SUMMARYRubber dam use during operative dentistry procedures has been quantified based on questionnaires completed by dentists. However, based on the knowledge of the authors of the current study, there are no reports based on use during actual clinical procedures other than in dental materials studies and none based on routine care. The objectives of the current study were to: 1) quantify how commonly the rubber dam is used during operative dentistry procedures; 2) test the hypothesis that certain dentist, restoration and patient-level factors are associated with its use. A routine aspect of procedures involving the placement of dental restorations is whether or not a rubber dam is used. This study documents the use of a rubber dam by dentists in non-academic routine clinical practice, finding that its use is low and significantly associated with certain dentist, restoration and patient characteristics. Most dentists (63%) did not use a rubber dam for any restoration in this study. A rubber dam was used for only 12% of restorations, 83% of which were used in one DPBRN region. With regions accounted for, no other dentist characteristics were significant. A multi-level multiple logistic regression of rubber dam use was done with restoration and patient-level variables modeled simultaneously. In this multi-variable context, these restoration-level characteristics were statistically significant: tooth-arch type, restoration classification and reason for placing the restoration. These patient-level characteristics were statistically significant: ethnicity, dental insurance and age. GH Gilbert • MSThese results, obtained from actual clinical procedures rather than questionnaires, document a low prevalence of usage of the rubber dam during operative dentistry procedures. Usage varied with certain dentist, restoration and patientlevel characteristics.

Objectives To identify factors that are significantly associated with dentists’ use of specific caries preventive agents in adult patients, and whether dentists who use one preventive agent are also more likely to use certain others. Methods Data were collected from 564 practitioners in The Dental Practice-Based Research Network, a multi-region consortium of participating practices and dental organizations. Results In-office topical fluoride was the method most frequently used. Regarding at-home preventive agents, there was little difference in preference between non-prescription fluoride, prescription fluoride, or chlorhexidine rinse. Dentists who most frequently used caries prevention were also those who regularly perform caries risk assessment and individualize caries prevention at the patient level. Higher percentages of patients with dental insurance were significantly associated with more use of in-office prevention modalities. Female dentists and dentists with more-recent training were more likely to recommend preventive agents that are applied by the patient. Dentists who reported more-conservative decisions in clinical treatment scenarios were also more likely to use caries preventive agents. Groups of dentist who shared a common preference for certain preventive agents were identified. One group used preventive agents selectively, whereas the other groups predominately used either in-office or at-home fluorides. Conclusions Caries prevention is commonly used with adult patients. However, these results suggest that only a subset of dentists base preventive treatments on caries risk at the individual patient level.

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Central to all value-based purchasing (VBP) approaches are value metrics, the measurements used to drive improvement, facilitate payment, and evaluate results of VBP programs. This article outlines approaches for adopting meaningful measurement systems that can be used to support VBP in the near term and identifies systemic changes critical to developing more robust measurement systems to advance VBP in the future.