Dr. Shamp: I had a patient with osteonecrosis of the jaw (ONJ) in my office, and a colleague (Dr. Brad Rindal) told me he was involved in a study of patients with ONJ. As a general dentist I had not thought much about P-values or statistical analysis since dental school, but I reluctantly agreed to take part. Our office had a very positive experience, and so we have participated in several research projects since. I enjoyed the fact that researchers doing practice-based research wanted my data, and I wanted research that applied to and reflected “real” dental office situations.
Q: How did your staff react when you got involved in the network doing research in your practice?
Dr. Shamp: When I first brought up the subject, I got some “here we go again” feelings from the staff about another one of my “new ideas”. The process was easily folded into our office, and the staff very shortly felt they were a part of something more than just dentistry as usual. Being part of a process to not only better our knowledge, but helping others at the same time developed a “win-win” attitude for all of us.
Dr. Foy: We all had a sense of pride knowing that our practice is contributing to and advancing dental research that will eventually help our profession improve patient care. Betty, our office manager, took it upon herself to administer and track all patients who were in the research studies. She made my participation relatively painless and seamless. We were also compensated fairly for the extra work filling out questionnaires and data sheets.
Q: What has been the benefit of your involvement?
Dr. Shamp: When the results of the ONJ study were published, I called a mini staff meeting and explained the data we helped to collect. The staff was really engaged and proud to be contributors. Our data mattered to them. Patients are almost universally supportive that their dentists are doing front line research.
Dr. Foy: I was fortunate to be elected to a member of the Executive Committee (EC) of the DPBRN. The EC is a small body of practicing dentists who vote on what is studied and funded. That vetting process has made me a much more critical thinker and has improved my skills of incorporating the principles of EBD into my dental practice. My participation and the results of certain studies have not only changed how I practice day to day, changed my verbiage, but have improved my informed consent procedures. One study that measured “patient satisfaction” illuminated the “disconnect” between the patient and doctor when both were asked whether enough information was provided to the patient before a specific procedure. Even though the dentist and the patient knew in advance that they would be questioned about the replacement of a restoration, the patients indicated that they did not feel they had enough information about the procedure about 60% of the time. So now before I proceed with a dental procedure, I ask, “Do you have enough information about today’s procedure?” before I proceed with what we had planned. I think this has improved my informed consent process, and patients have been given a better opportunity to clarify in their minds what will happen during the appointment.
Q: How has your participation changed your office’s approach to patient care?
Dr. Foy: Evidence-based, or “science-based”, care is what we think we have been taught, but many of our procedures are based on traditions and experience. Every day we are presented with many clinically relevant questions where there are no clear-cut answers or well-documented solutions. The dentist and his professional staff only want to do what is best for their patients, but sometimes the answers are not readily available. We are challenged to find out “what is right?” We have the opportunity to be part of a well-managed diverse network of dentists that generates the evidence that will improve patient care. We are challenged to pose the most clinically relevant questions that will advance dentistry to a higher standard of care that is based on real dentists doing real-life dentistry. Unfortunately, insurance claims data and inappropriately applied clinical guidelines have already influenced the dental marketplace in ways that do not necessarily improve patient care. I see a great potential for the National Dental PBRN to improve patient care and hope many of my colleagues will participate in future studies. You will learn something, and it is the right thing to do.
Dr. Shamp: We look at incoming information more critically and have developed ways to seek out credible evidence, as opposed to accepting as fact the “sales pipeline” or information of that type. For instance, recently the broadcast media reported on a study that linked the risk of intracranial meningioma to exposure of dental X-rays.9 Due to our more critical approach since being involved in the DPBRN, I looked at the study and found what I thought were some issues with study design. It made me “ready” for the questions that I knew we would get from our patients. The first thing I explained to our patients was that all dental radiation exposures were of concern, and our office was doing as much as possible to reduce exposures. Next, I explained that the study was retrospective and subjects with an intracranial meningioma were asked to recall how often they had X-rays previously, a very unreliable way to measure dental radiation exposure. In fact, none of our patients I spoke with could remember with any certainty their own past dental X-ray experience, which helped them recognize the limited value of that study’s results. Our ability to evaluate research is much better since our participation in practice-based research.
