Creating global systems for evidence-informed oral health policy

Health care—including oral health care—is a rapidly evolving field. For clinicians to offer their patients the best and most up-to-date care, they need guidance that not only integrates the latest science but also suits the setting in which they operate.

Situated at the intersection of science and policymaking, Alonso Carrasco-Labra, who joined the faculty at Penn Dental Medicine last year, aims to continue progress in helping develop this guidance in his new role at the School.

“My primary personal interest has always been to try to use the best available evidence to support decision making at all levels,” says Carrasco-Labra, now an associate professor in the Department of Preventive and Restorative Sciences.

Part of the School’s recently developed Center for Integrative Oral Health Care, Carrasco-Labra will use his experiences in policy development around the world to coordinate reviews of clinical care practices that lay out guidelines for dentists and other oral health care practitioners. At Penn Dental Medicine, he’ll do so relying on the complementary skill sets of such entities as the Center for Innovation in Precision Dentistry and Center for Clinical and Translational Research.

“Alonso brings a unique skillset to the dental school and the University at large because of his background in evidence-based medicine and dentistry,” says Michael Glick, executive director of the Center for Integrative Global Oral Health and a professor of clinical restorative dentistry. “And apart from his incredible training and pedigree, he’s also a nice guy and very, very curious. He makes people around him be much better. That is really what we want and need to be able to achieve our goals as a team.”

Learning from the larger world of health care

Carrasco-Labra began his career in the dental field, earning his D.D.S. from the University of Chile. Alongside his clinical training, he developed an interest in health research methods, a field he decided to pursue in studies at McMaster University in Canada, an institution that doesn’t have a dental school.

“That was intentional,” Carrasco-Labra says, “because I wanted to learn from researchers in the medical field. I wanted to learn the medical perspective.”

He earned a master’s degree in clinical epidemiology and a Ph.D. from McMaster in health research methodology, also devoting time to teaching and research in various appointments at dental schools, including the University of Toronto, University of Buffalo, and University of North Carolina at Chapel Hill.

Prior to coming to Penn Dental Medicine, Carrasco-Labra worked at the American Dental Association (ADA) Science and Research Institute as senior director of the Department of Evidence Synthesis and Translation Research. In other roles, he facilitated guideline and policy creation for the Pan-American Health Organization/World Health Organization, the World Bank, the U.S. Food and Drug Administration (FDA), and the American Gastroenterological Association, working with governments and health care agencies around the world.

His projects have spanned the realm of health care, involving guidelines and policies for the management of gastrointestinal diseases, stroke, breast cancer screening, cervical cancer, and others. Over the last several years at the ADA, most of his work has focused on oral health-related practices, producing half a dozen more sets of guidelines.

“It’s rewarding, as this work has an impact,” he says. “The documents are highly cited in and across disciplines.”

A new, pressing issue

Most recently, Carrasco-Labra has coordinated a joint effort involving the ADA, FDA, Penn, and the University of Pittsburgh focused on the management of acute dental pain. The work is particularly timely, given the opioid crisis and concerns about overprescribing among dental professionals. Several forthcoming peer-review articles will detail the guidelines and the underpinning evidence and provide suggestions for prescribing practices that address patients’ pain, while reducing the risk for undesirable effects.

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As in each of the guideline development processes he’s overseen, stakeholder engagement and outreach has been a crucial component.

“We’ve engaged several professional organizations, patient organizations, and government organizations of all sorts that touch on issues of acute dental pain,” says Carrasco-Labra. “That takes a lot of time, but it is essential. We take those contributions very seriously.”

A public comment period was also part of this policy development and promoted through channels such as stakeholder groups and social media.

“If you ask people, people will tell you what they think,” he says. “Addressing these inputs early on minimizes the chance that when the guidelines or policy comes out, some groups, organizations, or patients would feel left out of the conversation. We try to foresee and address concerns as part of the guideline development process.”

Progress at Penn

For Carrasco-Labra, his recent move to Penn Dental Medicine has opened new possibilities in furthering his aims of expanding the use of evidence-based methods.

“In my work at the American Dental Association, we made great advancements producing policy and guidelines for the United States,” he says. “Now I want to have the possibility of addressing these issues using a broader lens, thinking about how these methods, and this knowledge, can be applied in other settings abroad on a more global scale. Being at Penn, which itself has a global reach, made complete sense.”

Through the Center for Integrative Global Oral Health, Penn Dental Medicine’s first center focused on policy, Carrasco-Labra and colleagues aim to bring the ability to translate scientific oral health findings into practice and policy.

“Penn, in my opinion, is the perfect place for this,” Carrasco-Labra says.

Next steps, he says, will involve creating an advisory panel and launching a master’s degree in oral and population health, an academic program for which he will serve as director.

“We will be able to create a profile of a leader in oral health that is able to be right there between the evidence and the decision-makers,” he says. “Such a program doesn’t exist at the moment in the U.S., and we are very excited about it.”

Students in this program, he says, will be trained in a variety of disciplines from evidence creation to policy development and implementation, and will be open to people with dental training as well as those without a dental degree. “We want to be really broad in our scope and fold in people who want to work in oral health,” he says. “You have lots of people who work in oral health research who don’t have this training, so it’s a no-brainer to avoid restricting our talent pool in this way.”

Carrasco-Labra is building bridges to other parts of the University as well, as a Leonard Davis Institute scholar and soon to be a scholar at the Global Health Center at the Perelman School of Medicine. In addition, collaborations with the Center for Clinical and Translational Medicine and Center for Innovation and Personalized Dentistry at Penn Dental Medicine will be bearing fruit.

The COVID-19 pandemic, Carrasco-Labra says, has put into sharp relief the need for evidence-based health care like never before, highlighting gaps in our knowledge and underscoring the need for data and trusted information.

“In March 2020, we needed to make decisions, we needed to understand our processes and implement decisions that were needed, yet we had little to no data on which to base our decision,” he says. “Now we are at a crossroads. And people working in health policy can take advantage to implement the frameworks and establish the collaborations that will allow us to create solid, evidence-informed policies beyond COVID-19.”