COMMENTARY LETTERS

and essentially nonexistent for lished evidence. Only about 3 more practicing dentists in
data in private practice. percent of published work in chairside-driven research.
To change this situation for dentistry is of high-level scien- Clearly, dentistry is
the better, we need two things: tific design.1 The movement to equipped with the technologies
first, practitioners who are have a scientific basis for prac- and expertise needed to facili-
willing to use their electronic tice rightfully has been brought tate a better translation of
patient data for research and to the fore. knowledge across traditional
quality assurance; and, second, While it may be that the barriers. To best engage con-
methods to extract, validate and evidence-based movement was stituents in the private, aca-
analyze these data. In this man- initiated by the 1993 U.S. Su- demic and corporate sectors,
ner, motivated practitioners preme Court’s Daubert v. Mer- collaborative initiatives in-
could contribute to advancing rill Dow Pharmaceuticals deci- volving the American Dental
the art of clinical care on a daily sion, in which five tests were Association, the American
basis. Plus, coming back to the delineated for admissibility of Dental Education Association
main point of the editorial, it scientific evidence in federal and the American Association
would help forge a closer bond courts, the concept has gained for Dental Research (AADR)
between practitioners and popularity.2 are needed to establish an
researchers in dentistry. Since high-level scientific infrastructure that will make it
Titus Schleyer, DMD, PhD evidence is so difficult to ob- feasible for dental practitioners
Associate Professor tain, we need to tap into the to contribute information from
and Director wealth of data that can be sup- patient dental records that can
Center for Dental Informatics plied by practicing clinicians. then be processed, analyzed
School of Dental Medicine An accumulation of the infor- and validated.
University of Pittsburgh mation provided by individual As the flagship organization
1. Institute of Medicine of the National
Academies. Best Care at Lower Cost: The and groups of clinicians about for dental research nationwide,
Path to Continuously Learning Health Care techniques and materials can AADR is well positioned to
in America. www.iom.edu/Reports/2012/
Best-Care-at-Lower-Cost-The-Path-to-
be analyzed and conclusions engage practicing dentists in
Continuously-Learning-Health-Care-in- derived. The National Institute establishing links with aca-
America.aspx. Accessed Jan. 3, 2013. of Dental and Craniofacial Re- demic researchers as well as
2. Schleyer T, Song M, Gilbert GH, et al.
Electronic dental record use and clinical search truly has begun an industry. For example, the
information management patterns among important, beneficial project upcoming Joint AADR/Interna-
practitioner-investigators in The Dental that, hopefully, will be tional Association for Dental
Practice-Based Research Network. JADA
2013;144(1):49-58. successful. Research/Canadian Association
Thus, evidence-based prac- for Dental Research General
tice has developed practice- Session meeting, to be held in
MORE ABOUT RESEARCH based evidence. This could Seattle March 20-23 offers
I read with great interest the work in a perpetual cycle for many forums for dentists to
excellent October guest edito- the benefit of our beloved pro- learn about clinical research
rial of Dr. Rena D’Souza and fession and our patients so that methodology, the progress
colleagues, “How Practicing virtually all of the profession made by fellow dentists en-
Dentists Can Shape Dental can be involved with the ad- gaged in the National Dental
Research” (D’Souza RN, Eber- vancement of the knowledge Practice-Based Research Net-
sole JL, Fox CH, Poverini PJ, base. work and new research ad-
Scannapieco RA. JADA 2012; Dennis Flanagan, DDS vances in all of the disciplines
143[10]:1069-1071) where, in a Willimantic, Conn of dentistry.
National Institute of Dental 1. Vere J, Joshi R. Quality assessment of
Rena N. D’Souza, DDS,
prospective case series of dental implant sur-
and Craniofacial Research gery and prosthodontics published between PhD
(NIDCR) initiative, practicing 2004 and 2008: a systematic review. Int J Professor, Biomedical Sciences
dentists can contribute to clin- Oral Maxillofac Implants 2012;27(4):865-874.
2. Daubert v. Merrill Dow Pharmaceuticals Baylor College of Dentistry
ical research. (92-102) 509 U.S. 579 (1993). www.law. Texas A&M Health
Because high-level scien- cornell.edu/supct/html/92-102.ZO.html. Science Center
Accessed Jan. 3, 2013.
tific clinical research, with ran- Dallas
domized double-masked con- Authors’ response: The and President
trolled trials, is difficult to thoughtful commentaries pro- American Association
design and actuate and engen- vided by Dr. Titus Schleyer and for Dental Research
Alexandria, Va.
ders significant expense, it has Dr. Dennis Flanagan further
become a minor part of pub- underscore the need to engage Jeffrey L. Ebersole, PhD

