Reflection: “A frog in a well”
EDITORIAL ADVISORS Lisa Alvetro, DDS, MSD Daniel Bills, DMD, MS Robert E. Binder, DMD S. Jay Bowman, DMD, MSD Stanley Braun, DDS, MME, FACD Gary P. Brigham, DDS, MSD George J. Cisneros, DMD, MMSc Jason B. Cope, DDS, PhD Neil Counihan, BDS, CERT Orth Bradford N. Edgren, DDS, MS, FACD Eric R. Gheewalla, DMD, BS Dan Grauer, DDS, Morth, MS Mark G. Hans, DDS, MSD William (Bill) Harrell, Jr, DMD John L. Hayes, DMD, MBA Paul Humber, BDS, LDS RCS, DipMCS Laurence Jerrold, DDS, JD, ABO Chung H. Kau, BDS, MScD, MBA, PhD, MOrth, FDS, FFD, FAMS Marc S. Lemchen, DDS Edward Y. Lin, DDS, MS Thomas J. Marcel, DDS Andrew McCance, BDS, PhD, MSc, FDSRCPS, MOrth RCS, DOrth RCS Mark W. McDonough, DMD Randall C. Moles, DDS, MS Elliott M. Moskowitz, DDS, MSd, CDE Atif Qureshi, BDS Rohit C.L. Sachdeva, BDS, M.dentSc Gerald S. Samson, DDS Margherita Santoro, DDS Shalin R. Shah, DMD (Abstract Editor) Lou Shuman, DMD, CAGS Scott A. Soderquist, DDS, MS Robert L. Vanarsdall, Jr, DDS John Voudouris (Hon) DDS, DOrth, MScD Neil M. Warshawsky, DDS, MS, PC John White, DDS, MSD Larry W. White, DDS, MSD, FACD CE QUALITY ASSURANCE ADVISORY BOARD
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here is an old Japanese expression and similar sayings in other countries, “A frog in a well knows nothing of the great ocean.” Often we get in a routine of doing things the same way over and over again and expecting different results, often described as insanity. Too often it is easy to dismiss evidence-based decisionmaking and inquiry into the quality of evidence by rationalizing, “I am a clinician.” Some evoke possibly 20 years of experience as the validation, but was it 20 years with growth, change, and reflection, or was it 1 year, repeated the same way 20 times? Clinical experience is still very important but in juxtaposition with a more comprehensive approach such as evidence-based clinical practice (EBCP), which considers quality of evidence, particular clinical circumstances, patient-values (autonomy), and clinical experience. If it is only clinical experience, then is the person who is in practice the longest the expert? Hathaway and Long1 quote Dr. David Sackett as saying, “We cannot confidently infer anything about efficacy through the study of patients outside of a trial.” Likewise, Dr. Carl Sagan, the famous astrophysicist, said, “Extraordinary claims require extraordinary evidence,” the Sagan Standard. Have we come far enough since evidence-based dentistry was first described in 2004 by Ismail and Bader in the Journal of the American Dental Association2? Many experience-based orthodontic practices show enough treatment and financial success to tremendously support a practice. Yet some level of treatment success does not necessarily equate to treatment efficiency and effectiveness. At the recent 2017 AAO Annual Session in San Diego, it was gratifying to see many highquality evidence-based presentations, while on the other hand, there were still presentations showing only cases with limited records, no evidence, and personal opinion. The problem may not be solely with the clinician who is resistant or overwhelmed by the challenge that EBCP entails, but more a lack of educational resources to interpret research findings in a friendly and understandable way. There are currently some excellent social media blogs such as those written by Dr. Kevin O’Brien and Dr. Peter Miles that interpret research findings and present clinical implications. There are also two books on evidencebased orthodontics by Huang, et al.,3 and Miles, et al.,4 that can be helpful to the clinician. Also this journal, Orthodontic Practice US, presents some relevant clinical research in an interesting and friendly way, whereas often journals publish esoteric research that has little to no clinical impact or importance. Let’s challenge ourselves to see the great ocean and not be the frog in the well, and reflect on our practices, so they are evolving, embracing change, and the challenges of EBCP. Dr. Dan Rinchuse
Dr. Alexandra Day BDS, VT Julian English BA (Hons), editorial director FMC Dr. Paul Langmaid CBE, BDS, ex chief dental officer to the Government for Wales
REFERENCES
Dr. Ellis Paul BDS, LDS, FFGDP (UK), FICD, editor-inchief Private Dentistry
2. Ismail AI, Bader JD. Evidence-based dentistry in clinical practice. J Am Dent Assoc. 2004;135(1):78-83.
Dr. Chris Potts BDS, DGDP (UK), business advisor and ex-head of Boots Dental, BUPA Dentalcover, Virgin
1. Hathaway RR, Long RE Jr. Early cleft management: in search of evidence. Am J Orthod Dentofacial Orthop. 2014;145(2):135-141. 3. Huang GJ, Richmond S, Vig KWL. Evidence-based orthodontics. West Sussex, UK:Wiley-Blackwell;2011. 4. Miles PG, Rinchuse DJ, Rinchuse DJ. Evidence-based clinical orthodontics. Chicago:Quintessence Publishing Co. Inc.;2012.
Dr. Harry Shiers BDS, MSc (implant surgery), MGDS, MFDS, Harley St referral implant surgeon
© FMC 2017. All rights reserved. FMC is part of the specialist publishing group Springer Science+Business Media. The publisher’s written consent must be obtained before any part of this publication may be reproduced in any form whatsoever, including photocopies and information retrieval systems. While every care has been taken in the preparation of this magazine, the publisher cannot be held responsible for the accuracy of the information printed herein, or in any consequence arising from it. The views expressed herein are those of the author(s) and not necessarily the opinion of either Orthodontic Practice US or the publisher.
Volume 8 Number 3
Dan Rinchuse, DMD, MS, MDS, PhD, is professor and program director at Seton Hill University graduate program in orthodontics. He is an ABO Diplomate. He received his DMD, MS (pharmacology), MDS (Orthodontics), and PhD (Higher Education), from the University of Pittsburgh.
Orthodontic practice 1
INTRODUCTION
May/June 2017 - Volume 8 Number 3