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International Dental Journal logoLink to International Dental Journal
. 2020 Oct 22;69(3):183–191. doi: 10.1111/idj.12447

Practice-based research agenda priorities selected by patients: findings from a dental practice-based research network*

Naoki Kakudate 1,2, Yoko Yokoyama 3, Futoshi Sumida 4, Yuki Matsumoto 5, Joseph L Riley III 6, Valeria V Gordan 7, Gregg H Gilbert 8
PMCID: PMC6478567  NIHMSID: NIHMS984513  PMID: 30350855

Abstract

Objectives: This study aimed to identify (i) which practice-based research agendas had the highest priority among patients and (ii) whether priorities varied significantly with patient age and gender. Methods: We conducted a cross-sectional questionnaire survey of 482 patients from 11 outpatient dental practices. The patients were shown 31 items concerning practice-based research questions and asked to select the three items in which they were most interested. We generated a rank order of the 31 items. Subsequently, the 31 items were categorised into 10 groups, and we performed subgroup analyses according to age and gender using chi-square tests. Results: “Age-specific care to maintain oral health (n = 86)” was rated as the most interesting research question. When data were analysed according to age, patients less than 40 years old rated “Orthodontic treatment”, “Esthetic dental care” and “Topical fluoride application” as interesting questions significantly more frequently than did patients 40 years old or older (P < 0.01)?, while patients 40 years old or older rated “Regular dental check-ups”, “Dental implant”, “Diet and food” and “Social health insurance” as more interesting than did patients less than 40 years old (P < 0.05). When data were analysed according to gender, female patients rated the questions on aesthetic dental care as more interesting than did male patients (P < 0.01), whereas male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05). Conclusions: Patients assessed “Age-specific care to maintain oral health” as the highest priority among a broad range of research topics. This study also quantified patient priorities for research agendas according to age and gender group. Designing future research with these priorities in mind will promote patient-centred evidence.

Key words: Practice-based research, evidence-based dentistry, research agenda, patient-centred research

INTRODUCTION

Dental practice-based research is a form of research conducted in clinical practices by dental practitioners and their staff and is designed to answer questions faced by dental clinicians in the routine care of their patients1. Practice-based research holds great potential for answering clinical questions and for expediting the translation of research findings into clinical practice. A group of practitioners engaged in coordinated practice-based research constitutes a Practice-Based Research Network (PBRN)1., 2.. The purpose of the PBRN is to link practitioners with academic researchers to conduct relevant research and to address questions concerning quality improvement that can directly impact routine clinical practice. These networks offer unique advantages to both research and quality improvement3., 4., 5. and foster information-sharing among practitioners6.

The US National Institute of Dental and Craniofacial Research (NIDCR)7 is a component institute of the US National Institutes of Health. The NIDCR has funded the US National Dental PBRN8 over two cycles of funding (2005–2012 and 2012–2019). Example research agendas that might be conducted by a PBRN focussed on issues impacting the oral health of the public include: (i) effectiveness of strategies for diagnosis; (ii) effectiveness of strategies to prevent the progression of dental diseases; (iii) natural history of untreated oral conditions; (iv) effectiveness of interventions for treating and managing dental diseases; (v) assessing variations associated with the delivery of dental health care; (vi) assessing patient compliance; (vii) effectiveness of strategies for managing orofacial pain; and (viii) assessing the outcomes of treatments. These agendas mainly reflect a national-level viewpoint and the requirements of the research-funding provider.

Other research agendas have been generated by dental practitioners. In the USA, the Southwest Region of the National Dental PBRN held a series of workshops from 2012 to 2014 which generated 275 research ideas from the perspective of the dental practitioner attendees9., 10.. From these research ideas, 14 protocols were developed, namely: (i) novel tobacco products; (ii) xerostomia and dental caries; (iii) sealant recommendations; (iv) fluoride implications; (v) immediate implant placement; (vi) oral health literacy; (vii) craniofacial anomaly; (viii) laser-assisted periodontal therapy; (ix) dental office diagnostic testing; (x) prophylactic use of antibiotics in dental practice; (xi) sleep apnoea; (xii) critically appraised topics; (xiii) dietary effects on oral health; and (xiv) bisphosphonate-induced osteonecrosis of the jaw. Our previous study in Japan extracted the following six research areas desired by dental clinicians affiliated with the Dental Practice-based Research Network Japan (JDPBRN)11., 12., 13.: (i) standardisation of dental treatment and examination; (ii) research on regular dental check-ups; (iii) prognosis of dental treatment; (iv) risk factors of dental diseases; (v) dissemination of preventive dentistry; and (vi) dental health-care policy14. These areas were generated mainly in terms of the dental practioners’ point of view.

It has been noted that involving patients in health research may provide opportunities to produce research that is valid, relevant, accepted, sustainable and innovative15., 16., 17., 18.. Although not derived from PBRN research activities, Brocklehurst et al.19 conducted a study which allowed older people to prioritise the research agenda to improve their own oral health, reporting that the top three research priorities identified were: to identify ‘best practice’ in the prevention and treatment of oral diseases for older people; to identify the training needs for the dental profession; and to understand the key issues for older people from their perspective. However, to our knowledge, no previous research has attempted to identify and quantify such a research agenda by engaging a wide range of age groups and gender. Therefore, the objectives of this study were to identify 1) which practice-based research agendas had the highest priority among patients; and 2) whether priorities significantly varied with patient age and gender.

MATERIALS AND METHODS

Study design

We conducted a cross-sectional study, consisting of a questionnaire survey, in Japan between February 2016 and July 2016. This study was approved by the Ethics Committee of Kyushu Dental University (IRB protocol No. 13-73) in full accordance with the World Medical Association Declaration of Helsinki. All participants provided written informed consent to participate in the study.

Questionnaire development

First, we performed a pilot study with 62 dental patients to develop the questionnaire items. Patients were asked to describe what kind of practice-based research questions they are most interested in, using an open-ended questionnaire. Three dentists and two clinical epidemiologists then categorised the 62 answers into 31 items and finalised the questionnaire using the qualitative analysis of the KJ method developed as the affinity diagram by Jiro Kawakita20., 21.. These 31 items consisted of the following 10 categories: “Orthodontic treatment”, “Regular dental check-ups”, “Prognosis of dental treatment”, “Dental implants”, “Toothbrushing”, “Diet and food”, “Esthetic dental care”, “Topical fluoride application”, “Social health insurance” and “Bruxism” (Table 1).

Table 1.

Ten categories consisting of 31 research agendas

Category Research agenda
1. Orthodontic treatment Q1. Timing of orthodontic treatment
Q2. Need for orthodontic treatment
Q3. Effect of orthodontic treatment on general health
2. Regular dental check-ups Q4. Interval of regular dental check-ups
Q5. Effectiveness of regular dental check-ups
3. Prognosis of dental treatment Q6. Characteristics of crown and filling materials
Q7. Durability of crown and filling materials
4. Dental implants Q8. Benefit of dental implants
Q9. Durability of dental implants
5. Toothbrushing Q10. Toothbrushing techniques
Q11. Duration of toothbrushing
Q12. Selection of the proper toothpaste
Q13. Need for dental rinse
Q14. Use of an interdental brush and dental floss
Q15. Selection of proper toothbrushes including electric toothbrushes
Q16. Toothbrushing techniques for children
6. Diet and food Q17. Relationship between diet and dental caries/periodontal disease
Q18. Effect of types of food and diet on teeth
7. Esthetic dental care Q19. Etiology of discoloration and staining
Q20. Prevention of discoloration and staining
Q21. Effectiveness of whitening
8. Topical fluoride application Q22. Application of fluoride to teeth
Q23. Age range of fluoride application in children
Q24. Effectiveness of fluoride application in adults
9. Social Health Insurance Q25. Function of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI
Q26. Durability of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI
10. Bruxism Q27. Etiology of bruxism
Q28. Harmful effect of bruxism on teeth
Miscellaneous items Q29. Various treatment policies of different dentists
Q30. Age-specific care to maintain oral health
Q31. Standard criteria for the extraction of wisdom teeth
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NHI, National Health Insurance.

Participants

The JDPBRN11., 12., 13. is a consortium of dental practices with a broad representation of practice types, treatment philosophies and patient populations. It has a shared mission with the US National Dental PBRN to investigate research questions and share experiences and expertise6. The network regions of the JDPBRN represent all seven regions of Japan (Hokkaido, Tohoku, Kanto, Chubu, Kansai, Chugoku-Shikoku and Kyushu)11., 12., 13..

Study participants were 482 patients from 11 outpatient dental clinics which were affiliated with the JDPBRN. The 11 dental clinics were recruited from the JDPBRN website and mailings and are located in the Hokkaido, Kanto, Chubu, Kansai and Kyushu regions.

Priority of research questions from patients’ perspectives

Participants were asked to select three of the 31 research agendas they were most interested in and to record, in open-ended format, the reasons for their selection. We then used these selections to generate a rank order list of the 31 items. Participants were also asked to write down, in open-ended format, any topics of interest other than the 31 items mentioned above.

Statistical analysis

Descriptive statistics were used to summarise information about the study sample, including age, gender, number of missing teeth, presence of children aged 0–18 years and receipt of a regular dental check-up in the preceding 12 months. We determined the number of times each question was selected, and its percentage, and generated a rank order of the list of 31 items. In addition, we performed subgroup analyses according to participant age and gender. In the subgroup analyses, we used the 10 categories shown in Table 1 for independent variables. All statistical analyses were performed using IBM SPSS Statistics version 23.0 (IBM Corp., Armonk, NY, USA).

RESULTS

Participant characteristics

Questionnaires were distributed to 550 patients, and 482 (87.6%) were returned. Demographic characteristics of the study participants are shown in Table 2. The mean ± SD age was 44.9 ± 15.3 years, and 67% (n = 319) were female. The mean ± SD number of missing teeth was 2.9 ± 4.8. Furthermore, 46% (n = 218) of the participants had one or more children aged 0–18 years, and 51% (n = 238) had received a regular dental check-up in the past 12 months (Table 2).

Table 2.

Distribution of patient characteristics (N = 482)

Patient characteristics Value
Age (years) (N = 475) 44.9 ± 15.3
Male (N = 156) 44.8 ± 15.3
Female (N = 319) 44.9 ± 15.3
Gender (N = 475)
Male 156 (32.8)
Female 319 (67.2)
Number of missing teeth (N = 410) 2.9 ± 4.8
≥1 child aged 0–18 years (N = 474)
Yes 218 (46.0)
No 256 (54.0)
Received regular dental check-up in the past 12 months (N = 471)
Yes 238 (50.5)
No 233 (49.5)
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Values are given as number (%) or mean±SD.

Frequency of 31 items and representative quotes of participants

Table 3 shows the frequency of selection of the 31 items and representative quotes of participants. The 10 most frequently selected items were ranked as follows: (1) “Age-specific care” to maintain oral health (n = 86); (2) “Selection of the proper toothpaste” (n = 84); (3) “Toothbrushing techniques” (n = 79); (4) “Durability of crown and filling materials” (n = 72); (5) “Relationship between diet and dental caries/periodontal disease” (n = 69); (6) “Prevention of discoloration and staining” (n = 61); (7) “Interval of regular dental check-ups” (n = 57); (8) “Effectiveness of whitening” (n = 51); (8) “Etiology of bruxism” (n = 51); (10) “Timing of orthodontic treatment” (n = 50); and (10) “Selection of proper toothbrushes, including electric toothbrushes” (n = 50). Regarding any other topics of interest other than the 31 items, there were, in total, 21 descriptions, including: “Should I brush three times per day? Or is brushing too much per day bad for my teeth?”; “Can a toothache have an influence on mentality such as anxiety?”; “Is gum chewing good for oral health?”; and “Are there any prevention methods for gum recession due to aging or treatment methods for gum regeneration?”.

Table 3.

Frequency of 31 items and representative quotes of participants (N = 1,317)

Items Frequency (N) Representative participant quotes
1. Q30. Age-specific care to maintain oral health 86
  • (1)

    I feel that key points in the care of the teeth and whole body health have changed as I age

  • (2)

    I am interested in whether the key points of care to bear in mind or to watch out for are different for me and my child
2. Q12. Selection of the proper toothpaste 84
  • (1)

    I don’t know the criteria for how to judge the best toothpaste

  • (2)

    Although various effects are being advertised, I don’t know whether the ingredients contained are really effective
3. Q10. Toothbrushing techniques 79
  • (1)

    Daily toothbrushing is tough for me, so I would like to know if there is a simple way to polish my teeth or another good suggestion

  • (2)

    Various toothbrushes and polishing methods are recommended by different dentists. Why are they not uniform?
4. Q7. Durability of crown and filling materials 72
  • (1)

    I worry about how long a tooth which is receiving treatment will remain in good condition when treatment ends

  • (2)

    I’m worried about what will happen to the teeth that I had treated as a child
5. Q17. Relationship between diet and dental caries/periodontal disease 69
  • (1)

    I want to know how diet relates to caries and periodontal disease

  • (2)

    I would like to know what kind of diet should be followed so that I can stay healthy forever
6. Q20. Prevention of discoloration and staining 61
  • (1)

    My teeth eventually discolored despite periodical treatment for tooth discoloration

  • (2)

    Because I often drink coffee, I am concerned about discoloration of the teeth. I would like to know if there are any preventive methods against discoloration, and any foods or drinks that might cause it
7. Q4. Interval of regular dental check-ups 57
  • (1)

    The interval of regular check-ups recommended by dentists is not constant (apparent individual differences range from every 3 months to every 6 months). I want to know what interval of regular check-up is most appropriate

  • (2)

    The condition of my teeth is worsening with age. In addition, I am concerned about the condition of my gums. However, I have not visited a dentist regularly. How often should I visit the dentist to prevent caries?
8. Q21. Effectiveness of whitening 51
  • (1)

    I would like to know if there are any other merits to tooth whitening than cosmetic

  • (2)

    How long does the whitening effect continue?
8. Q27. Etiology of bruxism 51
  • (1)

    My 18-year-old child has had bruxism since infancy. I am concerned that this is due to some type of stress

  • (2)

    I am concerned about whether my daughter’s bruxism has any relation to the configuration of the facial skeleton
10. Q1. Timing of orthodontic treatment 50
  • (1)

    I felt that there are differences among individual dentists about when to start orthodontic treatment and in treatment methods

  • (2)

    I have been worried about when I should start and when it is too late
10. Q15. Selection of proper toothbrushes including electric toothbrushes 50
  • (1)

    I want to know what type of toothbrush is good for both teeth and gums

  • (2)

    Are electric toothbrushes more effective than manual toothbrushes when used for the same duration?
12. Q8. Benefit of dental implants 48
  • (1)

    I want to know the advantages and disadvantages of implanting foreign objects in the body

  • (2)

    I am interested in implants, but am worried about the risk
12. Q18. Effect of types of food and diet on teeth 48
  • (1)

    Toothbrushing methods are taught from childhood, but little is taught about the importance of chewing food well and food types (soft or hard)

  • (2)

    In the process of changing from deciduous teeth to permanent teeth in the child, what kinds of food are good for raising good permanent teeth? As a parent I care about foods which should be avoided so that children do not develop caries
14. Q16. Toothbrushing techniques for children 44
  • (1)

    I am worried that I cannot instruct my child in good toothbrushing methods

  • (2)

    I finish the toothbrushing of my child every day. I would like to know until what age I should continue to do this
15. Q24. Effectiveness of fluoride application in adults 43
  • (1)

    I know that fluoride is effective for children. I want to know whether it is also effective for adults

  • (2)

    I feel that my teeth are genetically weak. So, I’d like to know if fluoride coating is effective for preventing caries for adults also
16. Q25. Function of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI 39
  • (1)

    When I am unsure as to whether I should choose treatment covered by insurance or out-of-pocket treatment, it is good to have data or hints clearly showing the difference

  • (2)

    I think it is better to choose after identifying the advantages and disadvantages of each
17. Q11. Duration of toothbrushing 34
  • (1)

    Which is better–to brush the teeth immediately after eating or to wait a while after eating?

  • (2)

    Does the effect of toothbrushing change if the brushing session is continued for a longer time?
18. Q29. Various treatment policies of different dentists 31
  • (1)

    Some dentists seem to extract teeth with little apparent concern, but I have heard that it is better not to extract teeth

  • (2)

    There are various specialties in dentistry. I want to know to what extent diagnoses differ among dentists in different fields
18. Q31. Standard criteria for the extraction of wisdom teeth 31
  • (1)

    Some have their wisdom teeth extracted, but others do not. I don’t know the criteria to decide which is better

  • (2)

    I was told that it is better to extract wisdom teeth, but I have not had mine extracted yet. For the moment I do not mind, but I am concerned about the possible effects of this when I get older
20. Q2. Need for orthodontic treatment 29
  • (1)

    It would be better if one could foresee the alignment of one’s teeth in adulthood if orthodontics is not performed in childhood

  • (2)

    In addition to tooth loss, I have heard that poor tooth alignment also has adverse effects on posture and other influences
20. Q23. Age range of fluoride application in children 29
  • (1)

    Fluoride has been applied to my child from age 1. I would like to know until what age this treatment should be continued

  • (2)

    Is there an age period when fluoride application is most effective?
22. Q9. Durability of dental implants 26
  • (1)

    I want to know the difference in lifespan between implants and dentures

  • (2)

    I would like to receive implant treatment if it is sustainable for 20–30 years
22. Q26. Durability of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI 26
  • (1)

    I have been treated with expensive dental prostheses that were not covered by the NHI. I’d like to know the difference between the cases covered and not covered by this insurance. By how much does the total cost differ?

  • (2)

    When different materials are used, what is the difference in sustainability and appearance?
22. Q28. Harmful effect of bruxism on teeth 26
  • (1)

    I would like to know if bruxism affects tooth alignment

  • (2)

    Does bruxism have an adverse effect on the body? Please tell me if there is any way to prevent bruxism
25. Q13. Need for dental rinse 25
  • (1)

    Does simple flossing or use of toothpaste have sufficient efficacy if dental rinsing is not done?

  • (2)

    There are products that are advertised to have a preventive effect on periodontal disease. I want to know the extent of their preventive effect
26. Q3. Effect of orthodontic treatment on general health 24
  • (1)

    I would like to know to what extent our daily life and physical condition differ according to whether we undergo or do not undergo orthodontic treatment

  • (2)

    My child was diagnosed as having a deep overbite at the time of kindergarten and has been treated with orthodontics. I am worried that this may have some effect on bone development and so on in the future
27. Q6. Characteristics of crown and filling materials 23
  • (1)

    Some people point out that cavity filling materials have adverse effects on the body which differ depending on the type

  • (2)

    Currently my dental caries are being treated, but I want to know the most suitable filling materials for me
28. Q19. Etiology of discoloration and staining 21
  • (1)

    I want to know why the whiteness of teeth varies from person to person

  • (2)

    Is the discoloration of teeth with aging inevitable?
28. Q22. Application of fluoride to teeth 21
  • (1)

    What are differences between applying and not applying fluoride?

  • (2)

    I want to know about the bonding of fluoride with tooth surface
30. Q5. Effectiveness of regular dental check-ups 20
  • (1)

    If the effectiveness can be represented by a numerical value, people would be more enthusiastic about undergoing check-ups

  • (2)

    Can we prevent dental and other diseases by periodic health examinations?
31. Q14. Use of an interdental brush and dental floss 19
  • (1)

    I feel that using an interdental brush or dental floss creates a gap between my teeth

  • (2)

    When I use floss, it often gets caught between my teeth and then easily breaks
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NHI, National Health Insurance.

Top 10 ranking of research agenda items according to age group

The top 10 ranked research agenda items, according to age group, are shown in Table 4. “Q12. Selection of the proper toothpaste” was the only item included in all age groups. In patients under 40 years old, “Q12. Selection of the proper toothpaste” was rated as the most interesting factor, versus “Q30. Age-specific care to maintain oral health” in the group of patients 40 years of age and older. On classification of the top 10 ranked items according to age group, “Q31. Standard criteria for the extraction of wisdom teeth”, “Q2. Need for orthodontic treatment”, and “Q3. Effect of orthodontic treatment on general health” were ranked only by those in the group under 30 years of age. “Q23. Age range of fluoride application in children” was ranked only by those in the 30-39 years’ age group, while “Q25. Function of crown and filling materials in treatment covered by National Health Insurance (NHI) vs that in treatment not covered by NHI”and “Q26. Durability of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI” were ranked only by those over 60 years of age.

Table 4.

Top 10 ranking of research agenda items according to age group

Age group
Rank <30 years (n = 202) 30-39 years (n = 320) 40-49 years (n = 340) 50-59 years (n = 221) ≧60 years (n = 231)
1 Q12 (n = 19) Q12 (n = 26) Q30 (n = 23) Q30 (n = 19) Q30 (n = 23)
2 Q10 (n = 19) Q1 (n = 22) Q17 (n = 21) Q7 (n = 15) Q17 (n = 22)
3 Q20 (n = 15) Q16 (n = 20) Q7 (n = 20) Q15 (n = 15) Q4 (n = 18)
4 Q27 (n = 13) Q7 (n = 19) Q20 (n = 19) Q8 (n = 14) Q10 (n = 18)
5 Q31 (n = 11) Q20 (n = 16) Q10 (n = 18) Q4 (n = 13) Q11 (n = 15)
6 Q1 (n = 10) Q21 (n = 16) Q16 (n = 18) Q10 (n = 12) Q25 (n = 13)
7 Q21 (n = 10) Q23 (n = 16) Q12 (n = 15) Q12 (n = 12) Q8 (n = 11)
8 Q7 (n = 9) Q30 (n = 15) Q15 (n = 15) Q17 (n = 11) Q12 (n = 11)
9 Q2 (n = 8) Q24 (n = 14) Q1 (n = 14) Q24 (n = 10) Q18 (n = 11)
10 Q3 (n = 7) Q18 (n = 14) Q8 (n = 14) Q27 (n = 10) Q26 (n = 11)
Q21 (n = 14)
Q27 (n = 14)
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Top 10 ranked research agenda items according to gender

The top 10 ranked research agenda items, according to gender, are shown in Table 5. Among female patients, “Age-specific care to maintain oral health” (n = 63) was regarded as the most interesting research agenda, whereas “Toothbrushing techniques” (n = 36) was the most interesting among male patients. Among the top 10 rankings, “Prevention of discoloration and staining” (n = 47), “Effectiveness of whitening” (n = 41), “Etiology of bruxism” (n = 39) and “Timing of orthodontic treatment” (n = 37) were ranked only in the group of female patients, and “Selection of proper toothbrushes including electric toothbrushes” (n = 23), “Effectiveness of fluoride application in adults” (n = 20), “Benefit of dental implants” (n = 19) and “Duration of toothbrushing” (n = 17) were ranked only in the group of male subjects.

Table 5.

Top 10 ranking of research agenda items according to gender of patient (n = 1,317)

Male (n = 427) Female (n = 890)
Q10. Toothbrushing techniques (n = 36) Q30. Age-specific care to maintain oral health (n = 63)
Q17. Relationship between diet and dental caries/periodontal disease (n = 29) Q12. Selection of the proper toothpaste (n = 55)
Q12. Selection of the proper toothpaste (n = 29) Q20. Prevention of discoloration and staining (n = 47)
Q7. Durability of crown and filling materials (n = 28) Q7. Durability of crown and filling materials (n = 44)
Q15. Selection of proper toothbrushes including electric toothbrushes (n = 23) Q10. Toothbrushing techniques (n = 43)
Q30. Age-specific care to maintain oral health (n = 23) Q21. Effectiveness of whitening (n = 41)
Q24. Effectiveness of fluoride application in adults (n = 20) Q17. Relationship between diet and dental caries/periodontal disease (n = 40)
Q4. Interval of regular dental check-ups (n = 19) Q27. Etiology of bruxism (n = 39)
Q8. Benefit of dental implants (n = 19) Q4. Interval of regular dental check-ups (n = 38)
Q11. Duration of toothbrushing (n = 17) Q1.Timing of orthodontic treatment (n = 37)
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Subgroup analysis according to age and gender

Table 6 shows the results of subgroup analyses; data were analysed using the chi-square test, according to age and 10 categories. Patients aged less than 40 years rated “Orthodontic treatment” (P < 0.001), “Esthetic dental care” (P < 0.05) and “Topical fluoride application (P < 0.01)” as interesting agenda items significantly more than did patients aged 40 years or older, and patients aged 40 years or older rated “Regular dental check-ups (P < 0.01)”, “Dental implants (P < 0.001)”, “Diet and food (P < 0.05)” and “Social health insurance (P < 0.05)” as more interesting than did patients aged less than 40 years.

Table 6.

Subgroup analysis according to age (n = 1,314) and gender (n = 1,317) of patients

Category <40 years old (n = 522) ≥40 years old (n = 792) P-value* Male (n = 427) Female (n = 890) P-value*
Number (%) Number (%) Number (%) Number (%)
1. Orthodontic treatment 59 (11.3) 44 (5.6) < 0.001 25 (5.9) 78 (8.8) 0.084
2. Regular dental check-ups 18 (3.4) 59 (7.4) 0.004 31 (7.3) 46 (5.2) 0.165
3. Prognosis of dental treatment 35 (6.7) 60 (7.6) 0.716 35 (8.2) 60 (6.7) 0.400
4. Dental implants 15 (2.9) 59 (7.4) < 0.001 26 (6.1) 48 (5.4) 0.700
5. Toothbrushing 141 (27.0) 192 (24.2) 0.287 127 (29.7) 208 (23.4) 0.016
6. Diet and food 35 (6.7) 82 (10.4) 0.030 43 (10.1) 74 (8.3) 0.345
7. Esthetic dental care 66 (12.6) 67 (8.5) 0.018 29 (6.8) 104 (11.7) 0.008
8. Topical fluoride application 50 (9.6) 42 (5.3) 0.004 38 (8.9) 55 (6.2) 0.091
9. Social Health Insurance 16 (3.1) 49 (6.2) 0.015 21 (4.9) 44 (4.9) 1.000
10. Bruxism 31 (5.9) 46 (5.8) 1.000 19 (4.4) 58 (6.5) 0.170
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*

Chi-square test.

Table 6 also shows the result of subgroup analysis, according to gender, using the chi-square test. Female patients rated the questions on esthetic dental care as more interesting than did male patients (P < 0.01), and male patients rated questions on toothbrushing as more interesting than did female patients (P < 0.05).

DISCUSSION

Among the 31 research agenda items in this study, “Age-specific care to maintain oral health” was rated as the most interesting research question, followed by “Selection of the proper toothpaste” and “Toothbrushing techniques”. Given that “Age-specific care to maintain oral health” was not included in the research agendas generated by the NIDCR7 or the Southwest Region of the National Dental PBRN in the USA9., 10., or by a Japanese dental practitioner survey14, this item may be the top-priority research agenda for Japanese dental patients.

