June 1, 2003
by Oral Health
Re: What’s In a Name?… My View, Janice Goodman, March, 2003
I am a dentist in Vancouver and thought I would write a note of agreement to the sentiment expressed in your recent ‘Viewpoint’ in Oral Health. It would be a sad day indeed if the practice of cosmetic dentistry was restricted to accredited members of AACD or any other self-proclaimed organization.
Personally, if I was choosing a “cosmetic” dentist, I would want to know that he/she had received accreditation in the fundamentals of adhesive dentistry. This prompts the next editorial, ‘should dentists be obliged to “advertise” their accreditation in all aspects of dentistry?’ Cosmetic dentistry is part and parcel of general dentistry — let’s keep it that way.
Dr. William Liebenberg
North Vancouver, BC
Re: The Perils of Ignoring Scientific Method, January 2003 and the letter written by Dr. Gary Fortinsky, April 2003
There has been a great push this past decade in medicine and dentistry with an attempt to rationalize our clinical practice using an “evidence-based” approach to those practices. This has been seen to be synonymous with the published literature on a relevant topic. Such a goal is certainly a worthy one but it is fraught with potential problems.
The volume of literature has exploded in recent years. So much so that much of it is ignored. What is quoted, however, is repeated and repeated, often without assessment of the original article, its purpose, methodology, results and conclusions. Or its biases. The mere selection of supportive literature/ references brings with it a bias by virtue of the selection process. As Fortinsky rightly states, “people choose the research that supports the position they want to hold.”
An additional problem that exists in much of the literature is that although the statistical interpretation of the data may very well be ‘significant,’ it may also be clinically irrelevant.
Concensus articles that are often quoted are, regrettably, merely opinions watered down to the lowest common point of agreement, often between people of similar thinking. Contrarians are rarely invited to participate in the dialogue. Yet this consensus opinion is promulgated, referenced and established as fact. Review articles are, by nature, selective. This also means that they are not comprehensive. Even in refereed journals there is often disagreement between referees as to the validity of the article(s) being considered for publication.
Professor Donald Brunette, writing in his text, “Critical Thinking: Understanding and Evaluating Dental Research,” (Quintessence Books) concludes that in dentistry, “there is a huge amount of literature … much of it useless.”
There are aspects of our ‘art and science’ that those outside of full-time clinical practice may not understand, may not have an interest in or for which there is no commercial application and therefore no funding. Yet those who do practice full-time do not have the time or incentive to publish. As such, that reservoir of experience/evidence is unfairly discounted or ignored.
Victor Kutcher, BSc., MBA, DDS, Dip. Perio
Stoney Creek, ON
This is in response to several editorials that have appeared in Oral Health over the years. Basically it’s the culmination of my frustration with the amalgam/composite debate that seems never-ending. Unfortunately, our patients are caught in the middle.
The time has come to put our collective feet down on the ‘holistic’ attitude of some of our colleagues. I feel it is unethical and fraudulent to portray amalgam as a health hazard when used as fillings while at the same time portraying composite resins as the great ‘White Savior.’ I use composite on a daily basis, as well as amalgam. I do not believe that either pose any health hazard. I do believe each has its place in the mouth, and should be prescribed based on their physical properties and the patient’s aesthetic concerns.
For composite to be prescribed on the basis of being ‘healthier’ than amalgam, I believe, is nothing short of misrepresentation and fraud to get the extra billings. When you look at a list of chemicals that make up composite, many of which I can’t pronounce and all of which are ‘man made,’ how can anyone tell their patients, or me, it’s safer.
We have the right to use any material we want, but these materials can’t be misrepresented to our patients.
Mark C. Evans, DDS
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