May 2019 Volume LIV Number 3


Prove It To Me!

September 2012 Volume XLVIII Number 5

Every day in our practices we carry out a multitude of procedures based upon what is best for our patients. We draw upon our knowledge base, acquired over a long period of training, and eventually an even longer period of experience. The "standard of care"—a legal definition—attributed to the most prevalent practice combined with some measure of substantiation, often determines what we will do for our patients in a given scenario. The most prevalent practice in our minds, without further analysis, is often determined by what we encountered in our specialty training. Yet, as technology, science and disease patterns change, how can we be sure that what we are doing each day remains the most suitable care for our patients? Providing you with the most up-to-date clinical guidelines for caring for your patients is one of the most important roles of the AAPD, via its councils of Clinical Affairs and Scientific Affairs. In recognition of the reality that for some of what we do there is less supporting evidence for the standard of care than for other elements of our practice, we have embarked upon an exceptionally important plan to change the way we prepare many of our clinical guidelines. As all of the available evidence is gathered in preparation for writing each clinical guideline (an extremely important part of the process so as not exclude any aspect of the relevant literature), we will now provide a "weight" to the level of evidence supporting the guideline. By compiling all of the available supportive evidence and then characterizing the strength of that evidence prior to writing a guideline, the clinician can attribute a relative value to the words of the guideline. This important step will obviously differentiate guidelines based upon the availability and strength of all evidence.
Each of us can describe our own successes in our practice as seen within our follow-up visits with our patients. Such collection of information, although anecdotal, is important in determining the quality of our clinical decisions and treatments. There is no denial that what we see as success is indeed success in our own hands. However, the ability to predict success in the form of the best quality outcomes for someone else can only be made based upon having ample evidence to support such prediction. It is in the predictive value for others that the presence of sound evidence is distinguished from anecdote.
Today, there is more literature pertinent to our practices than ever. The rate of change at which technology grows, its application, as well as practice patterns that might (or should) change the way we practice is more rapid than ever. The ability to share information, even when originally published in languages besides English, is greater than ever. The need to maintain connection with the scientific communities that impact our clinical practice has never been more important. For example: it is distinctly possible that the body of literature relevant to emerging technologies in dental caries risk assessment may reside in publications outside of the dentistry arena. Engineering, health services, microbiology and other disciplines have become interested along with us in identifying a solution to the early childhood caries crisis. As the collective body of evidence potentially supporting our clinical practice grows in both quantity and quality, so will the challenge to characterize that evidence in order to make effective and appropriate recommendations to us in our practices, in the form of the AAPD’s clinical guidelines.
Societal and regulatory forces will soon compel us to document the quality of the outcomes of the care we provide. This will make the adherence to the best clinical practices, as supported by the strongest evidence, more important than ever. I often quote the phrase "the absence of evidence is not evidence of absence." There are indeed many clinical practices in dentistry, as in medicine, wherein there is little supportive scientific evidence. In spite of this, our collective clinical experiences and our own individual observations give us confidence in the practices we perform. However, as we have access to a growing body of sound evidence which changes more rapidly than ever, we will be required to stay closely connected with how we must change our practices to maintain the best care for our patients, based upon all that is out there to support that.
The AAPD is a leader in the profession in many ways, as exemplified by the outstanding work of our council and committees. The now upgraded work of the Councils of Clinical and Scientific Affairs will bring the best possible recommendations for care into our practices based upon all that is out there.
Stay tuned and stay connected, and we will prove it to you.