Oct.1,1999
The daily literature review and commentary on the subject of Evidence Based Dentistry which began September 1 will continue through the month of October.
Oct.4,1999
"When big businesses buy benefits for employees...they want some "evidence" that the treatment provided is quality treatment...evidence based care is an expression of accountability."
Foti,S.K.
Evidence Based Care Approaches Dentistry
Impact, A.G.D. 27:8,1999
Dr.J's. commentary:
A recent edition of the periodical sponsored by the Academy of General Dentistry was devoted to the movement by managed care programs and insurance plans to require scientific evidence of efficacy prior to payment for services rendered.
Oct.5,1999
"A new wave of dental plans is on the horizon...plans having evidence-based practice at their core.... No longer is cost the sole motivating factor in plan selection."
Singer,L.J.
Evidence Based Dental Plans:
Dentistry's Future Is Now
J Am College of Dentists. 66:21,1999
Dr.J's. commentary:
Just as patients are slowly becoming more aware of evidence based health care, governments and third party payers are becoming informed.
Oct.6,1999
"Treatment outcome measurement is the "sizzle" that many plan purchasers are demanding these days...they want statistically valid evidence. "
Singer,L.S.
Evidence Based Dental Plans:
Dentistry's Future Is Now
J Am College of Dentists. 66:21,1999
Dr.J's. commentary:
If dentists do not continue to progress with the evidence based movement voluntarily we may be forced to follow protocols developed and supported by third party organizations.
Oct.7,1999
"Outcomes assessment are showing us what works and what doesn't work. Probably, in the not too distant future, dental procedures will not be reimbursed by third parties unless there is long term support of evidence. Third parties will no longer soley rely on clinicians hunches, intuition, or the dogma of where they were trained."
McGuire,M.
Vice President, American Academy of Periodontology,
1999
Dr.J's. commentary:
Already some insurance companies are reconsidering reimbursement for procedures which are scientifically unsubstantiated.
Oct.8,1999
"There is no evidence to support 6 month cleanings for everybody, yet about 20% of the population are high risk and should be seen more often."
Joseph Leben, D.M.D.
Assistant Dental Director
Kaiser Permanente Dental Care Program
1999
Dr.J's. commentary:
At this time there are numerous procedures & protocols routinely utilized by practicing dentists for which there is little or no scientific substantiation.
Oct.11,1999
"The ideal decision-making process is deduction:Where the clinician examines the facts from available studies that are properly designed prospective, randomized clinical trials."
"We should not be paralyzed by the present scarcity of deduction in our daily decision-making processes, because the reality is that patients are waiting to be treated. Treatment decisions must be made with the best available evidence that exists."
Jacob,R.F.
The Traditional Therapeutic Paradigm:Complete Denture Therapy
J.Prosthet.Dent.79:6,1998
Dr.J's. commentary:
Although scientific evidence is lacking for many of the clinical decisions made daily by dentists, we must strive to remain informed of valid research results which will permit deductive decision making in the future.
Oct.12,1999
"The second decision making process involves induction:Where the clinician considers therapies that "ought to work" based on his or her own clinical experience or by taking an educated "leap of faith" to extend current concepts of treatment beyond what has been proved."
"As clinicians, we may be satisfied with inductive decision-making.
At least some of the time, our decisions will be the correct ones, although research has yet to prove them correct."
Jacob,R.F.
The Traditional Therapeutic Paradigm:Complete Denture Therapy
J.Prosthet.Dent.79:6,1998
Dr.J's. commentary:
At this time given that dentistry is only beginning to establish evidence based parameters, the majority of daily clinical decisions will be made by induction.
Oct.13,1999
"The third decision-making process is termed seduction:Where the clinician plans treatment based on conversations with colleagues, manufacturers advertisement, testimonials, case reports, and limited case series with minimal follow-up and vague inclusion/exclusion criteria for patient selection."
Jacob,R.F.
