Sept.1,1999
"Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research."
-Cochrane Center
Oxford,England
1993
Dr.J's. commentary:
Recommendations of the Cochrane Center in 1993 are generally credited with the movement in medicine toward evidence based decision making. Evidence based dentistry is relatively new. Traditionally, the selection of materials, techniques, and instrumentation have been made empirically. Future decision making will be more scientifically substantiated. This revolutionary movement known as evidence based dentistry will affect all aspects of clinical dentistry in the next decade.
Sept.2,1999
"...physicians and dentists can no longer rely solely on opinions of experts and their own practical experiences. Experts and their personal experiences vary widely and they are easily influenced by preferences for certain treatments, biased observations, and the type of patients seen in a dental practice."
Ismail,A.I.,et.al.
Systematic Reviews and the Practice of Evidence-Based Dentistry:
Professional and Policy Implications
J.Am.College Dent.66:5,1999
Dr.J's. commentary:
The entire last edition of the Journal of the American College of Dentists was devoted to Evidence Based Dentistry.
Sept.3,1999
"The National Academy of Science's Institute of Medicine recently published a monograph...which estimates that as much as 51% of the medical care provided in the United States may not be based on any evidence."
Niederman,R.
The Methods of Evidence Based Dentistry
Quintessence Int.29:811,1998
Dr.J's. commentary:
In dentistry the statistics are even more alarming. For example, it has been estimated that only 4% of the literature published in the past 10 years regarding the relationship between occlusion and TMD is scientifically valid.
Sept.6,1999
"With regard to dentistry, these are indeed the best of times. We have available materials and techniques that visionaries could only dream of 25 years ago."
"And yet, as our profession hurdles toward the 21st century, these are also the worst of times. As a profession, we have become so enamored with our technologies that we seem to have lost our collective common sense."
"...technologies have opened many doors for the restorative dentist. However, for those of us who have practiced for more than two decades, we know that many of these doors have not opened to long-term clinical success. So herein lies the problem: we have many wonderful new materials and techniques, but do we have the wisdom to use them appropriately?"
Robbins,J.W.
Evidence Based Dentistry: What is it and What Does it Have to do with Practice?
Quintessence Int.,29:796, 1998
Dr.J's. commentary:
One example of the application of technology prior to its scientific proof of efficacy involves the various all ceramic restorative materials which have gained popularity recently. None of these materials to date have demonstrated clinical superiority through long term clinical investigations.
Sept.7,1999
"We dentists are our own absolute worst enemies. Accepting an advertisement for a new material or device without scrutinizing the literature behind it is our modus operandi. We assume that anything we see in a scientific journal, ad, or article is valid in presentation and content."
"Pleas for research get lip service from one and all but then go unheeded in the marketplace. A new design for an implant or abutment, a new material for temporomandibular joint replacement, a clever new membrane, soft tissue liner, or a new restorative material gets its first trial at the expense of the innocent patient."
"We the practitioners in whom patients place their faith and their health, are the truly guilty party for submitting those patients to new devices, materials, and techniques that have not stood the test of scientific rigor."
Taylor,T.D. Editorial
Journal of Oral and Maxillofacial Implants
1996
Dr.J's. commentary:
For example, how many different materials espoused to be the optimum permanent resilient denture base liner have been marketed to the profession in the past 20 years? Most have failed to withstand long term clinical evaluation.
Sept.8,1999
"Unfortunately, dentists often make treatment decisions based on habit, familiarity, convenience, cost containment, advertising hype, subjective comments from colleagues, myth and other factors besides those based on scientific controlled clinical trials."
White,S.
Posterior Restorations: Change, Challenge & Controversy
J.C.D.A.,24:14,1996
Dr.J's. commentary:
The randomized controlled longitudinal investigation is the yardstick by which clinical performance should be measured.
Sept.9,1999
"The common denominator of evidence based dentistry is to provide patient care that is based on evidence derived from the best available studies as opposed to unsystematic observations from clinical experience & intuition."
Turp,J.C.& Strub,J.R.
Prosthetic Rehabilitation in Patients with Temporomandibular Disorders
J. Prosthet. Dent. 76:418,1996
Dr.J's. commentary:
Personal testimonials ("it works in my hands"), case presentations, and anecdotal reports are unreliable and unscientific. Recommendations based upon such "evidence" amount to nothing more than heresay.
Sept.10,1999
"With the increasing popularity of alternative medicine a number of dentists have seen an opportunity to garner a great deal of wealth by trading on patients fears. Thus there are those who advocate the wholesale removal of amalgam fillings....even though scientific studies have shown there is no danger to the patient from the amalgams"
Ring,M.E.
Quackery in Dentistry
J.C.D.A. 26:819,1998
Dr.J's. commentary:
The amalgam scare is one more example of scientifically unsubstantiated thinking.
Sept.13,1999
"Treatment decisions must be based upon solid scientific evidence...opinion and clinical experience amount to subjective judgement, not evidence of restoration performance or patient benefit."
White,S.
Posterior Restorations: Change, Challenge, and Controversy
J.C.D.A. 24:14,1996
Dr.J's. commentary:
The most reliable and accessible source of information for clinicians is the appropriately referenced current dental literature.
Sept.14,1999
"Treatment recommendations to patients must be made on the basis of published scientific evidence, not the latest fads proposed by charismatic speakers."
Donovan,T.E. and Cho,G.C.
Materials for conservative Posterior Restorations
J.C.D.A. 24:32,1996
Dr.J's. commentary:
For dental literature to be reliable, the manuscripts submitted for publication must undergo scientific scrutiny known as "critical appraisal" conducted by trained reviewers. Critical appraisal requires that data be formally scrutinized to ensure the validity of the author's conclusions. Parameters such as statistical significance, specificity, sensitivity, repeatability, reliability, and validity are evaluated.
Sept.15,1999
"...most of today's journals generaly do not provide adequate access to the "best available evidence" in an optimal format."
Deahl,S.T.
Conditions and Tools for Evidence Based Dental Practice
J.Am.College Dent. 66:13,1999
Dr.J's. commentary:
In the field of prosthetic and restorative dentistry, manuscripts and studies that have survived scientific scrutiny in the form of critical appraisal by trained reviewers may be accessed in the following journals
- Journal of Prosthetic Dentistry
- Journal of Prosthodontics
- International Journal of Prosthodontics
- International Journal of Oral and Maxillofacial Implants
- Journal of Evidence Based Dentistry
Unfortunately many journals which claim to be peer reviewed routinely publish articles which are scientifically unsubstantiated. Examples include most trade journals, many State or regional dental association periodicals and even the Journal of the American Dental Association.
Sept.16,1999
"It is hardly surprising that many enthusiastic presentations of novel materials and methods lack proper evaluation from a scientific perspective...It would be desirable for such presentations to acknowledge that current information is insufficient to assess the advantages and disadvantages of the new products or procedures."
Carlsson,G.
New Directions in Prosthodontics
Int.J.Pros. 11:537,1998
Dr.J's. commentary:
Teachers and lecturers promoting various instruments, materials or procedures should provide scientific substantiation for their recommendations.
Sept.17,1999
Dr.Jacobson will be lecturing at the Fall Scientific Session of the California Dental Association in San Francisco all day today on Evidence Based Prosthetic Dentistry.
Sept.20,1999
"Patient expectation is at an all time high around the world. Patients have access to the same data that doctors do in many cases, and their knowledge levels increase, as do their expectations and demands. While it is generally a good thing to have educated patients, attending doctors have the responsibility of being informed and being able to deliver learned commentary on what patients hear and read."
Wathen,W.
Evidence Based Dentistry:Is It Worth Changing our Approach to Practice?
Quintessence Int.29:757, 1998
Dr.J's. commentary:
In the future more knowledgeable patients will request evidence to support clinical decisions made by dentists on their behalf.
