#19 – Evidence Based Dentistry (EBD)

Beginning in level 1, I discussed the value of using evidence based dentistry. 

The best current definition of EBD is “integration of the best research evidence with clinical expertise and patient values.” This is obviously important to the dentists and hygienists, but it is also valuable to our clients. If they understand that our treatment recommendations are based on EBD, it eliminated discussions about alternative treatment suggestions by other dentists.

Currently only about 25% of dental procedures have been examined well enough to achieve an EBD agreed upon approach. However, since this approach only began in 2001, there will be more and more studies run that will expand our knowledge base.

The best resource for EBD is the “Journal of Evidence Based Dentistry,” which is published monthly.

Evidence Based Dentistry is especially useful in a group practice. Whenever the group must make a decision on what is the best piece of equipment to buy, or what is the best dental procedure to follow, then there is likely to be a variety of opinions based on personal experience. Evidence Based Dentistry provides an answer for the group that is based on nationwide research and scientifically documented studies. All of the dentists in the group can feel comfortable with the final decision made after a careful perusal of this evidence which saves time, money, and alleviates stress on the practice.

Minimally Invasive Dentistry (MID)

MID is a cornerstone of how we create value for our clients.
Decay is an infectious, communicable disease. In medicine if a patient has an infection on his hand, it is diagnosed and treated (usually with medications) to heal it. This is 21st century medicine.
Now, let’s say this same patient came to a dentist for this hand infection. The dentist diagnoses the infection and cuts the hand off to stop the infection. This is medicine’s 19th century approach.
Unfortunately, there is a strong reason for dentists to amputate the disease out of the teeth rather than heal the decay. MONEY. Dentists make most of our income from amputating pieces of teeth. Insurance companies will pay for dentists to do these amputations. Patients expect amputations.
If our clients expect amputations, insurance companies pay for it and it makes us a lot of money, why don’t we do this? The hard answer is:
It’s not in the best interests of out clients.

Using current techniques we can.
1. Use our Diagnodent
2. Be ready to utilize new saliva tests to accurately diagnose a client’s decay potential
3. Remineralize a decayed tooth. This is the most important concept. Small areas of decay can be healed rather than cut out.
a. Reduce the acidity of the saliva
b. Use pharmacology (antimicrobials, chlorhexidrine, fluoride, iodine, xylitol, amorphous calcium/phosphate products)
4. Never take any more tooth structure than necessary: small composite <bigger composite< large composite or silver filling<replacing a cusp<gold partial crown<porcelain veneer gold crown<extract a tooth and not replace<replace with implant<replace with bridge
5. Bleach teeth rather than porcelain crowns
6. Oral hygiene instruction/frequent root planning better than gum surgery
7. Repair existing crown rather than a new crown

Pay for Performance

Healthcare is too expensive. So is dentistry. In 2007 the secretary of U.S. Health and Human Services described the 10 year government plan to develop a system of competition based on value. The components are:
1. connected interoperable electronic health records
2. Independent assessment of a client’s care based on national standards
3. Understandable, comparable info on fees
4. Quality should be
a. measured
b. publicly reported
c. compensated differently

In 2013 there are no national standards for quality care in dentistry. The quality of care in a private dental office without national standards is virtually impossible to verify.
This will change by 2020. If dentists don’t develop national quality standards, then the insurance companies and/or the federal government will. The goal will be improved quality of care with cost controls. Dentists that meet this goal will be rewarded financially.