Evidence-based dentistry

March 15, 2004
Will it change the way dentists treat patients?

Evidence-based dentistry merges the patient's needs, dental expertise and the latest scientific evidence to provide oral health care.

Researchers suggest that the evidence-based practice could change the way dentists treat patients, and believe it is the best way for dentists to cull unbiased, current information from the massive amounts of clinical information published every year, according to an article in the March 2004 issue of AGD Impact, the newsmagazine of the Academy of General Dentistry (AGD).

Well-established in Canada and England, the concept is growing in the United States. "There is evidence-based purchasing, medicine, nursing, mental health�every possible area of health care is embracing this paradigm," says Susan Sutherland, DDS.

The methodology was initially developed for use in medicine in the 1970s, at McMaster University in Ontario, Canada. By examining a vast collection of sources rather than relying on "bits and pieces of conveniently selected evidence," physicians could make better-informed clinical decisions, according to a guest editorial published in the January 2003 issue of the Journal of Dental Records.

"Dentists are usually not in the possession of all or even some of the evidence to help them make informed decisions. Bringing evidence forth in easily digested bits was necessary," says James D. Bader, DDS, MPH.

Not all practitioners are ready to embrace the concept. Those wary of the practice worry the process will render patients' needs and the practitioner's experience�the heart of the
doctor-patient relationship�obsolete. Others fear that it will enable insurance carriers to dictate treatment, creating a "cookbook" for practicing dentistry.

"Denial of 'necessary' treatment by benefit managers continues to be the major criticism of health plans by patients and health care practitioners. Under these circumstances, it isn't difficult to visualize payers selecting only (evidence-based dentistry) that supports the cheapest treatments," noted a paper published in the 1999 issue of the Journal of the American Dental Association.
The excess of material currently published--roughly 500 trials for each of the dental specialties--is growing each year. That number doesn't include the unpublished information, such as seminars, lectures and rejected manuscripts.

"Evidence-based dentistry is not a set of cookbook methods. It is not a method for insurers to dominate dentists. It's not a pre-ordained, biased set of rules that people apply to other people. It is the integrating of the best evidence with clinical experience and patient needs and values in making clinical decisions," says Richard Niederman, DMD.

Dentists interested in learning more about the process of evidence-based dentistry have several organizations, institutions and government agencies to turn for information. The Forsyth Institute is home to the first U.S. center for evidence-based dentistry, and a search engine, EviDents, allows clinicians and patients to sift through information to find the best oral health evidence available.