From EBM, to EBD, EBO and… EBP
Evidence underpins medicine, dentistry and most recently orthodontics, but what about dentistry practice?
There is nothing mysterious or magical about evidence-based care, according to Professor Greg Huang, of the University of Washington’s Dental School. It just means, he says, that we need to have a good understanding of the principles of clinical research, and then “integrate the evidence with our education/experience and the patient’s preferences/condition”.
Huang is co-author of the book Evidence-Based Orthodontics and will be in the UK this autumn to deliver the Northcroft memorial lecture at the British Orthodontic Society’s annual conference in Glasgow. He will describe the findings from a large, prospective, practice-based network study conducted in the United States. The aims of the study were to assess practitioner recommendations, patient acceptance, treatment outcomes, patient satisfaction, and long-term stability.
While chance is an important factor in medical breakthroughs, it is the antithesis of good medical care”
Ahead of his visit, Professor Huang answered questions from Ireland’s Dental. His entry into the field was completely by chance, he reveals. When he began his academic career, he had decided to pursue a degree in epidemiology in order to improve his knowledge of clinical research. It happened to coincide with the development of evidence-based medicine and, subsequently, evidence-based dentistry. After completing his epidemiology degree in 2001, Huang started to receive invitations to speak on evidence-based orthodontics and, eventually, to write a textbook on the subject.
Chance is often a factor in the development of a new field or technology. The father of evidence-based medicine, Professor Archibald Cochrane, drew on his own experience as a young man struggling with a medical condition and later, after medical training, on his time as a prisoner of war in Greece and Germany tending to fellow inmates, to undertake the primitive clinical trials which ultimately resulted in his watershed book Effectiveness and Efficiency: Random Reflections on Health Services, with its memorable declaration: “You should randomise until it hurts”.
But while chance is an important factor in medical breakthroughs, it is the antithesis of good medical care. It is an issue which another subject of this edition, Derek Richards, has made a point of in his 20-year tenure as editor of the Evidence-Based Dentistry journal. His highlights from 20 years of reviews are featured on p37-38. Looking back, says Richards, there has been
a steady increase in both the number of trials and the number of systematic reviews available in dentistry. The Cochrane Oral Health Group has been at the forefront in producing high-quality systematic reviews. However, says Richards, many of these reviews continue to highlight in their findings that there is a lack of high-quality studies to answer the questions that are being asked.
Another challenge, he argues, is the broad range of outcomes measured by researchers. The lack of common or core outcomes measures continues to present challenges to systematic reviewers, argues Richards. The Core Outcome Measures in Effectiveness Trials Initiative aims to bring interested parties together, and there is some ongoing work in a number of dental areas including caries, periodontal disease, and cleft lip and palate. “Improving the quality of conducting and reporting research should facilitate the production of good quality reviews to drive and inform practice,” says Richards. “However, even where we have good evidence, the translation of research into practice and policy continues to present challenges, as evidence of good practice is not readily adopted and where ineffective interventions are not stopped. So, while the past 20 years have seen progress in developing the evidence base of dentistry there is still much to be done in developing evidence-based practice (EBP) in the profession.”
Will Peakin is Editor of Ireland’s Dental magazine firstname.lastname@example.org. Follow Ireland’s dental on Twitter.