Timothy A. DeRouen

UW Center for Global Oral Health

Practice-Based

REsearch

Collaborative in

Evidence-based

DENTistry

1. To create an infrastructure for the Network Chair component

of this application with personnel who possess outstanding

expertise and experience in all areas relevant to the creation

and administration of Northwest PRECEDENT.

Northwest PRECEDENT: Specific Aims

Northwest PRECEDENT Administrative Structure

P.I.: Timothy A. DeRouen (UW)

Co-P.I.: Jack Ferracane (OHSU)

Office of the Network Chair

Regional Coordinators

0.4 FTE TBN

Seattle

0.4 FTE TBN

Boise

0.4 FTE TBN

Spokane

0.4 FTE TBN

Salt Lake City

0.4 FTE TBN

Portland

Joel Berg (UW)

Tom Hilton (OHSU)

Co-Investigators

P.I.: Brian Leroux

Co-Investigators:

Lloyd Mancl, Philippe Hujoel,

Ruth McBride

Data Coordinating Center

Western Washington

30–35 practices

Eastern Washington

& Montana

30 practices

Eastern Oregon

& Idaho

30 practices

Utah &

Southern Idaho

25–30 practices

Western Oregon &

Southwestern

Washington

30 practices

2. To develop and implement a plan for recruitment of network

practitioners who will be representative of the demographics

of the regional practitioner population, but who will also be

highly motivated to be active, reliable network participants.

Northwest PRECEDENT: Specific Aims

Demographic Data from Practitioner Questionnaire:

Motivation

Motivation for interest in PRECEDENT. No

Motivation

Little

Motivation

Substantial

Motivation

Total

Responses

CDE Credits 24 (11%) 128 (58%) 65 (29%) 217 (94%)

Opportunity to design a dental research

project

25 (11%) 88 (40%) 105 (48%) 218 (94%)

Opportunity to conduct research in your

practice

6 (2%) 38 (17%) 173 (79%) 217 (94%)

Interaction with colleagues 3 (1%) 51 (23%) 166 (75%) 220 (95%)

Opportunity to give back to the profession 3 (1%) 32 (14%) 185 (84%) 220 (95%)

University faculty appointment 40 (18%) 103 (47%) 76 (34%) 219 (95%)

Professional growth and development 0 (0%) 11 (5%) 208 (94%) 219 (95%)

Opportunity to contribute to dental clinical

knowledge

1 (0%) 12 (5%) 205 (94%) 218 (94%)

3. To develop and implement an educational program for

participants that will ensure high quality of network studies.

Northwest PRECEDENT: Specific Aims

Part I: What is the Question?

PICO: Patient, Intervention, Control, Outcome

Part II: What are the Options?

Levels of Evidence

Part III: How to Evaluate the Evidence?

Statistical Analysis & Sample Size

Part IV: How to Do a Research Study

Recruitment, Informed Consent, Retention, Randomization,

Masking, Measurement

Part V: How PRECEDENT Works

Session on Protocol Ideas

Northwest PRECEDENT

Research Methods Course Outline

4. To develop and implement a strategy for eliciting ideas for new

network studies that are relevant to and likely to have an impact

upon the general practice of dentistry.

Northwest PRECEDENT: Specific Aims

• A large number of study ideas proposed

• Topics include restorative dentistry & others

• Many are amenable to randomized trials

• DCC works on experimental designs for selected

study ideas

Northwest PRECEDENT

Study Ideas

5. To work closely with Northwest PRECEDENT Data Coordinating

Center (DCC) at the University of Washington to carry out clinical

research studies through the network, ensuring that adequate

communication, training, and trouble shooting occurs at the

initiation of each study protocol approved for the network, and is

maintained throughout the conduct of each study.

6. To ensure dissemination of study findings by taking the lead, but

working closely with the Coordinating Center and practitioner

investigators in presenting and writing up the results of each

completed protocol and submitting it for publication.

