Practice Perfect

A new tooth-whitening product is coming on the market, and the manufacturer has a research contract with a dental school clinic to assess its effectiveness. Sure, you may say, the stuff works in a school setting where dentists can take as much time as they need with a patient, one who has agreed to come in multiple times in exchange for a gift card.

But what about in an actual dental practice, where the patient shows up late for an appointment and there is limited time to explain the product and how to use it? Will a busy patient take the time to follow the directions to the letter? Will that patient keep using the whitener if it becomes at all inconvenient?

“Some practicing dentists have been critical of university-sponsored research, saying the outcomes were not affected by real-life variables,” says Jennifer Towers, director of dental research affairs at Tufts School of Dental Medicine.

There was only one way to solve that problem: Move the research from the school and into private practice.

Over the last year, the dental school, which is already known for research done at One Kneeland Street on Tufts’ health sciences campus in Boston, has worked with a handful of private practitioners across the country to conduct research in their own dental offices.

Gerard Kugel, D85, M.S.93, the school’s associate dean for dental research, came up with the idea for the Tufts network. He knew the federal government had an interest in practice-based research; in 2005, the National Institute of Dental and Craniofacial Research created the National Dental Practice-Based Research Network.

Towers says that Tufts was uniquely positioned among dental schools to create its own practice-based network, because of its research administration team of coordinators and grant administrators who could handle the required training and paperwork. “So we were able to go out and train these practices and make sure that compliance—from a financial and nonfinancial standpoint—was upheld,” she says.

The first step was recruiting dental practices to take part. Kugel didn’t have to look far. He knew of several alumni who had proven themselves dedicated to research during their time at Tufts. Chad Anderson, D04, a cosmetic and general dentist in Fresno, Calif., completed 16 research studies while at Tufts, and continued to publish after graduation. Ancy Verdier, A96, D03, DG06, a periodontist in Wainscott, N.Y., worked with Professor Pamela Yelick, G89, on her well-known zebra fish experiments, which she is using to determine whether we can grow our own replacement teeth. Kistama Naidu, D02, DG04, an orthodontist in Pembroke Pines, Fla., tested the longevity of various restoration materials, among other things. And through another alumnus, Kugel was introduced to Heddamarie Hart, a general dentist in Las Vegas with an interest in research. All agreed to go through the training and preparation that would certify their practices for clinical research.

The initial practice-based project was done in partnership with Procter & Gamble, which wanted to get feedback from a wide range of consumers about a new toothpaste it developed. For a study like this, Tufts’ ability to use practices with different specialties in different regions of the country was a perfect fit.

Jacob Silberstein, the senior research coordinator at Tufts School of Dental Medicine, said the company liked the range of ages, backgrounds and dental needs represented in these dentists’ patient populations. “They were wondering if there might be something that affects someone who gets perio treatment versus someone who goes to a general dentist, for example,” he says.

Towers’ staff worked hard to get the dental practices ready to conduct research. Not only each dentist, but each member of his or her staff had to complete National Institutes of Health training and receive certification from Tufts’ Institutional Review Board, the federally mandated panel that reviews research studies involving human subjects.

An Expanding Network

All the dentists taking part are excellent clinicians, Kugel says, but even more important for conducting research such as this is that they and their staffs are highly organized. There are lots of compliance issues: Patients’ identities have to be kept private; their records have to be kept in a secure area, separate from other patient files; every adverse event has to be documented. Silberstein visited each practice to ensure everything was just as it should be.

The dentists receive a per-patient payment for taking part, but “I think they do it more for the intellectual interest,” Kugel says. All the dentists in the practice-based network can now say they are research associates at Tufts, so their patients know that they are helping to advance the science of dentistry.

“It’s been a wonderful experience,” says Naidu. “Patients see that you are not only doing general practice, which we love, but you are taking the time to go above and beyond, to influence the products of the future. They appreciate that.”

Plus, he says, “It helps me keep a close relationship with my colleagues at Tufts.”

Verdier says that practice-based networks can bring in a diversity of study participants—rural to urban, young to old—that a dental school cannot. “This kind of research is really the wave of the future,” he says. He can picture this network being ideal for studies of toothpastes, dental flosses, restorative materials and similar products.

Now that the practices are set up and certified, they should be ready to handle a variety of research projects, particularly ones that center on over-the-counter products and consumer reaction. “A lot of the companies, when they hear about this, are interested,” Kugel says.

Some studies, however, will still be best completed at a dental school. “We’ve done studies that test the use of pain medication after oral surgery, for example,” Silberstein says. “That’s something that takes a lot of moving parts to coordinate.” Having the same one or two oral surgeons complete each surgery at the Tufts dental clinic, and being able to interview the patients on-site were key.

Another alum, Chiann Fan-Gibson, D95, a cosmetic and family dentist in Chicago, will soon join the network, to represent the middle of the country. Kugel doesn’t envision the network growing too large—managing that many locations would be too time-consuming—but does think they might want to get an endodontics practice and a pediatric dentist involved to cover the full range of dental specialties.

Verdier says that so far, his patients seem to like taking part in the studies, which is good, because he is protective of them. “They trust me, and I value their trust,” he says.

Together, he says, they are doing something positive for public health. “The money is nice to cover our expenses,” Verdier says, “but it is really for the benefits and possibilities of something better.”

This article first appeared in the Spring 2014 issue of Tufts Dental Medicine magazine.

Julie Flaherty can be reached at julie.flaherty@tufts.edu.