Does Nonsurgical Periodontal Treatment Improve Systemic Health?

Clinicians frequently stress the importance of maintaining good oral health for multiple reasons, including its link to systemic health. Because periodontal treatment reduces inflammation in oral tissues, some hypothesize it may positively affect systemic outcomes by reducing inflammation in the body. A significant number of systematic reviews (SRs) and meta-analyses (MAs) have evaluated the effect of periodontal treatment on systemic outcomes. However, inconsistent findings and questionable methodological rigor make drawing conclusions difficult. We conducted a systematic review of reviews that studied the effect of nonsurgical periodontal treatment on systemic disease outcomes. We report on outcomes evaluated, categorizing them as biomarkers, and surrogate or clinical endpoints. In addition, we used A MeaSurement Tool to Access systematic Reviews 2 (AMSTAR 2) to evaluate the methodological quality of the reviews. Of the 52 studies included in our review, 21 focused on diabetes, 15 on adverse birth outcomes, 8 on cardiovascular disease, 3 each on obesity and rheumatoid arthritis, and 2 on chronic kidney disease. Across all studies, surrogate endpoints predominated as outcomes, followed by biomarkers and, rarely, actual disease endpoints. Ninety-two percent of studies had "low" or "critically low" AMSTAR 2 confidence ratings. Criteria not met most frequently included advance registration of the protocol, justification for excluding individual studies, risk of bias from individual studies being included in the review, and appropriateness of meta-analytical methods. There is a dearth of robust evidence on whether nonsurgical periodontal treatment improves systemic disease outcomes. Future reviews should adhere more closely to methodological guidelines for conducting and reporting SRs/MAs than has been the case to date. Beyond improved reviews, additional rigorous research on whether periodontal treatment affects systemic health is needed. We highlight the potential of large-scale databases containing matched medical and dental record data to inform and complement future clinical research studying the effect of periodontal treatment on systemic outcomes.

Using electronic dental record data for research: a data-mapping study.

Anecdotal evidence suggests that, during the clinical care process, many dental practices record some data that are also collected in dental practice based research network (PBRN) studies. Since the use of existing, electronically stored data for research has multiple benefits, we investigated the overlap between research data fields used in dental PBRN studies and clinical data fields typically found in general dental records. We mapped 734 unique data elements from the Dental Information Model (DIM) to 2,487 Common Data Elements (CDE) curated by the NIDCR's PBRNs in the Cancer Data Standards Registry and Repository (caDSR). Thirty-three percent of the DIM data elements matched at least one CDE completely and 9% partially, translating to about 9% and 2%, respectively, of all data elements used in PBRN studies. The most frequently used CDEs found in the DIM included data about dental anatomy, medications, and items such as oral biopsy and caries. Our study shows that a non-trivial number of data elements in general dental records can be mapped either completely or partially to data fields in research studies. Further studies should investigate the feasibility of electronic clinical data for research purposes.

Detection of disease outbreaks by the use of oral manifestations.

Oral manifestations of diseases caused by bioterrorist agents could be a potential data source for biosurveillance. This study had the objectives of determining the oral manifestations of diseases caused by bioterrorist agents, measuring the prevalence of these manifestations in emergency department reports, and constructing and evaluating a detection algorithm based on them. We developed a software application to detect oral manifestations in free text and identified positive reports over three years of data. The normal frequency in reports for oral manifestations related to anthrax (including buccal ulcers-sore throat) was 7.46%. The frequency for tularemia was 6.91%. For botulism and smallpox, the frequencies were 0.55% and 0.23%. We simulated outbreaks for these bioterrorism diseases and evaluated the performance of our system. The detection algorithm performed better for smallpox and botulism than for anthrax and tularemia. We found that oral manifestations can be a valuable tool for biosurveillance.

Dental informatics: a work in progress.

