Center for Clinical Research
Division of Extramural Research
The goal of this initiative is to support an infrastructure to conduct oral health research in dental practices on topics of importance to practitioners, to provide evidence useful in daily patient care, and to facilitate the translation of research findings into clinical practice. In 2005, NIDCR began supporting three regional dental practice-based research networks, or PBRNs, thereby establishing clinical research networks that link treatment approaches and outcomes in private practice settings. This new initiative builds upon the knowledge gained and lessons learned from the current PBRN networks. The PBRNs link practicing clinicians with a core of investigators experienced in clinical and health services research, at the same time enhancing the research skills of the practicing clinician network members. Moreover, because a PBRN uses the existing personnel and infrastructure of established dental practices, rapid subject recruitment is possible for certain types of clinical research. Practice-based research networks are expected to provide robust clinical evidence to inform treatment decisions made by practicing dentists in the daily care of their patients.
In the absence of a robust body of validated evidence, dental and oral health practitioners frequently use anecdotal information or data provided by industry to make clinical decisions for patient care. The overwhelming majority of dental patients receive their care in individual dental practices yet the majority of oral health research is conducted in the academic clinical setting. Clinical research studies with their stringent inclusionary and exclusionary criteria tend to create an artificial sample of patients who are not representative of patients receiving treatment in dental practices. Because treatment recommendations and oral disease management guidelines are often based on evidence from a relatively small number of large tertiary care centers, their applicability to the everyday practice of medicine may be limited. What is efficacious in randomized clinical trials is not always effective in the real world of day-to-day practice. The treatment effect and benefit-to-harm ratio reported in randomized trials are often not found in clinical practice. Unfortunately, these questions are infrequently addressed by academic and industry trials, which focus their attention and resources on discovering restorative materials and other dental devices.
Although there is a growing evidence base available 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 following are examples of clinical studies that could be conducted by a PBRN focused on issues impacting the oral health of the public:
Effectiveness of various strategies for the diagnosis of dental caries, periodontal disease, and oral cancer
Effectiveness of strategies to prevent progression of caries and periodontal disease
Natural history of untreated oral conditions, such as partially erupted third molars or cracked teeth
Effectiveness of interventions for treating and managing periodontal disease and caries
Assessing variations associated with the delivery of dental health care
Assessing patient compliance with treatment recommendations
Effectiveness of various strategies for managing acute and chronic orofacial pain
Assessing the outcomes of various treatments such as endodontic therapy, dental implants, and other prosthetics and restorative modalities
Data generated by practitioners in a PBRN can help fill this evidence gap and help answer important clinical questions faced by practicing dentists. A PBRN can support a variety of clinical studies with clear and easily defined outcome measures, and can typically draw on the experience and insight of practicing clinicians to help identify and frame research questions. Consistent with primary-care medical PBRNs, a dental and oral health practice-based research network links practicing clinicians with a core of investigators experienced in clinical and health services research at the same time enhancing the research skills of the practicing clinician network members. Because the PBRN research is conducted in the “laboratory” of dental practice, results are plausibly more likely to be readily accepted and adopted by practitioners and translated into daily clinical practice. Moreover, because a PBRN uses the existing personnel and infrastructure of established dental practices, certain types of clinical research can be conducted in a particularly cost-effective manner.
The current NIDCR dental PBRN networks are conducting and are expected to complete approximately 30 studies. Data from these studies has provided valuable information pertaining to the types of studies valued by practitioners, which studies are most likely to enroll subjects, and which designs were most successful when deployed in a practice-based research network.