Caries Management by Risk Assessment: Results from a Practice-Based Research Network Study.
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ABSTRACT:
SUBMITTER: Rechmann P
PROVIDER: S-EPMC6407860 | biostudies-literature | 2019 Jan
REPOSITORIES: biostudies-literature
Publications
Caries Management by Risk Assessment: Results from a Practice-Based Research Network Study.
Rechmann Peter P Chaffee Benjamin W BW Rechmann Beate M T BMT Featherstone John D B JDB
Journal of the California Dental Association 20190101 1
Thirty dentists with clinical practices outside of a university setting were trained and calibrated successfully in DMFS and ICDAS-scoring. This randomized, controlled, parallel-arm, double-blind 2-year clinical trial with individual-level caries risk assignment of 460 patients to standard of care as control versus active CAMBRA treatment as intervention demonstrated that caries risk level, as well as caries disease indicators, were significantly reduced in the CAMBRA intervention group compared ...[more]
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Project description:OBJECTIVES:(i) To quantify the importance that dentists place on caries risk factors when developing a caries treatment plan and (ii) to test the hypothesis that the ratings of importance for specific factors are significantly associated with whether or not the dentist performs caries risk assessment (CRA). METHODS:This study used a cross-sectional study design consisting of a questionnaire survey. The study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan (JDPBRN), which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n = 282). Participants (n = 189) were asked to rate the importance of caries risk factors when developing a caries treatment plan in both adult and pediatric patients. RESULTS:Oral hygiene status was rated as the most important risk factor when developing a treatment plan in both adult and pediatric patients, whereas the use of fluorides was rated as the least important. Results of multiple logistic regression analysis showed that the odds ratios for the decision to perform CRA in the adult patient for past caries experience and use of fluorides were 2.61 (95% confidence interval [CI]: 1.29-5.29) and 1.85 (95% CI: 1.12-3.04), respectively, whereas that for oral hygiene was 3.84 (95% CI: 1.15-12.79) and use of fluorides 1.79 (95% CI: 1.06-3.03) in the pediatric patient. CONCLUSIONS:These results suggest that enhancing dentists' concept of the importance of current use of fluorides when developing a treatment plan may increase the percentage of dentists who conduct CRA in both adult and pediatric patients (clinicaltrials.gov registration number: NCT01680848).
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Project description:ObjectiveThe purposes of this study were to (1) quantify dentists' practice patterns regarding caries prevention and (2) test the hypothesis that certain dentists' characteristics are associated with these practice patterns.DesignThe study used a cross-sectional study design consisting of a questionnaire survey.ParticipantsThe study queried dentists who worked in outpatient dental practices who were affiliated with the Dental Practice-Based Research Network Japan, which seeks to engage dentists in investigating research questions and sharing experiences and expertise (n=282).MeasurementDentists were asked about their practice patterns regarding caries preventive dentistry. Background data on patients, practice and dentist were also collected.Results38% of dentists (n=72) provided individualised caries prevention to more than 50% of their patients. Overall, 10% of the time in daily practice was spent on caries preventive dentistry. Dentists who provided individualised caries prevention to more than 50% of their patients spent significantly more time on preventive care and less time on removable prosthetics treatment, compared to dentists who did not provide individualised caries prevention. Additionally, they provided oral hygiene instruction, patient education, fluoride recommendations, intraoral photographs taken and diet counselling to their patients significantly more often than dentists who did not provide individualised caries prevention. Multiple logistic regression analysis suggested that the percentage of patients interested in caries prevention and the percentage of patients who received hygiene instruction, were both associated with the percentage of patients who receive individualised caries prevention.ConclusionsWe identified substantial variation in dentists' practice patterns regarding preventive dentistry. Individualised caries prevention was significantly related to provision of other preventive services and to having a higher percentage of patients interested in caries prevention, but not to the dentist's belief about the effectiveness of caries risk assessment. (Clinicaltrials.gov registration number NCT01 680 848).
