The evidence of the kitchen stool

April 1, 2004
Who does not remember the 1997 article published in the Reader's Digest that reported the variation in dental care? Many dental professionals were publicly outraged that it was published.

by Kristine Hodson

Who does not remember the 1997 article published in the Reader's Digest that reported the variation in dental care? Many dental professionals were publicly outraged that it was published. Privately, many felt that there is a broad gap in diagnostics, especially when considering practitioners' skills, career experiences, and education. The media attention led to patients asking even more questions about their dental treatment.

When the "second opinions" and questions increased, many of you thought (as I did too) of sentiments such as, "How dare Mrs. Happy Patient of five years now begin to challenge my recommended treatments."

I often have heard that the media always "shines its investigative eye on the poor, unassuming dental profession." To quote a friend from California, I respond, "Bring it on!"

If you, your child, or loved one was facing a minor or major medial surgery, isn't it appropriate for you to ask about other options, success rates, additional resources, or a second opinion? Why do some members of our profession get upset when our patients question what we diagnose.

My mother-in-law, who just recently celebrated five years free of breast cancer free, began her recovery by investigating a new drug, Letrozole. A nurse by profession, she was curious if she would be an appropriate candidate and approached her physician with the suggestion. Was she met with a holier-than-thou attitude? No, quite the opposite. Together, the physician and my mother-in-law researched the risks and benefits. Together, they made an evidence-based health-care decision.

The phrase, "evidence-based decision," is popping up in every magazine and on every convention calendar. And, quite frankly, I welcome this new focus on research. I think of an EBD as a kitchen stool with three legs. The first leg represents the clinician's experiences and knowledge, the second leg represents, the most current, clinical evidence/research on a topic (a service, treatment, or product), and the third leg represents the patient's concerns and values.

My mother-in-law absolutely should be involved in the evidence-based decision of whether or not to start using a new drug therapy. As a professional, her doctor's experiences and knowledge of the drug also needed to be considered. Finally, health-care providers must be able to support recommendations and drug protocols with current clinical research.

All three aspects of an EBD was present and successfully supported her decision. All three aspects of an EBD must be considered if we are to support our dental hygiene treatment plans and product recommendations.

Let's have a paradigm shift in regard to the Reader's Digest article. Instead of moaning that the media is unfair or biased toward our profession, it would have been quite enlightening if one of the dentists who was quoted in the article had, in turn, provided the clinical research that supported the treatment recommendations. A dental office with the mission of practicing evidence-based dentistry and hygiene could have very easily written a letter to Reader's Digest — or contacted a television news outlet such as 60 Minutes — and said, "Bring it on! Come interview us. We can provide systematic reviews or randomized controlled studies to support our treatment services and product recommendations."

It's not what sensational headlines are made of, and it probably would not have made it into the "sweeps" weeks. But it would have propelled our profession's credibility with the public.

Think about the proverbial kitchen stool mentioned earlier. All three legs need to be present in order to form an EBD. Why do you recommend x-y-z product? Did you make an evidence-based decision? Did you hear a compelling sales message that you believed? Is it your personal opinion? Are our hygiene services or product recommendations evidence-based, or are our stools lopsided?

Kristine A. Hodsdon, RDH, BS, is the Northeast manager of professional education for Oral-B Laboratories. She is the author of Demystifying Smiles: Strategies for the Dental Team. She is known for her high-energy, high content how-to presentations and articles. She can be contactedat [email protected].