.

STILL IN DEVELOPMENT

Abstract:

The spread of the novel coronavirus, SARS-CoV-2 (SC2), has currently infected over 1.7 million Americans with COVID-19 and caused over 100,000 US deaths. The pandemic has severely impacted healthcare delivery systems, economic activity, and social relationships. In March 2020, most states temporarily postponed non-emergency oral healthcare services to reduce exposure to the disease and to conserve personal protective equipment (PPE) for hospital care. Many dental procedures generate substantial aerosols, droplets, and fomites. Beginning in late April, states began allowing dental offices to reopen for routine care services. However, the incidence of COVID-19 and related deaths are increasing in the US, with considerable variation by state and county. Public health agencies and professional organizations have published general practice recommendations for dental care and are expected to evolve as we learn more about this novel coronavirus. Dental practitioners may use different approaches and combinations to reduce SC2 transmission, including modifications to facilities, patient flow, dental procedures and delivery methods, and personal protective equipment (PPE).

This study establishes a National Dental PBRN COVID-19 REsearch (CORE) Registry to support multilevel intervention and implementation science research on topics that are important to dental practitioners that include factors at the environmental, organizational, and/or individual level. We will recruit about 2,000 active National Dental PBRN practitioners to participate in the CORE Registry study. The objectives of the proposed CORE Registry are to: a) identify effective approaches used by National Dental PBRN practitioners to mitigate SC2 transmission risks, their costs, and assess practitioners’ comfort levels with these approaches; b) disseminate and discuss effective combinations of mitigation methods with participating practitioners and evaluate the impacts of these activities on the use of effective mitigation approaches and comfort levels, accounting for other factors; and d) establish a modular infrastructure to support the design and conduct of additional multilevel clinical and implementation science research. Classification and Regression Tree techniques are used to evaluate study objectives, overall and by practice setting, location, and specialty.

Abstract

Little is known regarding aerosol generation during dental procedures. This information is critical to help dental healthcare personnel make evidence-based decisions regarding appropriate personal protective equipment (PPE) use in dental clinics. The purpose of this proposal is to quantify aerosol formation during common dental procedures and evaluate current non-evidence-based strategies employed in dental settings to reduce aerosolization.

Our multidisciplinary team includes environmental engineers from Washington University in St. Louis who will quantify particle size, concentration, and duration in real world dental settings; infectious diseases and infection prevention experts from Washington University School in St. Louis of Medicine who will interpret the data;  dental partners, including St. Louis University Center for Advanced Dental Education and community clinics, which will serve as collaborating sites; and international leaders in dental research who will serve as dental content experts.

At the end of this grant, our team will provide pragmatic guidance to dentists regarding optimal PPE (e.g., surgical mask vs N95 respirator or equivalent) for a variety of common dental procedures. Furthermore, our team will determine the impact of a variety of aerosol mitigation interventions on particle size and quantity in real world dental settings.

Ongoing studies that are closed to further enrollment

None at the moment.

Studies for which data collection has ended

Précis:

A target of 1,000 men and women aged 30-69 years were enrolled over a 6-month period, with up to 1,200 enrollments allowed to avoid cutting off enrollment in the middle of a business day. Thirty practice locations were recruited from the 6 National Dental PBRN regions (5 practice locations per region). Participating patients were recruited during routine clinical visits with participating National Dental PBRN practitioners. Each practitioner recruited 25-30 patients. Patients were provided  with a tablet computer on which the study was explained, electronic consent was obtained, patient eligibility was assessed, an oral HPV risk factor survey was administered, and patient selection for oral rinse collection was determined. Based on survey responses, the top three deciles of risk (~300) and a random selection of 1 in 12 of those in the lower deciles (~59) were selected for oral rinse collection (~359 total). An oral rinse sample was obtained by means of a 30 second rinse and gargle with ScopeTM mouthwash (or saline), expectorated into a sterile specimen collection cup, sealed and stored at 4°C. Specimens were shipped by practice staff approximately weekly or twice a week to a central laboratory for human papillomavirus (HPV) detection. HPV results were communicated to the dental practitioner through the study’s secure web application. Patients with a high-risk oral HPV infection (anticipated to be ~25 individuals) were offered enrollment into a prospective study inclusive of a blood draw, an oral cancer examination, and a 6-month follow-up dental visit (window: 5-9 months) with a repeat oral rinse and an electronic oral cancer risk factor survey. Patients were compensated with a gift card for each major study procedure.

Objectives:

The primary objective of this study were to estimate the proportion of the study population with an oral high-risk HPV infection.

The secondary objectives of this study were to:

  1. Evaluate the feasibility and acceptability of baseline study procedures performed by participating patients and staff;
  2. Measure the distribution of demographic and behavioral characteristics associated with oral HPV infection;
  3. Determine compliance with and feasibility of procedures performed at a 6-month follow-up visit (window: 5-9 months), including blood draw, second oral rinse specimen collection, oral cancer screening examination, and completion of an oral cancer risk factor survey.

This was an internet-based clinical trial of oral cancer prevention. Eligibility required internet access in the dental practice. The project was directed at prevention of oral cancer in dentistry by offering internet education and tools for the practice and support for all members of the practice. The project was not very time consuming, did not require training beforehand, and enhanced preventive care and risk management in the practice. To participate, each practice: (a) completed a series of internet continuing education modules; (b) encouraged its staff to support the project by also completing the modules; (c) designated a staff member to distribute 100 postcard surveys to patients at four different times for total of 400 postcards; (d) used the educational tools to enhance the preventive care in the practice. In addition to other benefits, the practice was paid an honorarium for its participation. Due to the success of the recruitment of this study, we increased the number of participants from the original plan of 140 and recruited 190 practitioners into the study. Any information that was provided is confidential and only reported in the aggregate. This project was primarily funded by an R01 grant from NIDA and NIDCR (R01-DA-17971).

Précis:

Almost all research on AOB treatment and stability is from retrospective case series. Therefore, this study had tremendous potential to provide practitioners with stronger evidence about AOB treatment outcomes and stability for adults. It also provided information about retention outcomes. Additionally, the gathering of patient-reported data about the decision to pursue a specific treatment option and patient satisfaction after treatment was extremely valuable.

This was a prospective, observational 3.5 year cohort study of approximately 840 adult patients in active orthodontic treatment for AOB who expected to have treatment completed within 24 months of enrollment into the study from approximately 210 National Dental PBRN orthodontists or dentists who routinely performed orthodontic treatment.

Objectives:

The primary objective was to estimate the proportion of patients 1) treated successfully (determined at the end of active treatment), and 2) whose treatment was stable (determined at one year post-active treatment).

The primary outcome measure to determine success of treatment was overbite at the end of treatment, and the primary measure to determine the stability of treatment ascertained one year after removal of orthodontic appliances was the overbite measurement.

The purpose of this project was to identify methods that DPBRN dentists used to diagnose and treat caries lesions. The aims of this study were to: (a) quantify the percentages of DPBRN dentists who report using selected methods for caries diagnosis; (b) quantify the percentage of DPBRN dentists who report using a caries-risk assessment protocol of any variety; (c) quantify the percentages of DPBRN dentists who report intervening surgically at caries stages E1, E2, D1, D2, or D3. The aims were met by enrolling more than 500 DPBRN practitioner-investigators, each of whom completed a 10-page questionnaire about caries diagnosis and treatment assessment. Findings from this study were compared to treatment that was actually delivered as determined in DPBRN studies of primary and replacement restorations.

The incidence of diabetes mellitus has been increasing at epidemic proportions, making this chronic disease the most common medical condition in dental patients. Hyperglycemia has been identified as a potential risk factor for periodontal disease, disease infection, and poor response to treatment. Additionally, an estimated 4% of Americans are undiagnosed diabetics, and more than 80% of the diagnosed patients are not well-controlled. Early diagnosis and intervention have been shown to improve outcomes and reduce morbid medical complications in diabetic patients. Thus, identifying hyperglycemia in dental practice could lead to significant improvement in both the dental and medical outcomes.

This study investigated the prevalence of hyperglycemia in dental patients of DPBRN practitioner-investigators. The global aim of this study was to determine the feasibility of blood sugar testing and diabetes screening in dental practice. The specific aims of this study were to quantify the: 1) percentage of DPBRN patients who meet the American Diabetes Association screening criteria and describe the characteristics of these patients; and 2) acceptability of conducting blood sugar testing in the dental office and barriers to regular screening, as reported by DPBRN patients and practices.

*the terms ‘blood sugar’ , ‘blood glucose’, and ‘hyperglycemia’ are related and interchangeable in some contexts. DPBRN adopted the term ‘blood sugar’ for the title of this study to tailor its communication to a lay, non-dental, non-medical audience. This helps facilitate explaining the study to dental patients.

Osteonecrosis of the jaws (ONJ) is a potentially morbid and costly oral condition. In the recent past more than 200 cases of ONJ have been described in patients treated with bisphosphonates (BPs) for osseous cancer lesions or osteoporosis. The number of BP prescriptions has been steadily increasing, creating concerns about this potential side effect. The causes and risk factors for ONJ are not known. In this study we investigated these issues making use of the research infrastructure from the three dental practice-based research networks (PBRNs) funded by NIDCR.

The specific aims of this study were to test the hypotheses that: (1) BP treatment is a risk factor for ONJ; and (2) dental diseases, particularly periodontal disease and invasive dental procedures such as dental extractions are true risk factors for ONJ, or whether these procedures are a consequence of the necrotic disease process. This study quantified the impact that BP exposure had on the risk of developing ONJ, relative to comparable control patients, using a case-control study design. The risk factors studied included BPs, dental risk factors, and other factors, such as radiation and steroid therapy. All the patients with ONJ identified from the PBRNs were recruited for the study. Cases were identified by a dentist in the PBRN and were diagnosed by the dentist or a specialist as having ONJ with an onset between January 2005 and January 2007. Each case had three controls from the practice that identified the case. The dentist summarized the relevant dental treatment history and provided a dental disease diagnosis history from January 2000 until diagnosis of ONJ for cases, and until recruitment for controls. A professional centralized interviewer within each PBRN administered the same standardized questionnaire to cases and controls over the telephone.

Relevance to public health: This study was a unique and timely opportunity to investigate risk factors for ONJ, results from which may have a substantial impact on dental health and oral-related quality of life in an increasing number of patients.

Précis:

This was a prospective, observational 4-year cohort study of both symptomatic and asymptomatic cracked teeth in 3,000 patients of ages 19-85 from 150-300 National Dental PBRN practices. Subjects received patient-, tooth- and crack-level assessments of a cracked tooth at baseline and follow-up visits over the subsequent four years.

