ABSTRACT The Electronic dental record (EDR) represents a powerful tool with the potential to faci... more ABSTRACT The Electronic dental record (EDR) represents a powerful tool with the potential to facilitate incorporating best practice guidelines into dental treatments and improve quality of care. Studies of how professionals interact with EDRs are needed to maximize these potentials. Objectives: To: 1) understand EDR utilization in the context of patient care; 2) determine common patterns of EDR interaction and problematic issues, 3) identify practitioners attitudes towards EDRs, and 4) identify opportunities to implement elements that support clinical decision-making. Methods: Observations were carried out in a convenience sample of 15 hygienists and 12 dentists employed at 9 HealthPartners Dental Group (HPDG) locations. The principal investigator and study coordinator served as observers. We used contextual inquiry, an ethnographic research method, to document work sequence, information acquisition and documentation, work process breakdowns, and verbal feedback. Coded fieldnotes were analyzed using Qualrus. Results: Twenty-five observations were conducted. Work flow through EDR screens was fairly consistent. Most providers had favorable attitudes towards EDRs; although, they wish that electronic dental- and medical records could interact. Hygienists bore most of the information acquisition and documentation responsibilities. Single monitor use prevented EDR access while viewing radiographs resulting in duplication of data recording. EDR breakdowns were limited but seriously interrupted workflow. Adjunct features, such as patient education resources, were seldom utilized compared to features that must be completed to charge-out the patient. While hygienists actively asked patients about tobacco use, most did not assess patients' desire to quit. Practitioners expressed a willingness to utilize the EDR to assist in incorporating best practice guidelines, including tobacco cessation interventions. Conclusions: Practitioners' attitudes are generally positive about EDR usage and incorporation of best practice guidelines strategies to support clinical decision-making. Practitioner compliance with these strategies will be highest when elements are required rather than optional. Supported by grant R21DE017325-02 from NIDCR
Clinical Relevance Dentists who did not assess caries risk as a routine part of the treatment pla... more Clinical Relevance Dentists who did not assess caries risk as a routine part of the treatment planning process were more likely to choose a surgical intervention and less likely to choose a preventive treatment.
Clinical Relevance Accuracy of dentists' preoperative estimates of caries lesion depth is a m... more Clinical Relevance Accuracy of dentists' preoperative estimates of caries lesion depth is a major determinant in appropriate restorative treatment decisions. Dentists may benefit from a personal review of their accuracy on assessing lesion depth by considering the results from this study.
The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unkno... more The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unknown. Potential risk factors include bisphosphonate treatment, steroid treatment, osteoporosis, and head/neck radiation. This Dental Practice-Based Research Network study estimated ONJ incidence and odds ratios from bisphosphonate exposure and other risk factors using a key word search and manual chart reviews of electronic records for adults aged ≥ 35 yrs enrolled during 1995–2006 in two large health-care organizations. We found 16 ONJ cases among 572,606 cohort members; seven additional cases were identified through dental plan resources. Among 23 cases (0.63 per 100,000 patient years), 20 (87%) had at least one risk factor, and six (26%) had received oral bisphosphonates. Patients with oral bisphosphonates were 15.5 (CI, 6.0–38.7) more likely to have ONJ than non-exposed patients; however, the sparse number of ONJ cases limits firm conclusions and suggests that the absolute risks for ON...
Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentis... more Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentistry has not adopted or developed effective interventions to deal with tobacco dependence. With the expanded use of electronic dental records, the authors identified an opportunity to incorporate standardized expert support for tobacco dependence counseling during the dental visit. Using qualitative results from observations and focus groups, a decision support system was designed that suggested discussion topics based on the patient's desire to quit and his or her level of nicotine addiction. Because dental providers are always pressed for time, the goal was a three-minute average intervention interval. To fulfill the provider's need for an easy way to track ongoing interventions, script usage was recorded. This process helped the provider track what he or she had said to the patient about tobacco dependence during previous encounters and to vary the messages. While the individual elements of the design process were not new, the combination of them proved to be very effective in designing a usable and accepted intervention. The heavy involvement of stakeholders in all components of the design gave providers and administrators ownership of the final product, which was ultimately adopted for use in all the clinics of a large dental group practice in Minnesota.
