Evaluating dental studies with evidence-based practices benefits dentists, patients

Dental medicine has joined the fields of medicine, nursing, psychology, social work and others to develop evidence-based practices that are the gold standards of patient care, according to a Case Western Reserve University School of Dental Medicine researcher. Evidence-based practices evolve from studies that collect and analyze data to understand what does or doesn’t work. These practices go beyond observations or theories, and are backed by scientific research data to support how best to treat patients, said Leena Palomo, associate professor of periodontics. The Journal of Evidence-Based Dental Practice reviews and publishes original research articles as well as critical reviews of published articles. The journal’s editors invited Palomo, a researcher and practicing periodontist, to contribute an analysis of the Journal of Dental Research article, “Body mass index as a predictive factor of periodontal therapy outcomes.” According to Scott L. Tomar, the journal’s senior associate editor and a professor at the University of Florida College of Dentistry, the journal selects experts in the subject matter to review the results and strength of evidence. “Our goal in publishing critical reviews of journal articles is to give busy clinicians a brief synopsis and help them assess its strengths and weaknesses in deciding whether or not to incorporate its findings into clinical decision-making,” Tomar said. The article Palomo reviewed explored findings from a group of studies about people with severe gum disease. Data from five studies conducted during a seven-year period by the UCL Eastman Dental Institute in London were used in that analysis. The JDR article pulled data for 260 participants to determine whether a link existed among obesity, gum disease and poor outcomes after the patients received nonsurgical dental treatments. Palomo used evidence-based standards to see if the study met three goals:

• Citing and discussing findings from other studies that relate to the new research;
• Organizing in a standardized way that reports the hypothesis or purpose of the study, the research method and includes a discussion and conclusion about the findings and what they mean, and;
• Focusing on qualitative outcomes, disregarding intuition or unsupported theories.

Palomo reports both strong and weak factors in her analysis in the June issue of the Journal of Evidence-Based Dental Practice article, “BMI is a Predictor of Periodontal Therapy.” Palomo considered it a weakness that researchers used only four of the five databases from the studies to reach their conclusion, and that the information was secondhand, not original data. She also pointed out the databases lacked information about whether the participants smoked or had other health issues, which might confound the outcome for treating the gum disease. But overall, she concluded, the message is strong that a link exists between obesity and gum disease. Palomo said dentists can use this information to suggest to overweight patients that they follow up with a physician about weight-related health conditions that might interfere with treating and curing gum disease. “My conclusion after reviewing was that, although the above conclusion is consistent with emerging studies, this one study alone is not sufficient evidence for clinicians to be able to attribute poor results of periodontal therapy to obesity alone,” she said.  “More well-controlled studies are needed for this information to translate to chairside utilization.” These analyses are particularly important for practicing dentists who generally treat patients instead of conducting research, she said. Conversely, many researchers are in the lab instead of chairside with patients. Both the researcher and practicing dentist can benefit from understanding one another’s processes and how research can drive changes in patient care, she said.