title: Dental clinical research: an illustration of the value of standardized diagnostic terms.
abstract: Secondary data are a significant resource for in-depth epidemiologic and public health research. It also allows for effective quality control and clinical outcomes measurement. To illustrate the value of structured diagnostic entry, a use case was developed to quantify adherence to current practice guidelines for managing chronic moderate periodontitis (CMP).
  
  
  
  Six dental schools using the same electronic health record (EHR) contribute data to a dental data repository (BigMouth) based on the i2b2 data-warehousing platform. Participating institutions are able to query across the full repository without being able to back trace specific data to its originating institution. At each of the three sites whose data are included in this analysis, the Dental Diagnostic System (DDS) terminology was used to document diagnoses in the clinics. We ran multiple queries against this multi-institutional database, and the output was validated by manually reviewing a subset of patient charts.
  
  
  
  Over the period under study, 1,866 patients were diagnosed with CMP. Of these, 15 percent received only periodontal prophylaxis treatment, 20 percent received only periodontal maintenance treatment, and only 41 percent received periodontal maintenance treatment in combination with other AAP guideline treatments.
  
  
  
  Our results showed that most patients with CMP were not treated according to the AAP guidelines. On the basis of this use case, we conclude that the availability and habitual use of a structured diagnosis in an EHR allow for the aggregation and secondary analyses of clinical data to support downstream analyses for quality improvement and epidemiological assessments.
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Elsbeth
authors.initials: E
authors.lastname: Kalenderian
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Bunmi
authors.initials: B
authors.lastname: Tokede
authors.affiliation: Center for Biomedical Informatics, Harvard Medical School, Boston, MA, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Ramoni
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Khan
authors.affiliation: Department of Pathology & Radiology, Oregon Health and Science University School of Dentistry, Portland, OR, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Kimmes
authors.affiliation: Science Center School of Dentistry at Houston, Houston, TX, USA.|Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: White
authors.affiliation: Science Center School of Dentistry at Houston, Houston, TX, USA.|Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, CA, USA.
authors.forename: Ram
authors.initials: R
authors.lastname: Vaderhobli
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, MA, USA.
authors.forename: Alfa
authors.initials: A
authors.lastname: Yansane
authors.affiliation: Department of Material Science, Academic Centre of Dentistry Amsterdam, Amsterdam, The Netherlands.
authors.forename: Albert
authors.initials: A
authors.lastname: Feilzer
authors.affiliation: Department of Diagnostic and Biomedical Sciences, University of Texas Health, Houston, TX, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Walji
mesh_terms: D055113:Chronic Periodontitis / Q000175:diagnosis* / Q000628:therapy*; D018865:Dental Research; D057286:Electronic Health Records; D019983:Guideline Adherence; D006801:Humans; D009626:Terminology as Topic
keywords: clinical outcomes; clinical practice guidelines; dental public health; diagnostic systems; epidemiology; evidence-based dentistry