Practice Based Research : The Future of Dentistry

     There are some big changes happening in the world of dental and medical research. Technology affords our patients new and better ways to access the information they can use to improve their health. One of the most significant is "practice based research". This is a model in which hundreds of doctors in private practices throughout the country participate in a research project together, under the guidance and support of a national organization (in our case, the National Dental Practice Based Research Network).      In my practice, we have been participating in this type of research for several years now. We want the dental care we provide to be "evidence based". That seems obvious. But how do we decide what kinds of evidence we should be using, and how we should be collecting and evaluating it? What does it mean when we say a treatment or a cure is based on "research"? 
     Historically, basic dental research in this country was conducted in teaching hospitals and academic medical centers, and a much of it still is. But full time academics often conduct their studies far from the realities of private practice, and this can hinder their vision of the ultimate goal of research: improving dental practice and patient outcomes.

"Practice based" research is a welcome and growing trend in the profession of dentistry.

Your personal private health information is valuable. And it's YOURS. Protect It !

      When we visit the doctor these days, much of our health information is collected, transmitted and stored electronically. We might enter our medical history into an iPad.  Our prescriptions are often sent directly to our pharmacies electronically, and results of our lab tests might be made available for us to view online, through an online patient portal. Even our appointment reminders may be communicated via text or email. 

     You have probably noticed some of these trends, and you can expect them to continue. Here in New York for example, there will be no paper prescriptions permitted after March of 2016. Electronic prescribing will be the standard and the rule. Very convenient and efficient, many of these changes offer us enhanced efficiency, convenience and safety.

 HOWEVER....... some of these advances also conceal potential threats to the safety and security of our information. If huge corporations like Target, Sony and Microsoft can suffer a data breach, how safe can our health information be?  Here's some interesting info about the Sony breach as it relates to health information.
     This is something to be aware of any time you hand over your insurance card or your credit card, or type any information into a computer you do not own. Digital information can be shared easily, with the click of a button.  That is what makes it so convenient. The question of how to ensure that your data is safe is complicated, but a few simple principles are usually worth following.

     There are several sources of "information insecurity" when it comes to our health information. We always think about hackers and identity thieves first. The personal information in your doctor’s computers can be valuable, and there are criminals who would like to have it.  But the more easily data can be appropriately shared, the more easily it can be inappropriately shared.  Information access is inversely related to information security. Anything you type into some computer somewhere, might one day appear on any computer anywhere.  (Unless I can find a reference to that somewhere, I’m going to call it Rubinstein’s Law). 

     The most reasonable course is to practice what I call good "information hygiene". Share only the minimum amount of information necessary, and be sure you know who will have access to it, and for how long.

     DON'T use your social security number for health identification purposes. There is really no reason to write it down, even if there is a line for it on a form. Just leave it blank. Insurance companies are no longer using SSNs for identification purposes. Now they issue their own unique identifying numbers.
     DON'T access your medical information any public Wi-Fi access. Even if you are accessing your information from the doctor's "secure portal". Remember that nothing is "secure" unless your own internet access is secure also. If you're checking the results of your blood tests from a laptop at Starbucks, you might as well post them on your Facebook page.

     DO put expiration dates on your permissions. Many forms that you sign giving access to your data remain in effect unless you specifically cancel them, often in writing. Cross out the part that says "until canceled" and write in an expiration date. I usually pick 1 or 2 years from the day I sign the form. 

    This only scratches the surface. Here is a little more reading on the subject......

    

Ask your doctor MORE questions !

     It never fails to amaze me.  I will be talking to a patient who is contemplating a difficult procedure. He or she is being very inquisitive, trying to understand their options. Suddenly, they will say something like  "sorry for asking so many questions" ! !    My standard answer (yes, I have one) is that most people don't ask their doctors nearly enough questions. Ask away.  If a patient leaves my office without knowing what they need to know, then I haven't done my job properly. I try never to let that happen. I try never to seem like I am in a hurry, or that there is some place else I need to be. Trust me, your doctors WANT you to ask questions.     

     Yet, we've often been conditioned to believe that our doctors should just tell us what to do. That we shouldn't ask too many questions. That the doctor's time is somehow too valuable for us to "waste" with excessive questions. That simply isn't the case. Information is not "extra". It is an integral part of your treatment, and you're entitled to ask for it. More than entitled, actually. You are responsible to ask for it. That is one of the most important ways in which you can take an active role in your own health care. Your doctors should encourage that !

Painless Dentistry? Yes, it is possible.

     Is it really possible to have a painless dental injection? Actually yes. In the majority of cases, new technology and techniques  allow you to feel almost nothing. (I know..... it seems hard to imagine)

So why do some people expect that their routine dental treatment will involve discomfort or pain? It may be that they are recalling an unpleasant dental experience from their past or their childhood. Or perhaps their dentist is not using all the tools our profession has developed over the past few years to improve comfort and reduce pain and anxiety.

       Fact is, very few things we do nowadays are painful at all, and even the dental injection itself (the dreaded "needle") has evolved to the point where many patients, after receiving their injection, have a hard time believing they'd had one at all.

The most important ingredient in anxiety-free dentistry is communication. We dentists always need to keep our patients in the loop, and describe what we are doing in great detail, so we can be sure our patients know that we take their comfort very seriously. Some patients (unfortunately) want to avoid "bothering" the dentist with complaints, and will suffer their discomfort quietly.  Don't.  When you give us the information we need to keep you comfortable, you're doing us both a big favor.

I don't want there to be any surprises during your visit, exept that it was better than you expected!

Dr. Mitchell Rubinstein appointed to associate resarch position at N.Y.U. Dental School

   




     We're proud to announce that our practice has been designated a research site by New York University's School of Dentistry.  The P.E.A.R.L. Network is a practice based research network that allows our patients to participate in the ongoing efforts to improve treatment outcomes in our oral and general health.
      Under a grant from the National Institute of Dental Research, these practice based networks allow us to combine forces with other dental practices to create powerful and efficient research programs. The opportunity for patients to participate is, of course, completely voluntary and the information collected is kept completely confidential.
     P.E.A.R.L. network studies create a valuable opportunity for us to not only remain at the cutting edge of oral health treatment, but to give our patients the advantages of the most current and studied treatments in the practice of Dentistry.