Anecdotal Versus Evidence Based Dentistry
The profession of dentistry is undergoing a revolution in evaluating how we make decisions and provide a diagnosis for our patients. Treatment is always based off of that diagnosis, but are our treatment regimens based on good science or gut feelings? An example that I can give you is based on my military history as a dentist providing care for our soldiers within the military. Because I had the ability to follow up on care that I provided to my soldiers and that soldier was required to follow my advice to his commanders, I was always able to feel comfortable in using a decision matrix that kept my treatment guidelines fairly conservative. I did not give much thought to the possibility that I would be receiving a letter from a lawyer‘s office because a soldier was dissatisfied with a less that optimal result in my treatment. This gave me the latitude to treat more conservatively with the ability to adjust my treatment based upon appropriate follow up with my patients. Soldiers are a bit of a captive audience and I knew how to get their attention if I needed it.
In private practice, because my patients receive a bill for services rendered, they expect a positive outcome one hundred percent of the time and sometimes their expectations for symptom relief area can be a bit unrealistic. Because of this, I have noticed that my prescribing tendencies are a bit skewed towards using antibiotics more frequently than when I was in the military. Right or wrong, I wrote the prescription based on anecdotal experience and not any evidence based science. The problem with this strategy is that while patients like to be prescribed antibiotics for any number of reasons, they are not without their downside. Allergic reactions, anaphylaxis, and resistance are three of the major downsides to antibiotic overuse.
In the November 2019 issue of the Journal of the American Dental Association (IADA), the ADA published their guidelines for clinical practice in antibiotic use. A well researched and thorough article put together over a decade of study, this guideline will help our profession be better at treating a diagnosis in a more evidenced based approach. It puts meat on the bones on what we need to do in order to more ethically and effectively treat our patients.
We at Spring Lake Dental Group, in our upstairs classroom, have studied and discussed this important article. We have modified our prescription writing tendencies and hope that by endorsing a more evidence based approach, will provide care to our patients that will protect not only their health, but the health of the general public as well.