Richard Niederman, DMD

Long-term Goals 

The Center has two long-term goals. The first goal is  the implementation of evidence-based dentistry among all stakeholders ─ patients, clinicians, dental organizations and governments. The second goal is the  actual implementation of evidence in practice. Specifically, we are  providing comprehensive caries prevention for  at-risk elementary school children. We call this initiative ForsythKids.    The goals are to measurably: increase access to care; improve oral health; and demonstrate financial sustainability.

Short-term Initiatives

To achieve our long-term evidence-based dentistry (EBD) goals we are: providing annual, evidence-based dentistry training; collaborating with dental organizations and businesses to implement EBD; and expanding www.EviDentista.org content and providing Web 2.0 interactivity. To achieve our long-term ForsythKids goals we are expanding from two to six Massachusetts regions, four U.S. states and four Latin American countries.

Background

The international dental care system is  largely based on an outdated, 19^th century, surgical model of care.  Data from the 20^th century Forsyth studies demonstrate that caries and periodontal disease are preventable bacterial infections. Yet, dentists are still trained and compensated to surgically treat these preventable infections with three metals – gold, silver and stainless steel. This leaves large proportions of the population over treated, undertreated  or inappropriately treated. For the 21^st century we believe we need a new pathway to oral health that addresses the underlying infection, not the “hole” that the infection creates. This is particularly true when one considers that oral infections negatively affect systemic health. We are working on developing this new pathway.

We know that it takes 20-200 years for system change without active dissemination. We also know that 20 years is a full generation of unnecessary suffering. We are therefore implementing “bubble up” rather than “trickle down” evidence-based initiatives.

www.EviDentista.org 

EviDentista.org is a free-access, global eEBD center.  With identical versions in English, Spanish and Portuguese and an e-newsletter, it provides virtual international EBD training and answers to clinical questions. Seed funding came from the Fulbright Foundation and the International Association for Dental Research.

Training and Dissemination

Vigorous dissemination catalyzes sustainable change. Therefore, the Center actively delivers education and mentoring to governments, dental organizations and clinicians to increase awareness, acceptance and application of EBD precepts. Programs have been provided to stakeholders on four continents who are establishing EBD programs. In 2009 Forsyth initiated collaboration with the American Dental Association to provide yearly EBD training at Forsyth. To facilitate training, the Center Director co-authored the book Evidence-based Dentistry for Clinical Decision Making. To facilitate dissemination the Center Director is the U.S. Associate Editor for Evidence-Based Dentistry Journal.

Research

The Center actively generates and distributes systematic reviews and editorials primarily related to caries and periodontal disease prevention. This research is then implemented in pilot programs and then demonstration programs. The Center’s demonstration programs are designed from three perspectives:  1.) Increase awareness, acceptance and application of EBD principles; 2.) Integrate the current best evidence, with clinical judgment, and the patient/client’s needs and circumstances, to improve health; 3.) Measurably improve health, increase access to care and demonstrate financial benefit.

ForsythKids school-based caries prevention program is an example of a maturing program that is based on these precepts.  ForsythKids brings preventive dental care directly to children who face barriers to care, right in their schools, and the treatment significantly reduces caries with each round of prevention. This program began in 2003 and provided comprehensive preventive dental care to at-risk children in four elementary schools.  Approximately 50% of the children had untreated decay at our first visit with them, and 10% need immediate care for pain or an abscess. The program now delivers care to children in more than 50 elementary, middle and high schools. This includes the entire city of Lynn, several schools in greater Boston and school systems on Cape Cod and Nantucket, Massachusetts.

In the U.S. ForsythKids training and mentoring were requested and provided to programs in Maine, New Hampshire, Iowa and Colorado. Similar requests were also met for organizations in several Latin American countries including: Argentina, Brazil, Colombia and Peru.
 

Selected Publications

Rosenblatt A, Stamford TC, Niederman R. (2009) Silver diamine fluoride: a caries "silver-fluoride bullet". J Dent .Res. 88:116-125.

Niederman R. (2009) Evidence-based dentistry finds a new forum: Exelauno. J. Am. Dent Assoc.140:272-274.  

Bessa-Nogueira RV, Vasconcelos BC, Niederman R. (2008) The methodological quality of systematic reviews comparing temporomandibular joint disorder surgical and non-surgical treatment. BMC Oral Health. 8:27. 

Niederman R, Gould E, Soncini J, Tavares M, Osborn V, Goodson JM. (2008) A model for extending the reach of the traditional dental practice: the ForsythKids program. J. Am. Dent. Assoc.139:1040-1050.  

Niederman R, Leitch J. (2006) Know-how and know-what: Knowledge creation in practice. J. Dent. Res. 85:296–297.  

Niederman R, Richards D. (2005)  Evidence-based dentistry: Concepts and implementation. J. Am. Coll. Dent. 72:37–41.  

Moles DR, Needleman IG, Niederman R, Lau J. (2005) Introduction to cumulative meta-analysis in dentistry: lessons learned from undertaking a cumulative meta-analysis in periodontology. J.Dent .Res. 84:345-349.