The Traditional Therapeutic Paradigm:Complete Denture Therapy
J.Prosthet.Dent79:6,1998
Dr.J's. commentary:
Hopefully, as dentistry progresses and becomes increasingly evidence based, dentists will make fewer and fewer decisions based upon seduction.
Oct.14,1999
"...there is a widening of the gap between those who seek the why and those who seek just the how...there are those who are demanding more and more prospective clinical trials to help them better treat their patients, and they're not just ivory towered academics...on the other hand we have practitioners..." whose "...principal source of continuing education is what they read in the freebies, the unsolicited dental magazines that arrive weekly."
"Without constant critical vigilance, even the most informed reader might be bamboozled. The amazing clinical illustrations, the smooth writing style, and the perceived ease of the procedure have fooled innumerable practitioners."
Lloyd,P.
Editorial, The Gap Is Widening, and I'm Concerned
J.Pros.8:71,1999
Dr.J's. commentary:
Regardless of the amount of time a dentist devotes to C.E. monthly the source should be critically evaluated. Time spent reading scientifically unsubstantiated literature would be better utilized seeking valid information from reliable journals.
Oct.15,1999
"Go to work today and treat your patients, go home at night and read your journals, and then go to work tomorrow and apply the new information you have learned. Your patients will appreciate it."
Greene,C.S.
Letter to Editor
J.Prosthet.Dent. 81:250,1999
Dr.J's. commentary:
This recommendation by Dr.Charles Greene represents the essence of evidence based dentistry.
Oct.18,1999
"Dental education must be scientifically based and acquisition of new scientific and clinical knowledge is to be valued and actively pursued."
"Learning is a lifelong enterprise for dental professionals that cannot stop with the awarding of a degree or the completion of a residency program."
The Institute of Medicine
Study of Dental Education
Issues Affecting Prosthodontics
1996
Dr.J's. commentary:
Many of our dental schools have continued to teach concepts in prosthodontics which have been questioned or disproven by recent scientific research. Such practices contribute to misunderstanding and confusion.
Oct.19,1999
"Schools should expect all faculty to be critically knowledgeable about scientific advances in their fields and to stay current..."
Felton,D.A.
A Graduate Student's, Graduate Director's and Chairman's Perspective of the Dentist Scientist Award Program
J.Prosthet.Dent.75:671, 1996
Dr.J's. commentary:
Many of the RPD design concepts traditionally taught in dental schools were originally developed empirically by small groups of dentists based upon their clinical experiences 20-40 years ago. Despite the lack of scientific substantiation for some of these concepts, teachers persist in dogmatically perpetuating what often amount to nothing more than myth & heresay. We need to critically reevaluate our current RPD design concepts based on the results of scientific research.
This web-site will address these issues in the upcoming months.
Oct.20,1999
"Implant use has increased so quickly that questions concerning the efficacy and especially the effectiveness of oral endosseous implants for many clinical applications lack scientific trials."
Guckes,A.D.,et.al.
A Conceptual Framework for Understanding Outcomes of Oral Implant Therapy
J.Prosthet.Dent.75:633,1996
Dr.J's. commentary:
It may be that implant prosthetic dentistry has served as a major force driving the movement of evidence based dentistry. Generally, the consequences for the patient of poor decision making in most phases of restorative dentistry are relatively minor. However, the morbidity associated with scientifically unsubstantiated selection of procedures, materials, or instrumentation can be quite severe in the field of implant assisted restorative dentistry. As a result dentistry is compelled to be more evidence based in this arena.
Oct.21,1999
"...the reality even today is that the decision to use implant supported prostheses is made without clear evidence of comparative benefit over conventional prostheses (with the possible exception of dental implants used in the edentulous mandible of the maladaptive patient.)"
Carr,A.B.
Successful Long Term Treatment Outcomes in the Field of Osseointegrated Implants: Prosthodontic Determinants
Int.J. Oral Maxillo Implants 11:502,1998
Dr.J's. commentary:
Although many dentists often believe that the implant supported prosthesis provides the most ideal treatment plan alternative, there is little scientific evidence to prove this belief. Until studies demonstrate the clinical superiority of implant supported prostheses in terms of treatment outcomes measuring patient satisfaction, we can only assume that the procedures offer advantages over conventional approaches.
