|Year : 2015 | Volume
| Issue : 4 | Page : 127-128
Involving community dentists in evidence-based dentistry: A hypothetical quest for the next frontier
Division of Oral Biology and Medicine, UCLA School of Dentistry, Los Angeles, California, USA
|Date of Web Publication||27-Nov-2015|
AAAS Fellow, Fulbright Alumnus, UCLA School of Dentistry, CHS 63-090, 161598, Los Angeles, California
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Chiappelli F. Involving community dentists in evidence-based dentistry: A hypothetical quest for the next frontier. Dent Hypotheses 2015;6:127-8
The American Dental Association defines evidence-based dentistry (EBD) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." In other words, EBD integrates the consensus of the best evidence base into the process of clinical decision-making. EBD is distinct from dentistry based on the evidence, which utilizes the evidence in a few selected research reports. Because of the process of selection, dentistry based on the evidence is inherently biased. By contrast, EBD is grounded on research evidence that emerges from the systematic process of research synthesis, and reported as systematic reviews and meta-analyses. EBD is best performed in the context of comparative effectiveness research (CER), derived from the population-intervention-comparator-outcome-timeline-setting (PICOTS) question, designed to establish translational effectiveness, viz. the identification of the best evidence base and its utilization in specific clinical settings. ,
One fundamental question that leaders in the field ask is: Does CER drive translational effectiveness - that is, does the identification of the best evidence base drive its utilization in specific clinical settings in logic-based evidence-based clinical decision-making, or rather does translation effectiveness drive CER - that is, does information obtained by means of translational research and analysis of translational effectiveness outcomes research determine the search and consensus of the best evidence base? Certainly, this is not a mute point. In fact, it is central to  getting community dentists to become informed about and interested in the best evidence base for their patients, and  in obtaining and optimizing the utilization of said best evidence base. The question at hand fundamentally seeks to establish how the profession could get the average dentist to become active and involved in research for the benefit of the patient, and how it could inform the average dentist of the need and urgency of research in pursuit of the best evidence base. The query is as complex as it is timely and critical for community dentistry.
To be clear, we posit that engaging community dentists in EBD is problematic but it is essential for the benefit of patients. It is problematic because community dentists, while they are consumers of research, are often not disposed or trained to engage in traditional research designs, let alone research synthesis. It is essential for the patients' benefit because the goal of EBD is to optimize patient-centered, effectiveness-focused, and evidence-based dental care.
In brief, the practice of EBD ensures that the patient will receive optimal treatment, based on the consensus of the best available evidence that will carry maximal benefit for th lowest risk and costs, and that will be targeted toward the patient's needs, wants, and medical/dental history. This approach, which is quite a contrast to what most community dentists have been taught in dental school such as intervention-centered or protocol-centered treatment planning is often unfamiliar to the dentist. Nonetheless, in our age of research consumerism where so many research reports - sometimes contradictory - are available in various forms on the dentist's computer (Pubmed, blogs, Facebook pages, etc.), and where so many new materials and treatments are developed almost on a daily basis, it is important more than ever that the dental profession avoid provider benefit conflicts of interest, and focus instead on patient-centered effectiveness and individual patient data analysis.
To involve community dentists in the process of EBD is to ensure that they understand that will not betray their patients, caregivers, and stakeholders by getting involved in research. Choosing to learn about and to endorse EBD for the benefit of the patients, that is, choosing to become involved actors of EBD for the patients is a major step, which dentists must be empowered to make. Their motivation must be ignited by helping them make the correct attributions as to their abilities,  and their perceived self-efficacy  nurtured so as to raise their own person-environment fit  with respect to their actual and perceived knowledge and expertise of how to obtain and of how to utilize best evidence base for patient-centered dental care.
So the goal of involving community dentists in EBD is not utopian. It is not a hypothetical but a real achievable goal, one that necessitates concerted and assiduous efforts aimed at increasing the knowledge of EBD by the community dentist, and elevating his/her confidence level in this approach by raising his/her drive. Drive is often a silent agenda, an implicit set of attitudes that can be modified by simple techniques, such as behavioral reciprocity.
Reciprocal actions are important in social psychology because they often explain the maintenance or the change of social norms. As a community of professionals wishing to improve dental practice by changing its norms to EBD, it will behoove us to become more aware of the powerful force of reciprocity: People feel obligated to return a favor regardless of whether they like the person who originally bestowed the favor and even if they did not want the favor. Reciprocal actions are distinct from altruistic actions and from social gift-giving. Rather, reciprocity is centered more on trading favors than making a negotiation or a contract with another person. As a social construct, reciprocity relates to the fact that in response to friendly actions, people are frequently generally open and cooperative and willing to reciprocate. A case in point is the token gifts (e.g., free lunches) that pharmaceutical companies offer to physicians and dentists in the hope of having them prescribe their pain medication to their patients rather than that of their competitors.
Might it be as simple as that to engage community dentists in EBD? Could it be that all we have do is to visit community dentists at their practice, bring free lunches for their staff, initiate them to the EBD protocol, and give them a gift card for shopping at the mall as a token thank you for their beginning to walk the walk of evidence-based dental practice? The hypothesis that behavioral reciprocity can play a key role in involving community dentists in EBD needs to be tested.
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