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