Dental Decision Simulation (DDSim): Development of a virtual training environment.

Purpose: Case-based simulations are powerful training tools that can enhance learning and drive behavior change. This is an overview of the design/development of Dental Decision Simulation (DDSim), a web-based simulation of an electronic dental record (EDR). The purpose was to use DDSim to train dentists to make evidence-based treatment planning decisions consistent with current evidence.

Influence of 2 caries-detecting devices on clinical decision making and lesion depth for suspicious occlusal lesions: A randomized trial from The National Dental Practice-Based Research Network.

Background: A suspicious occlusal carious lesion (SOCL) can be defined as a lesion with no cavitation and no radiographic radiolucency but for which caries is suspected. The authors evaluated whether using a device changed the percentage of SOCLs that were opened surgically and, among those SOCLs that were opened, the proportion that had penetrated into dentin.

Methods: Eighty-two dentists participated.

Dentists' decision strategies for suspicious occlusal caries lesions in a National Dental PBRN study.

Objective: Case presentations (vignettes) were completed by dentists in the National Dental Practice-Based Research Network study "Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)". The objective was to determine dentists' decision strategies for SOCLs.

Methods: 107 dentists viewed a series of 16 vignettes that represented all combinations of 4 clinical cues: color, luster, lesion roughness, and patient-level caries risk.

Surface characteristics and lesion depth and activity of suspicious occlusal carious lesions: Findings from The National Dental Practice-Based Research Network.

Background: A lesion on an occlusal tooth surface with no cavitation and no radiographic radiolucency but in which caries is suspected owing to surface roughness, opacities, or staining can be defined as a suspicious occlusal carious lesion (SOCL). The authors' objective was to quantify the characteristics of SOCLs and their relationship to lesion depth and activity after these lesions were opened surgically.

Methods: Ninety-three dentists participated in the study.

A systematic review of the association between consumption of sugar-containing beverages and excess weight gain among children under age 12.

Objective: A systematic review was conducted to address this clinical question: Does consumption of (non-dairy) sugar-containing beverages (SCBs) among children under age 12 result in excess weight gain?

Methods: The authors searched four databases for controlled trials (randomized and non-randomized) and cohort studies published in English through March 29, 2016: PubMed, EMBASE, Cochrane Database of Systematic Reviews, CINAHL. Initial and full-text screening, data abstraction, and risk of bias assessment were performed independently and in duplicate.

Results: Thirty-eight studies met inclusion criteria for this systematic review.

A Predictive Model for Root Caries Incidence.

This study aimed to find the set of risk indicators best able to predict root caries (RC) incidence in caries-active adults utilizing data from the Xylitol for Adult Caries Trial (X-ACT). Five logistic regression models were compared with respect to their predictive performance for incident RC using data from placebo-control participants with exposed root surfaces at baseline and from two study centers with ancillary data collection (n = 155). Prediction performance was assessed from baseline variables and after including ancillary variables [smoking, diet, use of removable partial dentures (RPD), toothbrush use, income, education, and dental insurance].

Methods dentists use to diagnose primary caries lesions prior to restorative treatment: Findings from The Dental PBRN.

Objective: To (1) quantify the diagnostic techniques used by Dental Practice-Based Research Network (DPBRN) dentists before they decide to treat primary caries lesions surgically and (2) examine whether certain dentist, practice, and patient characteristics are associated with their use.

Methods: A total of 228 DPBRN dentists recorded information on 5,676 consecutive restorations inserted due to primary caries lesions on 3,751 patients. Practitioner-investigators placed a mean of 24.

The dynamic behavior of the early dental caries lesion in caries-active adults and implications.

Objective: To describe the full range of behavior of the visible, noncavitated, early caries lesion in caries-active adults with substantial fluoride exposure, and to consider implications.

Methods: The data were from the Xylitol for Adult Caries Trial (X-ACT) collected annually for 33 months using condensed ICDAS caries threshold criteria. Individual tooth surfaces having a noncavitated caries lesion were included, and the patterns of transition to each subsequent annual clinical examination to sound, noncavitated or cavitated, filled or crowned were determined.

Twenty-month follow-up of occlusal caries lesions deemed questionable at baseline: findings from the National Dental Practice-Based Research Network.

Background: A questionable occlusal caries (QOC) lesion can be defined as an occlusal surface with no radiographic evidence of caries, but caries is suspected because of clinical appearance. In this study, the authors report the results of a 20-month follow-up of these lesions.

Methods: Fifty-three clinicians from The National Dental Practice-Based Research Network participated in this study, recording lesion characteristics at baseline and lesion status at 20 months.

Concordance between clinical practice and published evidence: findings from The National Dental Practice-Based Research Network.

Background: Documenting the gap between what is occurring in clinical practice and what published research findings suggest should be happening is an important step toward improving care. The authors conducted a study to quantify the concordance between clinical practice and published evidence across preventive, diagnostic and treatment procedures among a sample of dentists in The National Dental Practice-Based Research Network ("the network").

Methods: Network dentists completed one questionnaire about their demographic characteristics and another about how they treat patients across 12 scenarios/clinical practice behaviors.

Visual scoring of non cavitated caries lesions and clinical trial efficiency, testing xylitol in caries-active adults.

Objectives: To better understand the effectiveness of xylitol in caries prevention in adults and to attempt improved clinical trial efficiency.

