November 1, 2014
by Mark Lin, BSc, DDS, MSc (Prostho), FRCD(C)
Mrs. Jones and her husband presented to my Prosthodontic Specialty clinic for an additional opinion regarding her treatment options to improve her existing oral condition. After conducting an interview with Mrs. Jones and completing a comprehensive clinical examination, along with diagnostic records, I presented three potential treatment plans. The advantages and disadvantages, risks and benefits and the respective professional fees of each of the treatment options were discussed thoroughly during the follow-up case presentation appointment.
At the conclusion of the case presentation, Mrs. Jones and her husband compared the treatment plans to those offered by a general practitioner and another prosthodontist they had previously consulted. The couple seemed perplexed and proceeded to voice the following concerns:
Why would there be such apparent differences from one dentist to another in regards to the treatment plans proposed?
Why would the professional fees vary so greatly from one dentist to another and between different treatment options?
While some of the offered treatment plans maintained similarities, they still varied enough to make it difficult to come to a final decision.
Finally, given all the questions and confusion, how could they be sure who the best dentist would be to provide their treatment?
Being valid concerns, my immediate response was to tell them, “When possible, I try to practice Evidence-Base Dentistry (EBD)”. Now the next obvious question from the Jones was, “what is evidence-base dentistry?”
I provided the definition of EBD from the Cochrane Centre: “the conscientious, explicit and judicious use of the best scientific evidence in making decisions about the care of the individual patient”. I explained to the Jones that essentially there are three components to EBD, which are, the patient, the dentist and the best available scientific literature.
The patient component is impacted based on each patient’s unique set of chief complaints, treatment goals and desires. In addition, they present with past dental histories, attitudes, values, time limitations and financial budgets. Along with the advancement of the Internet at home, our patients have become highly educated and inquisitive after consulting “Dr. Google and Dr. YouTube” before arriving at a dental practice.
The treating dentist providing the clinical expertise would directly influence the treatment plan based on their respective dental education, continuing education courses, clinical experience and consultations with other professional colleagues. Consultations with other dentists, specialists and laboratory technicians also provide valuable information that the dentist may incorporate prior to formulation of the treatment plan.
Finally, the third component of EBD is the scientific evidence that is proven and reported in peer reviewed journals. This process is based on integrating the scientific basis for clinical care, using thorough, unbiased reviews and the best available scientific evidence at the given time, with clinical and patient factors. Dr. David Sackett and colleagues generated “levels of evidence” for ranking the validity of scientific evidence.
The goal of EBD is to help practitioners provide the best care for their patients. This process uses clinical and mythological experts to synthesize all the evidence relative to a defined “question of interest” and is published in the scientific literature. The evidence is integrated with clinical experience and expertise along with other factors relevant to specific patients’ needs and preferences.
Therefore, it would be prudent to have an in-depth interview and consultation with our patients to aid in the formation of any treatment plan for that individual patient. The dentist would utilize the cumulative clinical experience and information gathered from various sources over the years to suggest viable treatment options. When possible, we would search out the highest ranking in the hierarchy of scientific evidence to support our clinical decisions and treatment plans.
Once Mr. and Mrs. Jones understood what EBD was and how I formulated my treatment plans, they were satisfied and appreciated the various different treatment options presented by my clinic. The final obstacle to treatment acceptance is now a discussion on the always-contentious subject of professional fees.
However, this is a topic for another editorial at another time. I will spare our readers the suspense by affirming that treatment was eventually accepted and rendered for Mrs. Jones by my clinic. OH
Dr. Mark H. E. Lin graduated from the University of Detroit Mercy for his dental program. He then completed a 1-year General Practice Residency program at the Miami Valley Hospital in Dayton Ohio. He practiced general dentistry for 13 years then returned to complete his postgraduate training in the specialty of Prosthodontics at the University Of Toronto. He maintains a full time specialty practice as a Prosthodontist at Dr. Mark Lin Prosthodontic Centre.