Dental informatics is a young scientific discipline that is undergoing continual maturation. Its literature is estimated to consist of approximately 600 papers published between 1975 and 2003, and it is currently growing at a rate of about 50 papers annually. While interest in the discipline is growing, the number of core contributors to dental informatics research remains relatively small. Two major questions for the discipline are: What are the research challenges that dental informatics faces today? and How can the discipline be strengthened and positioned to maximize its success in addressing those challenges? Progress toward research challenges formulated more than ten years ago has been varied. While many new technologies have become available for clinical dental practice, research, and education, many fundamental problems remain to be addressed with informatics research. Recommendations to augment the research capacity in dental informatics include creating a stronger worldwide dental informatics research community, drawing more biomedical informatics researchers to dental research areas, providing career opportunities for dental informatics researchers, addressing grand challenges together as a community, and recruiting subsequent generations of dental informaticians.

A preliminary analysis of the dental informatics literature.

Dental informatics is an emerging discipline applying computer and information science to dental practice, research, education, and management. To date, the dental informatics research literature has not been comprehensively reviewed. This study reports an initial analysis of the dental informatics literature. We developed an initial, comprehensive retrieval strategy to locate dental informatics citations in MEDLINE (1966-April 2003), including three concepts: dentistry, computers, and research. After refinement of the search, we manually classified the final set into four categories: (1) non-dental; (2) dental, but neither dental informatics nor IT-related; (3) dental informatics; and (4) IT in dentistry. We analyzed informatics and IT-related citations regarding their distribution across journals, growth rate, the number of authors and their publication frequency, and content as expressed by Medical Subject Headings (MeSH). The final set of citations (n = 3872) consisted of: 12% non-dental articles; 59% dental, but not informatics- or IT-related articles; 16% informatics-related articles; and 13% IT-related articles. Informatics-related citations appeared in 176 journals, and IT-related citations in 206 journals. Approximately 50 papers are currently published in both categories yearly. While a great many authors have contributed to this literature, very few have published more than three papers. Main topics of articles included "Imaging and Image Processing", "Computer-aided Diagnosis and Therapy", "Computer-aided Instruction", and "Other". The dental informatics literature is small, but growing. Imaging and image processing predominate as research topics.

Comparative genomics and structure prediction of dental matrix proteins.

Non-collagenous matrix proteins secreted by the ameloblasts (amelogenin) and odontoblasts (osteocalcin) play important roles in the mineralization of enamel and dentin. In this study, comparative genomics approaches were used to identify the functional domains and model the three-dimensional structure of amelogenin and osteocalcin, respectively. Multiple sequence analysis of amelogenin in different species showed a high degree of sequence conservation at the nucleotide and protein levels. At the protein level, motifs (a sequence pattern that occurs repeatedly in a group of related proteins or genes), conserved domains, secondary structural characteristics, and functional sites of amelogenin from lower phyla were similar to those of the higher-level mammals, reflecting the high degree of sequence conservation during vertebrate evolution. Osteocalcin, produced by both odontoblasts and osetoblasts, also showed sequence similarity between species. Three-dimensional structure predictions developed by modeling of conserved domains of osteocalcin supported a role for glutamic acid residues in the calcium mineralization process.

Retrieval and classification of dental research articles.

Successful retrieval of a corpus of literature on a broad topic can be difficult. This study demonstrates a method to retrieve the dental and craniofacial research literature. We explored MeSH manually for dental or craniofacial indexing terms. MEDLINE was searched using these terms, and a random sample of references was extracted from the resulting set. Sixteen dental research experts categorized these articles, reading only the title and abstract, as either: (1) dental research, (2) dental non-research, (3) non-dental, or (4) not sure. Identify Patient Sets (IPS), a probabilistic text classifier, created models, based on the presence or absence of words or UMLS phrases, that distinguished dental research articles from all others. These models were applied to a test set with different inputs for each article: (1) title and abstract only, (2) MeSH terms only, or (3) both. By title and abstract only, IPS correctly classified 64% of all dental research articles present in the test set. The percentage of correctly classified dental research articles in this retrieved set was 71%. MeSH term inclusion decreased performance. Computer programs that use text input to categorize articles may aid in retrieval of a broad corpus of literature better than indexing terms or key words alone.

Validation of an instrument to measure dental students' use of, knowledge about, and attitudes towards computers.

