Four “Lessons Learned” While Implementing a Multi-Site Caries Prevention Trial

As the number of dental-related randomized clinical trials (RCTs) increases, there is a need for literature to help investigators inexperienced in conducting RCTs design and implement studies. This commentary describes four “lessons learned,” or considerations important in the planning and initial implementation of RCTs in dentistry that to our knowledge have not been discussed in the general dental literature describing trial techniques. These considerations are 1) preparing or securing a thorough systematic review, 2) developing a comprehensive set of study documents, 3) designing and testing multiple recruitment strategies, and 4) employing a run-in period prior to enrollment. Attention to these considerations in the planning phases of a dental RCT can help ensure that the trial is clinically relevant while also maximizing the likelihood that its implementation will be successful

Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries-active adults

To better understand the effectiveness of xylitol in caries prevention in adults, and to attempt improved clinical trial efficiency

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

<p>Abstract</p> <p>Background</p> <p>Practice-based research networks offer important opportunities to move recent advances into routine clinical practice. If their findings are not only generalizable to dental practices at large, but can also elucidate how practice characteristics are related to treatment outcome, their importance is even further elevated. Our objective was to determine whether we met a key objective for The Dental Practice-Based Research Network (DPBRN): to recruit a diverse range of practitioner-investigators interested in doing DPBRN studies.</p> <p>Methods</p> <p>DPBRN participants completed an enrollment questionnaire about their practices and themselves. To date, more than 1100 practitioners from the five participating regions have completed the questionnaire. The regions consist of: Alabama/Mississippi, Florida/Georgia, Minnesota, Permanente Dental Associates, and Scandinavia (Denmark, Norway, and Sweden). We tested the hypothesis that there are statistically significant differences in key characteristics among DPBRN practices, based on responses from dentists who participated in DPBRN's first network-wide study (n = 546).</p> <p>Results</p> <p>There were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations.</p> <p>Conclusion</p> <p>Although as a group, participants have much in common with practices at large; their substantial diversity offers important advantages, such as being able to evaluate how practice differences may affect treatment outcomes, while simultaneously offering generalizability to dentists at large. This should help foster knowledge transfer in both the research-to-practice and practice-to-research directions.</p

Concordance between Clinical Practice and Published Evidence: Findings from The National Dental Practice-Based Research Network

Documenting the gap between what is occurring in clinical practice and what published research suggests is an important step toward improving care. This study quantified concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in the National Dental Practice-Based Research Network

Results from the Xylitol for Adult Caries Trial (X-ACT)

Although caries is prevalent in adults, few preventive therapies have been tested in adult populations. This randomized clinical trial evaluated the effectiveness of xylitol lozenges in preventing caries in elevated caries-risk adults

Examiner Training and Reliability in Two Randomized Clinical Trials of Adult Dental Caries

This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra- examiner reliability scores from the initial standardization sessions

Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline:findings from the National Dental Practice-Based Research Network

A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions

The prevalence of questionable occlusal caries:findings from the Dental Practice-Based Research Network

Objectives—Questionable occlusal caries (QOC) can be defined as clinically-suspected caries with no cavitation or radiographic evidence of occlusal caries. To our knowledge, its prevalence has not been quantified; this was the objective of this study. Methods—A total of 82 dentist and hygienist practitioner-investigators from “The Dental Practice-Based Research Network” (DPBRN) participated. When patients presented with at least one unrestored occlusal surface, their number of unrestored occlusal surfaces and QOC were quantified. Information also was recorded about patient characteristics on consented patients who had QOC. Data analysis adjusted for patient clustering within practices. Results—Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11% of unrestored surfaces among all patients had QOC. Patient- and surface-level QOC prevalence varied significantly by region (p<0.001; p<0.03). The highest percent for patient-and surface-level prevalence was in Florida/Georgia (42%; 16%). Conclusions—To our knowledge, this is the first study to quantify the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among DPBRN’s five main regions. Clinical Implications—QOC lesions are common in routine practice and warrant further investigation regarding how best to manage them