Dental Primary Care Practice-Based Research Network to Support Research in Clinical Practices

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  1. Goal
  2. Background
  3. Gaps and Opportunities
  4. Specific Areas of Interest
  5. References

Center for Clinical Research
Division of Extramural Research

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Goal

The goal of this initiative is to transform and advance NIDCR’s support of practice-based research by endorsing a Dental Primary Care Practice-Based Research Network (PBRN), building upon knowledge gained and lessons learned from the previous and current NIDCR-supported dental PBRNs. A 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 clinical practices (offices/clinics) with consenting patients, help to expand the profession’s evidence base and further refine care. This new initiative will promote an efficient and agile network, focused on integrating oral health care into whole patient care and able to implement research on important oral health topics in a variety of practice settings and locations.

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Background

In 2005, NIDCR launched the first phase of the dental PBRNs by supporting three regional dental PBRNs, which conducted multiple clinical studies over seven years. To build upon the strengths of the regional dental PBRNs and coordinate their efforts, NIDCR launched the second phase of the dental PBRNs in 2012 by funding one national, geographically diverse network. The national structure promoted standardization of study operations and involvement of practitioners in all aspects of research studies, from development to implementation to dissemination. In the third and current phase, funded in 2019, NIDCR has continued to support a national infrastructure, called the National Dental Practice-Based Research Network, organized into six regional Nodes with wide geographic distribution along with two administrative hubs that, combined, are capable of reaching interested participants within all states in the U.S. In addition, there is one specialty dentistry Node that operates across all network’s geographic areas. An Administrative and Resource Center (ARC) and Network Coordinating Center (NCC) provide the infrastructure to facilitate the conduct of research within a dental PBRN setting, while research studies are funded separately.

There are over 8,400 practitioner members of the National Dental PBRN across the United States representing different types of practice settings, with ~475 practitioners currently active in clinical studies that collect research data on their consenting patients. The ~5,675 practitioners who have participated in research studies have contributed to conducting 58 studies, enrolling over 75,000 patients, and analyzing health records from more than 790,000 patients. Many studies involve complex clinical data collection and analyses. The network has been highly productive, with 229 publications to date, and on-track to complete 18 studies in its third phase, including two clinical trials, two large observational longitudinal studies, and nine studies of SARS-CoV-2/COVID-19.

PBRNs are expected to provide robust clinical evidence to inform treatment decisions made by practicing dentists in the daily care of their patients and facilitate the translation of research findings into clinical practice. 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 a patient's perspective. Another benefit is the capability of efficiently enrolling large numbers of patients with a wide geographic distribution and from diverse practice settings/types. An important characteristic of the dental PBRN is the rapid ability to deploy primary care practices to address emerging topics of public health interest, taking advantage of the existing infrastructure and capacity for launching studies in a timely manner.

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Gaps and Opportunities

It is envisioned that the future Network will demonstrate continued growth and productivity, building on previous successes and lessons learned, and will transform into an agile network focused on integration of oral health care into whole patient care. The Dental Primary Care PBRN structure will maintain a similar structure to the current phase, with an Administrative and Resource Center (ARC) and Coordinating Center (CC) comprising the infrastructure, and for supporting research studies. The ARC will be responsible for recruiting and retaining practitioners for network membership and study participation, managing a single Institutional Review Board (IRB), ensuring that practitioners and office/clinic staff receive research and study-specific training, and coordinating study deployment across Nodes. The CC will be the central focus for data coordination and study management. In addition to managing the network membership database, the CC will develop and maintain study-specific data management systems that utilize flexible and innovative technologies for electronic data capture, including the capability to collect research participant data independent of in-office visits. Independent research studies would tap into infrastructure resources to conduct studies within the Dental Primary Care PBRN.

Clinical research skills training, development, and mentoring will be formalized to provide Dental Primary Care PBRN researchers and practitioner participants with opportunities for clinical research skills enhancement through courses and other training activities. The future network must recruit and retain practitioners who practice in rural areas and/or primarily care for underserved populations, such as those practicing in dental public health clinics or Federally Qualified Health Centers (FQHCs) or caring for medically complex patients such as in hospital dental clinics. Rural will be defined according to the Health Resources & Services Administration definition. Practitioners who primarily care for underserved populations will be defined by the practice setting described above or providing care to at least 50% of patients who receive dental services through Medicaid insurance.

The future Dental Primary Care PBRN will emphasize conduct of clinical trials and leverage the network’s resources to participate in developing NIH initiatives, such as the primary care Communities Advancing Research Equity for Health™ (CARE for Health™) network, and will serve as a pipeline for clinical application of devices and products developed through NIH-supported small business grants. Study topics will emphasize the integration of oral health care into medical care (whole person health), such as screening for medical conditions and health risk behaviors in a primary dental care setting and appropriate referral to medical providers for provision of care. In addition, the future network will maximize the use of remote data collection, as appropriate, to allow for data collection independent of office visits, and it will maintain a single IRB. 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 Primary Care PBRN is an ideal venue to rapidly and broadly disseminate and apply research findings and oral care guidelines to primary dental care settings.

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Specific Areas of Interest

The dental clinical practice (office/clinic) is a primary care setting that provides an opportunity for oral health practitioners to conduct preventive general and oral health services, such as evidence-based screenings. Many individuals in the U.S. may have a dental visit in a given year, but not a routine medical visit, or they may not be aware of the need to be screened for certain medical conditions throughout the lifespan. Health screenings in dental clinical practices (offices/clinics) provide opportunities to identify individuals with undiagnosed or progressing medical conditions beyond those conditions specific to the head and neck region. Previous research indicates acceptability of screening for medical conditions in a dental setting by both dental professionals and patients. Additionally, several studies have demonstrated the feasibility of conducting evidence-based screenings in the dental setting for certain medical conditions occurring throughout the lifespan. To address these gaps, research would be focused on strengthening the evidence that supports sustainable screening by oral health professionals in a dental setting and appropriate follow-up (treatment or referral) for medical conditions and risk behaviors. Examples of areas of interest could include studies that:

  • Seek to improve the evidence of effectiveness for medical and/or risk behavior screening in diverse dental settings, including those settings that target underserved or special needs populations.
  • Assess feasibility of and test screening tools and activities in dental care settings, to facilitate appropriate referrals to treatment.
  • Compare the effectiveness of different screening approaches in dental care settings.
  • Evaluate the effectiveness of coordinated screening efforts among health care professionals, with participation of dental care providers.
  • Enhance screening and referral using technology such as integrated Electronic Health Records and clinical decision support systems.
  • Assess novel screening approaches using new instruments, algorithms, or technologies.
  • Seek to Improve rates of referral and utilization of care from referral following screening.

Examples of other 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 (guidelines) and PBRN research findings and implementation into practice, as well as topics of emerging public health interest.
  • Questions of interest to dental specialty organizations.
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References

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Last Reviewed
September 2024