Evaluating the Caries Evidence with Respect to Fluorides - Scientific Support for Clinical Decisions
The world of dentistry has begun to change to require sound scientific evidence for clinical applications of both treatment and preventive approaches to dental caries. In a nutshell, Cariology is evolving as a part of evidence-based dentistry. Evidence-based dentistry (EBD) is defined by the American Dental Association as "...an approach to oral health care that requires the judicious integration of systematic assessments of clinically 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."48
Duke University has a tutorial "Welcome to the Introduction to Evidence-Based Practice" in Evidence based-Medicine that helps in the understanding of this approach. Forrest and Miller49 have provided an approach for evidence-based decision making in dentistry and demonstrate the process with clinical examples. The PICO approach – Population (P), Intervention (I), Comparison (C) and Outcome (O) system can easily be applied to remineralization/demineralization.
Ismail and Bader50 provided a practical clinical approach to evidence–based dentistry, discussed various models for use and stated in their conclusions "In the evidence-based approach to clinical decision making, dentists incorporate the best scientific evidence–evidence that is critically appraised in systematic reviews–with clinical experience and their patients’ preferences for treatment outcomes." Clinical practitioners have access to a large amount of scientific literature just as patients do via the Internet. A quick search using PubMed at the time of updating this course revealed 42,336 articles cited using the keywords tooth and demineralization. Two thousand and forty-four (2,044) citations were found when tooth remineralization was used and 1,544 discovered for enamel remineralization.
Jeyanthi51 indicates a number of useful databases to be used in evidence-based dentistry when performing searches that include:
ProQuest (Applied Social Sciences Index and Abstracts)
CancerLit (US National Cancer Institute)
ProQuest - Dissertations (Cumulative Index of Nursing and Allied Health Literature)
EMbase (Biomedical Database)
These will not normally be the object of many clinical practitioners’ searches for evidence, but one should be aware that they exist and are used in analysis of clinical questions. Evaluation of the evidence is done using strict criteria by such groups as the Cochrane database. When one looks at the current dental topics, the following reviews of fluorides are excellent examples: