Table of Contents

Periodontics

Inside Dentistry

July/August 2006, Volume 2, Issue 6
Published by AEGIS Communications

How Do You Choose the Products That You Use

Allison M. DiMatteo

Dental practitioners, take note. The products and equipment you purchase for use in your practice represent big marketplace bucks. It’s no wonder then that manufacturers are saturating assorted dental media and communication venues with messages about which products you should buy for what purposes and to achieve what kind of better clinical results.

In 2005, the professional dental equipment and supplies market was estimated to account for 34% of the total US dental products market, with sales totaling an estimated $2.3 billion in that area alone.1 Sales of professional dental equipment and supplies are expected to increase at an average annual growth rate of 6.5% and reach $3.2 billion by 2010.1

A significant driver in the growth of the dental supplies and equipment market is a boost in sales for cosmetic and restorative products to meet the demands of an aging population prepared to pay for high-end solutions that provide a youthful, natural-looking smile.2 Ease-of-use of certain products and materials - as well as additional education efforts directed toward you, the dental professional - are also driving the market.2

Although traditional equipment and materials continue to command a large portion of the dental market, new equipment and materials are being introduced constantly.1 Newer technologies (eg, dental lasers, esthetic dental products, product delivery systems) continue to impact the industry.1 A large number of the companies participating in the US dental marketplace are specifically dental product manufacturers, but generic companies and emerging dental technology providers are also among those competing for your business.1

“It has become even more confusing in 2006 than it was 30 years ago fordentists to evaluate dental products,” reflects Gordon J. Christensen, DDS, MSD, PhD, who - along with his wife, Rella Christensen, PhD - founded Clinical Research Associates in 1976. “There was probably more of an honesty in the profession at that point, and today - in my opinion - there is far too much orientation toward money and far too little toward service.”

So many products, so much information, so little time. There’s a great deal to be thoroughly considered before you purchase your materials, supplies, and equipment, as well as before you decide whether or not you’re going to switch from one product to another. But where to turn for the information on which you’ll base your purchasing decision is an equally important decision unto itself.

Do you only need reliable and verifiable information about a product, or do you need to be educated on its use? Do you want to know how the product compares to others that are well-established in terms of material characteristics and properties, or do you need information about practical, clinical performance?

From safety and efficacy considerations to the research that’s been conducted in support of product marketing claims, the information on which you can base your decisions is towering as high as the mound of products and equipment from which you can choose. Here’s the Inside look at how to weave through the maze of messages and come out with a clear understanding of what’s in your - but most importantly, your patients’ - best interest.

Selecting from Among the Choices

According to David Steck, vice president and general manager of Sullivan-Schein, today’s dental marketplace is characterized by multiple manufacturers marketing multiple variations of what are essentially the same types of products. They may appear to be new because they are promoted and advertised as being different, but they’re really not, he says.

“Manufacturers are selling their products,” emphasizes Gerard Kugel, DMD, MS, PhD, associate dean of research for Tufts University School of Dental Medicine, “but a lot of dentists base their purchasing decisions on the information a sales representative will give them.”

What must really be scrutinized when deciding among products are the key differentiating factors, Steck says. Unfortunately, when there isn’t much else new, manufacturers may jockey to position “influence leaders” on their side in support of a particular product in order to create the image that it’s different, he notes.

Information about a product’s physical properties and characteristics can come from the sales representative, who may also be able to share information about how the product compares to others on the market in a similar category. But beware. There’s obvious bias, our experts agree.

Therefore, Kugel advises dentists to ask questions. What evidence do you have that it works? How was this evidence obtained? Do you have an evaluation from one of the dental product evaluators? Steck and others also advocate asking questions to determine what attributes of a product really make it different from others and/or previous generations (ie, characteristics, features, benefits, how it’s used). By doing so, dentists can identify products that fit the description of what they need, rather than focusing on a brand or specific product name.

Richard Simonsen, DDS, MS, dean of Midwestern University College of Dental Medicine, cautions clinicians about new materials that might not yet have an adequate level of testing according to the clinician’s criteria. Also, he notes that dentists should recognize that whatever information is initially available is coming through a filter - most likely the company representative.

However, product research - in vitro studies and others - that is funded by larger corporations with reputable research facilities can be trusted once it is duplicated independently, suggests Christensen. He notes that if it weren’t for some of the companies’ research, there would be very little applicable, practical research available.

