Evidence-based dentistry has been in the news a lot lately. Some see it as a positive step toward a more scientific approach to the provision of dental care. Others see it as a potential intrusion on the professional judgment of practicing dentists.
The ADA defines EBD as "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."
When asked how they define EBD, respondents to March JADA’s Question of the Month gave a variety of responses. Here are a few:
- – "A bridge between research and clinical practice."
- – "A positive step toward a more scientific approach to providing proper dental treatment."
- – "An attempt to rigidly dictate the standard of care."
- – "Making treatment and diagnostic decisions based on the best available scientific evidence, rather than on testimonials, anecdotes and personal opinion."
- – "What works and what doesn’t."
- – "An insurance company scheme to promote lowest-common denominator treatment."
- – "Clinical practices based on best available evidence of effective dental care procedures."
The March Question of the Month also asked readers how they "see" EBD.
About one-third indicated that evidence-based dentistry is a good thing. "EBD is the way to go, because today all research has to be backed up by sound facts, logic, reasoning and results," said one respondent.
"I feel it will eliminate much of the anecdotal-based treatment that takes place, ultimately leading dentistry to a more uniform ‘standard of care’ nationally," said another.
Approximately one-fourth of respondents said they think EBD is a good idea but urged caution in applying it. "I feel that EBD is valid, but it must be combined with experienced classical judgment or it will be used as a ‘tool’ against dentists when needed," said one.
"I’m in favor of science, but dentistry is an art," said another reader. "EBD paints with a broad brush and may or may not be good for a specific case. What is good for a 30-year-old might not be reasonable for an 80-year-old."
Thirty percent of respondents said they are opposed to EBD. "It takes too much time and puts the dentist’s diagnosis in doubt," said one.
"It is a bad intrusion that ultimately will be used to control dentists and will be used by insurance companies as the sole determinant for coverage, even when this is based on old information," said another.
The ADA Policy on Evidence-Based Dentistry, which is available on ADA.org at "www.ada.org/prof/prac/issues/statements/evidencebased.html", addresses these concerns. It states that "EBD does not provide a ‘cookbook’ that dentists must follow, nor does it establish a standard of care. The EBD process must not be used to interfere in the dentist/patient relationship, nor is it to be used solely as a cost-containment tool by third-party payers."
"EBD is a new term for an old concept that the ADA has always adopted, which is a scientific basis for dentistry," Dr. Amid Ismail, member of the ADA Evidence-Based Dentistry Advisory Committee, said in the March 4 ADA News. "The evidence-based review process brings all the data together—not relying on just one study or one expert’s opinion."
The review process consists of four steps:
- – to define a clinically relevant and focused question in the interest of finding the best available evidence to promote the oral health of patients;
- – to focus on systematically conducting searches for all studies and databases that may help answer a clinically relevant question;
- – to focus on translating the findings from systematic reviews for use by practitioners;
- – to assess the health care outcomes following the findings of the previous three steps.
The process aims to help practitioners make the best-informed decisions with their patients. "It must consider patients’ preferences and other factors to determine the most appropriate care that benefits the individual patient," said Dr. Ismail.
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