“Evidence-Based Dentistry” supports smarter clinical translation
Watch Dr. Gordon Guyatt’s April 21 lecture, “Why Bother With Evidence-Based Dentistry?” at the Faculty of Dentistry.- Watch Dr. Guyatt’s April 21 lecture, “Evidence-based Medicine: Past, Present, and Future.”
“Before evidence-based medicine, something was going very wrong,” said Dr. Gordon Guyatt during his aptly titled Dean’s Lecture on April 21, “Evidence-Based Medicine: Past, Present and Future”
Prior to the 1990s, new medicines and protocols were routinely put in place, claimed Guyatt. But in some cases those protocols – relying on the strength of a few and potentially biased reviewers – were costing lives.
All that changed when, according to Guyatt, a Distinguished Professor in the Departments of Clinical Epidemiology & Biostatistics and Medicine at McMaster University, there was a cultural shift in medical evidence and translational practice.
Guyatt, widely credited with coining the term “Evidence-based Medicine,” argued, “prior to the 1990s, the people making the recommendations didn’t have systematic reviews and meta-analysis.”
But with the advent of big data, evidence-based medicine has been able to build solid evidentiary-based protocols. And while Guyatt’s experience is based in medicine, the case for evidence-based dentistry is the same, he argues, whereby professionals can make smarter choices for their patients.
“Scientific evidence is a crucial underpinning of clinical practice,”cited Dr. Amir Azarpazhooh, who has collaborated with Dr. Guyatt in establishing a users’ guide and practical approach to evidence-based dentistry. “Professor Gordon Guyatt coined the term “evidence-based medicine” in 1991 [to describe] an approach that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient’s condition and history, with the clinician’s expertise and the patient’s treatment needs and preferences.”
Adapted from the University of Toronto faculty of Dentistry Website
…”something was going very wrong” intimates that nothing good was happening in the health profession. Sorry, can’t buy that. “People making the recommendations” had experience and clinical judgement to rely on, and that often did a pretty good job in many cases. Evidence-based medicine and/or dentistry is a laudable goal, but its “underpinning” is excellent clinical research. This is not the strongest area in clinical dentistry, and one must remember that (no matter how you don’t want to hear this) researchers are not holy, but are subject to peer pressures, ego, bias and even corporate influences. Systematic reviews based on poor (yet still published incredibly enough) research are less than useful, and perhaps even harmful, because they lead to bad conclusions. If the “best available is lousy, then so are your conclusions. Systematic reviews should not be revered as gospel, but as an interesting piece of information that should lead one to more critically review the review itself to see if its “underpinnings” are indeed truly valid. I’ve seen too many EBD proponents who say that successful clinical procedures that I do every day can’t actually work to give them any credence at all. EBD is a great goal, but we’re a couple of decades of good dental research away from it becoming the All-Knowing Divine Oracle of clinical dental practice.