-
[show abstract]
[hide abstract]
ABSTRACT: Background: The randomized case presentation (RCP) study was designed to assess the degree of diagnostic accuracy for described periodontal cases. This was to lay the basis for practitioner calibration in the Network for future clinical studies. Methods: The RCP consisted of ten case scenarios ranging from periodontal health, gingivitis, mild, moderate, and severe periodontitis. Respondents were asked for their diagnosis of the described cases. Survey diagnoses were compared to two existing classifications of periodontal disease status. The RCP was administered via a proprietary electronic data capture system (Advantage EDC(®)) maintained by the Practitioners Engaged in Applied Research and Learning's (PEARL's) Data Coordinating Center(‡). Standard analytic techniques including frequency counts and cross-tabulations were used for categorical data with mean and standard deviation and median values reported for continuous data elements. Results: Demonstrable variations in periodontal assessment for health, gingivitis, mild, and moderate, and severe periodontitis were found among 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was found (88%) for severe periodontitis. The range of agreement among dentists for all ten case presentations was 55% to 88% representing the cases described from health to severe periodontitis. The highest percentage of the variation was found in cases with health and gingivitis. Conclusion: There was variation among PEARL practitioners in periodontal diagnosis which may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis.
Journal of Periodontology 06/2012; · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In 2005, the National Institute of Dental and Craniofacial Research / National Institute of Health (NIDCR/NIH) funded the largest initiative to date to affect change in the delivery of oral care. This commentary provides the background for the first study related to periodontics in a Practice Based Research Network (PBRN). It was conducted in the PEARL (Practitioners Engaged in Applied Research & Learning) Network. The PEARL Network is headquartered at New York University College of Dentistry. The basic tenet of the PBRN initiative is to engage clinicians to participate in clinical studies, where they will be more likely to accept the clinical results and to incorporate the findings into their practice. This process may reduce the translational gap that exists between new findings and the time it takes for those findings to be incorporated into clinical practice. The cornerstone of the PBRN studies is to conduct comparative effectiveness research studies to disseminate findings to the profession and improve care. This is particularly important as the majority of dentists practice independently. Having practitioners generate clinical data allows them to contribute in the process of knowledge development and incorporate the results in their practice to assist in closing the translational gap. With the advent of electronic health systems on the horizon dentistry may be brought into the mainstream health care paradigm and the PBRN concept can serve as the skeletal framework for advancing the profession provided there is consensus on the terminology used.
Journal of Periodontology 06/2012; · 2.60 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Practice-based research networks (PBRNs) provide a novel venue in which providers can increase their knowledge base and improve delivery of care through participation in clinical studies. This article describes some aspects of our experience with a National Institute of Dental and Craniofacial Research-supported PBRN and discusses the role it can play in dental education. PBRNs create a structured pathway for providers to advance their professional development by participating in the process of collecting data through clinical research. This process allows practitioners to contribute to the goals of evidence-based dentistry by helping to provide a foundation of evidence on which to base clinical decisions as opposed to relying on anecdotal evidence. PBRNs strengthen the professional knowledge base by applying the principles of good clinical practice, creating a resource for future dental faculty, training practitioners on best practices, and increasing the responsibility, accountability, and scope of care. PBRNs can be the future pivotal instruments of change in dental education, the use of electronic health record systems, diagnostic codes, and the role of comparative effectiveness research, which can create an unprecedented opportunity for the dental profession to advance and be integrated into the health care system.
Journal of dental education 08/2011; 75(8):1053-60. · 0.91 Impact Factor
-
Journal of the American Dental Association (1939) 12/2006; 137(11):1488-90, 1492, 1494. · 1.77 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A survey was conducted within a practice-based dental research network to determine dentists' treatment methods for deep caries lesions and whether the dentists' intended treatment approaches were influenced by their expectations for pulpal exposure. The survey further examined how general dentistry practices have adopted scientific evidence of caries classification, excavation, and capping techniques. Dentists were queried regarding liner use, hypersensitivity considerations, point of endodontic therapy, and anticipated vitality outcomes from Class I resin-based composite restorations over three to five years. Of the 93 practitioner-investigators who were in the network at the time of the survey, 85 (92%) completed it. Of those who responded, 62% said that they would remove all caries when presented with a case in which one would expect pulpal exposure, while 18% would partially remove caries and 21% would initiate endodontic treatment; 17% reported that they would utilize an antimicrobial agent before a liner or bonding agent during restoration. The outcomes projected for tooth vitality over the next three to five years were equivalent regardless of the caries removal approach or the use of a liner/bonding agent. When beginning the preparation, the method of treatment did not change if a pulpal exposure was anticipated, other than a threefold increase in immediate endodontic treatment. When dentists were given a direct pulp cap scenario, the projected use of a liner/bonding agent changed little while the vitality projections decreased. Overall survey findings indicate that approximately 20% of network dentists favor partial caries removal techniques and that deep caries treatment outcome studies are warranted, given the various treatments employed.
General dentistry 55(3):197-203.
