Evidence-based dentistry: are we there yet?

By Patrick J. Foy, DDS“The future has a way of arriving unannounced.” — George Will The Evidenced-Based Dentistry (EBD) ship has been built and is cruising in the right direction. Many professionals have jumped on board (early adopters) knowing there will be new discoveries ahead, with some unforeseen detours. Many other colleagues remain skeptical of the concept.At first, I was locked in the same state of resistance. It seemed that my involvement in organized dentistry exposed me to local and federal legislators, insurers, and health-related media. Even our own American Dental Association was unfurling foreign terms such as “Practice-Based Research” and “Evidence-Based Dentistry.” I was afraid that my future might be dictated by some outside authority, and so I began my own personal investigative journey. At one of our district dental meetings, I was approached by an HMO dentist, who served on the Executive Committee of the Dental Practice-Based Research Network (DPBRN), based out of the University of Alabama, Birmingham. He attempted to explain the program and invited me to join and become a practitioner-investigator. At the time, I was by no means an advocate, but I decided to join and investigate the DPBRN. This was my way of putting in my big toe to test the waters. To my surprise, I was quickly hooked. For the first time, practice-based research meant that the true “wet-gloved” dentists working in the trenches were generating data. These studies were of real-world dentistry being performed on real people. The DPBRN results would be instrumental in generating valuable new evidence to allow dental professionals to improve patient care throughout the world. The data would be credible only if the diversity of the network were broad enough and represented all types of dentistry. Now I wanted “my dentistry” to be a part of the evidence, and it drove me to recruit other “good dentists.” In the meantime, I read everything published by the ADA on EBD, and attended the EBD Champions Conference in 2008 and 2009. Armed with my research and experience, I became a zealot for the concept. I was invited to serve on the Minnesota’s EBD Taskforce, which allowed me to spread the word. I developed a slide show, “The Perfect Storm,” and took it on the road. It was a flop. Standing in front of my fellow professionals spewing out acronyms only appeared as if I had drunk the cooking wine. I had to revisit my own initial concerns.My number-one fear had been that the evidence would create a cookie-cutter dental-care model. My presentation fueled that notion, because I had not explained how the EBD data could be implemented into our daily practices. I had also failed to show that EBD would serve as a valuable new tool, not as an outside source of endless authoritative answers.Here is how the ADA defines EBD: “An approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.”This definition needs to be clarified so that every dental professional understands the concept. EBD was not intended to replace clinical skills, clinical evaluations, or patient preferences, but to act as another important implement in our treatment process. EBD will require each of us to rate the quality of scientific evidence, develop new searching techniques, evaluate the quality of outcomes, and apply care that produces better results in the clinical setting. Today’s evidence only supports about 10% of clinical treatments that most of us accomplish every day in our practices. With new advances, materials, techniques, equipment, and devices flowing daily into our world, we can expect a constant process of discovery. It is imperative for each of us to maintain our best competence as dental professionals. EBD can lift us to a new height of vital evaluation.Is EBD on the way? The answer is an enthusiastic yes! “The ship has left the port, but has yet to sail the ocean.” Bon voyage!For more information on evidence-based dentistry, go to http://ebd.ada.org/. To learn more about the Dental Practice-Based Research Network, go to http://www.dentalpbrn.org.