Evidence-based Practice in Dentistry: Benefit or Hindrance

dentistry depends on our consistent and concerted marriage, as it were, of the “best available” research evidence with the diagnostic modalities and the treatment interventions our patients need. The concerns over variability of practice is not a question of style or individuality. It is a question of quality and standards. Patients expect and deserve the best care available for them based on the evidence, personal preferences, and the skills and knowledge of the provider. The pressure on the dental care industry to have evidence for even its most basic of treatments and products is wellfounded. Take for example the recent NIH Consensus Conference (http://www.nidcr.nih.gov/news/consensus.asp), which discusses dental caries. Among many other conclusions, the panelists agreed that more rigorous studies are needed not only to support current methods but also to improve them. The American Dental Association Commission on Accreditation requires that dental students acquire a wide variety of skills in managing scientific information with critical thinking. However, most dentists were not taught the skills and tools of evidence-based dentistry in dental school. Therefore, they have little confidence in or respect for the scientific method, and place little or no demands for higher standards of research evidence. Certain dental manufacturers may be content to publish their research in the form of abstracts, and to support their products with statements such as “University studies show. ”. It is time that dentists take control of the products they utilize: The liability is theirs. Therefore, dentists must take it upon themselves to evaluate the validity of the research evidence for or against any given products they use. It is also time for the socio-political environment that surrounds dentistry (e.g., the insurance companies for the coverage of dental treatment, Congress for the funding of dental research) to have access to the “best available” evidence to make the better-informed and cost-effective decision. The well-being of our patients depends upon the successful integration of the “best available” evidence into novel and improved treatment modalities. The question is not “why” but “how”. How can we actualize this union? How can we identify the “best available” research evidence? How can we most effectively integrate it into the common day-to-day exercise of dental practice? These are fundamental and timely questions for dentistry in the 21st Century. There are many approaches to evidence-based dentistry, but it may suffice to paint a very broad picture at the onset and I has been said that “. the art (of dentistry) is in using the science and matching it with the patient's characteristics and needs. ” (Ismail, 2002). In reality, however, it may not always be the case that good practice rests on evidence from the literature as well as on the art and intuition of the practitioner. The awareness that the practice of dentistry needs to be based on research evidence actually appears to be quite recent. Evidence-based dentistry, which is distinct from dentistry based on evidence, has permeated dental research and dental practice only in the last few decades, as an offspring, as it were, of evidence-based health care in general and evidencebased medicine in particular. The first coherent set of scientific position papers on evidence-based medicine dates back only three decades, published from McMaster University in the early 1970s (Chiappelli and Prolo, 2001). The actual theoretical concept of basing medical intervention upon evidence gathered by observations is indeed less than 200 years old and can be traced to Dr. Pierre Louis (médecine d'observation) in Paris and Dr. Maurizio Buffalini (medicina basata sulle evidenze) in Florence in the mid-19th Century (Chiappelli and Prolo, 2001). Good and sound dental practice relies not upon bits and pieces of conveniently selected evidence (dentistry based on evidence), but rather upon the collection of the best available research evidence (evidence-based dentistry). The key phrase, “best available research evidence”, implies a most important and fundamental nature of this approach to dentistry: It seeks to identify what is the “best” research evidence presently at the disposal of the dentist for any given patient, and it recognizes that dental research evidence is continuously evolving. Evidence-based methodology reflects the vitality that is inherent in the research process itself—questioning, testing, discovering, and questioning anew—and in so doing seeks to generate novel and improved treatments. It is important to note that the term “research evidence” implies data generated by a variety of research modalities (i.e., observational research, experimental research, clinical research, basic research, translational research). The question, then, is not whether we who practice clinical dentistry or perform dental research ought to be concerned with