“A lot of it would be research that would be of interest to the researchers, but not necessarily applicable to practice,” Christensen says.

Keeping Up With the Influence Leaders

According to Steck, speakers and lecturers whose presentations require dentists to pay an on-site registration fee for attendance are “by far the most influential drivers of sales for products.” When famous-name speakers - considered by some to be “influence leaders” - have been present at tradeshows and conventions and have mentioned a particular product, sales of that product go up within hours, he says.

Those in the industry who lecture and teach other dental professionals have become key information sources about products and the techniques with which they are used. Some do so independently of corporate sponsorship, but others receive product and financial support from the manufacturers whose products they’re demonstrating. Regardless, for those eager to try the latest and greatest, what these presenters say matters.

“Dentists rely very strongly on the courses given by ‘gurus’ for their information, and if the speaker endorses a product, then the attendees will write it down,” observes John A. Sorensen, DMD, PhD, director of the Pacific Dental Institute and a researcher and educator for more than 19 years. “The problem is that some of these speakers have absolutely no research background - the presentation is all technique - and they might even be very strongly sponsored by a particular manufacturer and, therefore, recommend that manufacturer’s product.”

Therefore, he and others advocate full disclosure of any financial interest or commitment a speaker - and also an author of printed material on a topic - may have that could influence what they say about a product (See Disclosing Financial Interests, below). Sponsorship or funding is not necessarily bad, they say, but the dentists in the audience or readership pool need to know about potential bias in order to make informed and insightful decisions.

Steck has also observed that some dentists will not only follow the influence leaders, but also their peers. If a dentist isn’t an early adopter of products or technology by nature, he or she may rely on others to take the step for them and, therefore, trust their opinion when it’s time to make a purchase.

“We do rely on the clinical experience of our peers,” notes Kenneth A. Krebs, DMD, president of the American Academy of Periodontology. “I will many times call another doctor and ask him or her if they’ve tried such and such a product to see what their opinion is.” Additionally, when it comes to which cements to use with what types of restorative materials, or which impression material to use to achieve the best results, clinicians may also turn to their dental laboratories for direction about what to buy, Kugel says.

But Steck warns that one dentist’s successful use of a product or technique does not necessarily translate into success for all. “There are many dentists out there who can make any product work well because they are that good,” he says. “The acceptance of dentists is not a constant. In a particular dentist’s hand, one product may work well. For someone else, it might not. It’s impossible to know based on the presenter.”

What’s more, unfortunately, there is no fool-proof solution to this issue, Kugel clarifies. Even if there’s data that looks good, maybe even from research conducted at universities, the product may not perform as well in someone else’s hands as it did during the study, he explains.

Seeking Out Trustworthy Information

Whether it’s about a bur or a curing light, a composite or an impression material, the sources of information available to dentists about the products they may want to purchase are as varied as the product offerings in a given category themselves. And while you might think that what you’re looking to buy would factor into the type of information source you’d consult, our experts say that’s not always the case. Source reputation, reliability of information, and quick application are more likely to influence where you’ll go for the information you need - and what you’ll base your decisions on - than the type of product you’re considering.

“Ultimately, dentists tend to seek out information from sources that appear to be or are in fact non-biased, and there are not very many of them,” observes Christensen.

According to Simonsen, who is also a former employee of 3M Dental Products Division, nobody should rely 100% on any one information source. Rather, he suggests that clinicians maintain a healthy skepticism about what they hear and read until such a time that they’ve developed the trust necessary to accept what that source might say.

As we’ve suggested earlier, there are manufacturer sales representatives and product dealers; speakers, lecturers, and private institute educators; trade magazines; hands-on live-patient demonstrations and product use simulations; videos, audio tapes, and DVDs; and Internet resources, too. There are also the pure research journals - the stringently peer-reviewed, academic literature - that review materials, techniques, and research - as well as subscription-based product evaluation newsletters (See Product Evaluations, page 50).

“I know many dentists are getting a lot of their information from sales representatives and non-refereed publications in which people can say whatever they want to and often have a bias because of financial interest,” observes James B. Summitt, DDS, MS, chairman of the department of restorative dentistry at the University of Texas Health Science Center at San Antonio Dental School. “There is a huge amount of more credible information out there - such as randomized clinical trials and systematic reviews - but the problem is that not many dentists go to these sources.”

