I read with great interest the October JADA guest editorial by Dr. Lawrence A. Tabak, "Dentistry on the Road(Map)." As a practicing wet-gloved dentist, I appreciate the potential that Oral Health Practice-Based Research Networks (PBRNs) offer. While I can take comfort in knowing that the treatment I provide is successful at the conclusion of an appointment, it would be more valuable to have information about treatment longevity, long-term effects and costs of care, which would be expected to be revealed with the proposed initiative.
The current peer-reviewed literature is guided by statistical significance, using surrogate measures, leaving the clinician to determine clinical relevance in patient-oriented terms. Clinicians also rely on the non–peer-reviewed literature for guidance, but it lacks the level of scientific scrutiny to ensure the validity of its conclusions.
Even clinicians who have many years of experience cannot effectively counter scientific publications, as they rarely, if ever, document patients’ clinical conditions in a manner that allows them to analyze the effects, both beneficial and harmful, of treatment. Most clinicians rely on their subjective opinions, using the memory of most recently treated patients to determine treatment effectiveness, which may be an inaccurate method. Furthermore, subjective judgment is used to determine risk, which has been shown to be inconsistently accurate.
Hence, PBRNs would be expected to result in an improvement in care by determining the effects of treatment provided by clinicians. This could be a challenging task, as the information required to analyze treatment results includes pretreatment and posttreatment conditions, which are frequently not documented in patients’ clinical records. An additional confounding issue is the lack of a clinical objective standard to determine a periodontal diagnosis that would permit a meaningful comparison of two disease states. The simple matching of a treatment intervention to a clinical condition assumes that risk is equivalent. This is not true, as each patient has a unique set of risk factors for disease, and each treatment intervention has a unique set of factors for success. Hence, diagnosis and risk level more fully define a patient’s health status and provide a more accurate means of determining treatment effectiveness.