Objectives:

The primary objective of the study was to identify patient-, tooth-, and crack- level characteristics associated with initial tooth symptom status, and to determine, over a four-year follow-up period, the associations of these multi-level factors with changes (tooth “failure”) that occured in an initially symptomatic or asymptomatic cracked tooth. Changes in the study tooth over time—outcomes that define the development of tooth “failure”– included crack progression, sign/symptom development, need for restorative dentistry, endodontic therapy or tooth extraction, development of periradicular lucency and loss of pulp vitality.

Many teeth required treatment over the course of the study period. Therefore, secondary objectives of the study were to:

  1. Identify multi-level (practice-, practitioner-, patient-, tooth-, and crack- level) factors associated with treatment recommendations for asymptomatic and symptomatic teeth provided by practitioners across the US;
  2. Identify associations between crack characteristics and time-to-treatment rendered during the four-year follow-up period;
  3. Determine, among treated cracked teeth, associations between the external and internal crack characteristics, which included externally detectable characteristics and internal characteristics that are observed during invasive treatment of the tooth.
  4. Evaluate outcomes of various treatments rendered on cracked teeth by determining associations between treatment rendered and time to tooth failure after treatment has been rendered on cracked teeth during the four-year follow-up period. These tooth outcomes include crack progression, sign/symptom development, and further recommended treatment of the tooth, development of periradicular lucency and loss of pulp vitality.

Précis:

The study examined the use of two diagnostic devices on dental practitioners’ identification and treatment of SOCLs. A total of  90 practitioners throughout the nation collected and recorded descriptive and treatment information for 40 SOCLs (one lesion/patient), 20 during the pre-intervention period and 20 during the intervention period. Practitioners were randomized into one of three arms:  no diagnostic device, DIAGNOdent, and Spectra. They also completed diagnostic vignettes at the beginning and end of each study, as well as a post-study questionnaire.

Objectives:

The primary objective of the study was to quantify the difference in proportion of SOCLs treated operatively when a diagnostic device was used compared to when one was not used, and to quantify the difference in proportion of SOCLs treated operatively that extended into dentin when a diagnostic device is used compared to when one was not used.

The secondary objectives of the study were to:

  • Identify the clinical characteristics of SOCLs that best predict caries that extend into dentin;
  • Determine whether the principal factors used by participating practitioners in managing SOCLs change when a caries detecting device is employed; and
  • Obtain practitioners’ assessments of the utility of the devices in their practices.

This was an internet-based clinical trial of oral cancer prevention. Eligibility required having internet access in the dental practice. The project was directed at prevention of oral cancer in dentistry by offering internet education and tools for the practice and support for all members of the practice. The project was not very time consuming, did not require training beforehand, and enhanced preventive care and risk management in the practice. To participate, you must have: (a) completed a series of internet continuing education modules; (b) encouraged your staff to support the project by also completing the modules; (c) designated a staff member to distribute 100 postcard surveys to patients at four different times for total of 400 postcards; (d) used the educational tools to enhance the preventive care in your practice. In addition to other benefits, the practice was paid an honorarium for its participation. Due to the success of the recruitment of this study, we increased the number of participants from 140 to 190. The goal of 190 practitioners was met. Any information that was provided is confidential and only reported in the aggregate. This project was funded by an R01 grant from NIDA and NIDCR (R01-DA-17971).

There is great variation in caries diagnosis and management, with many dentists choosing a surgical approach rather than non-invasive treatment methods (“watchful monitoring” combined with prevention) for early caries. Approaches that delay placement of the first restoration may be a key source of improving the long-term effectiveness of dental care. This project focused on improving the quality of dental care by fostering movement of the latest scientific advances into daily clinical practice in the area of early caries treatment.

The aims of this project were to: (1) develop a patient handout to encourage patient acceptance of non-invasive treatment for early caries in permanent teeth and to increase dentists” use of non-invasive treatment; (2) quantify patient satisfaction with treatment options for early caries to quantify patient acceptance; and (3) quantify pre- and post-intervention caries stage at which dentists place the first restoration to determine the feasibility of the intervention.

This project entailed instrument development as well as a feasibility study that informed the design of a subsequent clinical trial in dental private practices. Semi-structured qualitative interviews with 30 patients and 10 dentists were conducted to develop the patient handout. Specific factors from pre-existing patient satisfaction surveys were used as quantitative tools. The handout was tested for readability and content structure. The study design was factorial, with patient satisfaction and handout assessment data from 300 surveyed patients diagnosed with early caries by participating dentists. The feasibility study design was longitudinal with pre- and post-intervention caries stage data from each participating DPBRN dentist collected from the practice assessment questionnaires. The 10 practitioners were recruited to participate in the study, based on their early caries treatment pattern and a stratified convenience sampling scheme that encouraged representation of minority dentists and patients.

This was a nested case-control study in which DPBRN Study 17 patients who still had pain at 6 months and were seen by endodontic and orofacial pain experts. The primary goal of this study was to determine the proportion of patients with pain who would best be managed with traditional dental care compared to those who had a non-odontogenic source for their pain, so that treatment directed at the etiology of their pain would occur.

Précis:

This study examined patient, dentist, and laboratory factors associated with the fabrication of successful crowns. Each year, dentists must re-do thousands of crowns that are returned from the dental laboratory but are not clinically acceptable. It is not clear why some of these crowns are unsatisfactory. This clinical study that analyzed dentist and clinical variables to find predictors for crown success. Data from dental laboratories was collected in the clinical study to determine the prevalence of acceptable impressions, crown preparations and jaw relation records sent to labs for crown fabrication.

Précis:

This study examined patient, dentist, and laboratory factors associated with the fabrication of successful crowns. Each year, dentists must re-do thousands of crowns that are returned from the dental laboratory but are not clinically acceptable. It is not clear why some of these crowns are unsatisfactory. This was a questionnaire that documented current practices among clinicians making crowns, such as material choices and impression techniques.

Dental practices have advanced tobacco cessation by adopting a model of brief advice similar to that used by medical providers. DPBRN will do a randomized clinical trial designed to allow dental hygienists to provide additional tobacco cessation counseling with little additional marginal effort. This would be done using an internet-based referral to external resources. This system, termed “Refer2Quit”, will allow hygienists to refer patients to a patient education website and accompanying Quitline, while the patient is still in the dental office. Our overall goal is to advance science related to internet use in health services delivery by targeting dental hygienists. The intervention will also support subsequent brief counseling by providing feedback on the activities of patients to the practice through a secure server.

We had these specific aims:

  1. Test the hypothesis that the proportion of patients REFERRED to self-management resource websites would be larger in intervention practices compared to control practices.
  2. To test the hypothesis that the proportion of patients referred who GO to the patient self-management website would be larger in intervention practices compared to control practices.
  3. To test the hypothesis that the proportion of smokers who are referred who QUIT at six months would be larger among intervention compared to control because of the additional connectivity of the intervention.

This was done by randomizing 80 community-based dental practices into a clinical trial that contrasts the intervention with a paper-based “information prescription”.

The overarching goal of DPBRN is to impact the practice of dentistry and improve patient care. A critical issue is assessing whether the research conducted is achieving this goal. The three NIDCR-funded PBRNs (DPBRN, NWPRECEDENT, and PEARL), collectively known as the “Collaboration on Networked Dental and Oral Health Research” (CONDOR), have developed a strategy for assessing the impact of practice-based dental research on the PBRN practices and on the practice of dentistry in general. The strategy involves the development and use of a core questionnaire that includes several questions from each PBRN that have been extracted from questionnaires previously administered as part of their initial research program activities.

This project comprised the first administration of this Core Questionnaire with the purpose of assessing dental practice changes that may have occurred since the earlier administration of the individual questions within the separate networks. It also collected baseline information for the others. The Core Questionnaire were re-administered at later points in time. In this manner changes in practice over time and concurrent with research results dissemination were measured.

The purpose of this study was to update the status of practices in the network with regard to these items: practice type (solo, group, public health, academic, other); percent of patients who are regular care seekers versus problem-oriented; whether the practice shares facilities or organizational structure with medical providers; percent of patients with certain chronic diseases; how commonly patients are referred to physicians for medical evaluations; electronic dental record usage and type of software; preferences for how to have study results communicated; rubber dam usage for endodontic procedures; utilization of dental staff for specific dental procedures; opinions about dental therapists and other expanded-function dental staff.

Précis:

The study assessed isolation techniques used when performing root canal treatment among dentists in the network. A questionnaire was administered to eligible dentists in the network. The questionnaire assessed dentists’ use of various isolation techniques when performing root canal treatment; identified factors associated with use (or non-use) of rubber dams when performing root canal treatment (RCT); and identifed factors associated with rubber dam use during RCT.

Objectives:

The primary objective of the study was:

  • To quantify the self-reported use or non-use of rubber dams when performing RCT.

The secondary objective was:

  • To identify factors associated with use or non-use of rubber dams for RCT.

Study PI: Dr. Thankam Thyvalikakath, Indiana University

Brief study description

Key study publication:

Thyvalikakath T, Duncan W, Siddiqui Z, Michelle L, Eckert G, Schleyer T, Rindal D, Jurkovich M, Shea T, Gilbert G, National Dental PBRN Collaborative Group. Leveraging electronic dental record data for clinical research in the National Dental PBRN practices. Applied Clinical Informatics 2020; accepted.

Study protocol

Study data dictionary [pending]

Data set [this data set is too large to store on this web site.  If you would like access, please email Gregg Gilbert at ghg@uab.edu]

As part of the recruitment process, practitioners were provided background information and a FAQ page.

The purpose of this project was to use data from “primary” restorations to assess how defects that may lead to failure develop over time, and to follow restorations placed in a practice-based setting for up to three years. The specific aims were to:

  1. quantify the annual and 3-year incidence of defects and replacement rates on restorations inserted as primary restorations;
  2. test the hypothesis that directly-placed composite restorations have a significantly higher 3-year incidence of defects and significantly higher replacement rate after 3 years compared to amalgam restorations;
  3. test the hypothesis that the 3-year replacement rate of restorations in permanent teeth of adolescents is significantly higher than that of restorations in adults. Criteria used to evaluate restorations over time will be the same as those employed in the DPBRN study of replacement restorations. Recall frequency was according to the schedule used in the practice where the restoration was placed. Patients were informed about the follow-up study as part of the informed consent procedure. If a patient sought treatment in a different practice, informed consent included permission to contact that practice for information related to restoration(s) in this longitudinal study.

Although the progression of cavitated dental caries has slowed dramatically over the years, the prevalence of precavitated lesions has significantly increased; therefore, diagnosing and following these lesions has become an important part of daily clinical practice. There has been some debate on the best way to manage and treat these small lesions long-term. Some clinicians believe it is best to perform operative treatment and conserve tooth structure; whereas, other clinicians believe in managing it with preventive treatment, allowing the lesion the potential to remineralize or arrest over time. Limited literature is available for these “questionable” lesions and the reasons behind why clinicians are having difficulty diagnosing and treating them.