First and foremost, clinicians should rely on good scientific evidence, and that evidence is most frequently found in peer-reviewed literature, says Harald O. Heymann, DDS, MEd, professor and graduate program director of operative dentistry at the University of North Carolina School of Dentistry and the editor-in-chief of the Journal of Esthetic and Restorative Dentistry. It may also be found in some continuing education programs if the presenters clearly use evidence-based - as opposed to anecdotal - information, he says.

With the advent of such online research tools as PubMed and Medline, as well as the Web sites of organizations such as the American Association for Dental Research (AADR), dentists can quickly obtain research abstracts about products that have been tested and/or investigated, Kugel notes. There is so much information available now that is literally at everyone’s fingertips, he says, but the issue becomes teaching students and practitioners how to critically evaluate the information they’re reviewing (See Dental Schools’ Role, page 52).

“I recommend that dentists use the Internet and MedLine,” says Summitt. “For those of us in academic institutions, this is part of our usual work, and our institution pays for it. Those in private practice may have to pay a fee, but it’s a great source of information.” He and others also advocate the use of Internet sites that provide free and unbiased product evaluations (See The USAF Dental Evaluation, page 54).

Asking for and Evaluating the Evidence

According to Summitt, more and more evidence-based information is now available. In particular, he recommends Evidence Based Dentistry and the Journal of Evidence-Based Dental Practice, two publications that provide systematic reviews and evaluations of research findings in a very concise and short manner. “If you pay more attention to things like this, you won’t have to wade through individual studies, but you’d have good answers,” Summitt says.

Evidence-based information typically refers to information that can be substantiated through a sufficient number of papers in the scientific literature that corroborate findings, Heymann explains. To support the use of a particular product or technique, clinicians should look for a number of studies - clinical trials, in vitro research, and even practical effectiveness evidence, he says.

Michael B. Miller, DDS, president of Reality Publishing Company, recommends asking speakers, in particular, one simple question when presented with information about a product’s performance: How do you know that? Meaning, ask the presenter what he or she is basing the opinion and/or claim on. If there’s science to support it, ask to see the data and how it was obtained, he advises.

“If someone says he or she has data but doesn’t present it to you or tell you how they obtained it, then you have no idea what the findings or opinions are based on,” Miller says.

Sorensen stresses that it is incumbent upon dentists to be more discerning during presentations or when reading articles, as well as more critical of what’s provided. Look deeper to see if the speaker or author is really justifying and supporting what they’re claiming.

“Not all readers know how to evaluate a good paper from one that is questionable, or how to tell what separates good research from bad research,” Kugel explains. “There are some articles in print that claim to be clinical or research-based that really read like product advertorials. A skilled reader will see through that.”

Knowing what the research really says about how a product performs clinically should be a #1 requirement for determining if it’s worth trying in your practice. In some of his lectures, Kugel presents students with a list of “10 Catastrophic Failures in Dentistry.” These, he says, are products that were introduced to the marketplace without sufficient research to support the respective manufacturers’ claims for their clinical use. The catastrophic nature of the failures could have been predicted, if not prevented, had the materials and product information been questioned, he believes.

“I am first and foremost a clinical dentist, and patients trust me as well as other clinicians to do a procedure the right way using the right materials that have been tested properly,” Miller emphasizes. “Too many materials or pieces of equipment have been put out on the market without proper testing.”

Heymann urges practitioners to be good dental consumers and not be swayed easily to buy the latest and greatest. In the end, he says, the latest and greatest may prove otherwise down the road.

“When you start using products with no track record whatsoever, you are basically assuming the liability and the risk for using those products if they don’t work in your practice,” Heymann asserts. “I can’t overemphasize the importance of just allowing sufficient time for these products to have a track record that may include formal clinical trials and usage studies to document efficacy.”

It’s not unheard of for dentists to receive product samples from manufacturers with little or no product research or data to support its use, Kugel observes. Yet, some clinicians routinely use these sample products in clinical practice - for example, cements or bonding agents - when treating actual patients, he says.

