Senior Member of the Staff
Department of Cytokine Biology
Senior Member of the Staff
Clinical Research Collaborative
Director
Center for Evidence-Based Dentistry
email:
University of California, Davis, B.S., 1968, Biology
University of California, Davis, M.A., 1971, Zoology
Harvard University School of Dental Medicine, D.M.D., 1976, Dentistry
Harvard University School of Dental Medicine, Certificate, 1984, Periodontology
Long-term goals: By 2014, when Medicaid expects the cost of oral health care to double, to have a national preventive oral health care program in place that is evidence-based, cost-effective, financially sustainable, and that measurably increases both access to oral health care and improves oral health.
Short-term goals: To complete the organizational structure and implementation of local demonstration programs that apply the precepts and accomplish the goals of a national preventive oral health program. As well, to complete the implementation of the Pan American Centers for Evidence-Based Dentistry and their website to support this change.
Over the last 30 years it was recognized that caries and periodontal disease are infections that can be prevented. Yet, the oral health infrastructure (training, licensing, reimbursement) continues to support a traditional surgical model of care developed in the 19th century.
Implementing a preventative model of care now is critical for a variety of reasons. It is predicted that the cost of health care, including dental care, will double over the next 10 years. Modest preventive care saves approximately $10 for every dollar invested. Despite the clear rationale for a preventative approach, the current care and compensation models continually drive care toward intervention to the detriment of prevention. Finally, it can take 20 years or more to incorporate effective preventive concepts into practice. Without active intervention, improvement in the quality of care and reduction in variation of care shows little impetus for improvement.
The CEBD proposes to work on all elements of the evidence pipeline, thus facilitating health care improvement and reducing the lag time between scientific discovery and widespread implementation.
Funding from the International Association for Dental Research and the Fulbright Foundation, is providing seed capital for the CEBD to specifically develop the Pan American Evidence-Based Dentistry Centers' website with identical versions in English, Spanish and Portuguese and an E-Newsletter. This project is in collaboration with the Pan American Health Organization;, the University of Pernambuco, Recife, Brazil; and Valparaiso University, Valparaiso, Chile.
The CEBD developed EviDents.org, an EBD search engine for identifying high quality clinical evidence on any given oral health topic in less then five seconds on MEDLINE. The team is currently in the process of developing the capability to simultaneously search: Bireme, the virtual health library of Latin American, Database of Reviews and Effects and the National Guideline Clearinghouse.
The CEBD proposes to work on all elements of the evidence pipeline, thus facilitating health care improvement and reducing the lag time between scientific discovery and widespread implementation. The Center will accomplish this by establishing four core activities.
Active dissemination of effectiveness stimulates sustainable change. Therefore, the CEBD has identified, and is actively working with, groups in Massachusetts and Maine to effect systematic change in clinical practice.
The mentoring and leadership model being employed is that developed and pioneered by the Institute for Healthcare Improvement. Representatives of the stakeholder groups are convened to: introduce the concepts of EBD and quality improvement; agree on what questions are to be asked and answered; and to develop a draft charter. Monthly electronic and quarterly meetings review process and outcome measures.
Over the previous three years the CEBD has conducted an average of three intensive EBD training workshops per year and an average of seven EBD lectures per year. The expectation is to continue this activity and to increase it to include a bi-annual EBD conference.
With the simultaneous 10-year anniversary of the Oxford Centre for Evidence-Based Dentistry, and the Cochrane Collaboration's Oral Health Group and the 5th anniversary of the Forsyth Center for EBD, Dr. Niederman and his team are in the discussion stages of planning an international EBD conference and workshop to be held in Boston.
As the value of video conferencing increases the CEBD is in the process of developing distance-learning modules, in conjunction with the development of an EBD Internet site. The distance-learning will be modeled after the current in-person intensives, with specific modules based on the five-step EBD process.
The CEBD currently publishes original research, systematic reviews, and editorials on clinical topics. The Center Director is the founding Associate Editor for both Evidence-Based Dentistry Journal and BMC's Education for Evidence-Based Practice.
Demonstration programs are defined as models for the delivery of evidence-based care that improves access to care, improves health and is financially sustainable. The CEBD currently has two ongoing programs, one in periodontal care, and a second in caries prevention.
The Caries Program facilitates the development of a large (>20,000 children) longitudinal (>5 years) database. This consolidated database offers the unique opportunity to determine the costs, outcomes and effectiveness of preventive care, delivered to different populations, by different clinicians, over multiple years. A school-based caries prevention program is in its third year and includes elementary school children, grades one-three, in three Massachusetts school systems: Lynn, Hyannis, and Boston. Care includes a dental examination, referral for comprehensive care, and/or provision of preventive care. Preventive care includes prophylaxis, fluoride varnish, sealants and temporary restorations. For those children provided with preventive care, initial analysis suggests a 50% reduction in caries prevalence. Detailed analysis will commence at the completion of the Spring 2006 treatment visits. This program is currently being expanded to include all elementary school children in the current schools, a trans-Cape Cod initiative and a trans-Maine program. The numbers of children expected to being provided with care and outcomes monitored is anticipated to be 20,000 over the next five years. CEBD is also in discussion with the state of West Virginia and its dental school to bring this program to 200,000 children there.
The Periodontal Disease Demonstration Program is very timely due to the association between periodontal infections and systemic disease, increases the need for accessible, cost-effective, periodontal care. Specifically, this program compares the cost and effectiveness of preventive non-surgical periodontal care delivered in general practitioners' offices by dental hygienists (150,000 in U.S.) with surgical care provided in periodontal specialty practices by periodontists (5,000 in U.S.). Data reduction and analysis is scheduled to commence during the Summer of 2006.
Niederman R, Leitch J. 2006. Know-how and know-what: Knowledge creation in practice. J. Dent. Res. 85(4):296–297.
Niederman R, Richards D. 2005. Evidence-based dentistry: Concepts and implementation. J. Am. Coll. Dent. 72 (4) :37–41.
Niederman R, Theodosopoulou JN. 2003. A systematic review of in vivo retrograde obturation materials. Int. Endod. J. 36(9):577–585.
Niederman R, Richards D, Matthews D, Shugars D, Worthington H, Shaw W. 2003. International standards for clinical trial conduct and reporting. J. Dent. Res. 82(6) :415–416.
Niederman R. Manual versus powered toothbrushes: The Cochrane Review. J. Am. Dent. Assoc. 134(9):1240–1244.
Niederman R, Chen L, Murzyn L, Conway S. 2002. Benchmarking the dental randomized controlled literature on MEDLINE. Evidence-Based Dent. 3(1):5–9.
Holstein A, Hargreaves K, Niederman R. 2002. Evaluation of NSAIDs for treating post-endodontic pain: A systematic review. Endo. Topics 3:3–13.
Chen JY, Will LA, Niederman R. 2002. An analysis of the efficacy of functional appliances on mandibular growth. Am. J. Orthod. Dentofac. Orthop. 122(5):470–476.
Ellen Gould, RDH, MPA, Associate Director
Joel Silverman, Data Analyst
Valerie Osborn, RDH, Research Hygienist
