Strengths and Limitations of the Evidence-Based Movement Aimed to Improve Clinical Outcomes in Dentistry and Oral Surgery

Evidence-based medicine (EBM) is a scientific movement that originated from the idea of the English epidemiologist Archie Cochrane in 1970. However, only in the 90s, the “EBM” first appeared in the medical literature. The main purpose of EBM was to base clinical decision on evidence produced by clinical research rather than on the authority of expert clinicians. This purpose was pursued by integrating the rigorousness and validity of scientific method with the clinical observation of biological events. To formulate clinical recommendations on a particular clinical problem, exhaustive reviews of the current literature are performed, and relevant scientific papers are scored according to the quality of clinical research. For this purpose, the methodology employed (study design, generalizability of results, follow-up, and power of study) is evaluated according to standardized criteria: the best evidence comes from systematic reviews of clinical trials. Also in the field of dentistry, evidence-based (EB) movement was born in order to seek the “best available research evidence.” But evidence is not measurable in the same way in different medical disciplines: in particular, while drug effect is rather independent from clinician’s characteristics, the effectiveness of surgical procedures is strictly related to surgeon’s expertise, which is rather difficult to quantify. The research problems of dentistry have a lot in common with other surgical fields where at the moment the best quality of clinical outcomes originates from an integration of EBM and data from consensus conferences. A recently developed new approach to combine clinical evidence with experts’ opinion is the GRADE system, where GRADE stands for “Grades of Recommendation, Assessment, Development and Evaluation.”