Editorials
Consensus – an alternative way to generate Evidence for practitioners to use( or Evidence based revisited)
Jean-François ROULET DDS, PhD, Dr hc, Prof hc, Professor
Editor-in-Chief
Dear Readers,
Clinical dentistry is a difficult topic because little is either black or white, instead there are many, many grey areas. Practitioners and dental students know that if you present a case to 6 different dentists you will probably generate six different treatment plans, five of which will be similar and one will likely be radically different. Therefore, it is understandable to search for guidelines that are based on sound science. The modern way is to look for reproducible Scientific Evidence( Evidence Based Dentistry). As we know from the Cochrane Collaboration, the highest evidence is given by meta analyses of random controlled double blinded prospective studies( RCT), which is called a systematic review. This should eliminate all bias and produce a trustworthy conclusion. 1 Unfortunately, this approach can introduce at least four more fundamental complications: 1. Not every clinical question can be tested with a RCT. Ethical norms and sometimes costs can severely limit the possible options. 2 2. By limiting the analysis to just RCT and excluding all other information, the analysis is often limited to a few studies with an end result that severely reduces the reliability of the outcome. Often there is no clear evidence of which option to choose and the conclusion of the systematic review is that more research is needed to answer the question. 3, 4, 5 3. Sometimes the inclusion-exclusion criteria are so strong that the articles that are problematic are filtered out, thus diminishing the value of the data. 4. Long observation times( e. g. at least 5 years or more) are preferred, with the assumption that the conditions under observation do not change. This may be true if someone is comparing two drugs or two different surgical techniques. But in restorative dentistry things are different. With evidence based medicine, basically a procedure or medication is administered to the human body and the outcome measure is the reaction of the human body, usually over time( e. g. survival of the individual, blood pressure, mobility of an articulation, etc). However, in restorative dentistry the dentist introduces into the oral cavity a foreign material( e. g., a direct restoration, crown, removable or fixed dental prosthesis). The outcome measure is then how this foreign body behaves under stress in the oral cavity. This is problematic, because its behavior is dependent on many factors: for example patients change their lifestyle over time, and this can have a strong influence on the stress level( e. g., diet may change or a divorce may create bruxing habits). Furthermore it is known that the dentist is the most significant variable when looking at the longevity of the restorations. 6, 7, 8, 9 For these reasons, I personally think that this approach may not be the best, when it comes to giving practitioners the most trustworthy information how to best carry out certain procedures. Since 2014, I have participated in four“ Northern Lights Conference”, key opinion leader conferences held at Dalhousie University in Halifax organized by Dr. Richard Price. So far the objective has been to obtain a consensus
82 Stoma Edu J. 2017; 4( 2): 82-83 http:// www. stomaeduj. com