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• W2272145367 abstract "The evidence-based movement has helped focus dentistry on the importance of a sound scientific foundation for clinical decision making. In fact, the American Dental Association (ADA) Center for Evidence-Based Dentistry describes “current, clinically relevant evidence” as 1 of the 3 pillars of effective decision making in practice.1American Dental Association, Center for Evidence-Based Dentistry. About evidence-based dentistry. Available at: http://ebd.ada.org/en/about. Accessed December 8, 2015.Google Scholar Science has indeed improved dental practice, and biomedical research will continue to yield exciting new technologies and treatments. Although essential to ensure the highest quality patient care, the evidence-based movement assumes dental practitioners are primarily consumers of research findings, when in fact clinicians have also been central to advancing the science of oral health. At the National Institute of Dental and Craniofacial Research (NIDCR), part of the National Institutes of Health, we are working to capitalize on the valuable contributions practitioners can and should make to the research that will improve health. The concept of practicing dentists advancing scientific research is hardly new. Often the practitioner first recognizes an abnormality in a patient that sparks a fruitful line of inquiry. A classic example is the permanent brown staining of enamel noted in the early 1900s by Colorado dentist Dr. Frederick McKay.2Harris R.R. Dental Science in a New Age: A History of the National Institute of Dental Research. Montrose Press, Rockville, MD1989Google Scholar On further investigation, McKay and colleagues3McKay F.S. The study of mottled enamel (dental fluorosis).JADA. 1952; 44: 133-137Abstract Full Text PDF PubMed Scopus (15) Google Scholar found that people with mottled enamel were also more resistant to dental caries. Subsequent studies identified the cause: high levels of fluoride in the local drinking water. This research matured to clinical trials and resulted in the use of fluoride at lower levels for hardening of enamel and protecting against caries. In the past decade, academic clinicians observed that certain patients taking bisphosphonates to control hypercalcemia related to cancer or to prevent osteoporosis were susceptible to osteonecrosis of the jaw (ONJ).4Marx R.E. Pamidronate (Aredia) and zoledronate (Zometa) induced avascular necrosis of the jaws: a growing epidemic.J Oral Maxillofac Surg. 2003; 61: 1115-1117Abstract Full Text Full Text PDF PubMed Scopus (2144) Google Scholar, 5Migliorati C.A. Bisphosphanates and oral cavity avascular bone necrosis.J Clin Oncol. 2003; 21: 4253-4254Crossref PubMed Scopus (431) Google Scholar Private dentists in the NIDCR-funded National Dental Practice-Based Research Network (PBRN) have since explored the connection between bisphosphonates and ONJ through patient interviews and reviews of dental records.6Barasch A, Cunha-Cruz J, Curro FA, et al; CONDOR Collaborative Group, Beadnells S, Craig RG, et al. Risk factors for osteonecrosis of the jaws: a case-control study from the CONDOR dental PBRN. J Dent Res. 2011;90(4):439–444.Google Scholar, 7Fellows J.L. Rindal D.B. Barasch A. et al.DPBRN Collaborative GroupONJ in two dental practice-based research network regions.J Dent Res. 2011; 90: 433-438Crossref PubMed Scopus (42) Google Scholar, 8Barasch A. Cunha-Cruz J. Curro F. et al.CONDOR Collaborative GroupDental risk factors for osteonecrosis of the jaws: a CONDOR case-control study.Clin Oral Investig. 2013; 17: 1839-1845Crossref PubMed Scopus (12) Google Scholar The growing body of evidence on bisphosphonates and ONJ has led to guidelines stressing the importance of dental care for patients entering into antiresorptive therapy.9Hellstein J.W. Adler R.A. Edwards B. et al.American Dental Association on Scientific Affairs Expert Panel on Antiresorptive AgentsManaging the care of patients receiving antiresorptive therapy for prevention and treatment of osteoporosis: executive summary of recommendations from the American Dental Association Council on Scientific Affairs.JADA. 2011; 142: 1243-1251Abstract Full Text Full Text PDF PubMed Scopus (273) Google Scholar, 10Van Poznak C.H. Temin S. Yee G.C. et al.American Society of Clinical OncologyAmerican Society of Clinical Oncology executive summary of the clinical practice guideline update on the role of bone-modifying agents in metastatic breast cancer.J Clin Oncol. 2011; 29: 1221-1227Crossref PubMed Scopus (278) Google Scholar, 11Ruggiero S.L. Dodson T.B. Fantasia J. et al.American Association of Oral and Maxillofacial SurgeonsAmerican Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw: 2014 update.J Oral Maxillofac Surg. 2014; 72: 1938-1956Abstract Full Text Full Text PDF PubMed Scopus (1508) Google Scholar Observations on bisphosphonates have also sparked basic research on the biological mechanisms causing osteonecrosis of the jaw as opposed to other skeletal tissues.12Hokugo A.S. Sun S. Park S. McKenna C.E. Nishimura I. Equilibrium-dependent bisphosphonate interaction with crystalline bone mineral explains anti-resorptive pharmacokinetics and prevalence of osteonecrosis of the jaw in rats.Bone. 2013; 53: 59-68Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 13Williams D.W. Lee C. Kim T. et al.Impaired bone resorption and woven bone formation are associated with development of osteonecrosis of the jaw-like lesions by bisphosphonate and anti-receptor activator of NF-κβ ligand antibody in mice.Am J Pathol. 