FACULTY Q&A

ALONSO CARRASCO-LABRA, DDS, PhD

Can you tell us a little bit about yourself and your background before coming to Penn Dental?

I am from Chile and am a dentist by training. I moved to Canada to pursue a masters degree in clinical epidemiology and then I completed a PhD in health research methodology. All those post grad studies were conducted in a school of medicine and not in a school of dentistry. This was intentional—my purpose was to learn research from the medical side because I was not happy with how clinical research was conducted in dentistry. My goal was to transfer the methods that I learned to oral health and it proved to be very successful as a solution.

While I was doing my PhD I had the opportunity to collaborate with a number of health organizations around the world to work on the development of national clinical practice guidelines and the establishment of systems to determine the provision of care through the use of evidence. My area of expertise is to collect the best available evidence to answer a question that can then be derived into a clinical practice guideline or a policy document at the national level. I worked for six years as the director of the Center for Evidence Based Dentistry at the American Dental Association (ADA) where I produced guidelines for ADA policies and helped with the implementation of evidence based dentistry in dental schools and in training front line clinicians. Then I came to Penn and here I am a part of the Center for Integrative Global Oral Health (CIGOH). The purpose of this center is to accelerate the creation, dissemination, and implementation of evidence-informed policies and guidelines in oral health, but now with a global lens. We are going out of the boundaries of the United States and moving forward with extensive collaborations with global organizations including the World Health Organization (WHO), Cochrane, FDI World Dental Federation (FDI), and others.

Can you talk about what your ongoing research projects are?

One key project that I would like to highlight that we are currently working on is a close collaboration with the WHO. We are closely working with colleagues from the WHO African office on the definition of the research agenda for implementing a global oral health action plan. In the past two years the WHO has put oral health on the agenda like never before. Having oral health be a part of these high levels policies is a once in a generation opportunity for us.

As a part of this project we are working on producing several evidence synthesis research documents to inform the creation of a research agenda to accelerate the implementation of high level bills in Africa. This project entails 2 large scoping reviews, which is a systematic way for us to go through literature and find all available research for a particular research question that is complex in nature. One review focuses 1) on understanding the barriers and facilitators for the creation, implementation, and dissemination of oral health policies in Africa and 2) what people think about it. The second scoping review is looking to learn more about what research output has been produced regarding oral health in that region in the past 10 years. We are planning on conducting a conference in Kenya where we will bring all the dental schools of Africa and the chief dental officers and present the challenges, the future goals, and the barriers to oral health in the area. This conference will happen at the end of next year.

Those are the two very important projects currently going on and inside that overarching project in Africa we are also conducting a needs assessment with all dental schools in Africa. Upon initial research we were surprised to find that there was no list of dental schools available in Africa. With the help of our colleagues in Africa, we were able to put together an entire directory of dental schools in Africa for the first time. It was fascinating to see all these people come together to create something like this, so now we have the list of dental schools and we are going to interview them and determine their needs to achieve oral health goals in Africa. Another important paper coming out soon is a clinical practice guideline for the management of acute dental pain. It is the first evidence-based clinical practice guideline in this topic for acute dental pain ever done and was created through collaboration between members from the ADA, University of Pittsburgh, and Penn Dental Medicine. This project is funded by the FDA and this guideline will now determine how clinicians should prescribe medications when talking about acute dental pain. I am very excited to be the Principal Investigator on this project and was excited to work alongside Dr. Elliot Hersh on this transformative project.

Is your lab open to interested students that would like to participate in your research?

I am always looking for more students to join my research team and we benefit tremendously from students working with us. I already have four students working with my group and it has been a fantastic experience. We always need more help and I really appreciate the opportunity because these students are able to interact with high level policy makers on a global level. Having students at Penn Dental interacting with these people contributes to a more global vision and this is what research is about: progressing what is going on in oral health and making some friends along the way. We learn from each other as we are doing this and all the students that have reached out to me have tremendous initiative, so I am learning from them and we are having a great time. For students we offer authorship and they are able to attend meetings with policy makers, so I encourage any interested students to please reach out to me.

What has been the biggest challenge in your career so far?

I have faced several challenges throughout my career. The first challenge would be that the research that we have been trying to do is research that is intended to improve patient care and healthcare outcomes. The challenge is that we can produce many of these documents, but if they are not accompanied by true actions, they will be just one more piece of paper published in a journal, but changing nobody’s life. This is a permanent challenge when working on these high level policies and guidelines. Conducting research from the ivory tower of academia and putting it out there hoping that someone will take it is extremely problematic. Researchers in the field where I work need to be thinking about how these recommendations are translated into true actions and we have not done a good job in that regard.

Researchers need to involve users in the production of these documents early on and accept that when writing something that is very complex it needs to be translated into something that leaves little to no space for doubts when communicated. It is very difficult to move the needle to the next level so that the work we are doing is not another paper that someone published with good intentions but no actions at the end. That is the biggest challenge: how do we really move the needle when creating these policies so they truly impact patient care?

What advice would you give to a younger version of yourself if you were to restart your dental and research career?

If someone has interest in research that means that there is genuine curiosity to see the world through the lens of science. A few things that I would say is that someone should be ready to explore different areas. Go to the lab and interact with individuals and explore different fields. This is the time to find out which area triggers that spark and curiosity in a way that other areas may not. Once you find that area, now is the time to get serious about it.

If a student is considering research and pursuing academia, it is very important to find a mentor. A mentor is like rocket fuel in this field. You can get there on your own, but it will take so long to get there. It is not only that a mentor knows more about the research itself, but they also have learned about the challenges of conducting research. Having a good mentor is priceless in the early stages of having a career. Don’t be scared of exploring and finding out what is going on to see what you like. Then it is time to get serious and find a mentor that can be of great value.