The aims of this study were to (1a) for unopened questionable occlusal carious lesions, test the hypothesis that the baseline clinical characteristics are significantly associated with change in caries status; and (1b) for opened questionable occlusal carious lesions, test the hypothesis that the clinical characteristics at baseline are significantly associated with caries depth.

These aims were met by performing a follow-up on the consecutive questionable occlusal carious lesions enrolled in “Prevalence of Occlusal Carious Lesions”. The study recorded the status of these lesions, if treatment changed,and the condition of the restoration or sealant, if applicable.

This study about occlusal carious lesions provided the opportunity to compare these results to “Assessment of Caries Diagnosis and Caries Treatment”, and “Prevalence of Occlusal Carious Lesions”.

The purpose of this project was to use data from the DPBRN study of replacement restorations to assess how defects that lead to failure develop over time, and follow restorations placed in a practice-based setting for up to three years.

The specific aims were to:

  1. quantify the annual and 3-year incidence of defects and replacement rates on restorations inserted as replaced restorations;
  2. test the hypothesis that directly-placed composite restorations have a significantly higher 3-year incidence of defects and significantly higher replacement rate after 3 years compared to amalgam restorations;
  3. test the hypothesis that there is no significant difference in 3-year replacement rates between restorations inserted that were partially replaced as compared to restorations that were completely replaced during DPBRN study of replaced restorations; and
  4. test the hypothesis that the 3-year replacement rate of restorations in permanent teeth of adolescents is significantly higher than that of restorations in adults.

Recall frequency was according to the schedule used in the practice where the restoration was placed. Patients were informed about the follow-up study as part of the informed consent procedure. If a patient sought treatment in a different practice, informed consent included permission to contact that practice for information related to restoration(s) in DPBRN longitudinal study.

Précis:

This was a prospective cohort study of patients with dentin hypersensitivity. The study population consisted of adult dental patients who had dentin hypersensitivity and the practitioners who provided treatment for this condition. Approximately 180 dentists across the nation enrolled 14 study patients, with an enrollment aim of 2,520 adult patients for the entire network.

Objectives:

The primary objective of the study was to gain a better understanding of the multiple treatments used to manage dentin hypersensitivity among US dental practitioners by characterizing methods of diagnosing dentin hypersensitivity in the practice setting, dentists’ selected treatment(s) of dentin hypersensitivity, and patient-reported pain outcomes over time.

The secondary objectives of the study were to explore patient-, practitioner-, practice-, and tooth-level characteristics that contributed to practitioners’ selected treatment(s) and approach(es) to care and to characterize patients’ satisfaction with the received treatment of dentin hypersensitivity.

Précis:

Temporomandibular Disorders (TMD) are the second most commonly occurring musculoskeletal disorders after chronic back pain resulting in pain and disability. Diagnosis and treatment of TMD are within the purview of general dentistry (NIDCR, 2009) with most patients consulting a general dentist regarding their painful TMD. Within the context of the National Dental Practice-Based Research Network (Network), the goal of this observational prospective cohort study was to identify factors contributing to TMD treatment decisions and treatment adherence, as well as the overall effect of TMD treatment on pain intensity and jaw function measured at 1-, 3- and 6-month follow-ups.  We recruited approximately 200 dentist practitioners from the six National Dental PBRN regions (Northeast, South Atlantic, South Central, Southwest, Midwest, Western).  Each participating dentist contributed to a total patient enrollment of approximately 1980.

Objectives:

The primary objective of this study was to identify the factors that contribute to practitioners’ treatment decisions for patients with painful TMD.

The secondary objectives of this study were to:

  • Identify factors that contribute to patients’ adherence to treatment, and
  • Describe observed changes from baseline at 1-, 3- and 6-month follow-up in pain intensity and jaw function associated with treatments.

The primary outcome measure of this study was the practitioners’ treatment decisions for painful TMD patients. The secondary outcome measures for this study were patient adherence, and pain intensity and jaw function measures. Numerous potential confounders and predictors were assessed for their associations with the treatment decisions, patient adherence, and changes in pain and function.

The overarching goal of DPBRN is to impact the practice of dentistry and improve patient care. A critical issue is assessing whether the research conducted is achieving this goal. The three NIDCR-funded PBRNs (DPBRN, NWPRECEDENT, and PEARL), collectively known as the “Collaboration on Networked Dental and Oral Health Research” (CONDOR), developed a strategy for assessing the impact of practice-based dental research on the PBRN practices and on the practice of dentistry in general. The strategy involved the development and use of a core questionnaire that included several questions from each PBRN that have been extracted from questionnaires previously administered as part of their initial research program activities. This project comprised the pre-planned second administration of this Core Questionnaire with the purpose of assessing dental practice changes that may have occurred since the first administration (DPBRN Study 16).

Patient satisfaction is important to practicing dentists because of links to regular return visits, caregiver trust, perception of technical competence, and treatment outcome.  However, little is known about the satisfaction of dental patients, particularly as related to specific dental procedures.  Dental restorations are one of the most commonly performed dental procedures, yet no study has documented patient satisfaction with a restoration-specific dental visit.  There are many unique characteristics to a dental restoration visit such as dentist-patient communication about the restoration material, comfort during and following the procedure, and the patient’s view of the quality of the restoration.  How patients prioritize these characteristics or use them in decisions about satisfaction are unknown.  It is known that patients make judgments of the technical competence of dentists, but whether these judgments have any association with immediate or long-term restoration quality and therefore the extent to which they are valid is undetermined.

The aims of the study were to determine the relative contribution and importance of characteristics of a restoration and restoration visit with overall patient satisfaction following a dental visit that involved a restoration replacement or repair; and to link patient’s satisfaction and perception of the dentist’s technical expertise with long-term objective outcomes of the dental restoration.

This study involved approximately 6,000 patients that received at least one dental restoration repair/replacement.  Patients were recruited from practices participating in the DPBRN study of replacement restorations, most of whom were enrolled in a DPBRN longitudinal study. Participants completed and mailed the survey questionnaire the day following the dental visit to allow them to evaluate and respond to the short-term outcomes, such as comfort and function, as well as to the immediate aspects of the visit.

Pain following root canal therapy occurs commonly, with an incidence range of 3% to 58% depending on the definition. The majority of this post-endodontic pain is well controlled using current treatment modalities, but a small subset of patients seems to be resistant to treatment and experiences severe pain. Significant post-endodontic pain is commonly referred to as an endodontic flare-up and has been defined as severe pain that precipitates a patient-dentist interaction within one week of treatment initiation. Such pain, when associated with local soft tissue swelling, is known to occur in 3% of all cases of root canal therapy. Given that >16.4 million root canal therapies are performed every year within the US, about half a million patients experience severe pain that is resistant to treatment. This pain is known to cause significant amounts of dental anxiety and fear, which in turn is a major barrier to receiving dental care and can have other negative psychosocial consequences. For these reasons, it is important to understand the factors related to the development of endodontic flare-up pain in efforts to better treat this pain. Research on endodontic-related pain has suggested that (a) the intensity of pre-operative pain and (b) the experience of intra-operative pain are significant factors related to the subsequent development of persistent tooth pain. Therefore, the primary goal of this study was to assess the presence and magnitude of pre-operative and intra-operative tooth pain, and determined how these factors were associated with the outcome of intense post-endodontic flare-up pain. The overall goal was to better understand how the experience of peri-operative pains relate to each other. The long-term goal of this line of research was to identify the modifiable pre-operative factors that put patients at greater risk of developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, increase their patients’ quality of life, and decrease the number of dental emergency interactions. Since future studies within the network are required to achieve this long-term goal, the secondary goal of this study was to assess the feasibility of recruiting patients using the DPBRN and to pilot test a more detailed data collection procedure from both patients and practitioners using a small subset of practitioners and within the DPBRN.

Dentists perform over 16.4 million root canal therapies every year in the United States (American Dental Association, 2002). Persistent tooth pain, which is pain present 6 months after root canal therapy, is known to occur following root canal therapy in a fashion similar to other post-surgical pains, such as phantom limb pain. Research in this area is limited, but suggests a frequency of occurrence of 3% to 12% for persistent post-root canal pain. Despite the commonality of root canal treatment, the occurrence and severity of persistent tooth pain and extent of interference with daily life from this condition has not been well studied in dental care populations. Adequate treatments for some of these pains are emerging, and early identification and treatment may improve prognosis, but the first step is to determine how widespread the problem is and how severely it affects dental patients. This knowledge is expected to influence patient and provider decisions about dental treatment and to facilitate the development of preventative treatment strategies, such as pre-emptive analgesia, aimed at reducing patients’ modifiable peri-operative risk factors. The long-term goal of this line of research is to identify pre-operative factors that put patients at greater risk for developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, and increase their patients’ quality of life. For this long-term goal to be realized, future externally funded research using the DPBRN is anticipated; hence, there is a need for pilot data to support the feasibility of such research. Even though this research proposal is focused on understanding the outcomes of root canal therapy, with the long-term goal of improving care, the resultant data may have ramifications for surgical procedures performed elsewhere in the body. Undoubtedly aspects of this research will be specific to root canal therapy, but since pain is a centrally derived phenomenon that affects the whole individual, aspects of the involved pain mechanisms are likely shared with other surgical procedures. Thus, this line of research could have an impact on healthcare in general.

This was a retrospective cohort study to test the hypothesis that endodontic treatment failure is significantly higher among dental patients with diabetes mellitus type II when compared to non-diabetic controls. The idea for this research project was a result of ideas provided by dentists who completed the Dental PBRN enrollment questionnaire. This project was primarily funded by an R21 grant from NIDCR (R21-DE-16033).

Précis:

Severe post-operative pain following root canal therapy (RCT) occurs in about 20% of patients. The presence of persistent pain following RCT is about 10%, and initial evidence suggests that half of these patients experiencing persistent pain have a non-odontogenic etiology for this pain. Applying odontogenic strategies to treat non-odontogenic pain may increase incidence and duration of chronic oral pain. The overarching goal of this prospective observational cohort study was to investigate risk factors for severe pain following RCT, the prevalence and impact of persistent pain following RCT, and the impact of severe and persistent pain on health-related quality of life. Patient and treatment-related data was collected before and after RCT completion. Follow-up data was collected 1 week, 6 months, and 12 months following RCT completion. Approximately 150 practitioners from six National Dental PBRN regions enrolled approximately 1,650 adult patients.

