Without evidence, where goes treatment?

A recent opinion article in Dental Economics went far beyond the bounds of common sense and professional responsibility in dismissing evidence-based science in favor of guru-mania and the evangelists of anecdote.1

A recent opinion article in Dental Economics went far beyond the bounds of common sense and professional responsibility in dismissing evidence-based science in favor of guru-mania and the evangelists of anecdote.1

My concern is that a substantial number of colleagues may latch on to this misguided and, in my opinion, socially irresponsible point of view. There is a small, but vocal, body of practitioners who feel that our universities are completely out of touch with the needs for present-day dental continuing-education courses. They feel that the courses taught in university dental continuing education programs are esoteric and clinically irrelevant by not including the latest and greatest new materials.

Let's face it: to some degree, they are right. University faculty don't always move as quickly as some would like. But this is probably a good thing in some cases, as we have seen in example after example of new material failures in clinical practice over the past few years. The fad materials are introduced with a lot of marketing hype, with testimonials and infomercials from the usual suspects, and then, when they predictably fail, they are recreated as version 2.0, or HP, or some other hype-generating suffix that implies improvement.

And who pays for the clinical failures? Certainly not the weekend guru. Most of the time, it is either the patient or the dentist who ends up eating the cost, not to mention the added retreatment time and discomfort that the patient must accept. By this example, I do not mean to imply that every manufacturer introduces new materials with hype and no evidence. There certainly are some who take their professional responsibilities seriously and ethically.

My opinion is this: Yes, there is some reason to be concerned with the current lack of some dental school involvement in the teaching of some of the current techniques in dentistry. At the very least, dental students should be exposed to as many of the current trends in restorative dentistry as possible before graduation. Even though some may turn out to be fads, students need to see marketing hype in action and learn to develop their critical thinking skills, as they already do in some dental schools.

Dental schools need to adjust elective curriculum time in the final year to accommodate this need. Dental students need to see the new developments, explore the science, and think critically, "Should I use this on my trusting patient?" Students need to understand that their treatment of patients is an almost-sacred responsibility - fellow human beings are entrusting us to treat them with caring, with respect, and with fairness. Is it fair to use patients as unsuspecting research subjects for new materials and techniques? Without evidence in the form of clinical research data, that is what is happening.

So, I do think there is room for improvement in the undergraduate curriculum and in continuing-education courses to reflect new developments. The pre- and postgraduate curricula need to be more nimble. But to use this present temporary situation - that has occurred in an era of extreme time compression for technological advances mixed with manufacturers racing to be first on the market with new developments - to support the claim that academics are Luddites searching for the next machine to destroy is outrageous. Frankly, it would be suicidal for practitioners to isolate themselves from the intellectual life of the university, no matter how out of touch they may feel academicians are at the present time.

Continuing dental education is an essential component of our profession. Of course it must be clinically relevant, but, more than that, it must be scientifically based, medically informed, and socially responsible. It is socially irresponsible to take every new material and jump to the conclusion that this is good for patients simply because Dr. Weekend Guru says so.

There is an urgent need for today's practitioners to appreciate the relevance and the excitement of applying today's scientific advances to the practice of dentistry and an urgent need for dental schools to address this in pre- and postgraduate curriculum changes. Education - all education - must be scientifically based. Evidence-based research is not a "laughable" goal.

Research and scholarship are essential elements of university-based continuing dental education. Our dental schools continue to play a crucial role in the dissemination of critically evaluated practice advice to dental practitioners - to ignore this is socially irresponsible.

Without evidence, where goes treatment?

Reference: 1. Davis, MW. The great dental debates: Viewpoint. Dental Economics, 2000:15-16.

Richard J. Simonsen, DDS, MS
Minneapolis, Minn.

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