Are We Comfortable Practicing Evidence-Based Dentistry?

Moving dentistry forward through the utilization of clinical research

Bobby Birdi, DMD, MSc

The phrase "evidence-based dentistry" has been used for many years in both academic and private practice environments. However, it can be difficult to understand what this really means to the profession today. What is evidence-based dentistry? How much evidence is needed, what kind of research is considered ratifying, and is evidence-based dentistry applicable to clinical practice in a realistic way?

With the ever-growing advances in materials, techniques, and digital technologies, it can be very challenging to keep up with the evidence supporting new innovations. A significant amount of amazing research continues to be conducted regarding all aspects of dentistry; however, as a clinician, you have to sort through it all to decipher if and how it can be applied to your clinical practice. Much of the research conducted may not be applicable to practice in a realistic way, and this creates a disconnect between academic and clinical practice arenas. Furthermore, empirical and anecdotal evidence continue to influence the decisions of private practitioners, which are also clouded at times by the messages of corporate entities. This can create a false sense of security and validity around certain advances. Furthermore, as clinicians, we should always weigh the risks of implementing new innovations in our practices against the potential benefits and avoid rushing into anything that is not appropriate.

Conversely, new evidence-based advances that push the envelope may challenge how clinicians have "always done things," which may make them uncomfortable about implementing new innovations that are actually appropriate for them. I have seen this in many instances where dentists continue to utilize treatment modalities and methods that may be dated and at times too traditional in their approach. This can lead to a slowing of the progression of dentistry, which may attenuate the potential benefits to clinicians and, ultimately, their patients. As a profession, we need to be better at challenging our beliefs and methods to benefit everyone.

So where do we draw the line between being too progressive and being too traditional? One last aspect of this dilemma is the cost involved in attaining and utilizing new technologies, such as intraoral scanning systems and 3D printers. Moreover, even if new technologies are attainable financially, how are clinicians supposed to find the time in their already busy practices and lives to become properly educated to use these new tools on a routine basis?

What we have found in our group practices is that clinical trials and clinical research are what we rely on most in progressing our techniques and implementing new technologies and materials. But first and foremost, any new innovation must make realistic sense for both our practices and patients. Clear and practical benefits of implementation must be indicated before we even think about adding something new or doing something differently. In addition, a new innovation must build on our previous clinical knowledge and methods. For any new protocols, we look to see that there are multiple corroborating clinical trials that support them. These clinical trials must be properly powered, well structured, and without bias. At times, this evidence can be very difficult to find, but we believe that this is the only way to feel confident about progressing our modalities.

The pursuit of clinical trials and clinical research that produce innovations that can be practically implemented in dental practices is how we will continue to progress and move forward as a profession. Although we must do this cautiously and with scrutiny, as dental professionals, we must also not be reluctant in implementing innovations if the evidence supporting them has been corroborated by studies in multiple publications. Universities and specialists should continue to be the voices of reason in our profession as we progress; however, this means that they must also remain up to date and be open to change. Innovation and modernization are necessary for our profession to move forward, but for that to happen in an evidence-based manner, these forces need to be driven by clinical trials supporting advances that can be practically implemented.

About the Author

Bobby Birdi, DMD, MSc, is a dual board-certified periodontist and prosthodontist with a private practice in Vancouver, Canada. He is the founder of the BC Perio Dental Health & Implant Centre and a cofounder of the Digital Dentistry Institute.