“That to me is unbelievable,” Kugel attests. “If you went to a cardiologist and needed a heart valve, and the doctor said he just received a sample for which he had no clinical data but he planned on putting it in your heart anyway, you’d think he or she was nuts!”

Considering Safety and Efficacy

Approval by the US Food and Drug Administration (FDA) is certainly something to be considered seriously. But seeking out what’s FDA-approved does not necessarily guarantee a product’s successful clinical performance. FDA approval is based on the safety and efficacy of new science, chemistry, and/or applications of it, explains Summitt. For example, there hasn’t been an FDA approval of a new composite since at least the 1970s, he says, because the chemistry hasn’t changed. If a new composite formulation is developed, then it would require FDA testing to show that the product is safe for its intended use.

Additionally, dental professionals have also relied on the American Dental Association (ADA) Professional Product Seal of Acceptance Program, which has been in effect since 1930. “In order to gain the ADA Seal of Acceptance, professional products had to meet the Council’s stringent criteria and guidelines for product safety and effectiveness,” explains Clifford W. Whall, Jr., PhD, director of the ADA Council on Scientific Affairs Acceptance Program. “But, recent focus groups and surveys of our members have shown that knowing that professional products are safe and effective is no longer enough information for dentists. They really want to know how these products compare to each other in terms of laboratory and clinical performance.”

According to Whall, ADA members have indicated that they really want comparative product information that is scientifically sound, unbiased, and clinically relevant. The Professional Product Seal program doesn’t provide comparative product information, he says, which is why the ADA began a 3-year phaseout of the program in January 2005. It is being replaced with the Professional Product Review (PPR) newsletter, which will debut in July 2006 (See Product Evaluations, page 50).

Whall points out that the ADA Seal of Acceptance Program for over-the-counter products - which has also been in existence for more than 75 years - will continue and will maintain strong criteria for product safety and effectiveness for the benefit of consumers. He adds, “You can be confident that any product bearing the ADA Seal of Acceptance has met ADA criteria for safety and effectiveness, and it does what its labeling says it does.”

Conclusion

Before you change products or use something new in clinical practice, Kugel advises spending more time evaluating it and taking a critical look at its composition, as well as examining the information provided by the manufacturer and what’s available in the literature. He also suggests thinking about your own motivations for switching to a new product. Do you really need it? Is your current product working well? If yes, why are you switching? If not, what do you need and expect from a new product in that category?

“We need to avoid the urge to be the first on our block to work with a material because it is a new material,” emphasizes Sorensen, “Dentists have to ask themselves: Does this technique make sense for this material? Can the manufacturer really show me how this new material is really better, or is it only slightly improved? Is trying this product worth the risk if I already have a system that works very well in my practice?”

Simonsen does encourage clinicians to be willing to embrace and use new technology in their practices, but not without first obtaining and reviewing specific kinds of information about its potential for success and longevity. And don’t switch completely to a new material, especially if you are having success with what you’re using now, until you’ve experienced success for yourself, he says.

“If you are interested in a new procedural technique, by all means, try it, document those cases more carefully in terms of what materials were used, when and how, and analyze the success in your own practice at 6 months and 1 year,” he says. “Once you’ve seen success in your own hands and have confirmed it with the data that is available in clinical trials or other sources, then adopt the new product or technology.”


1 The Dental Market Techniques, Equipment, and Materials. Market Summary. January 1, 2006. © Business Communications Co., Inc., Norwalk, CT. www.bccresearch.com

2 The Dental Market Techniques, Equipment, and Materials. Summary. January 1, 2006. © Business Communications Co., Inc., Norwalk, CT. www.bccresearch.com

The Inside Look From...

Without the candid comments shared by our interviewees, this inside look at how dentists choose the products they use in clinical practice would not have been possible. The staff and publishers of Inside Dentistry gratefully acknowledge the following individuals, all of whom made valuable and insightful contributions to this presentation.

