Many people assume that health professionals base medical decisions on sound, up-to-date scientific knowledge. But, in dentistry, studies show, professionals often rely on outdated or poorly conducted research. In fact, it can take 20 years for new knowledge to be incorporated into patient care.

To help remedy the situation, The Forsyth Institute, a nonprofit scientific research organization in Boston, founded the Center for Evidence-based Dentistry in late 2002. The Center’s missions are to encourage and teach dental professionals, manufacturers and insurers to better gather, evaluate and use new scientific evidence, and to speed up dissemination of the best new evidence to professionals and the public. The ultimate goal is to improve the public’s health.

The Center’s first project was a conference on evidence-based dentistry to be held January 10-18, 2003, in Boston. The Center asked Harris Communications to publicize the conference on a limited budget. Fewer than 100 professionals, dental industry representatives and insurers were expected to attend the conference.

We aimed to promote the use of good evidence in dentistry by:

• Informing dental professionals about the conference and the existence of the new center

• Furthering public and professional understanding of the nature and importance of evidence-based dentistry

• Communicating up-to-date knowledge of best dental practices to professionals and to the public

We subsequently added a fourth objective, which was to increase visibility for the Cochrane Collaboration, a little-known international nonprofit research organization composed of volunteer scientists that joined with the Center on this outreach project.

We knew that a small, technical conference on evidence-based dentistry held over a cold January weekend in Boston was not likely to attract the press. However, a representative of the Cochrane Collaboration was slated to speak at the conference, and Cochrane was about to publish the results of several long-term studies, including one on power toothbrushes. Scientific organizations commonly publicize research findings announced at their meetings, so, without knowing what the findings would be, we suggested that Cochrane announce the results of its toothbrush study at the Forsyth conference.

Cochrane and the Forsyth Center had collaborated in the past and their directors viewed press coverage as a good way to promote both evidence-based dentistry and their respective organizations. They decided to join forces. Forsyth would send a news release promoting its conference, including mention of the Cochrane announcement; Cochrane would announce its findings at the conference, and publicize them. Because Cochrane had no media expertise, the directors asked Harris Communications to write and disseminate both releases; both organizations were now our clients.

One challenge was that the Cochrane results were to be announced at noon on Saturday, January 11. Because few reporters cover dentistry and health/science reporters rarely work on weekends, we thought it unlikely that any journalists would attend.

Our strategy was to develop media interest in advance, then send an embargoed news release. This would allow reporters to interview key people and file articles before the conference began-- for release after the results were announced on Saturday.

We conducted research to obtain background information and to determine which journalists had covered dentistry or power toothbrushes in the past.

• On Tuesday, January 7, Forsyth faxed an advisory inviting some 240 health reporters to attend the conference and listing some of the topics to be covered—among them the results of Cochrane’s retrospective study on power toothbrushes. We offered to provide advance, embargoed copies of studies upon request. Reporters from the Bloomberg and Reuters News Services and from the Washington Post asked for more information.

• On Thursday, January 9, we faxed an embargoed release describing the Cochrane study to the same list of reporters; we also sent copies of the study to reporters who requested them. The release reported that, based on an analysis of 37 years of studies on power toothbrushes, only one type of power toothbrush showed better results than manual brushing—and that the improvement over manual was slight. The reporters from Bloomberg, Reuters Health and the Washington Post requested (and were granted) interviews with the Forsyth and Cochrane directors.

• On Friday morning, January 10, the editor of the early morning edition of the Washington Post called to say that he liked the story and wanted to run it on the front page, but asked that we move our embargo up by several hours so that the story would come out on his watch. (He said the story would run either way, but it would likely run on an inside page if left to the editor who came in later in the day). Our clients agreed to change the embargo time, and we called the Bloomberg and Reuters reporters to make sure that a change would not inconvenience them. One reporter asked which newspaper had requested the change; when told it was the Washington Post, he said it would be fine to move up the time. (An earlier release time would make it likelier that the story would be used on Saturday evening newscasts and in other Sunday papers).

• At 12N on Saturday, January 11, the Cochrane director announced his study results, and Reuters and Bloomberg released stories on the findings. Stories began appearing later that day.

• On Sunday, January 12, the Washington Post ran an article on the front page of its early edition, and, over the next few days, more than 100 outlets ran the Post, Reuters, and Bloomberg stories. Associated Press, HealthScoutNews, United Press International and other wire services later reported on the Cochrane findings, which were ultimately covered by at least 165 newspapers, magazines, radio, television, Internet, professional and trade outlets, worldwide.

The story did not end there, however.

• On Monday, January 13, Gillette sent out its own press release and called reporters.

• On Wednesday, January 15, Philips-Sonicare, which manufactures a power toothbrush that competes with the Gillette’s Oral B and had not done well in the Cochrane review, sent out a press release challenging the quality of the Cochrane study. That same day, Crest, which manufacturers a toothbrush that works like the Braun but which had come to market too late to be included in the Cochrane study, sent out a release touting the findings.

• On Thursday, January 16, the Cochrane director, now back in England, called to say that he wanted to send out a "rejoinder" to the PhilipsSonicare release, and e-mailed a statement for the national and international press. The statement charged that the Sonicare research was poorly conducted; that nearly all dental research is poorly conducted; and that, in fact, most medical research leaves much to be desired. The statement challenged the dental industry to improve its product research practices.

• On Monday, January 20, unbeknownst to us, the University of Manchester, the Cochrane Oral Health Group’s headquarters in England, sent a release based on ours to outlets in the United Kingdom.

• On Tuesday, January 21, we faxed and e-mailed a release based on the Cochrane Collaboration challenge to the dental industry. We also called numerous media outlets including the Boston Globe to encourage them to write about the need for better quality medical research, and mentioned the new angle to any reporters who called about the first Cochrane release. Several trade and professional publications covered Cochrane’s challenge to the dental industry. In March, the Boston Globe wrote an article entitled "The Great Toothbrush Wars;" which was picked up by numerous other major newspapers in the US and abroad.

The Power Toothbrush release promoted the use of good evidence in dentistry by garnering worldwide coverage of the new Forsyth center, the Cochrane Collaboration, evidence based dentistry, the best available evidence on power toothbrushes, and how best to care for your teeth. The coverage, in at least 165 media outlets, provoked public discussion and debate among professionals, industry representatives and individuals. It also led to steps toward industry reform, to increased recognition for both of my clients, and to a substantial financial grant to the Forsyth Center for Evidence-based Dentistry.

More specifically:

• The conference, Center and Cochrane Collaboration were mentioned in most news stories.
• Many articles explained the meaning of evidence-based dentistry, and a national public radio station interviewed the conference director on just that topic. Two newspapers conducted their own power toothbrush studies and several covered the industry debate.
• The Center directors saw an increase in speaking and teaching requests
• A toothbrush manufacturer whose product had not done well in the Cochrane review requested consulting help from the Center in order to improve its testing procedures.
• A major dental insurer granted $2M to finance both the Center and a demonstration project to assess evidence on how best to prevent cavities in children. As a result of the funding, some 1200 Massachusetts children will receive free preventive dental care. If successful, the project will serve as a model for similar programs, nationwide.

This project was innovative, thus maximizing results, in two ways:

(1) Rather than promote a technical conference in itself, we publicized research findings that would likely be of interest to consumers, thus focusing public, professional and industry attention on the important (but, otherwise, potentially boring) issue of how dental research is conducted.

(2) We encouraged two nonprofit organizations to join forces to promote their common missions.