Dental Practice-Based Research Network to Support the Conduct of Research in Clinical Practices

Center for Clinical Research, DER, NIDCR

Objective

The goal of this initiative is to support a third phase of the dental Practice-Based Research Network (PBRN) to conduct oral health research on topics of importance to dental practitioners and their patients, to provide evidence useful in daily patient care, and to facilitate the translation of research findings into clinical practice. The dental PBRN is a unique venue in which to conduct clinical research, providing practitioners with an opportunity to propose or participate in research studies that address day-to-day issues in oral health care. The studies, conducted in participating dental offices with consenting patients, help to expand the profession’s evidence base and further refine care. This new initiative will build upon knowledge gained and lessons learned from the previous and current NIDCR-supported dental PBRNs.

Background

NIDCR’s investment in practice-based research began in 2005, when three regional and geographically-diverse PBRNs were formed. The three PBRNs were viewed as highly successful, having engaged about 1,000 practitioners who participated in 40 research studies across the three networks. In 2012, NIDCR funded the second and current phase of the dental PBRN, a national structure with 6 regional hubs, centrally administered at the University of Alabama at Birmingham. This national structure, called the National Dental PBRN, has facilitated development of a central institutional review board (IRB), standardization of study operations, and involvement of practitioners in all aspects of research studies, from development to implementation to dissemination. There are about 6,000 practitioner members of the National Dental PBRN, who have enrolled over 25,000 patients in studies. By March 2019, the network intends to complete 17 clinical research studies, with participants from across the nation and different types of practice settings. Many of the studies involve complex clinical data collection and analysis. Some examples of research studies conducted in the National Dental PBRN include: assessing feasibility and acceptability of oral HPV detection in the dental office, characterizing methods of diagnosing and managing dentin hypersensitivity, investigating the feasibility of using electronic dental records in dental offices to assess treatment outcomes, assessing practitioners’ knowledge and decision-making related to opioid analgesic prescribing following dental procedures, establishing a registry of cracked teeth to record factors related to tooth symptom status and treatment outcomes over time, assessing factors related to temporomandibular joint disorder treatment decisions and pain and function outcomes over time, assessing factors for severe pain following root canal treatment and the prevalence of persistent pain following root canal treatment, and evaluating a software platform for implementing a dental practitioner-delivered smoking cessation intervention. Read more information about the National Dental PBRN www.nationaldentalpbrn.org ».

PBRNs are expected to provide robust clinical evidence to inform treatment decisions made by practicing dentists in the daily care of their patients. One benefit of practice-based research is the ability to collect data from practitioners about factors contributing to decision-making and procedures performed, and separately, to collect data from patients from their perspectives, sometimes independent of practitioners. Another benefit is the ability to efficiently enroll large numbers of patients with a wide geographic distribution; many practitioners are engaged in Network studies, with each contributing a relatively small number of patients. An important characteristic of the PBRN is the ability to address emerging topics of public health interest, taking advantage of the existing infrastructure and capacity for launching studies in a timely manner. It is envisioned that the future Network will demonstrate continued growth and productivity, building on previous successes and incorporating refinements based on lessons learned. A national dental PBRN structure will maintain a geographically diverse network capable of reaching all interested participants. In addition, the future Network will further explore use of electronic data collection to allow for data collection independent of office visits, will continue to maintain a single IRB and will increase the number of public-private partnerships. Although there is a growing evidence base to support practicing dentists in diagnosis and treatment of dental caries, periodontal disease, and other oral conditions, dissemination and implementation of this information remains challenging. The dental PBRN is an ideal venue to translate research findings into practice.

Examples of research topics could include, but are not limited to:

• Exploration of factors that contribute to practitioners’ decision making regarding oral health prevention or treatment, such as sealant placement.
• Assessment of oral disease prevention or treatment outcomes through longitudinal studies.
• Determination of best oral health treatment strategies for patients with oral disease.
• Dissemination of oral health evidence and PBRN research findings and implementation into practice.
• Topics of emerging public health interest.
• Questions of interest to dental specialty organizations.

Alignment with Institute Goals and Strategic Plan

This initiative is broadly aligned with the NIDCR Strategic Plan Objective 1-3: Conduct translational and clinical investigations to improve dental, oral, and craniofacial health; and Objective 4-2: Sustain research-related career enhancement opportunities in research. Specifically, Objective 4-2 states that NIDCR will continue to support dental practice-based research to strengthen the oral health evidence base and grow the oral health workforce to include clinician-scientists conducting research with people in everyday practice settings.

Feasibility

NIDCR has demonstrated that it is feasible to successfully assemble and maintain a National Dental PBRN. The Network has been highly successful to date, having produced 126 publications. With funding for the current phase expiring in 2019, this initiative will take advantage of NIDCR’s 14-year investment in practice-based research and the momentum created since the inception of the National Dental PBRN.

Current Portfolio Overview

In 2005, NIDCR funded the three regional PBRNs for a period of 7 years. NIDCR currently supports the National Dental PBRN through a cooperative agreement mechanism, for a period from 2012-2019.

Selected References

Funkhouser E, Vellala K, Baltuck C, Cacciato R, Durand E, McEdward D, Sowell E, Theisen SE, Gilbert GH, National Dental PBRN Collaborative Group. Survey methods used to optimize response rate in the National Dental Practice-Based Research Network. Evaluation and the Health Professions 2017 Sep:40(3):332-358.

Rindal DB, Flottemesch TJ, Durand EU, Godlevsky OV, Schmidt A, Gesko DS, Gilbert GH for the National Dental PBRN Collaborative Group. Practice change toward better adherence to evidence-based treatment of early dental decay in the National Dental PBRN. Implementation Science 2014; 9:177.

Gilbert GH, Williams OD, Korelitz JJ, Fellows JL, Gordan VV, Makhija SK, Meyerowitz C, Oates TW, Rindal DB, Benjamin PL, Foy PJ for the National Dental PBRN Collaborative Group. Purpose, structure and function of the United States National Dental Practice-Based Research Network. Journal of Dentistry 2013; 41(11):1051-1059.