Academia/Research
Harald O. Heymann, DDS, MEd
Professor and Graduate Program Director, Operative Dentistry
University of North Carolina School of Dentistry
harald_heymann@dentistry.unc.edu

Gerard Kugel, DMD, MS, PhD

Associate Dean for Research
Tufts University School of Dental Medicine
gerard.kugel@tufts.edu

Richard J. Simonsen, DDS, MS
Dean
Midwestern University College of Dental Medicine
rsimon@midwestern.edu

John A. Sorensen, DMD, PhD

Director
Pacific Dental Institute
drjohn@pacdent.com

James B. Summitt, DDS, MS
Chairman, Department of Restorative Dentistry
University of Texas Health Science Center at San Antonio Dental School
summitt@uthscsa.edu

Associations
Kenneth A. Krebs, DMD
President
American Academy of Periodontology
kkrebsdd@comcast.net

Industry
David Steck
Vice President & General Manager
Sullivan-Schein
david.steck@henryschein.com

Product Evaluators
Gordon J. Christensen, DDS, MSD, PhD
Co-Founder, Clinical Research Associates (CRA) Foundation/CRA Newsletter
Founder & Director, Practical Clinical Courses
info@pccdental.com

Michael B. Miller, DDS
President
Reality Publishing Company
michaelmiller@realityesthetics.com

Clifford W. Whall, Jr., PhD
Director, Acceptance Program
Council on Scientific Affairs
American Dental Association
whallc@ada.org

Disclosing Financial Interests, Potential Conflicts, and Information Sources
Speakers, authors, and researchers may receive product or financial support - or other incentives (eg, vacations, cars) from the manufacturers whose products they’re demonstrating, studying, and/or writing about. Publishers, also, may receive financial support and/or educational grants in exchange for the production of exclusive supplements that communicate information of special interest to a company’s target audience (eg, Inside Dentistry discloses that it produces such peer-reviewed supplements and other materials on behalf of sponsors). Our interviewees agree that the nature of the relationship must be fully disclosed to the respective audience up front and extensively.

Gordon J. Christensen, DDS, MSD, PhD, says that these days, the dentists are picking up pretty quickly who is going to be speaking about products (ie, giving a sales pitch) and who isn’t. Most of the dentists who are interested in continuing education are going where they know they’ll hear it like it is, not the way a product company intends it to be told, he adds.

“I think full disclosure is important,” believes Gerard Kugel, DMD, MS, PhD. “In other words, if Manufacturer A is supporting a course, it should be known up front that Manufacturer A is sponsoring it, and hopefully the dentist attending that program will be astute and question some of the information they’re receiving.”

Corporate sponsorship of lectures and programs at conferences and dental meetings is a way of life these days because many organized meetings cannot afford the fees that speakers demand today, Kugel explains. However, overt product promotion in a course or lecture should send up a “red flag” and prompt questions about what evidentiary support exists to substantiate product claims, he says.

According to Kenneth A. Krebs, DMD, most clinicians are not going to recommend a product that doesn’t work in their hands because doing so would jeopardize their credibility, but it helps to know if they are representing a company or not.

“The AAP meetings have continuing education classes that are not product specific at all, but many times clinicians will mention products,” Krebs says, adding that the AAP does not endorse any specific products. However, it does make information from manufacturers available during its annual corporate forum. “Our speakers are asked to sign a conflict of interest form to disclose whether they are being paid to do research by a company, receiving free products and/or financial compensation, etc, so that fact is known to our members.”

No matter what the financial and/or other beneficiary nature of the relationship is with a manufacturer, anything that may influence what is being said should be disclosed, advocates Richard Simonsen, DDS, MS. What’s more, anything in the business practices of product information producers (eg, publishers, product evaluators, researchers, etc) that could potentially influence information content should be removed so that it can be a trusted source.

Christensen, a regular editorial contributor to the Journal of the American Dental Association, observes that dental publications are “all pretty well bought, paid for, and influenced by companies.” He adds that the advertisements in them, particularly what he calls “lower level journals,” say almost anything.

Numerous dental trade publications feature articles containing information supplied by manufacturers (eg, technical product profiles or overviews) and/or that showcase the use of a particular product (eg, specific technique articles). The former are submitted by manufacturers and should clearly indicate that they are the suppliers of the information. The latter are usually submitted by clinician authors and, if sponsored or otherwise supported by a manufacturer, that fact should be clearly disclosed in print.

According to Kugel, product-specific technique articles are usually reviewed by a publication’s editorial board to help maintain clinical credibility. However, most such articles are not going to overtly include information about a product’s negative aspects, he says. But for clinicians, articles in trade magazines that demonstrate how a product is used and/or its technical aspects can be useful as long as readers know from what perspective the information was generated (ie, disclosure), comments David Steck.