Currently, no validated survey instrument exists to measure dental students' use of, knowledge about, and attitudes towards computers. Several studies have surveyed students about their knowledge and opinions regarding computers, but none of them has established the reliability and validity of the instrument(s) used. A measurement study to validate a preliminary survey for dental students was conducted. The preliminary instrument contained five scales: computer use, information resource use, computer knowledge, capabilities of computer systems, and effects of computers on dental practice. Selected variables were summarized descriptively, and a factor analysis for each scale was performed. In addition, construct validity was assessed through correlational analyses among several variables. Three hundred seventy surveys distributed to students at nine dental schools generated 156 responses (42 percent response rate). Sixty-four percent of respondents were male, 36 percent female. Respondents used computers an average approximately four hours per week, and most had begun using computers in 1991. All survey scales except computer use were unidimensional. Computer use required a two-factor solution that distinguished between clinical and nonclinical uses of computers. The instrument can be used for a demonstration study, but should be continuously refined and validated.

Collaboratories: leveraging information technology for cooperative research.

Economic, organizational, and societal pressures, as well as the desire to reach shared goals more efficiently and effectively, are driving an increase in collaborative research. Research collaborations frequently occur among participants separated by temporal, geographical, organizational, disciplinary, and cultural boundaries. Increasingly complex collaborative projects focus attention on the question of how to facilitate working together. Through so-called collaboratories, information technology can play an important role in addressing this question. A collaboratory can be defined as an information technology infrastructure that supports cooperation among individuals, groups, or organizations in pursuit of a shared goal by facilitating interaction, communication, and knowledge-sharing. Tools such as Web-based collaborative workspaces, Internet discussion lists/newsgroups/real-time chat, screen- and application-sharing, Web-based conferencing, online Web page mark-up, automatic notification, and videoconferencing can be used to implement collaboratories. Collaboratories have significant potential to facilitate cooperative research, but should be evaluated carefully to determine best practices.

Methods for the design and administration of web-based surveys.

This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.

Digital dentistry in the computer age.

BACKGROUND AND OVERVIEW: Computers are becoming an integral part of the practice of dentistry. Smaller, smarter and more ergonomic computing devices will support an increasing proportion of dental practice activities. Technology will make practice management more efficient, mainly by reducing transactional overhead. Educational software and intelligent assistants will increasingly support the needs for decision making in clinical practice. Research will benefit from automated tools for data acquisition, management and analysis. CONCLUSIONS: Dentistry must actively shape the application of technology. It can do this by developing a cadre of experts in dental informatics, relying on sound research principles, effectively disseminating best practices and developing strategic objectives for the implementation of technology. CLINICAL IMPLICATIONS: Computer technology is an essential ingredient for state-of-the-art patient care. Dentists must stay current with this rapidly developing field to make appropriate choices in their use of technology.

Is the Internet useful for clinical practice?

BACKGROUND: Internet use in dentistry is increasing. The authors surveyed dentists to determine how they are using the Internet to support patient care and how useful they perceive the Internet to be. MATERIALS AND METHODS: The authors sent a 25-question survey to 455 subscribers to the Internet Dental Forum, an Internet discussion list. Participants completed the survey through a Web page or by e-mail during an 18-day period in December 1998. The survey included questions about when they began using the Internet and their motivations for doing so, their positive and negative experiences, where they use the Internet and why, their use of information resources--including electronic information resources--and demographics. RESULTS: The authors received 314 surveys from 438 participants, a 72 percent response rate. Participants reported demographic characteristics similar to national averages and were highly computer-literate. Most considered the Internet essential for their practice and had increased their Internet use for professional reasons over time. Ninety-seven percent of respondents used the Internet at home, and 68 percent used it in the office. Only 5 percent used the Internet in the treatment area. The primary reason cited by participants for using the Internet was to keep up in general, followed by to answer patient-specific questions and to provide patient education. Reduction of professional isolation was one of the most frequently cited advantages of using the Internet. CONCLUSIONS: The authors found that some dentists use the Internet to support clinical practice and that it helped dentists adopt new techniques for patient treatment and obtain information on new materials or products. CLINICAL IMPLICATIONS: The Internet appears to support clinical practice mostly indirectly, by helping users keep up in general, rather than by answering specific clinical questions.

Internet basics.

This is a primer on the Internet, intended for those making a first-time acquaintance with how the system works. Topics include a brief history and discussion of access and basic services. The World Wide Web and information about finding material are also presented. Emphasis is placed on defining basic terms and providing addresses, resources, and help.