Methods: As part of the Xylitol for Adult Caries Trial (X-ACT), non cavitated and cavitated caries lesions were assessed in subjects who were experiencing the disease. The trial was a test of the effectiveness of 5 g/day of xylitol, consumed by dissolving in the mouth five 1 g lozenges spaced across each day, compared with a sucralose placebo.

Visual-tactile versus radiographic caries detection agreement in caries-active adults.

Objectives: The study aims to determine a) the extent of agreement between visual-tactile caries examination (VTE) and radiographic examination (RE) in detecting presumptive caries lesions on occlusal and proximal surfaces of posterior teeth of UNC Xylitol for Adult Caries Trial participants; and b) the additional caries diagnostic yield obtained by adding RE to VTE.

Methods: Data consisted of surface-level visual-tactile and radiographic classification of disease (cavitated and noncavitated caries lesions) or nondisease (sound surfaces). Participants (n = 114, adults with ≥12 erupted teeth and 1-10 caries lesions) received baseline VTE by a trained and calibrated examiner, and had interproximal radiographs obtained within 7 months before or after the VTE.

Results from the Xylitol for Adult Caries Trial (X-ACT).

Background: Although caries is prevalent in adults, investigators have tested few preventive therapies in adult populations. In a randomized controlled trial, the authors evaluated the effectiveness of xylitol lozenges in preventing caries in adults at elevated risk of developing caries.

Methods: The Xylitol for Adult Caries Trial (X-ACT) was a three-site placebo-controlled randomized trial.

The prevalence of questionable occlusal caries: findings from the Dental Practice-Based Research Network.

Background: Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study

Methods: A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable.

Dental care plan assessment using the CAHPS Dental Plan Survey.

Objectives: The performance of a recently developed survey instrument that inquires about patients' experiences with the receipt of dental care was examined to evaluate its potential utility as a patient-reported outcome measure for dental care plans.

Methods: Individuals with dental insurance (n = 1,216) were surveyed using the Consumer Assessment of Health Care Providers and Systems (CAHPS) Dental Plan Survey. The instrument's pre-established composite and rating scores were compared across dental insurance carriers (6 most common and all others combined) using ANOVA.

A practitioner's guide to developing critical appraisal skills: translating research into clinical practice.

Background And Overview: To understand research and develop skills in adopting research findings, clinicians must overcome a series of challenges. First is determining exactly what constitutes evidence-based care. The amount of often contradictory research findings and "expert" opinion that is available can be overwhelming and should not always be taken as best evidence.

Examiner training and reliability in two randomized clinical trials of adult dental caries.

Objectives: This report describes the training of dental examiners participating in two dental caries clinical trials and reports the inter- and intra-examiner reliability scores from the initial standardization sessions.

Methods: Study examiners were trained to use a modified International Caries Detection and Assessment System II system to detect the visual signs of non-cavitated and cavitated dental caries in adult subjects. Dental caries was classified as no caries (S), non-cavitated caries (D1), enamel caries (D2), and dentine caries (D3).

Risk indicators for the presence and extent of root caries among caries-active adults enrolled in the Xylitol for Adult Caries Trial (X-ACT).

Objective: This paper uses baseline data from a randomized clinical trial to evaluate cross-sectional indicators of root caries in caries-active adults.

Materials And Methods: Adults (21-80 years) having at least 12 erupted teeth and between one and ten caries lesions were enrolled. Participants (n = 437) received caries exams by trained, calibrated examiners and responded to baseline demographic and medical-dental questionnaires.

Restoration of noncarious tooth defects by dentists in The Dental Practice-Based Research Network.

Background: The authors conducted a study to quantify the reasons for restoring noncarious tooth defects (NCTDs) by dentists in The Dental Practice-Based Research Network (DPBRN) and to assess the tooth, patient and dentist characteristics associated with those reasons.

Methods: Data were collected by 178 DPBRN dentists regarding the placement of 1,301 consecutive restorations owing to NCTDs. Information gathered included the main clinical reason, other than dental caries, for restoration of previously unrestored permanent tooth surfaces; characteristics of patients who received treatment; dentists' and dental practices' characteristics; teeth and surfaces restored; and restorative materials used.

Clinical technical performance of dental therapists in Alaska.

Background: The Alaska Dental Health Aide Therapist program has matured to the point that therapists have been in practice for up to four years.

Methods: A case-study evaluation of the program included assessments of the clinical technical performance of five of these therapists practicing in clinics in small Alaskan villages and towns.

Results: The results indicate that therapists are performing at an acceptable level, with short-term restorative outcomes comparable with those of dentists treating the same populations.

Design of the Prevention of Adult Caries Study (PACS): a randomized clinical trial assessing the effect of a chlorhexidine dental coating for the prevention of adult caries.

Background: Dental caries is one of the primary causes of tooth loss among adults. It is estimated to affect a majority of Americans aged 55 and older, with a disproportionately higher burden in disadvantaged populations. Although a number of treatments are currently in use for caries prevention in adults, evidence for their efficacy and effectiveness is limited.

Design of the xylitol for adult caries trial (X-ACT).

Background: Dental caries incidence in adults is similar to that in children and adolescents, but few caries preventive agents have been evaluated for effectiveness in adults populations. In addition, dentists direct fewer preventive services to their adult patients. Xylitol, an over-the-counter sweetener, has shown some potential as a caries preventive agent, but the evidence for its effectiveness is not yet conclusive and is based largely on studies in child populations.