Methodology for the development of a national Dental Practice-Based Research Network survey on dentist’s beliefs and behaviors concerning antibiotic prophylaxis

Background Dentists are high prescribers of antibiotics for both treatment and prevention of infection, although there are few guidelines to aid clinicians. Given the worldwide concerns about unnecessary use of antibiotics, there is a need for a better understanding of dentists’ use of these drugs for antibiotic prophylaxis (AP) to prevent distant site infections (i.e., infective endocarditis and prosthetic joint infection). Objective The aim of this study was to develop and implement an effective, self-reporting, cross-sectional, survey instrument that optimized the response rate and maximized reliability and validity for determining the beliefs and behaviors of a large and nationally representative group of generalist and specialist dentists concerning their use of AP. Study Design A 15-question survey (58 items) was developed in a structured process by a multidisciplinary team and configured for automated online dissemination to 3584 national Dental Practice-Based Research Network (DPBRN; hitherto referred to as “Network”) practitioners. The implementation phase consisted of 3 waves of greater than 1000 Network members. Additionally, 47 randomly selected dentists were surveyed twice to assess test–retest reliability. Results Of 3584 eligible Network members, 2169 (60.5%) completed the survey. The age and geographic distributions of responders was similar to those of dentists in the 2019 American Dental Association census. Furthermore, test–retest weighted kappa values for the survey were acceptable (median 0.56; interquartile range 0.42–0.64). Conclusions We developed a highly structured survey with a high response rate and good reliability that will allow us to obtain unique data on dentists’ beliefs and practices regarding AP prescribing

Distinguishing pulpal from periapical pain by pain characteristics : National Dental PBRN

Objective Root canal treatment (RCT) is often initiated upon pain caused by inflammation of pulpal or periapical tissues. To explore to what extent certain clinical signs and symptoms differ between these two conditions, we compared pain of pulpal and periapical origin with regard to symptoms, clinical signs and diagnostic findings. Methods 62 dentists within the National Dental PBRN (www.NationalDentalPBRN.org) enrolled consecutive patients requiring RCT. Preoperative data were collected from patients (symptoms, pain characteristics) and dentists (examination findings) by questionnaires. Patients with average pain intensity >0 (0–10 numeric rating scale; NRS) for >1 day in the week preceding treatment were eligible. The definition for pain of pulpal origin was tooth pain with bleeding within the pulp chamber in the absence of periapical radiolucency. The definition for pain of periapical origin was tooth pain without bleeding pulp and presence of radiolucency. Pearson's chi-square test and t-test compared groups, and sensitivity and specificity were calculated. Results 370 patients met criteria; 234 (63%) exhibited pulpal pain and 136 (37%) had periapical pain. Patients with pain of pulpal origin more often reported sharp (p=0.004), dull (p=0.039), or shooting pain (p=0.026), provoked pain onset (p=0.002), pain aggravated by cold/hot food or drink (p<0.001) and prolonged response to cold (p<0.001). Patients with pain of periapical origin more often had tenderness to percussion (p<0.001) and biting pressure (p<0.001), as well as swelling (p<0.001). To identify pain of pulpal origin, prolonged response to cold had 71% sensitivity and 92% specificity. To identify pain of periapical origin, tenderness to percussion had 89% sensitivity and 38% specificity and for biting pressure, 81% sensitivity and 42% specificity. Conclusion Clinical characteristics and symptoms clearly differed between conditions. Although no single factor had adequate validity to be used as an indicator of the source of pain, several should be considered for inclusion in future diagnostic algorithms

Preferences for peer-reviewed versus other publication sources: a survey of general dentists in the National Dental PBRN

Abstract Background Medical professionals have access to a broad range of resources to address clinical information needs. While much attention is given to new sources of data such as those available on the internet, it is less clear how clinicians choose between peer-reviewed research literature and other publication-based sources. This analysis distinguishes between possible drivers of publication type preference (namely, practice setting, advanced training, professional development experiences). Dentists enrolled in the National Dental Practice-Based Research Network (PBRN) are the population for this study. Theories of human and intellectual capital and institutional logics theory are used to understand how advanced training and other clinical experiences may explain the choices that dentists make when faced with clinical questions. Methods An online questionnaire was implemented with general dentists in the US National Dental PBRN. A series of logistic and Ordinary Least Squares (OLS) regression models were used to explain the use of peer-reviewed and other publications. Measures of knowledge-based human capital distinctions (advanced clinical training and research engagement, advanced professional status, personal motivation for professional advancement) were used to explain preferences for research literature as a clinical resource. Results General dentists with advanced training, as well as those with a skill advancement motivation, show a preference for peer-reviewed materials. General dentists who have been practicing longer tend to favor other dental publications, preferring those sources as a resource when faced with clinical challenges. Human capital and professional motivation distinguish the information preferences among general dentists. Further, these factors explain more variance in use of peer-reviewed materials than practice setting does. Few differences by demographic groups were evident. Conclusions Results point to a distinct variation in the general dentistry professional community. Advanced training among general dentists, as well as the types of procedures typically conducted in their practice, distinguishes their information preferences from other general dentists, including those with more years of clinical experience