Clinical decision-making and the Internet.

The Internet has potential to make dentists more effective decision makers. Statistics are given regarding current patterns of computer use by dentists. Use is primarily for communication rather than decision support. The Internet will increasingly fulfill its promise as an information resource for practitioners as issues such as access, searching, understanding, relevance, and cost are solved. The future of the Internet includes a number of likely enhancements: technical changes, portals, meta-sites, personalization, collaborative filtering, and improved information retrieval.

Educational implications for copyright in a digital world.

Statutory law and court cases currently leave fair use of copyrighted material poorly defined and fail to provide effective guidance for the use of others' work. Copyright legislation is undergoing significant change, accelerated by the evolution of computing and communication technologies. This paper reviews copyright issues, fair use guidelines, and applicable laws and statutes to help administrators and educators understand and comply with copyright regulations. The paper describes principles of copyright and ownership, the rights of copyright holders, and the conditions under which copyrighted material can be used by others. Recently introduced legislation, such as the 1998 Digital Millennium Copyright Act, may significantly affect how educators can use copyrighted material in the future. The integration of computer and communication technology into education raises a number of intellectual property issues for dental schools. This paper provides some general guidelines regarding copyright issues in academic environments.

Online continuing dental education.

BACKGROUND: An increasing number of continuing dental education, or CDE, courses are available on the Internet. The authors conducted this study to determine general characteristics of online CDE course offerings. METHODS: The authors found online CDE courses through Internet search engines and dental indexes. They recorded each course's Web page address, title, topic, length, credit hours and cost. Then they classified course providers, categorized topics, compared course length with credit hours and calculated cost per credit hour. RESULTS: The authors located 157 online CDE courses offered by 32 providers. The courses covered a wide range of topics, and most were five screens long or shorter. Credit hours per screen ranged from 0.05 to two, and cost per credit hour ranged from no charge to $25. CONCLUSIONS: Online CDE courses are hard to locate, making this material accessible only to people who are well-versed in retrieving information on the Internet. The brevity of most courses may make them appropriate for incremental study at the dental practitioner's convenience. Guidelines to correlate credit hours with course length should be developed. PRACTICE IMPLICATIONS: Online CDE courses may become an important tool to help practitioners keep current. Several issues, however, need to be addressed before online CDE can reach its full potential.

Computer-based oral health records on the World Wide Web.

Recently, the World Wide Web has emerged as a platform for computer-based oral health records. Web-based patient records can make teledentistry an instant reality. Because an increasing number of dental care providers can access Web pages, traditional barriers to exchanging information are dropping. Web-based records also make cumulative, longitudinal patient records possible. Sophisticated security mechanisms can ensure the integrity and confidentiality of patient information. Because Web-based systems are simpler to install and configure, the cost of operating them may be reduced. However, their development is complex, difficult, and expensive because the Web was not developed as a programming environment. Furthermore, the technologies underlying the Web are constantly evolving, forcing developers to continuously reengineer their systems. In addition, several policy questions, such as storage of and access to computer-based patient records, have to be answered. This article describes CMSWeb, a Web-based clinical information system implemented at Temple University School of Dentistry.

A profile of current Internet users in dentistry.

The authors developed a profile of current Internet users in dentistry using a survey administered through electronic mail and the World Wide Web. Eight hundred twenty-five respondents from 52 countries comprised dentists, assistants, hygienists, dental students and educators. Respondents reported that they used the Internet for discussing clinical cases, obtaining diagnostic and therapeutic information, buying dental products, communicating with patients and participating in continuing education. Eighty percent considered the Internet to be a useful or very useful resource in dentistry.

A portable, GUI-based, object-oriented client-server architecture for computer-based patient record (CPR) systems.

Software applications for computer-based patient records require substantial development investments. Portable, open software architectures are one way to delay or avoid software application obsolescence. The Clinical Management System at Temple University School of Dentistry uses a portable, GUI-based, object-oriented client-server architecture. Two main criteria determined this approach: preservation of investment in software development and a smooth migration path to a Computer-based Patient Record. The application is separated into three layers: graphical user interface, database interface, and application functionality Implementation with generic cross-platform development tools ensures maximum portability.