Recruitment Flier

Although the progression of cavitated dental caries has slowed dramatically over the years, the prevalence of precavitated lesions has significantly increased; therefore, diagnosing these lesions has become an important part of daily clinical practice. Due to the size of these lesions, the ability to correctly diagnose and treat them can be difficult. There has been some debate on the best way to manage and treat these small lesions. Some clinicians believe it is best to perform operative treatment and conserve tooth structure; whereas, other clinicians believe in managing it with preventive treatment, allowing the lesion the potential to remineralize or arrest. Limited literature is available for these “questionable” lesions and the reasons behind why clinicians are having difficulty diagnosing and treating them.

The aims of this study were to (1) quantify the prevalence of questionable occlusal carious lesions in permanent teeth in the first 100 consecutive eligible patients of DPBRN practitioners; (2a) for unopened questionable occlusal carious lesions, test the hypothesis that the patient’s baseline caries risk is significantly associated with lesion description (i.e., perceived caries status); and (2b) for opened questionable occlusal carious lesions, test the hypothesis that the patient’s baseline caries risk is significantly associated with caries depth.

These aims were met by enrolling 80-100 practitioner-investigators, each of whom recorded information about 100 consecutive patients and 25-50 consecutive questionable early occlusal caries lesions on a 2-page questionnaire. The study recorded the reason why these occlusal lesions were questionable, the tools used to diagnose the lesions, the reason why a certain treatment was rendered, and the depth of the lesions when treated operatively.

This study about early occlusal caries lesions provided the opportunity to compare these results to DPBRN study entitled “Assessment of Caries Diagnosis and Caries Treatment”, a questionnaire wherein practitioners’ caries diagnosis, caries treatment, and preventive dentistry practices were quantified as well as compare these results to the DPBRN study entitled “Longitudinal Study of Questionable Occlusal Carious Lesions”.

The overall goal of this project was to collect data to be used in preparing an application for a Clinical Trial Planning Grant and then in designing a subsequent Phase III clinical trial. The ultimate goal was to determine the most practical approach to conduct a randomized clinical trial to evaluate initial interventions for patients with painful temporomandibular muscle and joint disorders (TMJD) in primary care clinics. This project characterized by surveying the feasibility of recruiting dentists in primary care dental clinics in The Dental Practice-Based Research Network and document their current initial care for their TMJD pain patients.

Précis:

Since the advent of antibiotics in the mid-1940s, and in particular with the first formal recommendations for antibiotic prophylaxis (AP) by the American Heart Association (AHA) in 1955, there has been a significant proliferation of the use of secondary AP in dental practice.However, there has been increasing controversy about the widespread use of antibiotics for some prophylactic, as well as therapeutic dental purposes, primarily due to concerns about antibiotic resistant bacteria and adverse drug reactions, weak evidence to support the practice of AP, and the costs and inconvenience associated with the use of AP.  Consequently, this study aimed to identify critical conceptual and standardization gaps in the practice and implementation of AP for patient populations felt to be at increased risk to develop infective endocarditis (IE) and/or prosthetic joint infections (PJI) prior to dental procedures. By surveying approximately 2,500 members of the National Dental Practice-Based Research Network, the survey revealed some of the common tendencies and practices regarding AP by practitioners across the United States.

Précis:

Using a single-arm trial design, this study examined the feasibility and acceptability of evaluating “QuitAdvisorDDS”, a clinical decision support software application designed to facilitate implementation of evidence-based tobacco treatment interventions into the dental setting. The study examined the impact of the QuitAdvisorDDS tool on patient outcomes related to tobacco use and cessation attempts as well as provider knowledge, attitudes, and practices regarding tobacco treatment. Practitioner (dentists and hygienists) completed surveys at baseline and follow-up, while patients completed surveys at baseline and 1-month follow-up. An embedded substudy also evaluated the feasibility and acceptability of collecting biospecimens (saliva) to serve as biochemical verification of smoking status.

Précis:

This study characterized and examined the structure, content, and pathways of clinical information in the dental information ecosystem. It also gave attention to disruptive events that impact knowledge and information diffusion through a focus on alternative nicotine products (ANPs). The study addressed the clinical information-seeking networks (both formal and informal) of dentists and hygienists.
This was a multi-methodological 39-month study that was conducted in the National Dental Practice-Based Research Network (National Dental PBRN). The study involved one round of survey implementation, on-going bibliometric data collection and web scraping, as well as one round of feedback interviews/focus groups via video conference and/or at regional Dental PBRN meetings.

This study of previously-untreated permanent tooth surfaces was the second of the restorative dentistry studies planned for the Dental Practice-Based Research Network (DPBRN). The aims for this study were to: (a) quantify DPBRN practitioner-investigators’ pre-operative and post-operative assessments of the depth of the caries lesion being treated and (b) quantify the prevalence of dental material types used to restore the first restoration in a permanent tooth surface. These aims were met by enrolling 229 DPBRN practitioner-investigators in this study, each of whom recorded information about an average of 50 consecutive restorations that they placed on unrestored permanent tooth surfaces. The study recorded the main reason that the restoration was placed, the preoperative and postoperative depth of the caries lesion on the previously unrestored surface, and the type of dental restorative material that was used. This study about restorative treatment received by DPBRN patients provided the opportunity to record not only the diversity in the treatment provided, but also to generate information for subsequent hypothesis testing and for the design of future studies.

This study recorded the reason(s) for replacement or repair of 50 consecutive restorations as diagnosed by 200 DPBRN clinicians. This constituted baseline data which was used for analysis of factors that affect the diagnoses.

Factors that affected the number of replaced or repaired restorations was analyzed using baseline data, e. g., how they vary among clinicians, the practice setting, the gender of the patients and the clinicians, and the clinicians” attitudes towards caries lesion development and caries risk assessment. These data was also a source for monitoring treatment changes in restorative dentistry that may occur over time. A better understanding of the reasons why restorations needed to be replaced or repaired led to improvements in the longevity of restorations.

Précis:

This study aimed to identify critical training gaps in dental implementation of opioid prescribing risk mitigation strategies. Dentists follow primary care physicians as the second leading prescriber of immediate release opioids. However, dentists typically have limited exposure to addiction training and may not be familiar with recommended opioid prescribing risk mitigation strategies. This study consisted of an online survey that documented current knowledge, training experiences, and practice behaviors related to acute dental pain management and opioid analgesic prescribing among member dentists. Data from the survey was paired with key practice-related enrollment data to identify aforementioned gaps in knowledge and directly inform the development of an educational intervention that provided dentists’ training in opioid misuse screening and implementation of risk mitigation strategies when prescribing opioids for acute pain management.

In the past two years, the literature has described more than 200 cases of osteonecrosis of the jaws (ONJ) among patients treated with bisphosphonates (BPs). About 3 million patients have been treated with BPs and another 7-8 million osteoporotic or cancer-afflicted persons in the U.S. may take BPs in the near future. To date, the prevalence of ONJ has not been quantified, nor is it known whether exposure to BPs actually increases ONJ prevalence. We investigated these issues using data from a large cohort of patients from the Kaiser Permanente Northwest and HealthPartners medical and dental plans. Both health maintenance organizations are part of DPBRN, allowing us to take advantage of an already-functioning interdisciplinary collaborative infrastructure.

This study addressed three specific aims. Aim 1 quantified the annual, consecutive prevalence of confirmed ONJ cases in a large cohort of adults 40 years of age and older from 1994 to 2005. Aim 2 tested the hypothesis that BP treatment is a risk factor for ONJ. We quantified the impact of BP exposure on the risk of developing ONJ, relative to comparable patients not exposed to BP, using a retrospective cohort design and time-to-event analysis. Finally, Aim 3 tested the hypothesis that ONJ develops only in patients treated with BPs who have additional risk factors. These health maintenance organizations provided a unique, unprecedented opportunity to investigate ONJ by including thousands of patients through their electronic medical and dental records.

Relevance to public health: In light of the substantial morbidity due to ONJ, this study provided important information about this growing health concern.

Précis:

The dentist’s office may be an important setting for conducting multi-risk assessments (MRAs) for oral and physical health risks to increase opportunities for early assessment of and intervention for risk behaviors.  This study characterized dental practitioners’ (dentists and hygienists), dental payers’, and patients’ attitudes about: (a) conducting/participating in MRAs during dental visits; and (b) providing/receiving follow-up counseling about and referrals for identified risks. An analysis was also conducted of the dentists’ and dental hygienists’ scope of practice documents to determine if there were any regulatory barriers for conducting MRAs, risk behavior counseling, and referrals.

Read about the the following study highlights from the Practice-Based Research Network:

  • Assessing Outcomes of Cracked Teeth
  • Remineralization of White Spot Lesions after Removal of Orthodontic Brackets
  • Single Tooth Endodontic and Restorative Treatment Outcomes: PEARL Interim Findings
  • PEARL Non-Carious Cervical Lesion RCT Baseline and Sleep Bruxism Findings
  • Lessons Learned During the Conduct of Clinical Studies in the Dental PBRN
  • Repair or Replacement of Defective Restorations by Dentists in the Dental PBRN

Précis:

Worldwide, there were an estimated 274,000 new cases and 127,000 deaths attributed to oral cancer (OC) (ICD-O C00-C06), and over 600,000 new cases of head and neck cancer (HNC) reported in 2008. Over 70% of U.S. dentists self-report performing oral cancer (screening) examination (OCE) on most of their patients over 40 years of age, although the completeness, quality, frequency and validity of these examinations are unknown. Regardless, 18% of adults (8% of Blacks and 7% of Latinos) aged 40 years and over are reported to have had an OC examination in the last year.  Moreover, only 20% to 29% of adults reported ever having had an OCE. The overall goal of the project was to ascertain common practices related to oral cancer examinations by U.S. dentists and dental hygienists, by geographic region, demographics and practitioner and practice characteristics.
This was a National Dental Practice-Based Research Network (National Dental PBRN) survey study that consisted of 2 components: 1) a questionnaire survey (33 questions), and 2) sixteen standardized clinical case-vignette presentations with 6 specific process questions. National Dental PBRN general dentists and dental hygienists were invited to participate in the study to describe the details of the OCE, including who, what, when, where, and why, as well as the details involved with patient disposition of newly discovered “suspicious” for oral pre-malignant or malignant lesions.

Studies for which we are currently recruiting

I am text block. Click edit button to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

Précis:

Pain is a common, and unwelcome aftermath of seeing the dentist. Indeed, pain has been deemed the fifth vital sign and many describe it as an adverse event (AE). After the effects of the most commonly-used local anesthetic diminishes, dental patients must rely on themselves and their own understanding for pain management following dental procedures. This has led to an over-reliance on prescribed opioids as there are no means to actively track patients’ pain once they leave the clinic. To understand effective/appropriate pain management, we need to examine the pain levels experienced by patients caused by which dental procedures. Such an inventory will allow providers to anticipate and better manage their patients’ post-operative pain.