Sensitive Teeth Study Baseline Exam. Patient Baseline Examination Form: Information on number and... more Sensitive Teeth Study Baseline Exam. Patient Baseline Examination Form: Information on number and location of sensitive teeth and recommended treatments. (PDF 221 kb)
Sensitive Teeth Study Online Practitioner Questionnaire. Pre-Study Questionnaire: Information on ... more Sensitive Teeth Study Online Practitioner Questionnaire. Pre-Study Questionnaire: Information on practitionersâ diagnosis and treatment modalities used when seeing patients presenting with a dentin hypersensitivity complaint. (PDF 226 kb)
BackgroundFew published reports have presented concordance between treatment choices selected by ... more BackgroundFew published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners’ questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations.MethodsA total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen’s kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated.ResultsFor individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner’s top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low.ConclusionsConcordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen’s kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration.Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.Electronic supplementary materialThe online version of this article (10.1186/s12903-019-0772-y) contains supplementary material, which is available to authorized users.
This study examines the accuracy of adolescents&a... more This study examines the accuracy of adolescents' reports of tobacco use on a health history form completed in the dental office and the relationship between these reports and cessation advice provided by dental professionals. The authors compared reports of smoking status provided by adolescents during phone interviews with the adolescents' reports of smoking on a health history form completed during a dental visit. Adolescents aged between 14 and 17 years who were scheduled for a dental hygiene visit in a large managed care system were eligible for the study: 1162 completed the phone interview, and the study staff members audited the charts of a stratified random sample (n=280) of these. The health history form identified only 38.0 percent of those who reported having smoked in the previous 30 days during the phone interview and 57.4 percent of those who reported having smoked daily. Only 8.9 percent of all subjects interviewed reported that a dentist or a dental hygienist had ever talked with them about smoking. An examination of the chart audit sample indicated that advice was reported more often by adolescents who had identified themselves as smokers on the health history form (odds ratio = 2.62, 95 percent confidence interval = 1.35 to 5.10), but the reported rate of receiving advice still was low (25 percent). Adolescents underreport tobacco use on health history forms that ask them to specify whether they use tobacco products. Dentists and dental staff members provide advice about tobacco use to adolescents only infrequently. The wording of tobacco-use screening questions on health history forms and the conditions under which the forms are completed might affect the accuracy of the information adolescents provide.
BACKGROUND: "Pay for performance" is an incentive system that has been gaining acceptan... more BACKGROUND: "Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we
The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unkno... more The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unknown. Potential risk factors include bisphosphonate treatment, steroid treatment, osteoporosis, and head/neck radiation. This Dental Practice-Based Research Network study estimated ONJ incidence and odds ratios from bisphosphonate exposure and other risk factors using a key word search and manual chart reviews of electronic records for adults aged ≥ 35 yrs enrolled during 1995-2006 in two large health-care organizations. We found 16 ONJ cases among 572,606 cohort members; seven additional cases were identified through dental plan resources. Among 23 cases (0.63 per 100,000 patient years), 20 (87%) had at least one risk factor, and six (26%) had received oral bisphosphonates. Patients with oral bisphosphonates were 15.5 (CI, 6.0-38.7) more likely to have ONJ than non-exposed patients; however, the sparse number of ONJ cases limits firm conclusions and suggests that the absolute risks for ON...
