The term “evidence-based” receives considerable usage by both academicians and clinicians in today’s professional dental environment. In some cases it is appropriately used, but often it is inappropriately applied. According to David Sackett, a pioneer of evidence-based decision making, “evidence-based practice” is the conscientious, explicit, and judicious use of current best evidence when making decisions about the care of a patient. Evidence-based practice means integrating individual clinical expertise with the best-available clinical research: ie, systematic reviews and randomized controlled trials. So how do you know if you have an evidence-based practice? Let me create some clinical examples so that you can assess how you might approach each situation.
Suppose you’ve just placed orthodontic brackets on a 12-year-old girl and inserted a 0.014-in nickel-titanium archwire. As is typical with your routine on first appointments, you have the parent back to the treatment area and describe what you have accomplished. The parent asks whether the daughter will have any tooth pain and, if so, what to do. You suggest ibuprofen, but the parent states that her daughter cannot take this drug and asks what else besides drugs would be effective at relieving the pain. Do you know the answer? Is it evidence-based?
During your lunch break, you decide to stay at your desk in your private office and complete some overdue correspondence with referring doctors. During this time, a dental supply representative comes and asks for a few minutes of your time. You agree, and he tells you about a new self-etching primer that eliminates several steps in the bracket-bonding process. You’ve traditionally used a conventional etch-and-rinse technique. Should you now change your protocol? Should you believe what the rep tells you? Is his information evidence-based?
One of your afternoon new-patient examinations is a young woman with an Angle Class I malocclusion, a beautifully aligned maxillary dentition, and about 4 mm of mandibular incisor crowding. The only reason for treatment of this woman would be to align the mandibular dentition. But her mandibular incisors are not visible when she talks or smiles. Here is her concern: she wants to know whether the incisor crowding will increase her risk for dental decay in the future. How would you answer her? Would your answer be evidence-based?
During your afternoon patient consultation, you’re proposing and discussing some complicated orthodontic treatment with a young man. He will need miniscrews to enhance anchorage, if you are to accomplish your treatment goals. Although you could place the miniscrews yourself, you choose to refer him to the periodontist in your building. You give the patient a referral slip, and then he asks you about the success rates for miniscrews, especially in the location where they will be placed. In addition, he wants to know whether there are risk factors that he should consider before having miniscrews placed. How would you answer? Is your answer evidence-based?
During the after-school rush in your office, you encounter an adolescent patient with poor oral hygiene. You’ve been critical of his past performance with a toothbrush, and you’re considering suggesting the use of MI Paste Plus to help prevent potential demineralization of the enamel around the brackets. So, you have the parent come back to the dental chair, and you give her a sample of the MI Paste. You suggest that she should buy more of this product at the pharmacy for the boy to use regularly. Then, the parent asks whether MI Paste has been proven to be effective at reducing demineralization. How would you answer? Is your answer evidence-based?
The answers to each of these 5 questions can be found in systematic reviews or randomized controlled trials published during the preceding 12 months in the AJO-DO . You can access this information in seconds on the AJO-DO ‘s Web site. So what’s stopping you? The next time your patient asks you these types of questions, log onto the AJO-DO ‘s Web site, type in a few key words in the search box, and use the Journal as your lifeline to the best systematic research. Then you will have an evidence-based practice.