“The authors of these articles are writing about a certain technique and discussing certain materials that are being used,” explains John A. Sorensen, DMD, PhD. “Readers have to consider where the author is coming from and whether the article is neutral in terms of just being about a technique or whether it’s a form of advertising.”

However, the more academic, research-oriented publications are not immune to potential bias, either. For example, dental schools - at which some of the finest research may be conducted - can be accused of having a bias also, if they are heavily involved in research with a particular company, notes Simonsen.

“Dental schools, by necessity, go after the so-called soft money, whether from companies or government,” explains Christensen. “That money is oriented toward the desire of the funding source, not necessarily toward the desire of the researcher.”

Here again, Simonsen says that a healthy skepticism should be developed so that if it is known that a certain school receives a tremendous amount of funding from a certain company, the information that’s disseminated as a result of the research can be critically considered.

Product Evaluations - Relevant & Practical Information for Dentists

According to David Steck, paid newsletter subscriptions focusing on product evaluations - such as CRA Newsletter, Reality, and The Dental Advisor - are the second biggest drivers of dentists toward specific products. “Because clinicians actually have made an investment into this information source, they are reading it and thinking about it.”

Gerard Kugel, DMD, MS, PhD, who disclosed that he does work with the CRA Newsletter and The Dental Advisor, notes that these types of product evaluation publications - in general - are pretty influential because busy clinicians don’t have time to read scientific papers. Rather, they want to read the quick consumer-reports type of reviews that these newsletters provide.

WHAT’S EVALUATED & HOW
“I would look at these product evaluation reports as a background,” explains John A. Sorensen, DMD, PhD. “Generally speaking, they will provide you with an overall look at all of the manufacturers’ products in a certain category, offering a good screening for dentists who don’t have the wherewithal or knowledge to screen products themselves.”

All of the product newsletters/reports available to clinicians have something to offer, despite the different formats in which they may present their information and/or product category evaluations. Some reports look at a few products in a given category; others may include 10 or more.

Since 1976, Clinical Research Associates - now known as CRA Foundation, a nonprofit organization that does not accept payment or products from manufacturers for the tests it performs - has been evaluating dental materials, devices, and concepts for efficacy and clinical usefulness and reporting its findings in the monthly CRA Newsletter. CRA Foundation conducts multiple-user field evaluations, controlled long-term clinical research, and basic science laboratory research. Products evaluated by CRA Foundation and reported in the CRA Newsletter are selected based on merit.

“We don’t solicit the research,” explains Gordon J. Christensen, DDS, MDS, PhD, co-founder of the CRA Foundation. “We go after those things that are hot in the profession-digital radiography and computer-driven milled crowns, for example.”

Clinical field evaluators for CRA are located worldwide, and all professional staff volunteer their time. At least one of the following criteria must be met in order for a product to be reported in the CRA Newsletter: innovative and new to the market; less expensive but meets use standards; unrecognized, valuable classic; or superior to others in its broad classification.

Reality maintains its own research laboratory staffed by a team of dentists and research assistants in order to as closely approach a clinical simulation as possible. By virtue of the fact that it is a laboratory, it cannot be an exact replication of what is happening in the mouth.

Product evaluations are also performed by teams of 10 Reality editorial team members, each of whom evaluate products clinically and/or in their respective laboratories and then complete and return a questionnaire about the product.1 The procedures, methods, and materials used to conduct evaluation tests are available on the Reality Web site.

“Obviously I have a vested interest in the noncommercial type of product evaluations that we conduct,” comments Michael B. Miller, DDS, president of Reality Publishing Company. “But, it doesn’t matter to me whether we give a good evaluation to a product or not. Our main focus is to protect the patient by informing the dentist.”

The ADA Professional Product Review, which will be introduced officially in July 2006 as a free ADA member benefit, will incorporate laboratory and clinical evaluations of a number of products within three given categories each issue (www.ada.org/goto/ppr). The laboratory tests may include existing ADA or national standards tests, as well as new tests developed in consultation with industry, explains Clifford W. Whall, Jr., PhD, director of the ADA Council on Scientific Affairs Acceptance Program. Manufacturers will not conduct, financially support, or be involved in any way with any ADA evaluations (eg, laboratory or clinical). However, because manufacturers possess a wealth of experience in terms of product testing, Whall said working with industry to ensure that appropriate laboratory testing protocols are developed is essential to providing meaningful and relevant evaluations.