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Project description:BackgroundThe International Caries Consensus Collaboration (ICCC) has published recommendations on carious tissue removal to treat cavitated carious lesions in a manner that preserves hard tissue and retains teeth long term. This study quantifies The National Dental Practice-Based Research Network dentists' use of selective caries removal.MethodsThis cross-sectional questionnaire study assessed reported use of selective caries removal when treating deep caries in asymptomatic and symptomatic teeth in response to clinical case scenarios. Statistical methods included the proportion of respondents concordant with ICCC guidelines at various thresholds and logistic regression to model factors associated with concordance.ResultsA total of 500 dentists responded. The study sample was 57% male, mean (SD) age was 50.9 (12.6) years, and 60% worked in private practice settings. Higher levels of concordance for choosing selective caries removal 50% or greater of the time were found for asymptomatic (62.4%; 95% CI, 57.6 to 67.2) than for symptomatic caries (49.3%; 95% CI, 44.4 to 54.2). These differences were significantly associated with type of practice setting.ConclusionsThe National Dental Practice-Based Research Network dentists reported using selective caries removal strategies when managing deep carious lesions more often than in previous US and Japanese practice-based research network studies and from results of a systematic review and meta-analysis. Nonetheless, substantive discordance with the ICCC guidelines was seen by the authors of this study.Practical implicationsMore dissemination and continuing education activities, as well as implementation studies, may further encourage use of selective caries removal to soft or firm dentin when indicated.
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Project description:OBJECTIVES:This study quantified and compared practice patterns of treatment for deep occlusal carious lesions among Japanese dentists, and tested the hypothesis that dentist characteristics are significantly associated with the decision to choose an indirect pulp capping (IPC), a form of selective carious tissue removal that involves leaving a thin layer of demineralized tissue over the pulp, that is then covered with a protective liner. METHODS:This cross-sectional study was conducted using a questionnaire survey of dentists affiliated with the Dental Practice-based Research Network Japan (n?=?297). Dentists were asked to indicate what percentage of time they use three treatment options when treating patients with deep occlusal caries and possible mild pulpitis on a posterior tooth. Response options were "1. Stop before removing all caries and perform an IPC", "2. Remove all caries and proceed with a direct pulp cap", and "3. Remove all caries and proceed with endodontic-related procedures". Percentages of options 1-3 were compared by multiple comparison. Associations between dentist characteristics and a higher percentage of IPC provision (option 1) were analyzed via logistic regression. RESULTS:Responses were obtained from 206 dentists. Median percentages (interquartile ranges) of options 1, 2 and 3 were 30% (10-59%), 10% (0-30%), and 40% (19-80%), respectively. The differences between option 3 and options 1 and 2 were significant (p?<?0.001). In logistic regression analysis, a higher frequency of obtaining evidence from English-language scientific articles was significantly associated with a higher percentage of IPC, with an odds ratio of 2.28 (95%CI: 1.14-4.54). CONCLUSIONS:Endodontic-related procedures remain the most frequent treatment option for deep occlusal caries. Frequent use of evidence-based information in English-language scientific articles was associated with Japanese dentists' preference toward IPC. CLINICAL SIGNIFICANCE:Japanese dentists would most frequently choose endodontic-related procedures, followed by IPC and direct pulp capping for treatment of patients with deep occlusal caries with possible mild pulpitis on posterior teeth. Significant association was identified between use of evidence-based information in the English-language scientific literature and Japanese dentists' preference for IPC.
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Project description:PurposeThe study aims were: (i) to examine dentist practice patterns regarding treatment recommendations for dental sealants; and (ii) to identify characteristics associated with this recommendation.MethodsThe study was performed using a cross-sectional questionnaire survey (Clinicaltrials.gov registration number NCT01680848). Participants were Japanese dentists (n = 282) recruited from the Dental Practice-based Research Network Japan. Three clinical photographs of the occlusal surface of a mandibular first molar were presented, portraying increasing depths of cavitation in a 12-year-old patient with high caries risk. Sealants would be an appropriate treatment in all three scenarios. We asked about the treatment decision for each case. We then performed multiple logistic regression analyses to evaluate associations between the decision to recommend sealants, and dentist, patient and practice characteristics.ResultsResponses were obtained from 189 dentists (response rate = 67%). In the hypothetical scenarios, dentists' recommendations for sealants for the 12-year-old patient varied from 16% to 26% across the three hypothetical clinical scenarios. Multiple logistic regression analysis indicated that dentist agreement with the efficacy of assessment for caries risk showed a significant association with the percentages of patients receiving sealants.ConclusionsDentist practice patterns for sealant treatment recommendation show changes that are dependent on caries severity. The dentists' recommendations for sealants for the 12-year-old patient were low for all three selected scenarios, based on indications for sealants in the American Dental Association guidelines. Recommending a sealant showed a significant relationship with the dentist having a higher agreement with efficacy of caries risk assessment.