Innovative mobile applications and connected health technologies that allow real-time tracking of patients’ symptoms, functional status and quality of life, provide healthcare professionals with data that were previously unavailable, and have fostered patient engagement, shared decision-making and adherence to treatment plans. We propose to explore an innovative solution to dental pain monitoring and management by implementing mobile phone technology to monitor patients’ pain during the critical acute post-operative phase.

We believe that by tracking patient reported outcomes (PROs) using mobile phones, patients with sub-optimal pain experiences will be easily identified. This study will demonstrate that PROs provide actionable data. This study can also serve as a model for implementing new health IT (mHealth) within dental practices to improve patient engagement.

This observational study will be conducted at the National Dental Practice-based Research Network (the Network) sites, which we believe are ideal for the development of this practical and focused post-operative pain management study. We will recruit up to 50 Network practices and 4050 patients who will receive push notifications through text messages using FollowApp.Care on their mobile phones at designated time intervals following their dental procedure. This innovative approach of implementing an existing and tested mHealth system technology (FollowApp.Care) into the real-world dental office setting of the Network will actively track pain and other complications following dental procedures. By patients using their mobile phones, we expect to promptly and precisely identify specific levels of pain for surgical dental procedures.

During the UG3 phase of the study (Yr 1-2) we will develop all study materials in UG3-Aim1, and in UG3-Aim 2 develop the design features and workflow for implementation of the study. During the UH3 phase (Yr 3-6) we will in UH3-Aim1, pilot test procedures to streamline data collection and workflow in the Network dental office. In UH3- Aim 2 we will assess post-operative pain intensity by procedure type; in UH3-Aim 3 we will assess provider and patient post-op management strategies and in UH3-Aim 4, we will evaluate patients’ and providers’ acceptance of the mHealth technology.

Ongoing studies that are closed to further enrollment

None at the moment.

Studies for which data collection has ended

Précis:

A target of 1,000 men and women aged 30-69 years were enrolled over a 6-month period, with up to 1,200 enrollments allowed to avoid cutting off enrollment in the middle of a business day. Thirty practice locations were recruited from the 6 National Dental PBRN regions (5 practice locations per region). Participating patients were recruited during routine clinical visits with participating National Dental PBRN practitioners. Each practitioner recruited 25-30 patients. Patients were provided  with a tablet computer on which the study was explained, electronic consent was obtained, patient eligibility was assessed, an oral HPV risk factor survey was administered, and patient selection for oral rinse collection was determined. Based on survey responses, the top three deciles of risk (~300) and a random selection of 1 in 12 of those in the lower deciles (~59) were selected for oral rinse collection (~359 total). An oral rinse sample was obtained by means of a 30 second rinse and gargle with ScopeTM mouthwash (or saline), expectorated into a sterile specimen collection cup, sealed and stored at 4°C. Specimens were shipped by practice staff approximately weekly or twice a week to a central laboratory for human papillomavirus (HPV) detection. HPV results were communicated to the dental practitioner through the study’s secure web application. Patients with a high-risk oral HPV infection (anticipated to be ~25 individuals) were offered enrollment into a prospective study inclusive of a blood draw, an oral cancer examination, and a 6-month follow-up dental visit (window: 5-9 months) with a repeat oral rinse and an electronic oral cancer risk factor survey. Patients were compensated with a gift card for each major study procedure.

Objectives:

The primary objective of this study were to estimate the proportion of the study population with an oral high-risk HPV infection.

The secondary objectives of this study were to:

  1. Evaluate the feasibility and acceptability of baseline study procedures performed by participating patients and staff;
  2. Measure the distribution of demographic and behavioral characteristics associated with oral HPV infection;
  3. Determine compliance with and feasibility of procedures performed at a 6-month follow-up visit (window: 5-9 months), including blood draw, second oral rinse specimen collection, oral cancer screening examination, and completion of an oral cancer risk factor survey.

This was an internet-based clinical trial of oral cancer prevention. Eligibility required internet access in the dental practice. The project was directed at prevention of oral cancer in dentistry by offering internet education and tools for the practice and support for all members of the practice. The project was not very time consuming, did not require training beforehand, and enhanced preventive care and risk management in the practice. To participate, each practice: (a) completed a series of internet continuing education modules; (b) encouraged its staff to support the project by also completing the modules; (c) designated a staff member to distribute 100 postcard surveys to patients at four different times for total of 400 postcards; (d) used the educational tools to enhance the preventive care in the practice. In addition to other benefits, the practice was paid an honorarium for its participation. Due to the success of the recruitment of this study, we increased the number of participants from the original plan of 140 and recruited 190 practitioners into the study. Any information that was provided is confidential and only reported in the aggregate. This project was primarily funded by an R01 grant from NIDA and NIDCR (R01-DA-17971).

Précis:

Almost all research on AOB treatment and stability is from retrospective case series. Therefore, this study had tremendous potential to provide practitioners with stronger evidence about AOB treatment outcomes and stability for adults. It also provided information about retention outcomes. Additionally, the gathering of patient-reported data about the decision to pursue a specific treatment option and patient satisfaction after treatment was extremely valuable.

This was a prospective, observational 3.5 year cohort study of approximately 840 adult patients in active orthodontic treatment for AOB who expected to have treatment completed within 24 months of enrollment into the study from approximately 210 National Dental PBRN orthodontists or dentists who routinely performed orthodontic treatment.

Objectives:

The primary objective was to estimate the proportion of patients 1) treated successfully (determined at the end of active treatment), and 2) whose treatment was stable (determined at one year post-active treatment).

The primary outcome measure to determine success of treatment was overbite at the end of treatment, and the primary measure to determine the stability of treatment ascertained one year after removal of orthodontic appliances was the overbite measurement.

The purpose of this project was to identify methods that DPBRN dentists used to diagnose and treat caries lesions. The aims of this study were to: (a) quantify the percentages of DPBRN dentists who report using selected methods for caries diagnosis; (b) quantify the percentage of DPBRN dentists who report using a caries-risk assessment protocol of any variety; (c) quantify the percentages of DPBRN dentists who report intervening surgically at caries stages E1, E2, D1, D2, or D3. The aims were met by enrolling more than 500 DPBRN practitioner-investigators, each of whom completed a 10-page questionnaire about caries diagnosis and treatment assessment. Findings from this study were compared to treatment that was actually delivered as determined in DPBRN studies of primary and replacement restorations.

The incidence of diabetes mellitus has been increasing at epidemic proportions, making this chronic disease the most common medical condition in dental patients. Hyperglycemia has been identified as a potential risk factor for periodontal disease, disease infection, and poor response to treatment. Additionally, an estimated 4% of Americans are undiagnosed diabetics, and more than 80% of the diagnosed patients are not well-controlled. Early diagnosis and intervention have been shown to improve outcomes and reduce morbid medical complications in diabetic patients. Thus, identifying hyperglycemia in dental practice could lead to significant improvement in both the dental and medical outcomes.

This study investigated the prevalence of hyperglycemia in dental patients of DPBRN practitioner-investigators. The global aim of this study was to determine the feasibility of blood sugar testing and diabetes screening in dental practice. The specific aims of this study were to quantify the: 1) percentage of DPBRN patients who meet the American Diabetes Association screening criteria and describe the characteristics of these patients; and 2) acceptability of conducting blood sugar testing in the dental office and barriers to regular screening, as reported by DPBRN patients and practices.

*the terms ‘blood sugar’ , ‘blood glucose’, and ‘hyperglycemia’ are related and interchangeable in some contexts. DPBRN adopted the term ‘blood sugar’ for the title of this study to tailor its communication to a lay, non-dental, non-medical audience. This helps facilitate explaining the study to dental patients.

Osteonecrosis of the jaws (ONJ) is a potentially morbid and costly oral condition. In the recent past more than 200 cases of ONJ have been described in patients treated with bisphosphonates (BPs) for osseous cancer lesions or osteoporosis. The number of BP prescriptions has been steadily increasing, creating concerns about this potential side effect. The causes and risk factors for ONJ are not known. In this study we investigated these issues making use of the research infrastructure from the three dental practice-based research networks (PBRNs) funded by NIDCR.

The specific aims of this study were to test the hypotheses that: (1) BP treatment is a risk factor for ONJ; and (2) dental diseases, particularly periodontal disease and invasive dental procedures such as dental extractions are true risk factors for ONJ, or whether these procedures are a consequence of the necrotic disease process. This study quantified the impact that BP exposure had on the risk of developing ONJ, relative to comparable control patients, using a case-control study design. The risk factors studied included BPs, dental risk factors, and other factors, such as radiation and steroid therapy. All the patients with ONJ identified from the PBRNs were recruited for the study. Cases were identified by a dentist in the PBRN and were diagnosed by the dentist or a specialist as having ONJ with an onset between January 2005 and January 2007. Each case had three controls from the practice that identified the case. The dentist summarized the relevant dental treatment history and provided a dental disease diagnosis history from January 2000 until diagnosis of ONJ for cases, and until recruitment for controls. A professional centralized interviewer within each PBRN administered the same standardized questionnaire to cases and controls over the telephone.

Relevance to public health: This study was a unique and timely opportunity to investigate risk factors for ONJ, results from which may have a substantial impact on dental health and oral-related quality of life in an increasing number of patients.

Précis:

This was a prospective, observational 4-year cohort study of both symptomatic and asymptomatic cracked teeth in 3,000 patients of ages 19-85 from 150-300 National Dental PBRN practices. Subjects received patient-, tooth- and crack-level assessments of a cracked tooth at baseline and follow-up visits over the subsequent four years.

Objectives:

The primary objective of the study was to identify patient-, tooth-, and crack- level characteristics associated with initial tooth symptom status, and to determine, over a four-year follow-up period, the associations of these multi-level factors with changes (tooth “failure”) that occured in an initially symptomatic or asymptomatic cracked tooth. Changes in the study tooth over time—outcomes that define the development of tooth “failure”– included crack progression, sign/symptom development, need for restorative dentistry, endodontic therapy or tooth extraction, development of periradicular lucency and loss of pulp vitality.

Many teeth required treatment over the course of the study period. Therefore, secondary objectives of the study were to:

  1. Identify multi-level (practice-, practitioner-, patient-, tooth-, and crack- level) factors associated with treatment recommendations for asymptomatic and symptomatic teeth provided by practitioners across the US;
  2. Identify associations between crack characteristics and time-to-treatment rendered during the four-year follow-up period;
  3. Determine, among treated cracked teeth, associations between the external and internal crack characteristics, which included externally detectable characteristics and internal characteristics that are observed during invasive treatment of the tooth.
  4. Evaluate outcomes of various treatments rendered on cracked teeth by determining associations between treatment rendered and time to tooth failure after treatment has been rendered on cracked teeth during the four-year follow-up period. These tooth outcomes include crack progression, sign/symptom development, and further recommended treatment of the tooth, development of periradicular lucency and loss of pulp vitality.

