My spin on EBD

May 1, 2006
The best thing about evidence-based dentistry is that, as Trisha O’Hehir used to say, it forces you to become an “oral health detective.

The best thing about evidence-based dentistry is that, as Trisha O’Hehir used to say, it forces you to become an “oral health detective.”

There are, however, three problems with evidence-based dentistry.

First, don’t you have to go all the way back to Fact #1? As I recall, it was the caveman using sign language to say, “Mouth hurt!” Won’t you then have to sort through all of the educated guesses that ensued since then? In 21 years of observing dentistry from its perimeter, I have noticed some educated guesses taking root in mainstream dentistry. In HBO’s “Assume the Position,” I watched host Robert Wuhl do a funny bit on how Paul Revere warned fellow patriots along a stretch of 19 miles. A fellow patriot named Israel Bissell warned countrymen about the British along a 350-mile stretch. Why is Revere so prominent in American folklore? Poet Henry Wadsworth Longfellow thought Revere’s name sounded catchier.

How many times has a particular concept sounded catchy to dental professionals?

Somebody will have to go all the way back to the beginning. But it probably won’t be you, or any of your friends and colleagues who you see at the monthly meetings. We have to keep dentistry moving forward too, and you’re just the person for that job.

Secondly, who thinks dental hygienists are unimportant? Yes, dentists are on the EBD bandwagon too. Dentists serve on committees and voice concerns about wayward treatment protocols.

Some dentists think dental hygienists are unimportant.

“I think dental hygienists are unimportant.”

“Why’s that?”

“Because they want to make more than $20 an hour. I’m not going to hire one.”

“Okey-dokey. You’re entitled to your opinion.”

Overall, though, you sometimes get the impression that dental hygiene is staking its entire future on the recognition of the “evidence.”

Is this sort of gamble really necessary? Everyone who knows what dental hygienists are thinks they are as important as any other career path. This group would include even journalists, another occupation that I happen to know something about. I monitor the mainstream media for references to dental hygiene. The media’s references generally are professional and respectful. In the past three months, I think I have read just one newspaper account where the dental hygienist was confused with occupation of dental assisting, and it was just a small newspaper in the middle of nowhere.

Your future does not depend on the public’s recognition of you diligently gathering up the evidence. They assume you are already doing that. Besides, what are people going to think about all the things you did to them when there was no evidence? My guess is they are not going to pantomime “mouth hurt” - at least not to you. What your future does depend on is making a larger segment of the population aware of dental hygiene’s services, and public health dentistry labors daily to make that happen.

The third problem with evidence-based dentistry is the “spin.” Manufacturers, speakers, and even editors/authors (which is why this entire column must be titled “my spin”) will take information from evidence-based dentistry that best serves their purposes. In fact, I think it has already happened. Some evidence is hammered into your skull, while the rest of it is buried on page 697 in ... gosh, I can’t remember the name of it.

I really like Patti DiGangi’s article on page 14. If nothing else, it serves as a reminder of how the insurance industry is paying attention to evidence-based dentistry too. Based on your experience with patients’ insurers, do you think they might come up with a spin too?

It all comes back to you, sitting in an operatory somewhere between Maine and San Diego. All of the problems alluded to above with EBD may seem overwhelming. But it shouldn’t be a cause of depression. You’re smart, skilled, and dedicated. Again, as Trisha would say, “You’re also one helluva detective!”