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Patients | EBD Dental Hygiene

Evidence-based dental hygiene

Understanding where we fall short and how we can move forward in evidence-based care. by Shirley M. Beaver, RDH, PhD

Everything I learned in dental hygiene school was evidenced based, right? Wrong.

Ask yourselves these questions:

*    Why do you provide certain oral health services to the patients you serve?

*    Do those procedures really have an effect on oral health?

*    Do you know if those procedures are evidenced-based?

*    How do we know if what we are doing is evidence-based?

Often, decisions are made with the best available research—which in some cases may be only one article. Or, you make the decision based on what you were taught in school 20 years ago by a respected professional. Or, the decision is based on current knowledge, but without any real evidence of the need or outcome. Or, maybe such decisions are based on what your boss implements in the practice, even though it’s not necessarily a “best practice.”

None of the aforementioned decision-making processes are wrong per say, but it is critical that dental hygienists strive to have a comprehensive view of what works. That means one thing: Research, and plenty of it. The more research with the same results, the more likely the information is to be accurate.

WHO KNEW?

So much of what we emphasize in our daily appointments is based on tradition, not facts. Consider these examples:

We say: Visit the dental hygienist every six months.

But: I recently learned that the six-month recall evolved from a toothpaste advertisement. While what we see in some patients does require a six-month recall, others need three, four, five, seven, nine, 12 or more.

We say: Women who have morning sickness or those who are bulimic should not brush immediately after regurgitation.

But: We tell patients to brush immediately after eating, when the oral pH is the most cariogenic.

And it goes beyond dentistry: Bisphosphonates were prescribed to prevent bone loss in persons with osteoporosis. Now we find out that it actually destroys bone in some situations. Or, just a few years ago physicians insisted that caregivers put babies to sleep on their stomachs to avoid spitting up and choking. Today, they advise just the opposite in order to avoid sudden infant death syndrome. We could enumerate many more “traditions” that have now been proven to be inaccurate if not dangerous.

WHAT DO WE DO?

It seems simple, but the best place to start is with an accurate definition of evidenced-based practice:

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centered clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens. External clinical evidence both invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious, and safer.”¹

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