Sept.21,1999
"Dentistry is a stunningly inexact science...ADA parameters are mostly nebulous generalities that do little to guarantee patients adequate treatment."
Ecenberger,W.
How Honest are Dentists? A Special Report
Readers Digest February, 1997
Dr.J's. commentary:
This recent article in Readers Digest is typical of the kind of information which dental consumers are reading. The lack of science in dentistry is gradually becoming common knowledge among patients. At some point patients will demand evidence to support their health care.
Sept.22,1999
"The process of evidence-based healthcare has three important and distinct steps. The first is asking a clinically relevant question that, if answered, can help clinicians to provide better care to their patients."
"The second is systematic rewiew of all the evidence that may help to answer a clinically focused question."
"The third step is the transfer of evidence-based conclusions into practice."
Ismail,A.I.,et.al.
Systematic Rewiews and the Practice of Evidence-Based Dentistry:
Professional and Policy Implications
J.Am.College Dent.66:5,1999
Dr.J's. commentary:
Ideally, every treatment decision made on a patient's behalf should follow this protocol. Of course, for the short term day to day decisions will be made based upon the current level of knowledge of the clinician.
Sept.23,1999
"A systematic rewiew, according to the Agency for Health Care Policy and Research, is a 'summary of available scientific evidence in which studies are collected, evaluated, and synthesized in accordance with an organized, structured methodology'."
Ismail,A.I.,et.al.
Systematic Rewiews and the Practice of Evidence-Based Dentistry:
Professional and Policy Implications
J.Am.College Dent.66:5,1999
Dr.J's. commentary:
It will be some time before meaningful systematic reviews are available and accessible to clinicians. However, being aware of the process is the first step toward fulfillment of the goal.
Sept.24,1999
Dr.Jacobson is preparing today for tomorrow's lecture at the
University of California entitled
"The Edentulous Predicament: 2000 & Beyond"
Sept.27,1999
"The existence of testimonials from honest people, which claim that ineffective treatments are useful, suggests that reasons must exist that explain the apparent effectiveness of ineffective treatment."
Brunette,D.M.
Alternative Therapies:
Abuses of Scientific Method and Challenges to Dental Research
J.Prosthet.Dent. 80:605, 1998
Dr.J's. commentary:
Factors such as bias and the placebo effect are extremely powerful influences which are capable of modifying the results of research by even well-meaning and conscientious investigators.
Sept.28,1999
"The placebo effect. This refers to the apparent improvement in symptoms that result when either the patient or the provider believe that an efficacious treatment is being applied."
Brunette,D.M.
Alternative Therapies:
Abuses of Scientific Method and Challenges to Dental Research
J.Prosthet.Dent. 80:605, 1998
Dr.J's. commentary:
The placebo effect may only be eliminated by meticulous application of the scientific method to the protocol of the investigation. Only when factors such as randomized assignment to test & control groups, blindness of subjects and investigators, appropriate inclusion/exclusion criteria, & valid statistical analysis are applied to a study can the placebo effect be minimized or eliminated.
Sept.29,1999
"Science is not absolute and what we thought was good scientifically based treatment at a given period in time may be shown to be incorrect at a later period in history"
Goddard,G.
Controversies in TMD
CDA Journal 26:827, 1996
Dr.J's. commentary:
The results of recent scientific investigations such as those cited in the 1996 NIH Consensus Statement on the Management of TMD should influence clinicians to reconsider time honored concepts.
Sept.30,1999
"The take-home message is simple: use unbiased high quality information to guide clinical decision making. Cast aside anecdotal and uncontrolled data, since it will ultimately lead you astray, no matter how enthusiastic or charismatic the messenger is who tells the story."
Laney,W.
Reducing the Variability of Treatment Outcomes
Int.J Oral Maxillo Implants 11:283, 1996
Dr.J's. commentary:
Dentists should question any clinician, manufacturer, teacher, speaker, or colleague regarding the evidence available to support their recommendations.
