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Abstract Background 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. Methods 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). Results There were statistically significant, substantive regional differences among DPBRN-participating dentists, their practices, and their patient populations. Conclusion 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.

Background: The objectives were to: (1) quantify patient satisfaction with treatment for early dental caries overall, and according to whether or not (2a) the patient received invasive treatment; (2b) was high-risk for dental caries, and had dental insurance; and (3) encourage practitioners to begin using non-invasive approaches to early caries management. Methods: Ten practitioners recorded patient, lesion, and treatment information about non-cavitated early caries lesions. Information on 276 consecutive patients with complete data was included, who received either non-invasive (no dental restoration) or invasive (dental restoration) treatment. Patients completed a patient satisfaction questionnaire and were classified as dissatisfied if they did not "agree" or "strongly agree" with any of 14 satisfaction items. Results: Patients had a mean (± SD) age of 41.8 (±15.8) years, 64% were female and 88% were white. Twenty-five percent (n = 68) were dissatisfied in at least one of the 14 satisfaction items. Satisfaction levels did not significantly vary by patient's gender, race, caries risk category, or affected tooth surface location. Overall, 11% (28 of 276) received invasive treatment; satisfaction did not differ between patients who had invasive or non-invasive treatment. Seven patients received invasive treatment at their request even though that was not what their practitioner recommended; 5 out of 6 were satisfied with their treatment nonetheless. Conclusions: About one-fourth of patients treated for non-cavitated early caries were dissatisfied with at least some aspect of their dental care experience. Satisfaction of patients who received invasive treatment did not differ from those who received non-invasive treatment. [ABSTRACT FROM AUTHOR]

Background. 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. Methods. Fifty-three clinicians from The National Dental Practice- Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months. Results. At baseline, 1,341 QOC lesions were examined; the treatment that was planned for 1,033 of those at baseline was monitoring (oral hygiene instruction, applying or prescribing fluoride or varnish, or both), and the remaining 308 received a sealant (n = 192) or invasive therapy (n = 116). At the 20-month visit, clinicians continued to monitor 927 (90 percent) of the 1,033 monitored lesions. Clinicians decided to seal 61 (6 percent) of the 1,033 lesions (mean follow-up, 19 months) and invasively treat 45 (4 percent) of them (mean follow-up, 15 months). Young patient age (< 18 years) (odds ratio = 3.4; 95 percent confidence interval, 1.7-6.8) and the lesion’s being on a molar (odds ratio = 1.8; 95 percent confidence interval, 1.3-2.6) were associated with the clinicians deciding at some point after follow-up to seal the lesion or treat it invasively. Conclusions. Almost all (90 percent) QOC lesions for which the treatment planned at baseline was monitoring still were planned to undergo monitoring after 20 months. This finding suggests that noninvasive management is appropriate for these lesions. Practical Implications. Previous study results from baseline indicated a high prevalence of QOC lesions (34 percent). Clinicians should consider long-term monitoring when making treatment decisions about these lesions. [ABSTRACT FROM AUTHOR]

Background. Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographie evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study. Methods. A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors 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 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively). Conclusions. To the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions. Clinical Implications. QOC is common in routine practice and warrants further investigation regarding how best to manage it. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the relationship between: (1) children's caries score (dmft, DMFT) at the time of sealant placement; and (2) "success" (measured as being caries-free) of that tooth at follow-up visits. Methods: An existing database of over 38,000 sealants (10,038 children) placed between 1997 and 2002 by the Jefferson County Health Department's Community Based Sealant Program, Birmingham, Ala, was used in the analysis. Only children returning for follow-up visits after the initial placement of the sealants were included in this study, resulting in 6,452 sealants (2,097 children). Logistic regression analysis was performed to determine the differences in sealant success between children with a dmft score of 0 vs a dmft score of >0 at baseline, and a DMFT score of 0 vs a DMFT score of >0 at baseline. Results: In the permanent and primary dentitions, those who had no caries at the time of sealant placement (dmft/DMFT=0) had a significantly higher success of sealants during years 1 to 5 compared to those with a caries score of greater than 0 (dmft/DMFT>0; P<.023, P<.002, respectively). Conclusion: Children with previous caries experience may be at a higher risk for sealant "failure" (measured as caries on a tooth surface previously sealed) after 1 year and, therefore, may require more diligent sealant maintenance. [ABSTRACT FROM AUTHOR]

Purpose: The purposes of this study were to: (1) evaluate the retention rates of occlusal sealants in children in an urban school-based sealant program run by a County Health Department in Alabama; and (2) assess the clinical benefits of this sealant program by comparing caries experience of a group of participants and nonparticipants. Methods: The records of 2,097 children (mean age=8.1±1.6 years) who received sealants and had at least 1 follow-up examination were analyzed to determine the outcome of sealed and nonsealed surfaces of permanent first molars (PFM). Additionally, 103 fifth-grade students who did and did not participate in the sealant program (P=participants; NP=nonparticipants) were examined by a masked examiner who recorded their PFM condition. Results: Sealants placed by the County Health Department had a retention rate of 71% over an average of 1.6±0.7 years (range=0.5-4.4 years). The patient's age at the initial visit appeared to be the only factor that influenced retention. On average, participants had at least 1 PFM that remained caries-free, compared to nonparticipants (permanent decayed, missing, and filled teeth [DMFT] in NP=1.5±1.4, P=0.5±0.8; <.016). Conclusions: Retention rates for occlusal sealants in this public health program were similar to those reported in previous clinical studies. Furthermore, children who had sealants had significant protection from occlusal decay up to grade 5. [ABSTRACT FROM AUTHOR]

People that the author would like to thank for their review of manuscripts in the January to June 2007 issues of the "Journal of the American Geriatrics Society" are mentioned.