ABSTRACT The Electronic dental record (EDR) represents a powerful tool with the potential to faci... more ABSTRACT The Electronic dental record (EDR) represents a powerful tool with the potential to facilitate incorporating best practice guidelines into dental treatments and improve quality of care. Studies of how professionals interact with EDRs are needed to maximize these potentials. Objectives: To: 1) understand EDR utilization in the context of patient care; 2) determine common patterns of EDR interaction and problematic issues, 3) identify practitioners attitudes towards EDRs, and 4) identify opportunities to implement elements that support clinical decision-making. Methods: Observations were carried out in a convenience sample of 15 hygienists and 12 dentists employed at 9 HealthPartners Dental Group (HPDG) locations. The principal investigator and study coordinator served as observers. We used contextual inquiry, an ethnographic research method, to document work sequence, information acquisition and documentation, work process breakdowns, and verbal feedback. Coded fieldnotes were analyzed using Qualrus. Results: Twenty-five observations were conducted. Work flow through EDR screens was fairly consistent. Most providers had favorable attitudes towards EDRs; although, they wish that electronic dental- and medical records could interact. Hygienists bore most of the information acquisition and documentation responsibilities. Single monitor use prevented EDR access while viewing radiographs resulting in duplication of data recording. EDR breakdowns were limited but seriously interrupted workflow. Adjunct features, such as patient education resources, were seldom utilized compared to features that must be completed to charge-out the patient. While hygienists actively asked patients about tobacco use, most did not assess patients' desire to quit. Practitioners expressed a willingness to utilize the EDR to assist in incorporating best practice guidelines, including tobacco cessation interventions. Conclusions: Practitioners' attitudes are generally positive about EDR usage and incorporation of best practice guidelines strategies to support clinical decision-making. Practitioner compliance with these strategies will be highest when elements are required rather than optional. Supported by grant R21DE017325-02 from NIDCR
Clinical Relevance Dentists who did not assess caries risk as a routine part of the treatment pla... more Clinical Relevance Dentists who did not assess caries risk as a routine part of the treatment planning process were more likely to choose a surgical intervention and less likely to choose a preventive treatment.
Clinical Relevance Accuracy of dentists' preoperative estimates of caries lesion depth is a m... more Clinical Relevance Accuracy of dentists' preoperative estimates of caries lesion depth is a major determinant in appropriate restorative treatment decisions. Dentists may benefit from a personal review of their accuracy on assessing lesion depth by considering the results from this study.
The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unkno... more The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unknown. Potential risk factors include bisphosphonate treatment, steroid treatment, osteoporosis, and head/neck radiation. This Dental Practice-Based Research Network study estimated ONJ incidence and odds ratios from bisphosphonate exposure and other risk factors using a key word search and manual chart reviews of electronic records for adults aged ≥ 35 yrs enrolled during 1995–2006 in two large health-care organizations. We found 16 ONJ cases among 572,606 cohort members; seven additional cases were identified through dental plan resources. Among 23 cases (0.63 per 100,000 patient years), 20 (87%) had at least one risk factor, and six (26%) had received oral bisphosphonates. Patients with oral bisphosphonates were 15.5 (CI, 6.0–38.7) more likely to have ONJ than non-exposed patients; however, the sparse number of ONJ cases limits firm conclusions and suggests that the absolute risks for ON...
Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentis... more Dentistry has historically seen tobacco dependence as a medical problem. As a consequence, dentistry has not adopted or developed effective interventions to deal with tobacco dependence. With the expanded use of electronic dental records, the authors identified an opportunity to incorporate standardized expert support for tobacco dependence counseling during the dental visit. Using qualitative results from observations and focus groups, a decision support system was designed that suggested discussion topics based on the patient's desire to quit and his or her level of nicotine addiction. Because dental providers are always pressed for time, the goal was a three-minute average intervention interval. To fulfill the provider's need for an easy way to track ongoing interventions, script usage was recorded. This process helped the provider track what he or she had said to the patient about tobacco dependence during previous encounters and to vary the messages. While the individual elements of the design process were not new, the combination of them proved to be very effective in designing a usable and accepted intervention. The heavy involvement of stakeholders in all components of the design gave providers and administrators ownership of the final product, which was ultimately adopted for use in all the clinics of a large dental group practice in Minnesota.
