I would like to commend Dr. Michael Glick on his May JADA editorial, "The Numbers Game," (
JADA 2008;139[5]:528, 530[Free Full Text]
) and offer a few additional comments. Health care providers strive to provide the best patient care. Nevertheless, available care is not always supported by the best evidence. We see this in dentistry and medicine, where many practices are supported by limited levels of evidence or limited understanding of its significance.1,2
It is true that it is not always practical or ethical to achieve an ideal level of evidence (randomized double-blinded clinical trials) in many fields, such as occurs with antibiotic prophylaxis and dental procedures. We are left with the best evidence that we can gather from other types of clinical trial designs, basic and epidemiologic data. The results from further progress in this type of research will guide clinicians to provide the best care to their patients.
As Dr. Glick correctly stated in his editorial, oral care providers should become familiar with basic terms that often are used to support the efficacy of dental devices or interventions promoted by industry. Only then can we make an informed decision as to what constitutes the best therapeutic or diagnostic option. Moreover, few in dentistry are committed to doing this type of research.
My initial experience with "the numbers game" was during my first year as a faculty member. A manuscript that I submitted to a peer-reviewed journal was rejected because of failure to control for type I and type II error and misclassification bias. I was not familiar with any of these terms, and only after painful literature searching and reading did I understand what the flaws in my research were. Unfortunately, due to my lack of knowledge, seven months of work was wasted.
Training for dentists in biostatistics and epidemiology, including the application of published evidence-review guidelines to dental research, is sorely needed.3 Funding is available to train such people, both from the National Institute of Dental and Craniofacial Research and from the Clinical and Translational Science Awards, which often includes slots for dental students or senior residents who wish to become independent investigators. For those of us who are involved in academia, our responsibility is to identify and nurture people who express interest in this career choice, making them aware of available options. Dental students also should be exposed to the practical applications of biostatistics in dentistry to recognize the value of becoming familiar with this field.
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