We understand the concerns of Drs. Bader and Shugars regarding use of the terms "consecutive prevalence" and "incidence." However, we disagree with their statement that "consecutive prevalence studies can only be used to calculate incidence when the event of interest is permanent ... ."
We did, in fact, measure incidence, albeit by using a tooth-specific consecutive prevalence method. Using this method, the tooth-specific new events are observable, although the incidence estimate is of necessity a lower-bound estimate.
We share Drs. Bader’s and Shugar’s concern about communicating to the typical reader the distinction between consecutive prevalence and incidence. This is why we made such a point of being careful to communicate to the reader exactly what we mean by those terms and their limitations.
We also agree that readers should keep these distinctions in mind when making inferences from this study. This is why we emphasized this point in the Abstract, reminded the reader again in the Results section, closed the article by devoting a full paragraph to that point and then strategically made that paragraph the last one in the Discussion section.
Drs. Bader and Shugars take issue with our sentence, "Blacks and people who seek care on a problem-oriented basis are at greater risk of developing [fractures]." As a stand-alone sentence, we agree that the typical reader might misinterpret our intent. In retrospect, we wish that we had added at the end of that sentence a phrase such as "keeping in mind the limitations of the consecutive prevalence method."
We do not believe that this study is flawed, much less seriously so. It simply has limitations, limitations that we emphasized throughout the article. We believe that this study is a substantive contribution to the literature.
Before we analyzed these data, we thought that the incidence of these events would be quite low, and that we as dental clinicians may be doing more dental treatment than necessary to prevent low-probability events. We were surprised that the incidence of these conditions was quite high, especially keeping in mind that our incidence estimate is a lower-bound one (that is, the true incidence could only be higher).
Undoubtedly, because fractures could be treated in the dental office before we were able to observe them, the real incidence figure is significantly higher, which in our opinion makes our article even more compelling. To our knowledge, this is the first study to measure restoration and cusp fractures in a representative, community-based sample of dentate adults.
We are grateful for comments made by the anonymous JADA reviewers, and to The Journal for helping us communicate these findings to the scientific and clinical audience.