The clinical evaluations will be handled differently and based in large part on member surveys of their clinical experiences with products. Products are selected and evaluated based on input from ADA Clinical Evaluators (ACE) and other member dentists. ACE membership now totals close to 1,500 ADA members. Additional clinical input for the newsletter will come through expert and user panel discussions, individual member dentist interviews, and annual product use forums at the ADA Annual Session, Whall says. ACE panel members are required to disclose any financial interest they may have in products under evaluation, he says, and panel participation is open to any and all ADA members.

BENEFITS & LIMITATIONS
“Even though I come from a research background, and I certainly try to stress the importance of controlled studies and good evidence-based research, I do think it needs to be complemented by real-world assessments from wet-finger dentists,” believes Harald O. Heymann, DDS, MEd, an executive board member of CRA Foundation, which publishes the CRA Newsletter. “All of the synoptic publications provide a valuable service because they give you practical information based on real-world user evaluations, and they’re an adjunct to our decision-making process.”

Steck admits he’s a big fan of product evaluation publications because they save the dentist time and help in the decision process, especially for big-ticket items. He notes that good and ethical sales representatives are always going to give you good advice, but some might not always give you the best advice.

However, both Christensen and Miller admit that it’s very difficult to evaluate large pieces of equipment because of their costs. Practice management software, CAD/CAM, and digital radiography systems are all capital-intensive.

“I think it is much more difficult to do a true evaluation of a large piece of equipment compared to a composite or an impression material,” Miller elaborates. “In that respect, I think it is hard to garner good information on these pieces of equipment compared to smaller items.”

Sorensen notes that what is needed for some of the product evaluations is an explanation of what the source of the opinion is and how the information was formulated. Product evaluators may or may not be using a scientific method, the reviews could be based on a collection of opinions, and there isn’t always a way to know how objective they really are, he says.

“I think we do need to have more transparency as to the process that’s undertaken for these evaluations,” Sorensen believes.

Additionally, Heymann says that dentists must keep in mind that any time they review evaluations based on subjective usage of products, what they’re reading are the opinions of practitioners and should be viewed as such. Therefore, it is important to examine what the clinicians looked at when using and evaluating the products in question (ie, in the context of their application), he adds.


1 www.realityesthetics.com

Dental Schools’ Role in Fostering Educated Product Consumers

Dental schools can play a role in helping practitioners better evaluate the products they’re considering for use in their practice, whether by undertaking research, conducting continuing education programs, or disseminating information about how to critique and evaluate research and clinical papers. But to first create a marketplace represented by educated consumers, graduates of today’s dental schools must first be taught themselves - about what constitutes scientific method, how to critically examine product information, and what makes for good comparative analyses.

According to James B. Summitt, DDS, MS, dental schools can play a significant role in furthering the research that’s available to the dental profession when their endeavors and findings are published in the refereed literature. “I think that is our role, and it is certainly one of our main purposes,” he says.

Another critical contribution to the product evaluation process is the in vitro clinical research conducted at dental schools, explains John A. Sorensen, DMD, PhD. It is from dental schools that the industry tends to see the highest level of research with the most controls.

“I think that type of research should be a very big part of what dentists review,” Sorensen believes. “Unfortunately, faculty that are publishing great research do so in refereed journals that the majority of dentists don’t take the time to read.”

Whether in regular classes or continuing education programs, dental schools have a responsibility to teach their students the use of proven techniques and materials that have been substantiated by good science and “tried and true” experiences, says Harald O. Heymann, DDS, MEd. Additionally, educators have a responsibility when giving lectures to disseminate information that’s based on good scientific evidence, he adds.

“I think our dental schools should be a primary source of information for practicing clinicians, but I don’t think that is very often the case,” admits Richard Simonsen, DDS, MS, dean of the United States’ newest dental school, Midwestern University College of Dental Medicine in Glendale, Arizona. “It all depends on who is at the dental school and whether or not the dental school is committed to being a resource for the community and state, local, or even national dentists.”

