Julie Frantsve-Hawley

Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.

BACKGROUND Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. METHODS A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. RESULTS The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). CONCLUSIONS AND PRACTICAL IMPLICATIONS With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.

Clinical Decision Support Chairside Tools for Evidence-Based Dental Practice

Evidence-based clinical decision support (EB-CDS) tools designed for chairside use, help support the implementation of Evidence-Based Dentistry. EB-CDS tools organize available evidence and risk factors in order to facilitate clinical decision-making as well as to enhance rapid and effective transfer of knowledge to the patient at the point of care. Gingival recession, root exposure, caries, dental sealants, decay prevention and topical fluoride guides are presented and discussed. The Assess-Advise-Decide Approach, described in this article, better enables patients to determine which course of action is in line with their preferences and values.

The evidence-based dentistry champions: a grassroots approach to the implementation of EBD.

In order for evidence-based dentistry (EBD) to become part of decision making in practice, the most current and comprehensive research findings must be translated into practice. The use of Champions, influential individuals to support the transfer of knowledge among their peers, is one effective approach used by others in the health care field to successfully implement science research into clinical care. With the success of Champions in other health care areas, the American Dental Association (ADA) and the Journal of Evidence-Based Dental Practice, through an educational grant from Procter and Gamble, have launched a novel program to develop Evidence-Based Dentistry Champions. The EBD Champion program is developing a network of oral health care workers who will disseminate information about the application of an evidence-based approach to dental care and will serve as resources and mentors to their colleagues. The primary mechanism for developing the network of EBD Champions is through 3 annual EBD Champion Conferences, the first of which will be held at the ADA Headquarters in Chicago, IL, on May 2 and 3, 2008. The EBD Champion will serve as a resource to the practitioners in their communities, providing a grassroots approach to facilitating the implementation of an evidence-based approach to providing dental care.

The Benefits of Evidence-Based Dentistry for the Private Dental Office

Dentistry over the last 100 years has been characterized by improved approaches to education and practice. Parallel to trends in the field of medicine as a whole, dentistry is moving toward evidence-based practices. The goal of evidence-based dentistry is the assurance, through reference to high-quality evidence, that care provided is optimal for the patient and that treatment options are presented in a manner that allows for fully informed consent. As we transition toward broad-based use of evidence-based dentistry approaches in clinical practice, many dental offices will benefit from a better understanding of how evidence-based dentistry can improve patient outcomes. This article lists the likely benefits evidence-based dentistry can provide to patients, staff, and dentists when routinely adopted in daily practice.

Barriers to sealant guideline implementation within a multi-site managed care dental practice

BackgroundThe purpose of this study was to identify barriers frequently endorsed by dentists in a large, multi-site dental practice to implementing the American Dental Association’s recommendation for sealing noncavitated occlusal carious lesions as established in their 2016 pit-and-fissure sealant clinical practice guideline. Although previous research has identified barriers to using sealants perceived by dentists in private practice, barriers frequently endorsed by dentists in large, multi-site dental practices have yet to be identified. Identifying barriers for these dentists is important, because it is expected that in the future, the multi-site group practice configuration will comprise more dental practices.MethodsWe anonymously surveyed the 110 general and pediatric dentists at a multi-site dental practice in the U.S. The survey assessed potential barriers in three domains: practice environment, prevailing opinion, and knowledge and attitudes. Results were summarized using descriptive statistics.ResultsThe response rate to the survey was 62%. The principal barrier characterizing the practice environment was concern regarding liability; endorsed by 33% of the dentists. Many barriers of prevailing opinion were frequently endorsed. These included misunderstanding the standard of practice (59%), being unaware of the expectations of opinion leaders (56%) including being unaware of the guideline itself (67%), and being unaware of what is currently being taught in dental schools (58%). Finally, barriers of knowledge and attitudes were frequently endorsed. These included having suboptimal skill in applying sealants (23% - 47%) and lacking knowledge regarding the relative efficacy of the different ways to manage noncavitated occlusal carious lesions (50%).ConclusionsWe identified barriers frequently endorsed by dentists in a large, multi-site dental practice relating to the practice environment, prevailing opinion, and knowledge and attitudes. All the barriers we identified have the potential to be addressed by implementation strategies. Future studies should devise and test implementation strategies to target these barriers.

American Dental Association’s Resources to support Evidence-Based Dentistry

Time and access have often been cited as barriers to implementing Evidence-Based Dentistry (EBD). This paper describes a new web-based resource launched by the American Dental Association to enable practitioners to incorporate evidence into treatment planning. The website offers a database of systematic reviews, critical summaries of systematic reviews, evidence-based clinical recommendations and links to external resources to enable practitioners to access evidence at the point of care. In addition the site offers an online space for clinicians to suggest clinical scenarios where evidence is lacking. This could potentially be a source of topics to drive future research. With the explosion in the use of information technology within a dental office, this web-site will serve as the one-stop resource for credible scientific information for practitioners.

Women’s Oral Health: Growing Evidence for Enhancing Perspectives

Womens health, including oral health, is an evolving science with foundation knowledge from many disciplines. Key milestones, particularly in the last decade, provide a roadmap towards the necessary inclusion of gender into dental practice. Such focus is especially important for the evolving role of oral health care providers as primary health care providers. Continued progress of the vibrant incorporation of evidence-based womens oral health into the standard practice of oral health care is encouraged. This expanded preface provides an introduction to this DCNA issue, a brief history and timeline of major womens oral health events, and resources for further consideration.