Précis:

The study examined the use of two diagnostic devices on dental practitioners’ identification and treatment of SOCLs. A total of  90 practitioners throughout the nation collected and recorded descriptive and treatment information for 40 SOCLs (one lesion/patient), 20 during the pre-intervention period and 20 during the intervention period. Practitioners were randomized into one of three arms:  no diagnostic device, DIAGNOdent, and Spectra. They also completed diagnostic vignettes at the beginning and end of each study, as well as a post-study questionnaire.

Objectives:

The primary objective of the study was to quantify the difference in proportion of SOCLs treated operatively when a diagnostic device was used compared to when one was not used, and to quantify the difference in proportion of SOCLs treated operatively that extended into dentin when a diagnostic device is used compared to when one was not used.

The secondary objectives of the study were to:

  • Identify the clinical characteristics of SOCLs that best predict caries that extend into dentin;
  • Determine whether the principal factors used by participating practitioners in managing SOCLs change when a caries detecting device is employed; and
  • Obtain practitioners’ assessments of the utility of the devices in their practices.

This was an internet-based clinical trial of oral cancer prevention. Eligibility required having internet access in the dental practice. The project was directed at prevention of oral cancer in dentistry by offering internet education and tools for the practice and support for all members of the practice. The project was not very time consuming, did not require training beforehand, and enhanced preventive care and risk management in the practice. To participate, you must have: (a) completed a series of internet continuing education modules; (b) encouraged your staff to support the project by also completing the modules; (c) designated a staff member to distribute 100 postcard surveys to patients at four different times for total of 400 postcards; (d) used the educational tools to enhance the preventive care in your practice. In addition to other benefits, the practice was paid an honorarium for its participation. Due to the success of the recruitment of this study, we increased the number of participants from 140 to 190. The goal of 190 practitioners was met. Any information that was provided is confidential and only reported in the aggregate. This project was funded by an R01 grant from NIDA and NIDCR (R01-DA-17971).

There is great variation in caries diagnosis and management, with many dentists choosing a surgical approach rather than non-invasive treatment methods (“watchful monitoring” combined with prevention) for early caries. Approaches that delay placement of the first restoration may be a key source of improving the long-term effectiveness of dental care. This project focused on improving the quality of dental care by fostering movement of the latest scientific advances into daily clinical practice in the area of early caries treatment.

The aims of this project were to: (1) develop a patient handout to encourage patient acceptance of non-invasive treatment for early caries in permanent teeth and to increase dentists” use of non-invasive treatment; (2) quantify patient satisfaction with treatment options for early caries to quantify patient acceptance; and (3) quantify pre- and post-intervention caries stage at which dentists place the first restoration to determine the feasibility of the intervention.

This project entailed instrument development as well as a feasibility study that informed the design of a subsequent clinical trial in dental private practices. Semi-structured qualitative interviews with 30 patients and 10 dentists were conducted to develop the patient handout. Specific factors from pre-existing patient satisfaction surveys were used as quantitative tools. The handout was tested for readability and content structure. The study design was factorial, with patient satisfaction and handout assessment data from 300 surveyed patients diagnosed with early caries by participating dentists. The feasibility study design was longitudinal with pre- and post-intervention caries stage data from each participating DPBRN dentist collected from the practice assessment questionnaires. The 10 practitioners were recruited to participate in the study, based on their early caries treatment pattern and a stratified convenience sampling scheme that encouraged representation of minority dentists and patients.

This was a nested case-control study in which DPBRN Study 17 patients who still had pain at 6 months and were seen by endodontic and orofacial pain experts. The primary goal of this study was to determine the proportion of patients with pain who would best be managed with traditional dental care compared to those who had a non-odontogenic source for their pain, so that treatment directed at the etiology of their pain would occur.

Précis:

This study examined patient, dentist, and laboratory factors associated with the fabrication of successful crowns. Each year, dentists must re-do thousands of crowns that are returned from the dental laboratory but are not clinically acceptable. It is not clear why some of these crowns are unsatisfactory. This clinical study that analyzed dentist and clinical variables to find predictors for crown success. Data from dental laboratories was collected in the clinical study to determine the prevalence of acceptable impressions, crown preparations and jaw relation records sent to labs for crown fabrication.

Précis:

This study examined patient, dentist, and laboratory factors associated with the fabrication of successful crowns. Each year, dentists must re-do thousands of crowns that are returned from the dental laboratory but are not clinically acceptable. It is not clear why some of these crowns are unsatisfactory. This was a questionnaire that documented current practices among clinicians making crowns, such as material choices and impression techniques.

Dental practices have advanced tobacco cessation by adopting a model of brief advice similar to that used by medical providers. DPBRN will do a randomized clinical trial designed to allow dental hygienists to provide additional tobacco cessation counseling with little additional marginal effort. This would be done using an internet-based referral to external resources. This system, termed “Refer2Quit”, will allow hygienists to refer patients to a patient education website and accompanying Quitline, while the patient is still in the dental office. Our overall goal is to advance science related to internet use in health services delivery by targeting dental hygienists. The intervention will also support subsequent brief counseling by providing feedback on the activities of patients to the practice through a secure server.

We had these specific aims:

  1. Test the hypothesis that the proportion of patients REFERRED to self-management resource websites would be larger in intervention practices compared to control practices.
  2. To test the hypothesis that the proportion of patients referred who GO to the patient self-management website would be larger in intervention practices compared to control practices.
  3. To test the hypothesis that the proportion of smokers who are referred who QUIT at six months would be larger among intervention compared to control because of the additional connectivity of the intervention.

This was done by randomizing 80 community-based dental practices into a clinical trial that contrasts the intervention with a paper-based “information prescription”.

The overarching goal of DPBRN is to impact the practice of dentistry and improve patient care. A critical issue is assessing whether the research conducted is achieving this goal. The three NIDCR-funded PBRNs (DPBRN, NWPRECEDENT, and PEARL), collectively known as the “Collaboration on Networked Dental and Oral Health Research” (CONDOR), have developed a strategy for assessing the impact of practice-based dental research on the PBRN practices and on the practice of dentistry in general. The strategy involves the development and use of a core questionnaire that includes several questions from each PBRN that have been extracted from questionnaires previously administered as part of their initial research program activities.

This project comprised the first administration of this Core Questionnaire with the purpose of assessing dental practice changes that may have occurred since the earlier administration of the individual questions within the separate networks. It also collected baseline information for the others. The Core Questionnaire were re-administered at later points in time. In this manner changes in practice over time and concurrent with research results dissemination were measured.

The purpose of this study was to update the status of practices in the network with regard to these items: practice type (solo, group, public health, academic, other); percent of patients who are regular care seekers versus problem-oriented; whether the practice shares facilities or organizational structure with medical providers; percent of patients with certain chronic diseases; how commonly patients are referred to physicians for medical evaluations; electronic dental record usage and type of software; preferences for how to have study results communicated; rubber dam usage for endodontic procedures; utilization of dental staff for specific dental procedures; opinions about dental therapists and other expanded-function dental staff.

Précis:

The study assessed isolation techniques used when performing root canal treatment among dentists in the network. A questionnaire was administered to eligible dentists in the network. The questionnaire assessed dentists’ use of various isolation techniques when performing root canal treatment; identified factors associated with use (or non-use) of rubber dams when performing root canal treatment (RCT); and identifed factors associated with rubber dam use during RCT.

Objectives:

The primary objective of the study was:

  • To quantify the self-reported use or non-use of rubber dams when performing RCT.

The secondary objective was:

  • To identify factors associated with use or non-use of rubber dams for RCT.

Study PI: Dr. Thankam Thyvalikakath, Indiana University

Brief study description

Key study publication:

Thyvalikakath T, Duncan W, Siddiqui Z, Michelle L, Eckert G, Schleyer T, Rindal D, Jurkovich M, Shea T, Gilbert G, National Dental PBRN Collaborative Group. Leveraging electronic dental record data for clinical research in the National Dental PBRN practices. Applied Clinical Informatics 2020; accepted.

Study protocol

Study data dictionary [pending]

Data set [this data set is too large to store on this web site.  If you would like access, please email Gregg Gilbert at ghg@uab.edu]

As part of the recruitment process, practitioners were provided background information and a FAQ page.

The purpose of this project was to use data from “primary” restorations to assess how defects that may lead to failure develop over time, and to follow restorations placed in a practice-based setting for up to three years. The specific aims were to:

  1. quantify the annual and 3-year incidence of defects and replacement rates on restorations inserted as primary restorations;
  2. test the hypothesis that directly-placed composite restorations have a significantly higher 3-year incidence of defects and significantly higher replacement rate after 3 years compared to amalgam restorations;
  3. test the hypothesis that the 3-year replacement rate of restorations in permanent teeth of adolescents is significantly higher than that of restorations in adults. Criteria used to evaluate restorations over time will be the same as those employed in the DPBRN study of replacement restorations. Recall frequency was according to the schedule used in the practice where the restoration was placed. Patients were informed about the follow-up study as part of the informed consent procedure. If a patient sought treatment in a different practice, informed consent included permission to contact that practice for information related to restoration(s) in this longitudinal study.

Although the progression of cavitated dental caries has slowed dramatically over the years, the prevalence of precavitated lesions has significantly increased; therefore, diagnosing and following these lesions has become an important part of daily clinical practice. There has been some debate on the best way to manage and treat these small lesions long-term. Some clinicians believe it is best to perform operative treatment and conserve tooth structure; whereas, other clinicians believe in managing it with preventive treatment, allowing the lesion the potential to remineralize or arrest over time. Limited literature is available for these “questionable” lesions and the reasons behind why clinicians are having difficulty diagnosing and treating them.

The aims of this study were to (1a) for unopened questionable occlusal carious lesions, test the hypothesis that the baseline clinical characteristics are significantly associated with change in caries status; and (1b) for opened questionable occlusal carious lesions, test the hypothesis that the clinical characteristics at baseline are significantly associated with caries depth.

These aims were met by performing a follow-up on the consecutive questionable occlusal carious lesions enrolled in “Prevalence of Occlusal Carious Lesions”. The study recorded the status of these lesions, if treatment changed,and the condition of the restoration or sealant, if applicable.

This study about occlusal carious lesions provided the opportunity to compare these results to “Assessment of Caries Diagnosis and Caries Treatment”, and “Prevalence of Occlusal Carious Lesions”.