Additionally, dental schools should play a larger role than they do today in providing what he calls independent evaluations of new products, Simonsen says. He admits that role becomes costly, but he encourages dental schools to be more of a resource in the direct information chain for clinicians who are constantly bombarded with new products but don’t know how to evaluate them.

However, according to Sorensen, probably the dental schools’ most important role in the training of dental students is teaching them to critically review publications, identify the scientific method, and determine if there are controls in the research. For example, if you are looking at a graph of research conducted on a material, did that research project actually use a well-documented control material for comparison? If it did, then you can get a good idea of how the new product or material compares in relation to something that’s already proven and established, he explains.

When evaluating publications, our interviewees say that students and practicing clinicians alike need to determine if they were peer-reviewed and whether the review was by multiple reviewers; consider where the research was published - trade journal or academic publication. Identify if the published research was corporately funded or not; look for complete disclosure. Consider the type of research - university-based, randomized clinical trial, in-office use. Also, pay attention to the references cited in the paper and ensure that they are relevant, clinically and scientifically based, and/or published in academic, peer-reviewed journals themselves. Also, the materials and procedures used to conduct product evaluations and studies should be made known; these are significant because scientific method dictates that someone should be able to duplicate an experiment using the same parameters to see if they can achieve the same results.

The USAF Dental Evaluation & Consultation Service - Free & Unbiased Product Evaluations at Your Fingertips

As our experts have explained, identifying reliable, evidence-based information about dental products and equipment that is free from commercial bias is difficult today. There are many manufacturer influences playing upon speakers and authors, so determining which product assessments are truly valid can be challenging.

According to James B. Summitt, DDS, MS, the United States Air Force (USAF) Dental Evaluation & Consultation Service (DECS), formerly known as the USAF Dental Investigation Service, represents an exceptional source of information about products currently on the market, all of which can be accessed free of charge via the Internet at http://decs.nhgl.med.navy.mil. Because the military dental personnel evaluating the products have no financial interest in them or the research outcomes, the DECS is a valuable and practical resource for clinicians interested in different types of products, Summitt says.

“If you’re looking into bonding agents, this site would tell you what bonding agents are working best in their evaluators’ opinions,” Summitt explains. “If you’re looking into composites, it would tell you what composites they’ve tested, what are working well, and what shades are available, as well as what the costs are.”

DECS - which was established in 1976 specifically to solve operational problems and evaluate methods, techniques, procedures, equipment, and materials as identified by military dental activities and the office of the Air Force Surgeon General - provides investigative guidance and assistance for all USAF dental personnel. It consists of clinical, laboratory, and consultative capabilities maintained as a detachment of the USAF School of Aerospace Medicine at Brooks Air Force Base in San Antonio, Texas. The four operational sections of DECS include materials evaluation, equipment evaluation, facility standards and design, and infection control and safety.1

“I think this is probably one of the best resources for information for use in the evaluation and selection of dental products, and it’s one that most dentists have never heard of,” believes Harald O. Heymann, DDS, MEd. “Yet, it is totally free and, in my opinion, one of the most unbiased sources of dental product information.”

In an editorial published in the Journal of Esthetic and Restorative Dentistry, Heymann refers to DECS as a “hidden gem” based on the valuable information it provides and its success in disseminating objective information to federal dental services. Although the organization’s comprehensive and objective evaluations of dental products have gone largely unnoticed by the dental profession at large, they are exceptionally well presented, Heymann says.

“What I like is that the Web site rates the materials and equipment using a rating scale, but they also provide links to various published research findings that help validate the claims they’re making,” Heymann explains. “In my opinion, DECS is not just making subjective evaluations, but its staff of scientists and researchers are making evaluations based on good science.”

Evaluations are posted on the DECS Web site and include a description of the product or equipment tested, as well as information about the manufacturer and both the suggested retail and government price. Its advantages and disadvantages are clearly bulleted, and an “In a Nutshell” box provides a synopsis of the ultimate evaluation and critique. An overall summary/conclusion of the evaluators’ findings is also provided.

DECS is located at Great Lakes Naval Training Center, Illinois, along with the Naval Institute for Dental and Biomedical Research and the US Army Dental and Trauma Detachment.1 The organization also provides support to military medical centers and dental training programs through continuing education lectures and technical assistance for investigations that contribute to training programs.


1 https://decs.nhgl.med.navy.mil/aboutdis.htm