The National Practice-Based Research Network: An Opportunity for the Members of the MDA
The funding cycle of NIDCR for the three original PBRNs ends in 2012. As the next phase of support for practice-based dental research, the NIDCR put out a request to the three original PBRNs for proposals to develop a successor, a single consolidated national PBRN (RFADE- 12-002). This award was granted to the original DPBRN led by Dr. Gregg Gilbert at the University of Alabama at Birmingham in the form of a $66.8 million, seven-year grant to form a National Dental Practice- Based Research Network (National Dental PBRN).10 The new National Dental PBRN has an administrative hub in Birmingham, Alabama and six regional research nodes at Rochester, New York; Gainesville, Florida; Birmingham, Alabama; San Antonio, Texas; Portland, Oregon; and most importantly for the MDA, in Minneapolis, Minnesota.
The National Dental PBRN in time will provide important findings which have been missing from the evidence base of dental care, evidence that will lead to improved patient care in the future. In addition, as has been noted by Drs. Foy and Shamp, there are many intangible benefits to the entire dental team which will impact the sense of mission for any dental clinic. The Minnesota Dental Association has made a commitment to support the National Dental PBRN based upon our unique experiences as an Association.
The EBD Task Force looks forward with great enthusiasm to a large participation by the MDA’s membership. To this end, the MDA will provide a symposium for its membership and their office staffs on the morning of October 12, 2012. The symposium will provide background on practice-based research as well as information regarding enrollment and participation in the new National Dental PBRN, and will be held at the University of Minnesota’s Continuing Education and Conference Center. We encourage your attendance, including that of all staff members. More information regarding registration will be provided in future MDA publications and e-mails (Figure 1). To enroll in the National Dental PBRN, visit www.NationalDentalPBRN.org. Previous participants in the DPBRN should re-enroll due to revised enrollment questions, the need to update information, and the opportunity to submit ideas for research studies. For more information or to speak with your Midwest Region staff about participation or a study idea you wish to share, please see the contact information in Figure 2
1. Sackett DL, Richardson WS, Rosenberg W et al. Evidence-Based Medicine: How to Practice and Teach EBM. London: Churchill Livingston, 1997.
2. “About EBD”, ADA Center for Evidence-Based Dentistry: http://ebd.ada.org/about.aspx (accessed June 16, 2012)
3. American Dental Association’s Center for Evidence-based Dentistry website: http://ebd.ada.org/ (accessed June 16, 2012)
4. 2006 House of Delegates Manual, Minnesota Dental Association, Minneapolis, Minnesota.
5. Pihlstrom BL, Tabak L: The National Institute of Dental and Craniofacial Research: research for the practicing dentist. JADA 2005;136:728-737.
6. Nutting PA: Practice-based research networks: building the infrastructure of primary care research. J Fam Pract 1996;42:199-203.
7. Solberg LI, Cole PM, Seifert MH: The Minnesota Academy of Family Physician’s Research Network: a vehicle for practice-based research. Minn Med 1986;69:599-601.
8. Dental Practice-Based Research Network website: http://www.dentalpbrn.org/home.asp (accessed June 18, 2012)
9. Longstreth WT Jr, Phillips LE, Drangsholt M, Koepsell TD, Custer BS, Gehrels JA, van Belle G: Dental X-rays and the risk of intracranial meningioma: a population-based case-control study. Cancer 2004;100:1026-1034
10. NIH News, Thursday, April 12, 2012: National Institutes of Health, National Institute of Dental and Craniofacial Research: http://www.nih.gov/news/health/apr2012/nidcr-12.htm (accessed
June 22, 2012)
* Dr. Anderson is chair of the Minnesota Dental Association’s Evidence-Based Dentistry Task Force and a member of the faculty of the School of Dentistry, University of Minnesota. Email is firstname.lastname@example.org.
** Dr. Foy is a past president of the Minnesota Dental Association, a member of the Executive Committee of the National Dental PBRN, and a private practitioner in Minneapolis, Minnesota.
***Dr. Shamp is a member of the National Dental PBRN and a private practitioner in Maple Grove, Minnesota.
†Dr. Rindal is a past president of the Saint Paul District Dental Society, Midwest Regional Director of the National Dental PBRN, and practices with HealthPartners Dental Group in Saint Paul, Minnesota.
‡Ms. Glasrud is the past Director of Policy for the Minnesota Dental Association.