Practice based research networks impacting periodontal care:PEARL initiative

In 2005, the National Institute of Dental and Craniofacial Research /National Institutes of Health 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 Practitioners Engaged in Applied Research & Learning (PEARL) 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 results and to incorporate the findings into their practices. This process may reduce the translational gap that exists between new findings and the time it takes for them 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 because 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

Advantages of the dental practice-based research network initiative and its role in dental education

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

Restoration variables and postoperative hypersensitivity in Class I restorations:PEARL Network findings. Part 2.

BACKGROUND: This study investigated postoperative hypersensitivity at 1, 4, and 13 weeks following resin-based composite restoration of occlusal caries as well as the relationship to materials and technique employed by PEARL Network Practitioner Investigators (P-Is). METHODS: PEARL P-Is (n = 45) enrolled patients with early occlusal caries lesions deemed to require treatment and placed restorations using their routine technique. Data on 485 restorations at 4 weeks included: baseline sensitivity; ranking of dentin caries activity; post-preparation use of antimicrobials, liners, and dentin bonding agent; type of resin-based composite (RBC) employed; whether layer or bulk fill was used; and patient demographics. Patients anonymously reported at 1, 4, and 13 weeks any sensitivity to hot, cold, sweets, clenching, and chewing as well as quality of life (QOL) related to the restoration(s). RESULTS: Appreciable hypersensitivity (AH)—ie, sensitivity of 3 or greater on an 11-point anchored scale—was reported in 30% of all 668 eligible carious teeth at baseline. Among them, 10% of study teeth with no baseline AH had developed AH at 4 weeks post-treatment. With restoration, 63% of teeth with baseline AH no longer had AH, while the remainder had no improvement. Neither change in AH nor change in greatest sensitivity was associated with use of a liner, use of flowable or hybrid RBC, or bulk or layer technique. With use of an antimicrobial, at 1 week, there was a significant but transient effect on AH (P = 0.006), which was generally not present at 4 weeks, although it continued for one product. At 4 weeks, the change in greatest sensitivity was associated with the type of dentin bonding agent, total etch or self etch, (P = 0.004). Using similar materials and techniques, P-Is had widely differing patient-reported outcomes. CONCLUSION: Patient self-reported post-restoration AH—either acquired or remaining—at 4 weeks was generally not related to the materials or techniques recorded in these small- to moderate-sized occlusal restorations. However, the change in greatest sensitivity was associated with the type of dentin bonding agent used; but the clinical significance of this difference is questionable

Periodontal Diagnosis Affected by Variation in Terminology

BACKGROUND: The randomized case presentation (RCP) study is designed to assess the degree of diagnostic accuracy for described periodontal cases. This is to lay the basis for practitioner calibration in the Practitioners Engaged in Applied Research and Learning (PEARL) Network for future clinical studies. METHODS: The RCP consisted of 10 case scenarios ranging from periodontal health to gingivitis and mild, moderate, and severe periodontitis. Respondents were asked to diagnose 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 maintained by the PEARL 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, and mild, moderate, and severe periodontitis were found among the 130 PEARL general practitioners who participated in the RCP survey. The highest agreement for diagnosis among dentists was for severe periodontitis (88%) and the lowest for gingivitis (55%). The highest percentage of variation was found in cases with health and gingivitis. CONCLUSIONS: There was variation among PEARL practitioners in periodontal diagnosis that may affect treatment outcomes. Our findings add clinical support to recent publications suggesting a need for standardization of terminology in periodontitis diagnosis