November 12, 2019
by Mark H.E. Lin, BSc, DDS, MSc(Prostho), FRCD(C)
Evidence Based Dentistry (EBD) may be defined as a process which combines “the best available scientific evidence and the clinical expertise of dentists with the patient needs and preferences in order to serve as the foundation for clinical dental care”. Therefore, combining the innovative findings of medical and dental research with clinician knowledge is highly important when making clinical decisions. However, it has been found that a great deal of published clinical research results are not reflected in everyday clinical decisions, generating a ‘gap’ in what is proven in research and what is clinically practiced.
A great deal of research has been produced offering suggestions to clinicians regarding the use (or non-use) of specific materials, techniques, and/or treatment across a range of preventative, diagnostic, and treatment procedures. However, it has been found that the amount of new research implemented into everyday clinical practice is incredibly limited at approximately 14%. Additionally, it may take between 10 to 20 years for this new research to be reflected in everyday clinical practice. For instance, Norton et al. (2014) found that “only 69% of dental practitioners reported performing caries risk assessment (CRA) on their patients” regardless of the suggestion made through evidence-based research that CRA’s should be applied to all patients.
Furthermore, the ‘gap’ is also present between evidence-based research and medical clinical practice. This may be better understood through an example which considers the use of Aspirin. Masic et al. (2008) explain that during the 1970’s, treatment such as thrombolytic therapy and use of aspirin were both found to efficiently treat acute myocardial infarction. However, it took almost a decade for these treatments to be used routinely in medical practice. Khera (2015) mentions that a possible negative consequence resulting from the delayed implementation of research findings to clinical practice is that “failure to change practice according to the evidence provided by these trials can be expensive and harmful since it may perpetuate over utilization of ineffective care and underuse of beneficial interventions”. In order to decrease the gap between what we know and what we do, research findings need to be translated from knowledge to action, but in a judicious manner”. Through the use of EBD and EBM, clinicians may be able to drastically improve the quality and results of the treatment which they provide, further reinforcing the trust that is fostered between themselves and their patients. As a result, both patients and clinicians mutually benefit from evidence-based processes.
The Canadian Dental Association (CDA) notes the importance of EDB to strengthening the profession of dentistry. Accordingly, the following are five core principles to the implementation of EBD that may help to bridge the ‘gap’:
1. Recognize a need for information and formulate an answerable question.
2. Find best evidence with which to answer that question. Look for systematic reviews, meta-analyses and double- blind randomized controlled studies.
3. Evaluate the evidence for its validity, reliability, relevance and usefulness.
4. Integrate the evidence with your clinical expertise and your patient’s needs.
5. Evaluate the overall results and your process. Make any necessary changes.
The CDA Resource Centre offers professional literature searches and a document delivery service for CDA members. They provide a guideline which may help clinicians to identify helpful and pertinent studies that may be applied to their everyday practice.
The dental profession as a whole should be responsible to implement EBD into clinical practice and to bridge this gap in the best interest for our dental patients. Starting at the undergraduate dental curriculum courses, all resources of continuing education and all the individual dental practitioners, we are all collectively and individually responsible to bridge what is known from research to what is practiced clinically.
Overall, EBD and EBM are considered to be a helpful tool used to bridge the ‘gap’ between evidence-based research and the way that clinicians’ practice. The benefits of evidence-based practice to both clinicians and patients help to reinforce the importance of bridging the existing ‘gap’.
About the Editor
Dr. Mark Lin, graduated from the University of Detroit Mercy for his dental program. He then completed a one-year General Practice Residency program at the Miami Valley Hospital in Dayton, Ohio. He practiced general dentistry for 13 years and then returned to complete his post-graduate 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.