2014; 184: 3084-3093Abstract Full Text Full Text PDF PubMed Scopus (60) Google ScholarThe National Institute of Dental and Craniofacial Research is taking steps to further integrate practitioners into the full range of research, from the laboratory bench to the academic clinic and into practice. The National Institute of Dental and Craniofacial Research is taking steps to further integrate practitioners into the full range of research, from the laboratory bench to the academic clinic and into practice. Through the National Dental PBRN, NIDCR is continuing to engage practitioners in shaping research to answer additional real-life clinical questions. Topics of study include oral human papillomavirus infection, cracked teeth, occlusal carious lesions, dentin hypersensitivity, and crown placement.14National Dental Practice-Based Research Network. Studies. Available at: www.nationaldentalpbrn.org/studies.php. Accessed December 8, 2015.Google Scholar With nearly 6,000 dentists and dental hygienists in the network, practitioners are not only caring for their patients but also generating scientific evidence to support and advance precision oral health care. The new NIDCR-funded dental, oral, and craniofacial tissue regenerative consortium (DOCTR-C) will also benefit from practitioner involvement. The goal of the DOCTR-C is to develop effective, clinically applicable strategies for regenerating functional tissues of the human dental, oral, and craniofacial complex.15National Institutes of Health. Planning grants for dental, oral and craniofacial tissue regeneration consortium resource centers (R34). Available at: http://grants.nih.gov/grants/guide/rfa-files/RFA-DE-15-005.html. Accessed December 8, 2015.Google Scholar To develop products of optimal clinical value, practitioners are required to be involved in the research teams. These practicing dentists will define areas of unmet clinical need and establish product design criteria. Biologists, bioengineers, and regulatory experts will then chart approaches to address these areas anticipating specific scientific, technical, ethical, and regulatory issues involved in bringing promising research findings into the marketplace. At the same time, NIDCR is taking steps to further integrate practitioners into the full range of research, from the laboratory bench to the academic clinic and into practice. We will enable robust bidirectional communication between dentists and researchers so that scientific findings can better improve dental practice, and observations from the dentist’s chair can more quickly advance research. To make this vision a reality, NIDCR has entered into a collaboration with the ADA. An initial step in this collaboration will be asking dentists to identify the areas of research that may best improve practice and the areas in which practitioners’ expertise and observations can advance science. These conversations will also seek to identify the best mechanisms for ongoing, interactive communications beyond the National Dental PBRN and DOCTR-C. During a 2014 workshop on integrating research and practice, Institute of Medicine president Dr. Harvey Feinberg remarked that the domains of medical practice and medical research should be seen as integrated efforts: “If we can bring those [domains] more tightly together over time, I believe we have the opportunity not only to make faster progress, but to make the kind of progress in health care that really pays dividends immediately and over the long-term for the health consequences of our population.”16Institute of Medicine of the National AcademiesIntegrating Research and Practice: Health System Leaders Working Toward High-Value Care—Workshop Summary. The National Academies Press, Washington, DC2015: 7Google Scholar NIDCR’s aim is to make faster progress in improving oral health by integrating the domains of dentistry and research. Practicing dentists are by nature inventive, entrepreneurial, and forward thinking, and progress in genomics, big data science, and precision medicine are forging an amazing new path in health care. To advance the science of oral health, practitioners and researchers must work together more closely than ever. NIDCR will soon be asking for your involvement, your insights, and your vision for a combined practice-research working relationship that holds so much promise for advancing the health of all. Dr. Vannier is the chief, Science Communication Branch, National Institute of Dental and Craniofacial Research, National Institutes of Health, 31 Center Drive, Room 5B55, Bethesda, MD 20892. Dr. Somerman is the director, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD." @default.
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