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4 | CERECDOCTORS.COM | QUARTER 3 | 2014
what is the optimum solution for
a patient’s dental problem? This is
a question dentists deal with every
day in their practice. What is the best
material, technique or procedure of
the alternative options available to
solve the oral health problems their
patients? Evidenced-based dentistry
first became popular in the 1990s as a
technique for reviewing and summa-
rizing the vast amount of research
evidence in health care fields, and is
advocated as the preferred process to
answer this difficult question.
The American Dental Association
(ADA) defines Evidenced-Based
Dentistry (EBD) on its
website as, “An approach
to oral health care that
requires the judicious
integration of system-
atic assessments of clin-
ically 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.” 1
A more succinct definition is, “…
practice that integrates evidence, clinical
experience and patient preference.” 2
EBD is an approach to dental prac-
tice, essentially an approach to making
clinical decisions and offering recom-
mendations. It is about providing dental
treatment for patients
based on the most current
scientific evidence that
is compliant with the
Should Evidenced-based Dentistry
Replace Clinical Judgment?
A Non- “Cook Book” Approach to Clinical Practice
COMMENTARY ||| BY DENNI S J. FASBINDER, D.D.S. , A.B.G.D.
patient’s signs, symptoms and history,
and understand the patient’s wishes.
EBD should integrate the best scientific
evidence with a clinician’s clinical expe-
rience, leading to the patient’s choice of
treatment options.
The critical roles of clinical expe-
rience and clinical judgment tend to
receive less emphasis in most discus-
sions of EBD when, in fact, they are
essential to it. Scientific evidence
can only inform and guide, but not
replace, clinical experience. Clinical
experience is what lets a clinician
know that although the scientific
evidence may indicate a treat-
ment is 90 percent effective,
in this particular patient
case, it may not be quite
as effective. Clinical
experience is the filter
that scientific evidence
must pass through to
ensure it applies to the
particular needs and
preferences of a patient.
However, clinical
experience does not allow
one to ignore new scientific
evidence as clinical experience
is significantly influenced by our
perceptions and bias. Awareness of good
scientific evidence will improve knowl-
edge and influence clinical experience.
Astute clinical judgment helps patients
decide between treatment alternatives.
Essentially, clinical judgment is decision
making. Interpretation of the patient’s
symptoms andhistory is just as important
as awareness of good scientific evidence
in formulating the final treatment plan.
EVIDENCE VS. EXPERIENCE
EBD is not a “cook book” approach to
clinical practice. Scientificevidencedoes
not dictate solution “1” for problem “A”.
If it were as simple as that, then dental
students would have as much clinical
success as experienced clinicians. The
clinical experience and judgment of the
clinician are required to interpret the
patient’s treatment wishes.
Scientific evidence should not
prescribe or mandate specific treatment,
but rather provide important informa-
tion on the likely outcomes of selected
treatment options.
EVIDENCED-
BASED
DENTI STRY
SCIENTIFIC
EVIDENCE
CLINICAL
EXPERIENCE
PATIENT
PREFERENCE