Thank you for sending me Dr. Stanford’s opinions. This column, and nearly 200 others I have written for JADA, are "editorials," which by very definition relate to the "opinions and observations" of the author.
As a board-certified prosthodontist, I have now personally placed over 45,000 units of crowns and fixed prostheses, some of which I have continued to observe for nearly 50 years. My opinions are based on that personal, private-practice experience and on my observations as a study club mentor in many groups; a full-time educator, a researcher and an administrator for part of my career, and co-founder of the Clinical Research Associates Foundation, which has active basic science and clinical research projects going in all areas of dentistry.
Our current fixed prosthodontic study involves many types of zirconia-based fixed prostheses, with controls being conventional porcelain-fused-to-metal prostheses. You may want to peruse some of our scientific research on the CRA Web site at "www.cranews.org" or in peer-reviewed and non–peer-reviewed journals. Quite obviously, this column happened to be stated as my opinions and observations, not scientific research. Apparently, JADA readers appreciate reading editorials from a real-world practitioner.
I recognize the fact that Dr. Stanford has access to PubMed to find the research articles he cited. I respect those individuals and their articles. However, my editorials in any journal will remain my opinions and observations, based in this case on the previously stated sources and some of the research I can trust in the literature, not on the observations of others, which can be read at will by anyone with a computer.
I’m sorry that the column upset Dr. Stanford. Without sounding disrespectful of his views, I invite him to again critique the column after he personally has had the thousands of clinical experiences with crowns and the patient interactions I expressed above.
I applaud Dr. Glick for his foresight in allowing some clinical observations to be published in JADA. I am told by readers of JADA that my "Observations" articles in The Journal are the first they read. Dental practice is called "practice" because we learn from our clinical experiences, not just from "scientific studies."
I am proud to have my experienced clinical colleagues provide me with information about the real clinical world, clinical practice, patient preference and, most importantly, quality service to patients. In addition to my interactions with thousands of dentists annually, I read voraciously, and even sometimes believe the "scientific" literature that has not been funded by companies or special-interest groups.
Our 30 years of product evaluation in CRA and my many years of serving in some type of editorial capacity on many journals have made me highly skeptical of a significant portion of the so-called "peer-reviewed" literature, some of which is actually misleading to clinicians. I can identify numerous so-called "evidence-based" studies that have provided evidence subsequently proven to be wrong in clinical practice. We must work together, combining scientific studies and controlled clinical studies as well as clinical observations.
Dr. Stanford, we are in this profession together, and I hope we are working for the same goal—quality oral care service for the public. Clinical practice provides useful observations and forms behavior changes and opinions for practitioners to the betterment of their patients. Scientific projects augment and support practice. I welcome a discussion with you regarding your thoughts on the subject of "when is a full crown indicated?"
