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Evidence based healthcare (EBHC) is acquiring great deal of significance in recent times and increasingly, doctors and nurses are depending on EBHC to improve decision making and patient outcomes (Jahn, 2004). “The American Dental Hygienists’ Association (ADHA) and the American Dental Association (ADA) have policy statements on EBHC” (Jahn, 2004, p. 1). Evidence based health care involves the integration of “best research evidence with clinical expertise and patient values” (Jahn, 2004, p. 1). Evidence based periodontal care is an approach in which the dental professionals and the patients make decisions about periodontal care based on best available information (Nield-Gehrig and Willman, 2006). Browsing the internet for scientific information is a great way to get evidence regarding possible treatment outcomes (Andrews, 2006).
In the EBHC method, healthcare providers are encourage to look for and make sense of scientific evidence in the treatment process for periodontal care. The scientific information about treatments, drugs and devices is shared with the patients so that they are also involved in making informed decisions about their periodontal care (Nield-Gehrig and Willman, 226). “Assisted periodontal therapy: a new dental hygiene paradigm” by Lynne Slim and Cynthia Chillock (2008) declares that periodontal therapy whether surgical or nonsurgical needs to be based on research evidence and clinical results. They point to the fact that “periodontal diseases are now being increasingly linked to systemic diseases such as rheumatoid arthritis, diabetes, and cardiovascular and pulmonary diseases” (Slim and Chillock, 2008, p. 1). This underlines the importance for patients to be well informed about their health status so that they can become more involved in the treatment process.
Michael P. Rethman (2009) in his article titled “Where we go from here” says that new information has confirmed that “what appears to be the same disease from site to site or patient to patient may be quite different at tissue, cell, and molecular levels” (Rethman, 2009, p. 1). Rethman says as a result of these differences, duration between treatments may differ from one patient to another. While one particular patient may benefit from biweekly dental appointments, others may be able to go 2-3 years between appointments. He concludes that “optimal periodontal treatment and maintenance” is based on “knowledge-based and insightful interpretations and re-interpretations of site-specific information collected over time” (Rethman, 2009, p.1). In other words, Rethman agrees that EBHC is the best way to find out the optimal periodontal treatment and maintenance for a particular patient.
In the article titled “Evidence-based health care” Carol Jahn (2004) says that evidence is most effectively implemented via clinical expertise. For example, periodontal infections are generally treated using full-mouth disinfection protocol, but this might not be advisable when the patient has Type 1 diabetes and is dependent on insulin. He might raise concerns regarding hypoglycemia and proper eating after back-to-back procedures in which case, a more traditional approach might be better (Jahn, 2004). Another example cited by Jahn in support of EBHC is that the recent practice of recommending a solution of diluted bleach for home irrigation in order to promote periodontal health is often thought to be due to the solution of diluted bleach, but has been found to be due to the process of irrigation. Knowing this fact helps to recognize “the inherent bias and ensuing limitations” in clinical experiences (Jahn, 2004, p. 1). Carol Jahn illustrates the impact of EBHC with the evidence of smoking and how it affects periodontal health. Jahn says that generally the treatment plan for a missing molar would include a bridge and an implant. But if the patient is a heavy smoker, it is not advisable to use implant as research shows that implants have an increased risk of failure in the case of smokers. From the patient’s point of view, he is made to realize that the recommended periodontal therapy will be most effective only if he quits smoking first. On the macroscopic level, the information that 50% of all periodontal diseases are caused by smoking implies that it is best to include smoking cessation information into the treatment plans of all smokers (Jahn, 2004). Thus evidence based periodontal therapy helps at all levels – by helping in crucial decision making and improving patient outcomes.
Bibliography
- Andrews, K. Esther (2006). Practice management for dental hygienists. Lippincott Williams & Wilkins, 2006
- Jahn, C. (2004). Evidence-based health care. RDH, 24(9).
- Nield-Gehrig, S. Jill and Willman, E. Donald (2007). Foundations of Periodontics for the Dental Hygienist. Lippincott Williams & Wilkins, 2007
- Rethman, M. (2009). Where we go from here? Dimensions of Dental Hygiene, 7(4), 24-25.
- Slim, L., & Chillcock, C. (2008). Assisted periodontal therapy: a new dental hygiene paradigm. RDH, 98(2).
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