Northwest PRECEDENT: Specific Aims (cont’d)

I. Establish Infrastructure

II. Develop Data Capture System

III. Develop & Conduct Research Methods Training

IV. Design Studies

V. Implement Studies

Northwest PRECEDENT

DCC Specific Aims

Principles of Practice-Based Research

1.Identify topics of interest to practitioners, relevant

to practice of dentistry

2.Design studies that are straightforward, with

simple clinical endpoints

3.Carry out studies requiring minimal interference

with everyday practice

4.Evaluate clinical effectiveness of approved

techniques/materials

Surveys •Study 7: Treatments for Hypersensitivity (N=209 dentists)

•Study 10: PIRG (CONDOR) (N=207 dentists)

•Study 11a: Orthodontists’ Attitudes to Temporary Anchorage Devices (N=47 orthodontists)

•Study 12: Overbite Retention Strategies in Orthodontics(N=50 orthodontists, n=302 patients)

•Study 13: TMJD (CONDOR) (N=229 dentists)

•Study 17: Special Needs Patients (N=291 dentists)

Cross-Sectional Studies

Study 1: Disease Prevalence and Treatment

Patterns in PRECEDENT Patients (N=101 dentists, n=1943 patients)

Study 8: Prevalence of Hypersensitivity (N=37 dentists, n=787 patients)

•Estimate needed to design a future RCT

Case-Control Studies

Study 3: ONJ (n=277 patients)

- Determine risk factors for ONJ (eg BP use)

Prospective Cohort Studies

Study 2: Prediction of caries (N=63 dentists,

n=1763 patients)

Study 5: Outcomes of cracked teeth (N=36 dentists, n=827 patients)

Study 9: Outcomes of 3rd molar extraction (N=51 dentists, n=815 patients)

Study 11b: Outcomes of temporary anchorage devices (N=18 orthodontists, n=81)

Randomized Trials

Study 4: Effect of computer-based treatment on needle phobia (N=7 dentists, n=84 patients)

Study 6: Comparison of pulp-capping materials (randomized by dentist) (N=35 dentists, n=376 patients)

Study 15: Effect of remineralization paste on white spots after orthodontic treatment (N=21 orthodontists, n=171 patients)

Final

Active Members 358

Fully Trained Members 217

- Orthodontists 44

- Community Clinic Dentists 20

- Pediatric Dentists 7

Friends 169

24 states 10 countries

Study 001: Oral Disease

Indicators Survey

Study 002: Salivary Markers in

Caries Risk Assessment

Study 003: Case Control Study

of Osteonecrosis of the Jaw

(CONDOR Trans-PBRN Study)

Study 004: Computer Assisted

Relaxation Learning (CARL)

Study 005: Assessing the

Outcomes of Cracked Teeth

Study 006: MTA and Calcium

Hydroxide in Direct Pulp

Capping

Study 007: Treatment of

Dentin Hypersensitivity in

Dental Practices

Study 008: Dentin

Hypersensitivity - Prevalence

in Patients

Study 009: Third Molar

Extraction: Indications

and Outcomes

Study 010: (PIRG) Impact

of Dental Practice-Based

Research

Study 011: TAD

Study 012: Overbite

Retention Strategy

Study 013: Advancing Primary

Care Management for TMJD

Pain

Study 015: Remineralization

Treatment of White Spot

Lesions

Study 017: Special Health Care

Needs

•PEARL

•DPBRN

•PRECEDENT

Ortho Ortho

Ortho +

Some Lessons Learned

Between dentists and their patients

Between regional coordinators and the offices

“We appreciated the visits of PRECEDENT staff – it made us feel that what we are doing is important, and that we are part of a larger operation.”

Different regions have different practices,

interests.

Recruitment, incorporation of community clinic

dentists requires personal touch, flexibility.

The cracked teeth study has from the start been

one of the members’ primary interests

“This is a very important study Just participating in it has changed the way I think and practice.”

“This is such an important program. I am very proud to be part of it.”

Panel discussions of what works

best.

Breakout sessions –dentists/staff sharing experience and advice on conducting the study in their offices.

Member enthusiasm helps recruit participants for ongoing studies.

Feedback TO members about studies:

- report card

- study results

Feedback FROM members about ideas/options:

- “clicker” responses

- SurveyMonkey short questionnaires

Visit www.Nationaldentalpbrn.org/