Oct.22,1999
"There is no question that dental implants can be an effective modality for providing prosthesis support. The only question is, when should they be used in place of time tested conventional treatment options in like clinical situations? This question cannot be answered without formal comparisons providing clear evidence that implant supported prostheses are as good or better for patients with similar clinical conditions."
Laney,W.R.
Considering Treatment Options
Int.J. Oral Maxillo Imp. 13:593,1998
Dr.J's. commentary:
This dilemma described by Dr.Laney is one example of the need for evidence based decision making in dentistry. Fortunately the movement is occurring and answers to many clinical questions will be provided as we move through the year 2000 and into the next millenium.
Oct.25,1999
"It has been suggested that patients are the best judges of which factors determine treatment outcome...Neither assessments made by clinicians nor "objective" measures of function necessarily reflect the way that a patient feels and functions...In this context the clinical scientists have to work with patients to identify and quantify the important factors and to express the outcome of clinical trials in these terms."
Feine,J.S. et.al.
Outcome Assessment of Implant Supported Prostheses
J.Prosthet.Dent. 79:575,1998
Dr.J's. commentary:
The most recent buzzwords in evidence based dentistry are "Patient Centered Treatment Outcomes".
Oct.26,1999
"The health professional is striving to assess patient centered treatment outcomes....One must not only design a sound and often complicated research investigation to determine if treatment A is more effective than treatment B, but he or she must also include a patient assessment to determine if a patient can discern and is satisfied with the differences in the outcomes of treatment A and treatment B."
Lamb,D.J. & Ellis,B.
Comparison of Patient Self-Assessment of Complete Mandibular Denture Security
Int.J.Pros. 9:309,1996
Dr.J's. commentary:
It appears that providing evidence of improved performance as measured through traditional parameters established by the investigator are important but not sufficient to unequivocally prove clinical superiority. In addition it is becoming increasingly apparent that the technique or materials being evaluated should be perceived as superior from the patients perspective. Essentially, does the patient perceive an improvement in his/her quality of life as a result of the application of the technique or material in question?
Oct.27,1999
"Like everything else we seem to meet in life, EBD requires much more effort. But, as in everything else, the reward for expending the effort is far greater than wasting along in a rut of self-complacency."
"Evidence based dentistry is hard.It makes you question.You have to think about what you are doing and then seek information to check. You have to read scientific journals and assess the validity of the papers. You have to keep abreast of current thinking and question past assumptions. "
Grace,M.
The Referance of Evidence
Quintessence Int. 29:802,1998
Dr.J's. commentary:
These practitioners who seek out scientific substantiatum for their decision making will ultimately be rewarded with the confidence that accompanies knowledge.
Oct.28,1999
"We are experiencing accelerated changes in the final decade of the 20th century. There have been more scientific and technical publications in the first five years of this decade than in the entire history of mankind. "
Slavkin,H.
Editorial. Compendium of Cont. Dent.Ed. 1997
Dr.J's. commentary:
The amount of scientific information that is published is increasing geometrically. Dentists must develop a method of filtering this information so that quality time can be spent studying valid, clinically relevant literature. This website will assist dentists in this objective by screening the prosthodontic literature. Concise statements pertaining to selected topics will be presented reflecting a consensus of the recent relevant referenced literature.
Oct.29,1999
"So what are we to believe as we sift through the data rich world of the millenium. How can we have confidence that what we read, see, and hear is valid and will improve our chances of satisfactory patient outcomes. "
Wathen,W.
Evidence Based Dentistry: Is It Worth Changing Our Approach to Practice? Quintessence Int. 29:757,1998
Dr.J's. commentary:
Be discerning of the literature you choose to read. Be demanding of the speakers and teachers to whom you listen. Be skeptical of commercial sponsors promoting ideas that are self-serving. On a lighter note......Don't believe everything you read...unless you wrote it yourself...and even then you should have a reasonable doubt."