According to classification by age group, the top 10 most frequent items selected by those under 30 years of age were related to the extraction of wisdom teeth and orthodontic treatments, which seem relevant dental treatments for mainly young patients. “Age range of fluoride application in children” was the only item ranked in the 30–39 years’ age group, which seems to be a question related to their children’s dental care. Furthermore, “Function of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI” and “Durability of crown and filling materials in treatment covered by NHI vs that in treatment not covered by NHI” were the only items ranked in the group of patients over 60 years of age. In Japan, NHI coverage guarantees dental care, with the inclusion of most prosthetic treatments, although some prosthetic treatments are not covered, such as porcelain crowns and implants22. Therefore, comparison of prosthetic treatment outcomes between NHI-covered and non-covered treatment may be an important concern for elderly dental patients. Statistical analysis using 10 categories also revealed that patients aged less than 40 years rated “Orthodontic treatment”, “Esthetic dental care” and “Topical fluoride application” as interesting agenda items, while patients aged 40 years or older rated “Regular dental check-ups”, “Dental implant”, “Diet and food” and “Social health insurance” as interesting agenda items. As patients in different age groups require different treatments and have different chief complaints23, the results obtained may stem from differing clinical questions at different life stages.

Classification according to gender showed that female patients rated the questions on aesthetic dental care as interesting, with “Prevention of discoloration and staining”, “Effectiveness of whitening” and “Timing of orthodontic treatment” ranked in the top 10 only in the female group of patients. By contrast, male patients rated four questions on toothbrushing as interesting in their top 10 ranking, namely “Toothbrushing techniques”, “Selection of the proper toothpaste”, “Selection of proper toothbrushes including electric toothbrushes” and “Duration of toothbrushing”. Subgroup analysis (using the chi-square test), according to gender and the 10 categories, supported that these findings were statistically significant. The finding that women tend to show more interest in oral health than men24 and that women and men differ in their oral health and in their dental behaviours25., 26., 27. may be one explanation for the results of this subgroup analysis.

In this study, we identified relevant research agendas generated by actual dental patients. Patient-centredness is achieved by shaping research questions around the concerns, needs and values of stakeholders15., 28.. On this basis, the design of future research with consideration to the results of this study will enable the implementation of patient-centred research29., 30. and subsequently lead to the accumulation of patient-centred evidence. In addition, these results will help research funders identify future research priorities that have the greatest impact on patients and the clinicians who treat them31.

The strength of this study is that we provided an opportunity to involve actual dental patients in development of a practice-based research agenda. This ensures that priorities were grounded in the experience of participants19. This study also featured a relatively wide range of age groups, with respondents from 11 dental clinics from the Hokkaido, Kanto, Chubu, Kansai and Kyushu regions of Japan, which should enhance the generalisability of the findings. Among the limitations of the study, participants were not selected by random sampling and relatively few clinics were involved, raising the possibility that our results were confounded by selection bias.

In conclusion, we found that patients assessed “Age-specific care to maintain oral health” as having the greatest priority among a broad range of research agenda items. This study also revealed what kind of questions dental patients have according to age group and gender. The design of future research with consideration of these results should help promote the accumulation of patient-centred evidence and its implementation into the daily lives of patients.

Acknowledgements

The authors wish to thank Dr. Masaki Kudo, Dr. Miku Fukuhara, Dr. Makoto Sugai, Dr. Keisuke Manabe, Dr. Masahiro Nakajima, Dr. Shigehito Fujii, Dr. Hiroko Mega, Dr. Gen Horikawa, Dr. Yutaka Sugai and Dr. Etsuko Sugai for their cooperation with the questionnaire survey of this study. Financial support for this study was provided by NIH grant U19-DE-22516 and the Kyushu Dental University Faculty Funding. Opinions and assertions contained herein are those of the authors and are not to be construed as necessarily representing the views of the respective organisations or the National Institutes of Health.

Conflict of Interest

The authors declare that there are no conflict of interests regarding the publication of this article.

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