EDITORIAL
Do you have an evidence-based practice?
Vincent G. Kokich, Editor-in-Chief
Tacoma, Wash
T
he term “evidence-based” receives considerable
usage by both academicians and clinicians in to-
day’s professional dental environment. In some
cases it is appropriately used, but often it is inappropri-
ately applied. According to David Sackett, a pioneer of
evidence-based decision making, “evidence-based prac-
tice” is the conscientious, explicit, and judicious use of
current best evidence when making decisions about
the care of a patient. Evidence-based practice means in-
tegrating 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 par-
ent asks whether the daughter will have any tooth pain
and, if so, what to do. You suggest ibuprofen, but the par-
ent 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
Am J Orthod Dentofacial Orthop 2013;143:1
0889-5406/$36.00
Copyright Ó 2013 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2012.11.001
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 in-
crease 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 treat-
ment 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 ad-
dition, 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 en-
counter an adolescent patient with poor oral hygiene.
You’ve been critical of his past performance with a tooth-
brush, 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 ques-
tions, log onto the AJO-DO's Web site, type in a few key
words in the search box, and use the Journal as your life-
line to the best systematic research. Then you will have
an evidence-based practice.