Keeping Up With Evidence-Based Dentistry

The science and practice of dentistry are evolving at a record pace, and it has become extraordinarily difficult to keep up with all of the changes. The half-life of the information we learned in dental school (assuming it was current at the time) is said to be five years. By definition, if you don’t keep up, you fall behind.

Today, there is an emphasis on evidence-based dentistry, a concept that involves making clinical decisions based on the best available scientific information. Under ideal circumstances, this information is fused with the patient’s needs and desires. That said, it is difficult to do these types of studies well, meaning that oral health professionals will sometimes find a dearth of articles relevant to the information they are seeking. In other cases, the literature exists, but the clinician lacks the skill to discern its clinical relevance and merit. In these circumstances, how can you find appropriate material?

Today, there is an emphasis on evidence-based dentistry, a concept that involves making clinical decisions based on the best available scientific information

Some of us are fortunate enough to practice with more experienced colleagues who do not mind sharing their knowledge of the literature, as well as daily practice skills. For those who are just starting practice or moving to a new setting, this can be an ideal way to learn. Not everyone finds himself or herself in this situation, however.

Study clubs, which come in all forms, are a great way to keep current. For years, I was a member of a group that reviewed the periodontal literature. We also attended practice management seminars. It was a highly focused group of like-minded clinicians who faced the same problems. Even though we were competitors, no one held back information that might have been helpful to the group. It was great while it lasted, but, eventually, everyone but me retired. If you can find a group like this, join it.

Some study clubs have commercial tie-ins and may be affiliated with a dental manufacturer or other commercial enterprise. In these situations, the manufacturer often presents information about its products or services to the exclusion of others. This doesn’t mean that you can’t get good information in these forums. In fact, I have been a member of one since 1991 and have gained a great deal of knowledge. Furthermore, I think my patients are better served as a result of my participation. One must recognize the potential for bias, however, and exercise due diligence during the information-gathering process.

Another way to keep current is to go back to school. A number of my friends practiced general dentistry for a few years and then decided to get more training. This is not a simple decision, but it can be rewarding personally, professionally and economically.

There are also for-profit continuing educations (CE) centers, some of which offer affiliated study clubs. I have participated in one over the last few years and have greatly expanded my knowledge of restorative dentistry. The quality of information provided at these centers varies greatly, however, as does cost — so choose wisely.

With all the changes in techniques and materials, how do you decide what CE to take and where to take it? First, consider the source. Aside from going back to school, one of the purest forms of information exchange is the private study club previously mentioned; there are no sponsors and no money changes hands. Another option is to read. The most up-to-date data are commonly found in refereed journals (you are reading one now). Papers sent to these journals are reviewed by experts, who comment on the material and recommend rejection or acceptance, often with suggestions for revisions. If the paper is found acceptable after appropriate modifications, it is published.

One of the purest forms of information exchange is the private study club. … Another option is to read. The most up-to-date data are commonly found in refereed journals

When seeking CE, consider the source of the information carefully. Some courses have commercial ties that are obvious — but ties can also be subtle. In some cases, sponsorship can influence the content; in other cases, it has no bearing on the material.

The quality of information available online varies significantly. In this environment, it is important to consider any factors that may influence the content. Many online CE portals offer high-quality, evidence-based information that’s free from commercial bias. On the other hand, you will also find so-called educational offerings that run the gamut from private practitioners who want to show you how cool they are, to sophisticated material put together by companies that want nothing more than to sell you their products and services.

Here again, websites hosted by refereed journals are typically a good source for information. Another credible online resource is the American Dental Association, which offers its members access to The Center for Evidence- Based Dentistry. This website provides systematic reviews, along with clinical recommendations. Some of the reviews contain summaries that help providers apply the information in the literature into clinical practice.

Ultimately, we have an obligation to our patients to keep current with the literature and understand — and implement — changes in practice standards. While most dental schools are doing more to teach students how to research and read studies critically, practicing professionals must dig in to find the best available scientific-based information upon which to base clinical decisions. It takes effort, yes — but the rewards are worth it.

From Decisions in Dentistry. July 2016;1(09):6–7.