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Project description:BackgroundDespite general practitioners' (GPs') key role in Germany`s primary health care, clinical research in general practice is scarce. Clinical research is mainly conducted at inpatient facilities, although their results are rarely transferable. German GPs have no extra time or funding for research, as well as limited research training. To support clinical research in German primary health care, practice-based research networks (PBRNs) are developed. As they will be based on an active involvement of GPs, we need more information on GPs` participation-readiness. The aim of this study was to explore facilitators and barriers to participation in the Bavarian Research Practice Network (BayFoNet) from the GPs`perspective before clinical trials will be performed.MethodsWe have performed semi-structured qualitative interviews with a purposive sample of 20 Bavarian GPs in 2022 under the application of the consolidated framework for implementation research (CFIR). Transcriptions were analysed according to Kuckartz` qualitative content analysis. The five domains of the CFIR framework served as initial deductive codes.ResultsN = 14 interviewees already agreed to participate in BayFoNet, whereas n = 6 interviewees opted not to participate in BayFoNet at the time of data collection. Main facilitators to conduct clinical research within BayFoNet were the motivation to contribute to evidence strength and quality in general practice, professional development and training of practice staff, as well as networking. Barriers for an active participation were bad experiences with previous clinical studies and lack of resources.ConclusionsPBRNS in Germany have to be promoted and the entire practice team has to be involved at an early stage of development. Professional training of general practice staff and a living network might enhance engagement. Participatory approaches could help to develop acceptable and feasible study designs. Furthermore, PBRNs should support patient recruitment and data collection in general practices and disseminate the results of their research projects regularly to maintain GPs` engagement.Trial registrationDRKS00028805, NCT05667207.
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Project description:BackgroundRecruitment efforts for child health research are often based on assumptions, therefore improving knowledge about parents' perceptions and preferences could enhance engagement.Aim/objective1) To describe parents' perceptions about and preferences for participation in child health research within a pediatric practice-based research network (PBRN), and 2) to investigate any associations with the presence of on-site PBRN research staff, office location, and child age.MethodsWe conducted a 2-phase study with a convenience sample of parents from diverse office settings. Phase 1 was a qualitative assessment using semistructured, in-person interviews. Phase 2 consisted of a quantitative self-administered survey assessing: 1) perceptions of importance, benefits/motivations, and risks/barriers of child health research, and 2) preferences for recruitment method and enrollment location.ResultsParents (n = 627) uniformly perceived child health research to be important in prevention (89%), diagnosis (89%), and treatment (92%). They were motivated to participate most commonly by altruism and rarely by compensation. Parents perceived side effects (60%), discomfort (52%), and time (45%) as the main risks of participation. Most parents preferred to learn about research opportunities at their pediatric office (70%), and if interested, to enroll their child in their pediatric office (57%) or in their home (52%). Parents were significantly more altruistic and interested in participation in offices with on-site PBRN research staff and greater proximity to the University.ConclusionsChild health researchers could enhance participation by using recruitment resources and enrollment strategies that match parent preferences, including engagement by on-site PBRN staff.
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Project description:To demonstrate that Caries Management by Risk Assessment (CAMBRA) can be successfully implemented in dental practice, 30 dentists were recruited to perform a 2-y CAMBRA trial. Twenty-one dentists (18 private practices, 3 community clinics) participated in a randomized, controlled, parallel-arm, double-blind clinical trial with individual-level assignment of 460 participants to standard of care (control) versus active CAMBRA treatment (intervention). Control or active antimicrobial and remineralizing agents were dispensed at baseline and 6-, 12-, 18-, and 24-mo recall visits according to risk level and assigned treatment arm. Primary outcome measure was dentist-determined caries risk level at recall. Among initially high-risk participants, secondary outcomes were recorded disease indicators. Generalized estimating equations were used to fit log-linear models for each outcome while accounting for repeated measurements. At 24 mo, follow-up rates were 34.3% for high-risk participants (32.1% intervention, 37.1% control) and 44.2% for low-risk participants (38.7% intervention, 49.5% control). Among 242 participants classified as high caries risk at baseline (137 intervention, 105 control), a lower percentage of participants remained at high risk in the intervention group (statistically significant at all time points). At 24 mo, 25% in the intervention group and 54% in the control group remained at high risk ( P = 0.003). Among 192 participants initially classified as low risk (93 intervention, 99 control), most participants remained at low risk. At 24 mo, 89% in the intervention group and 71% in the control group were low caries risk ( P = 0.18). The percentage of initially high-risk participants with recorded disease indicators decreased over time in both intervention and control groups, being always lower for the intervention group (statistically significant at the 12- and 18-mo time point). In this practice-based clinical trial, a significantly greater percentage of high-caries-risk participants were classified at a lower risk level after CAMBRA preventive therapies were provided. Most participants initially assessed at low caries risk stayed at low risk (ClinicalTrials.gov NCT01176396).
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Project description:Saliva contains various microbes and host biological components that could be used for caries risk assessment. This review focuses on the research topics that connect dental caries with saliva, including both the microbial and host components within saliva.
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