Sensitive Teeth Study Baseline Exam. Patient Baseline Examination Form: Information on number and... more Sensitive Teeth Study Baseline Exam. Patient Baseline Examination Form: Information on number and location of sensitive teeth and recommended treatments. (PDF 221 kb)
Sensitive Teeth Study Online Practitioner Questionnaire. Pre-Study Questionnaire: Information on ... more Sensitive Teeth Study Online Practitioner Questionnaire. Pre-Study Questionnaire: Information on practitionersâ diagnosis and treatment modalities used when seeing patients presenting with a dentin hypersensitivity complaint. (PDF 226 kb)
BackgroundFew published reports have presented concordance between treatment choices selected by ... more BackgroundFew published reports have presented concordance between treatment choices selected by dentists in hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice. The aim of the current cross-sectional study, conducted within the Management of Dental Hypersensitivity (MDH) study, was to assess the potential value of practitioners’ questionnaire responses regarding their typical treatment provided for management of dentin hypersensitivity (DH), by evaluating agreement between these responses and subsequently-observed recommendations recorded during actual clinical examinations.MethodsA total of 171 practitioners enrolled in the National Dental Practice-Based Research Network completed both a questionnaire and a clinical study regarding methods they use to treat dental hypersensitivity. The questionnaire solicited first-, second- and third-choice products when prescribing or recommending management of dentin hypersensitivity. Agreement was calculated for first-choice products/recommendations and for inclusion in the top three choices, as identified by the practitioners, from 11 listed treatment options. Overall percent agreement and Cohen’s kappa statistic were calculated, with associated 95% confidence intervals (CI). Associations between practitioner characteristics and agreement were also evaluated.ResultsFor individual treatment modalities, percentage agreement ranged from 63 to 99%, depending on the specific item. Percentage agreement between typical treatment and actual treatment for each practitioner’s top three treatment modalities, as a combined grouping, ranged from 61 to 100%. When these same agreement pairings were quantified to account for agreement above that expected by chance, kappa values were poor to low.ConclusionsConcordance between hypothetical clinical scenarios and treatment choices made by the same dentists in actual clinical practice showed moderate to high levels of percentage agreement, but Cohen’s kappa values suggested relatively low levels of agreement beyond that expected by chance. This analysis adds to the larger work of the network which has now observed a wide range of agreement between hypothetical and actual care, depending upon the specific diagnosis or treatment under consideration.Questionnaire data for DH might serve as a useful adjunct to clinical data regarding treatment recommendations, but agreement was not sufficiently high to justify use of questionnaires alone to characterize patterns of treatment for this particular condition.Electronic supplementary materialThe online version of this article (10.1186/s12903-019-0772-y) contains supplementary material, which is available to authorized users.
This study examines the accuracy of adolescents&a... more This study examines the accuracy of adolescents' reports of tobacco use on a health history form completed in the dental office and the relationship between these reports and cessation advice provided by dental professionals. The authors compared reports of smoking status provided by adolescents during phone interviews with the adolescents' reports of smoking on a health history form completed during a dental visit. Adolescents aged between 14 and 17 years who were scheduled for a dental hygiene visit in a large managed care system were eligible for the study: 1162 completed the phone interview, and the study staff members audited the charts of a stratified random sample (n=280) of these. The health history form identified only 38.0 percent of those who reported having smoked in the previous 30 days during the phone interview and 57.4 percent of those who reported having smoked daily. Only 8.9 percent of all subjects interviewed reported that a dentist or a dental hygienist had ever talked with them about smoking. An examination of the chart audit sample indicated that advice was reported more often by adolescents who had identified themselves as smokers on the health history form (odds ratio = 2.62, 95 percent confidence interval = 1.35 to 5.10), but the reported rate of receiving advice still was low (25 percent). Adolescents underreport tobacco use on health history forms that ask them to specify whether they use tobacco products. Dentists and dental staff members provide advice about tobacco use to adolescents only infrequently. The wording of tobacco-use screening questions on health history forms and the conditions under which the forms are completed might affect the accuracy of the information adolescents provide.
BACKGROUND: "Pay for performance" is an incentive system that has been gaining acceptan... more BACKGROUND: "Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we
The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unkno... more The incidence of osteonecrosis of the jaw (ONJ) in the population is low, but specifics are unknown. Potential risk factors include bisphosphonate treatment, steroid treatment, osteoporosis, and head/neck radiation. This Dental Practice-Based Research Network study estimated ONJ incidence and odds ratios from bisphosphonate exposure and other risk factors using a key word search and manual chart reviews of electronic records for adults aged ≥ 35 yrs enrolled during 1995-2006 in two large health-care organizations. We found 16 ONJ cases among 572,606 cohort members; seven additional cases were identified through dental plan resources. Among 23 cases (0.63 per 100,000 patient years), 20 (87%) had at least one risk factor, and six (26%) had received oral bisphosphonates. Patients with oral bisphosphonates were 15.5 (CI, 6.0-38.7) more likely to have ONJ than non-exposed patients; however, the sparse number of ONJ cases limits firm conclusions and suggests that the absolute risks for ON...
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