JADA 144(2) http://jada.ada.org February 2013 131

Professor and Associate contributory to his problem due without a specific diagnosis.
Dean for Research to bilateral stable contacts in The association of psychiatric
The Center maximum intercuspation (MI). problems with temporoman-
for Oral Health Research
Assessing the bite relation- dibular problems requires that
University of Kentucky
Lexington
ship in MI is inadequate for oc- both structural and psycholog-
clusal analysis and cannot dis- ical factors be evaluated and
count a structural cause for the treated. Splint therapy is
Christopher H. Fox,
patient’s symptoms.1,2 Three- useful in this situation, as it
DMD, DMSc dimensional models mounted on provides the patient protection
Executive Director
a semiadjustable articulator from attrition with a preview of
International and American
Associations for Dental Research
with the condyles in centric rela- how an optimal occlusion af-
Alexandria, Va. tion are required for precise fects the masticatory muscles
replication and analysis of the and orofacial pain.
Peter J. Polverini, DMD, patient’s occlusion. We recom- The scientific literature for
mend verifying this position occlusal correction with ortho-
DMSc with bimanual guidance and a dontics, splint therapy, equili-
Professor and Dean
School of Dentistry
marked anterior deprogrammer bration and comprehensive res-
University of Michigan as a predictable technique.3 toration is extensive.4-7 All of
Ann Arbor Accurate mounted models con- these modalities share the
and President-Elect sistently show arc-of-closure same goal of increased comfort
American Association interferences in patients after and function via benign redis-
for Dental Research orthodontics, restorative den- tribution of force to the teeth
tistry or improper equilibration and periodontium to eliminate
Frank A. Scannapieco, that are not apparent in MI. masticatory muscle hyperac-
DMD, PhD Dentists cannot assume that tivity. Multiple clinical studies
Professor and Chair a history of bite problems with with computerized occlusal
Department of Oral splint therapy, equilibration or analysis objectively document
Biology orthodontics that did not re- occlusal correction and MP res-
University at Buffalo solve the patient’s pain indi- olution from dramatic reduc-
The State University cates a nonphysical explana- tion in masticatory muscle
of New York tion. In our practices, it is rare hyperactivity.8,9
and Treasurer
to see a patient with a splint Equilibration is a predictable
American Association
for Dental Research
that is stable with zero mobil- and highly conservative treat-
ity, has multiple bilateral pos- ment modality when done prop-
terior teeth contact to 2– erly.10 The amount of reshaping
UNDERSTANDING micron-thick ribbon and should be quantified with trial
OCCLUSION smooth anterior guidance with equilibration on mounted
After reading Dr. Vladimir immediate posterior teeth dis- models. Reduction into dentin
Leon-Salazar and colleagues’ clusion. If these criteria are not is not acceptable without initial
September JADA article, “Pain met, the splint has introduced a comprehensive planning for
and Persistent Occlusal Aware- new malocclusion to the postequilibration restoration.
ness: What Should Dentists patient. Irreversible procedures is
Do?” (Leon-Salazar V, Morrow The patient described in the not a derogatory term. Most of
L, Schiffman EL. JADA 2012; article may have an arc-of- the procedures in dentistry—
143[9]:989-991), we are con- closure interference on his crowns, endodontics and third-
cerned about the diagnostic anterior teeth from orthodon- molar removal—are irre-
basis used to ascribe a neuro- tics or overreduction of pos- versible. All disciplines of den-
logical cause for the patient terior teeth. This could have tistry base their standard of
they diagnosed as having been determined from proper care on comprehensive diag-
myofascial pain (MP), temporo- occlusal analysis. It is the den- nosis and predictable pro-
mandibular arthralgia and tist’s responsibility to assess all cedures. All dentists need to
occlusal hyperawareness. This factors that may cause or con- understand the role of occlusion
patient had orthodontics, mul- tribute to the problem and in their daily practice and learn
tiple equilibrations, severe avoid treating pain of unknown how to diagnose, prevent and
abrasion and self-applied origin. This is especially true treat occlusal problems. We
coronoplasty. Despite this, his when multiple dentists and encourage dentists to take
occlusion was assessed as non- treatments have been involved hands-on continuing education

132 JADA 144(2) http://jada.ada.org February 2013