The purpose of this project was to use data from the DPBRN study of replacement restorations to assess how defects that lead to failure develop over time, and follow restorations placed in a practice-based setting for up to three years.

The specific aims were to:

  1. quantify the annual and 3-year incidence of defects and replacement rates on restorations inserted as replaced restorations;
  2. test the hypothesis that directly-placed composite restorations have a significantly higher 3-year incidence of defects and significantly higher replacement rate after 3 years compared to amalgam restorations;
  3. test the hypothesis that there is no significant difference in 3-year replacement rates between restorations inserted that were partially replaced as compared to restorations that were completely replaced during DPBRN study of replaced restorations; and
  4. test the hypothesis that the 3-year replacement rate of restorations in permanent teeth of adolescents is significantly higher than that of restorations in adults.

Recall frequency was according to the schedule used in the practice where the restoration was placed. Patients were informed about the follow-up study as part of the informed consent procedure. If a patient sought treatment in a different practice, informed consent included permission to contact that practice for information related to restoration(s) in DPBRN longitudinal study.

Précis:

This was a prospective cohort study of patients with dentin hypersensitivity. The study population consisted of adult dental patients who had dentin hypersensitivity and the practitioners who provided treatment for this condition. Approximately 180 dentists across the nation enrolled 14 study patients, with an enrollment aim of 2,520 adult patients for the entire network.

Objectives:

The primary objective of the study was to gain a better understanding of the multiple treatments used to manage dentin hypersensitivity among US dental practitioners by characterizing methods of diagnosing dentin hypersensitivity in the practice setting, dentists’ selected treatment(s) of dentin hypersensitivity, and patient-reported pain outcomes over time.

The secondary objectives of the study were to explore patient-, practitioner-, practice-, and tooth-level characteristics that contributed to practitioners’ selected treatment(s) and approach(es) to care and to characterize patients’ satisfaction with the received treatment of dentin hypersensitivity.

Précis:

Temporomandibular Disorders (TMD) are the second most commonly occurring musculoskeletal disorders after chronic back pain resulting in pain and disability. Diagnosis and treatment of TMD are within the purview of general dentistry (NIDCR, 2009) with most patients consulting a general dentist regarding their painful TMD. Within the context of the National Dental Practice-Based Research Network (Network), the goal of this observational prospective cohort study was to identify factors contributing to TMD treatment decisions and treatment adherence, as well as the overall effect of TMD treatment on pain intensity and jaw function measured at 1-, 3- and 6-month follow-ups.  We recruited approximately 200 dentist practitioners from the six National Dental PBRN regions (Northeast, South Atlantic, South Central, Southwest, Midwest, Western).  Each participating dentist contributed to a total patient enrollment of approximately 1980.

Objectives:

The primary objective of this study was to identify the factors that contribute to practitioners’ treatment decisions for patients with painful TMD.

The secondary objectives of this study were to:

  • Identify factors that contribute to patients’ adherence to treatment, and
  • Describe observed changes from baseline at 1-, 3- and 6-month follow-up in pain intensity and jaw function associated with treatments.

The primary outcome measure of this study was the practitioners’ treatment decisions for painful TMD patients. The secondary outcome measures for this study were patient adherence, and pain intensity and jaw function measures. Numerous potential confounders and predictors were assessed for their associations with the treatment decisions, patient adherence, and changes in pain and function.

The overarching goal of DPBRN is to impact the practice of dentistry and improve patient care. A critical issue is assessing whether the research conducted is achieving this goal. The three NIDCR-funded PBRNs (DPBRN, NWPRECEDENT, and PEARL), collectively known as the “Collaboration on Networked Dental and Oral Health Research” (CONDOR), developed a strategy for assessing the impact of practice-based dental research on the PBRN practices and on the practice of dentistry in general. The strategy involved the development and use of a core questionnaire that included several questions from each PBRN that have been extracted from questionnaires previously administered as part of their initial research program activities. This project comprised the pre-planned second administration of this Core Questionnaire with the purpose of assessing dental practice changes that may have occurred since the first administration (DPBRN Study 16).

Patient satisfaction is important to practicing dentists because of links to regular return visits, caregiver trust, perception of technical competence, and treatment outcome.  However, little is known about the satisfaction of dental patients, particularly as related to specific dental procedures.  Dental restorations are one of the most commonly performed dental procedures, yet no study has documented patient satisfaction with a restoration-specific dental visit.  There are many unique characteristics to a dental restoration visit such as dentist-patient communication about the restoration material, comfort during and following the procedure, and the patient’s view of the quality of the restoration.  How patients prioritize these characteristics or use them in decisions about satisfaction are unknown.  It is known that patients make judgments of the technical competence of dentists, but whether these judgments have any association with immediate or long-term restoration quality and therefore the extent to which they are valid is undetermined.

The aims of the study were to determine the relative contribution and importance of characteristics of a restoration and restoration visit with overall patient satisfaction following a dental visit that involved a restoration replacement or repair; and to link patient’s satisfaction and perception of the dentist’s technical expertise with long-term objective outcomes of the dental restoration.

This study involved approximately 6,000 patients that received at least one dental restoration repair/replacement.  Patients were recruited from practices participating in the DPBRN study of replacement restorations, most of whom were enrolled in a DPBRN longitudinal study. Participants completed and mailed the survey questionnaire the day following the dental visit to allow them to evaluate and respond to the short-term outcomes, such as comfort and function, as well as to the immediate aspects of the visit.

Pain following root canal therapy occurs commonly, with an incidence range of 3% to 58% depending on the definition. The majority of this post-endodontic pain is well controlled using current treatment modalities, but a small subset of patients seems to be resistant to treatment and experiences severe pain. Significant post-endodontic pain is commonly referred to as an endodontic flare-up and has been defined as severe pain that precipitates a patient-dentist interaction within one week of treatment initiation. Such pain, when associated with local soft tissue swelling, is known to occur in 3% of all cases of root canal therapy. Given that >16.4 million root canal therapies are performed every year within the US, about half a million patients experience severe pain that is resistant to treatment. This pain is known to cause significant amounts of dental anxiety and fear, which in turn is a major barrier to receiving dental care and can have other negative psychosocial consequences. For these reasons, it is important to understand the factors related to the development of endodontic flare-up pain in efforts to better treat this pain. Research on endodontic-related pain has suggested that (a) the intensity of pre-operative pain and (b) the experience of intra-operative pain are significant factors related to the subsequent development of persistent tooth pain. Therefore, the primary goal of this study was to assess the presence and magnitude of pre-operative and intra-operative tooth pain, and determined how these factors were associated with the outcome of intense post-endodontic flare-up pain. The overall goal was to better understand how the experience of peri-operative pains relate to each other. The long-term goal of this line of research was to identify the modifiable pre-operative factors that put patients at greater risk of developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, increase their patients’ quality of life, and decrease the number of dental emergency interactions. Since future studies within the network are required to achieve this long-term goal, the secondary goal of this study was to assess the feasibility of recruiting patients using the DPBRN and to pilot test a more detailed data collection procedure from both patients and practitioners using a small subset of practitioners and within the DPBRN.

Dentists perform over 16.4 million root canal therapies every year in the United States (American Dental Association, 2002). Persistent tooth pain, which is pain present 6 months after root canal therapy, is known to occur following root canal therapy in a fashion similar to other post-surgical pains, such as phantom limb pain. Research in this area is limited, but suggests a frequency of occurrence of 3% to 12% for persistent post-root canal pain. Despite the commonality of root canal treatment, the occurrence and severity of persistent tooth pain and extent of interference with daily life from this condition has not been well studied in dental care populations. Adequate treatments for some of these pains are emerging, and early identification and treatment may improve prognosis, but the first step is to determine how widespread the problem is and how severely it affects dental patients. This knowledge is expected to influence patient and provider decisions about dental treatment and to facilitate the development of preventative treatment strategies, such as pre-emptive analgesia, aimed at reducing patients’ modifiable peri-operative risk factors. The long-term goal of this line of research is to identify pre-operative factors that put patients at greater risk for developing persistent tooth pain following root canal therapy, thereby providing evidence that will allow dentists to act preventively to mitigate this risk, improve pain control, and increase their patients’ quality of life. For this long-term goal to be realized, future externally funded research using the DPBRN is anticipated; hence, there is a need for pilot data to support the feasibility of such research. Even though this research proposal is focused on understanding the outcomes of root canal therapy, with the long-term goal of improving care, the resultant data may have ramifications for surgical procedures performed elsewhere in the body. Undoubtedly aspects of this research will be specific to root canal therapy, but since pain is a centrally derived phenomenon that affects the whole individual, aspects of the involved pain mechanisms are likely shared with other surgical procedures. Thus, this line of research could have an impact on healthcare in general.

This was a retrospective cohort study to test the hypothesis that endodontic treatment failure is significantly higher among dental patients with diabetes mellitus type II when compared to non-diabetic controls. The idea for this research project was a result of ideas provided by dentists who completed the Dental PBRN enrollment questionnaire. This project was primarily funded by an R21 grant from NIDCR (R21-DE-16033).

Précis:

Severe post-operative pain following root canal therapy (RCT) occurs in about 20% of patients. The presence of persistent pain following RCT is about 10%, and initial evidence suggests that half of these patients experiencing persistent pain have a non-odontogenic etiology for this pain. Applying odontogenic strategies to treat non-odontogenic pain may increase incidence and duration of chronic oral pain. The overarching goal of this prospective observational cohort study was to investigate risk factors for severe pain following RCT, the prevalence and impact of persistent pain following RCT, and the impact of severe and persistent pain on health-related quality of life. Patient and treatment-related data was collected before and after RCT completion. Follow-up data was collected 1 week, 6 months, and 12 months following RCT completion. Approximately 150 practitioners from six National Dental PBRN regions enrolled approximately 1,650 adult patients.

Recruitment Flier

Although the progression of cavitated dental caries has slowed dramatically over the years, the prevalence of precavitated lesions has significantly increased; therefore, diagnosing these lesions has become an important part of daily clinical practice. Due to the size of these lesions, the ability to correctly diagnose and treat them can be difficult. There has been some debate on the best way to manage and treat these small lesions. Some clinicians believe it is best to perform operative treatment and conserve tooth structure; whereas, other clinicians believe in managing it with preventive treatment, allowing the lesion the potential to remineralize or arrest. Limited literature is available for these “questionable” lesions and the reasons behind why clinicians are having difficulty diagnosing and treating them.

The aims of this study were to (1) quantify the prevalence of questionable occlusal carious lesions in permanent teeth in the first 100 consecutive eligible patients of DPBRN practitioners; (2a) for unopened questionable occlusal carious lesions, test the hypothesis that the patient’s baseline caries risk is significantly associated with lesion description (i.e., perceived caries status); and (2b) for opened questionable occlusal carious lesions, test the hypothesis that the patient’s baseline caries risk is significantly associated with caries depth.

