Evidence-based dentistry | British Dental Journal

When I was first appointed as editor to the _BDJ_ (1992) I was told repeatedly by general dental practitioners that they were just not interested in research papers and that the _BDJ_ should

publish practical, clinical 'how to do it' articles instead. I know for a fact that this is the experience of most other editors of association journals. Yet this issue of the

_BDJ_ (as do many others) illustrates how relevant and important much of the research published in the _BDJ_ is to GDPs, and how helpful these papers can be in the day-to-day care of

patients. I was particularly taken by the paper _General dental practitioners' knowledge of and attitudes towards evidence-based practice_ in this issue by Iqbal and Glenny. While the

title is a little dry (they have to be to enable electronic database searches to work) the content is most definitely not. Apart from anything else the paper contains the best definition of

evidence-based dentistry I have seen, although it is hidden away in the text on page 590. The definition simply states that evidence-based dentistry (EBD) is 'practice that integrates

evidence, clinical experience and patient preference'. The paper contains much more of value, especially in the introduction and discussion, and I recommend reading the whole paper.

However, I wish to return to the subject of EBD and consider it in more detail. I shall use the definition I have just described as a framework, starting with the last point - patient

preference. Dental practice involves the care of patients, both clinical and non-clinical. Obviously EBD focuses on the clinical but we must never forget the non-clinical because that is

such an important part of the patient experience. Many years ago the concept of patient involvement in clinical treatment decisions was not only fairly unusual in practice, but also seen as

unnecessary. Patients were supposed to accept the advice handed down by the professional without question and simply pay the bill at the end. Not so today, although I do not believe

treatment decisions are always as equally shared between dentist and patient as they should be, and it is refreshing to see that EBD recognises the importance of the patient's views in

the whole process. > _Dental practice relies heavily on clinical experience. . . > situations that cannot be simply analysed in textbooks or research > laboratories._ The next

factor (still in reverse order) is clinical experience, which hopefully includes clinical judgement (not quite the same thing). Dental practice relies heavily on clinical experience, mainly

because that is what most dentists have in situations that cannot be simply analysed in textbooks or research laboratories. We know what tends to work in our hands and with certain types of

patients. Or at least, we think we do. Sometimes we are wrong, and hopefully we always learn from that. Nonetheless, clinical experience is important, if simply because of the differing

competences, skills and abilities of different dentists at different times. Finally we have the evidence itself, such as it is. As science progresses there is no doubt that the evidence that

might have satisfied us twenty years ago no longer always does so, which is why it is so important to understand what is happening with the Cochrane Collaboration (see the Iqbal _et al_

paper for more information on Cochrane) and similar ventures, such as _Evidence-based Dentistry_ (the journal). But just because evidence is still lacking in some areas does not mean we can

discount it. While EBD should be a mix of evidence and clinical experience we cannot ignore the evidence because clinical experience has 'been all right until now'. Checking we

have appropriate evidence for our treatment is vital, and to my mind it is unthinkable to ignore evidence for the best way to treat patients, regardless of previous preconceptions. We have a

duty to investigate the evidence, and where it conflicts with past experience then we must consider it and where appropriate change our behaviour accordingly. This is not only common sense,

it is a responsibility we have to those who put their trust in us - our patients. So, the final piece in the equation is the source of that evidence, and here the paper by Iqbal and Glenny

sounds a warning note. It appears 60% of GDPs in their study turn to friends and colleagues for evidence rather than looking in a textbook or an electronic database. Surely, if we have a

responsibility to seek the best evidence in our treatment decisions then we must ensure that the evidence is the best available as well, as we would if looking for our own benefit. AUTHOR

INFORMATION AUTHORS AND AFFILIATIONS * Mike Grace Authors * Mike Grace View author publications You can also search for this author inPubMed Google Scholar RIGHTS AND PERMISSIONS Reprints

and permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Grace, M. Evidence-based dentistry. _Br Dent J_ 193, 545 (2002). https://doi.org/10.1038/sj.bdj.4801624 Download citation * Published: 23

November 2002 * Issue Date: 23 November 2002 * DOI: https://doi.org/10.1038/sj.bdj.4801624 SHARE THIS ARTICLE Anyone you share the following link with will be able to read this content: Get

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