These aims were met by enrolling 80-100 practitioner-investigators, each of whom recorded information about 100 consecutive patients and 25-50 consecutive questionable early occlusal caries lesions on a 2-page questionnaire. The study recorded the reason why these occlusal lesions were questionable, the tools used to diagnose the lesions, the reason why a certain treatment was rendered, and the depth of the lesions when treated operatively.

This study about early occlusal caries lesions provided the opportunity to compare these results to DPBRN study entitled “Assessment of Caries Diagnosis and Caries Treatment”, a questionnaire wherein practitioners’ caries diagnosis, caries treatment, and preventive dentistry practices were quantified as well as compare these results to the DPBRN study entitled “Longitudinal Study of Questionable Occlusal Carious Lesions”.

The overall goal of this project was to collect data to be used in preparing an application for a Clinical Trial Planning Grant and then in designing a subsequent Phase III clinical trial. The ultimate goal was to determine the most practical approach to conduct a randomized clinical trial to evaluate initial interventions for patients with painful temporomandibular muscle and joint disorders (TMJD) in primary care clinics. This project characterized by surveying the feasibility of recruiting dentists in primary care dental clinics in The Dental Practice-Based Research Network and document their current initial care for their TMJD pain patients.

Précis:

Since the advent of antibiotics in the mid-1940s, and in particular with the first formal recommendations for antibiotic prophylaxis (AP) by the American Heart Association (AHA) in 1955, there has been a significant proliferation of the use of secondary AP in dental practice.However, there has been increasing controversy about the widespread use of antibiotics for some prophylactic, as well as therapeutic dental purposes, primarily due to concerns about antibiotic resistant bacteria and adverse drug reactions, weak evidence to support the practice of AP, and the costs and inconvenience associated with the use of AP.  Consequently, this study aimed to identify critical conceptual and standardization gaps in the practice and implementation of AP for patient populations felt to be at increased risk to develop infective endocarditis (IE) and/or prosthetic joint infections (PJI) prior to dental procedures. By surveying approximately 2,500 members of the National Dental Practice-Based Research Network, the survey revealed some of the common tendencies and practices regarding AP by practitioners across the United States.

Précis:

Using a single-arm trial design, this study examined the feasibility and acceptability of evaluating “QuitAdvisorDDS”, a clinical decision support software application designed to facilitate implementation of evidence-based tobacco treatment interventions into the dental setting. The study examined the impact of the QuitAdvisorDDS tool on patient outcomes related to tobacco use and cessation attempts as well as provider knowledge, attitudes, and practices regarding tobacco treatment. Practitioner (dentists and hygienists) completed surveys at baseline and follow-up, while patients completed surveys at baseline and 1-month follow-up. An embedded substudy also evaluated the feasibility and acceptability of collecting biospecimens (saliva) to serve as biochemical verification of smoking status.

Précis:

This study characterized and examined the structure, content, and pathways of clinical information in the dental information ecosystem. It also gave attention to disruptive events that impact knowledge and information diffusion through a focus on alternative nicotine products (ANPs). The study addressed the clinical information-seeking networks (both formal and informal) of dentists and hygienists.
This was a multi-methodological 39-month study that was conducted in the National Dental Practice-Based Research Network (National Dental PBRN). The study involved one round of survey implementation, on-going bibliometric data collection and web scraping, as well as one round of feedback interviews/focus groups via video conference and/or at regional Dental PBRN meetings.

This study of previously-untreated permanent tooth surfaces was the second of the restorative dentistry studies planned for the Dental Practice-Based Research Network (DPBRN). The aims for this study were to: (a) quantify DPBRN practitioner-investigators’ pre-operative and post-operative assessments of the depth of the caries lesion being treated and (b) quantify the prevalence of dental material types used to restore the first restoration in a permanent tooth surface. These aims were met by enrolling 229 DPBRN practitioner-investigators in this study, each of whom recorded information about an average of 50 consecutive restorations that they placed on unrestored permanent tooth surfaces. The study recorded the main reason that the restoration was placed, the preoperative and postoperative depth of the caries lesion on the previously unrestored surface, and the type of dental restorative material that was used. This study about restorative treatment received by DPBRN patients provided the opportunity to record not only the diversity in the treatment provided, but also to generate information for subsequent hypothesis testing and for the design of future studies.

This study recorded the reason(s) for replacement or repair of 50 consecutive restorations as diagnosed by 200 DPBRN clinicians. This constituted baseline data which was used for analysis of factors that affect the diagnoses.

Factors that affected the number of replaced or repaired restorations was analyzed using baseline data, e. g., how they vary among clinicians, the practice setting, the gender of the patients and the clinicians, and the clinicians” attitudes towards caries lesion development and caries risk assessment. These data was also a source for monitoring treatment changes in restorative dentistry that may occur over time. A better understanding of the reasons why restorations needed to be replaced or repaired led to improvements in the longevity of restorations.

Précis:

This study aimed to identify critical training gaps in dental implementation of opioid prescribing risk mitigation strategies. Dentists follow primary care physicians as the second leading prescriber of immediate release opioids. However, dentists typically have limited exposure to addiction training and may not be familiar with recommended opioid prescribing risk mitigation strategies. This study consisted of an online survey that documented current knowledge, training experiences, and practice behaviors related to acute dental pain management and opioid analgesic prescribing among member dentists. Data from the survey was paired with key practice-related enrollment data to identify aforementioned gaps in knowledge and directly inform the development of an educational intervention that provided dentists’ training in opioid misuse screening and implementation of risk mitigation strategies when prescribing opioids for acute pain management.

In the past two years, the literature has described more than 200 cases of osteonecrosis of the jaws (ONJ) among patients treated with bisphosphonates (BPs). About 3 million patients have been treated with BPs and another 7-8 million osteoporotic or cancer-afflicted persons in the U.S. may take BPs in the near future. To date, the prevalence of ONJ has not been quantified, nor is it known whether exposure to BPs actually increases ONJ prevalence. We investigated these issues using data from a large cohort of patients from the Kaiser Permanente Northwest and HealthPartners medical and dental plans. Both health maintenance organizations are part of DPBRN, allowing us to take advantage of an already-functioning interdisciplinary collaborative infrastructure.

This study addressed three specific aims. Aim 1 quantified the annual, consecutive prevalence of confirmed ONJ cases in a large cohort of adults 40 years of age and older from 1994 to 2005. Aim 2 tested the hypothesis that BP treatment is a risk factor for ONJ. We quantified the impact of BP exposure on the risk of developing ONJ, relative to comparable patients not exposed to BP, using a retrospective cohort design and time-to-event analysis. Finally, Aim 3 tested the hypothesis that ONJ develops only in patients treated with BPs who have additional risk factors. These health maintenance organizations provided a unique, unprecedented opportunity to investigate ONJ by including thousands of patients through their electronic medical and dental records.

Relevance to public health: In light of the substantial morbidity due to ONJ, this study provided important information about this growing health concern.

Précis:

The dentist’s office may be an important setting for conducting multi-risk assessments (MRAs) for oral and physical health risks to increase opportunities for early assessment of and intervention for risk behaviors.  This study characterized dental practitioners’ (dentists and hygienists), dental payers’, and patients’ attitudes about: (a) conducting/participating in MRAs during dental visits; and (b) providing/receiving follow-up counseling about and referrals for identified risks. An analysis was also conducted of the dentists’ and dental hygienists’ scope of practice documents to determine if there were any regulatory barriers for conducting MRAs, risk behavior counseling, and referrals.

Read about the the following study highlights from the Practice-Based Research Network:

  • Assessing Outcomes of Cracked Teeth
  • Remineralization of White Spot Lesions after Removal of Orthodontic Brackets
  • Single Tooth Endodontic and Restorative Treatment Outcomes: PEARL Interim Findings
  • PEARL Non-Carious Cervical Lesion RCT Baseline and Sleep Bruxism Findings
  • Lessons Learned During the Conduct of Clinical Studies in the Dental PBRN
  • Repair or Replacement of Defective Restorations by Dentists in the Dental PBRN

Précis:

Worldwide, there were an estimated 274,000 new cases and 127,000 deaths attributed to oral cancer (OC) (ICD-O C00-C06), and over 600,000 new cases of head and neck cancer (HNC) reported in 2008. Over 70% of U.S. dentists self-report performing oral cancer (screening) examination (OCE) on most of their patients over 40 years of age, although the completeness, quality, frequency and validity of these examinations are unknown. Regardless, 18% of adults (8% of Blacks and 7% of Latinos) aged 40 years and over are reported to have had an OC examination in the last year.  Moreover, only 20% to 29% of adults reported ever having had an OCE. The overall goal of the project was to ascertain common practices related to oral cancer examinations by U.S. dentists and dental hygienists, by geographic region, demographics and practitioner and practice characteristics.
This was a National Dental Practice-Based Research Network (National Dental PBRN) survey study that consisted of 2 components: 1) a questionnaire survey (33 questions), and 2) sixteen standardized clinical case-vignette presentations with 6 specific process questions. National Dental PBRN general dentists and dental hygienists were invited to participate in the study to describe the details of the OCE, including who, what, when, where, and why, as well as the details involved with patient disposition of newly discovered “suspicious” for oral pre-malignant or malignant lesions.

Amid the COVID-19 outbreak, dentistry urgently needs modified dental examination regimens that render quality care and ensure the safety of patients and the dental health care personnel (DHCP). Traditional dental examinations – more than 300 million per year in the US – rely on person-to-person visual-tactile examination, posing challenges to infection control and consuming large quantity of advanced level personal protective equipment (PPE).

Our long-term goal is to develop an innovative mDentistry (mDent) model. This model supplements the traditional practice of dentistry with virtual visits supported by mobile devices such as mobile phones, tablets, personal digital assistants, and the wireless infrastructures. The mDent leverages advantages of virtual dental visits and digital mHealth tools, such as intraoral cameras, to deliver virtual oral examinations, treatment planning, and interactive oral health management on a broad population basis.

This mDentistry (mDent) eHygiene study is the first step of utilizing the mDentistry model, which will access the rich resources of the National Dental Practice-Based Research Network, recruit 48 DHCP (Dentists and Hygienists) and 192 patients from practices across regions of the Network, and assess the acceptance of virtual dental examinations by patients and the dental health care personnel. The mDentistry eHygiene model has the potential of empowering patients with mhealth tools and engaging them in oral health care delivery.

Study results will inform of immediate modification of the dental service system, provide safe care delivery, and preserve PPEs amid COVID-19 pandemic.