Dentists take on the challenge of change
Table talk: Drs. Herbert Edwards (seated, right) of College Place, Wash., Eli Schwarz (seated, left) of Portland, Ore., and Cheon Joo Yoon of Champaign, Ill., engage in a breakout table discussion at the 2013 Evidence-Based Dentistry Champions Conference.
They numbered 100 and were generalists, specialists and academics; and they were curious and eager to attend the ADA's sixth annual Evidence-Based Dentistry Champions Conference, held April 25-27 at ADA Headquarters.
"It was a privilege to be chosen to be there," said Dr. Sibel Dincer, an assistant professor at the Ostrow School of Dentistry of University of Southern California. "If we're going to make some changes, it should be multidimensional because we have private practices; we have dental schools. These are two different environments. In creating change for private practices, I am so proud of the ADA for initiating this type of work because this is a very long-term investment."
In a day of preconference sessions, participants learned EBD basics and engaged in structured literature searches. Then, during the two-day conference, they learned ways to effectively marry their clinical expertise and their patients' needs and preferences with the application of the best available evidence. They agreed to later share their newfound knowledge of literature searches, the patient intervention comparison outcome process and other EBD components with dental colleagues.
Dr. Daniel Meyer, senior vice president, ADA Division of Science and Professional Affairs, and Julie Frantsve-Hawley, Ph.D., senior director of the ADA Center for Evidence-Based Dentistry, are lead organizers for the conference. Both addressed the conference, Dr. Meyer welcoming participants on day one and Dr. Frantsve-Hawley presenting Exploring the ADA's Resources on day two.
"This is the sixth year that we have had the EBD Champions Conference, and it has been a hugely successful program," said Dr. Frantsve-Hawley. "There are now more than 600 EBD Champions scattered throughout the U.S. They are working together to make EBD an integral part of dentistry. They are doing this in their practices, talking to their colleagues and even inspiring their local and state societies."
Dr. Dincer attended the conference with three colleagues from USC. Since then, they have been discussing ways to fulfill their roles as EBD Champions.
"Being there already means something," Dr. Dincer said by phone on May 22. "It means that you are determined to make and produce a change. We are meeting next week. We're going to brainstorm on what is the applicability of what we learned to our particular environment. I've already scheduled an appointment with our associate dean to share the possibilities I am seeing. I will share it with my colleagues and with my administrative people, and I am going to be inspiring my students."
Dr. W. Ken Rich, a practicing general dentist who is the dental director for Kentucky's Medicaid department, is another new Champion. He also serves on the U.S. National Oral Health Alliance board, is a past ADA 6th District trustee and a member of the ADA Dental Quality Alliance. He regarded the conference as complementary to his various roles.
"The most positive thing about the Champions Conference was that it gives you the tools you need to make the best decisions given the best data of the day," Dr. Rich said.
He also said, "Sometimes, based on the best evidence, the traditional treatment that we employ may well not be the most scientifically sound. So what [EBD] does is it gives you a tool to use to render the most appropriate treatment to your patient, rather than basically saying, 'This is the standard of care. This is what we always do.' That's the real positive part about it. That's the part that makes it such a valuable tool."
While the new Champions were excited to learn and share effective strategies for approaching scientific research to find the best evidence and for dealing with a high volume of journal articles, they were duly cautioned: change can be challenging.
Dr. Robert Weyant, professor and chair of the Department of Dental Public Health at the University of Pittsburgh School of Dental Medicine, addressed this very topic in his presentation The Challenges of Change on day one of the conference.
"By virtue of you being Champions, the model that we posit is, you see the evidence, you act accordingly," Dr. Weyant said. "It's very straightforward. That's the ideal model. That's the model we hope that works. However, that presumption may not necessarily hold in all cases."
Dr. Karen Walters, who was among the first to register for the conference, said by phone on May 8 that one of the biggest surprises she got from the lineup of expert EBD speakers was hearing about the lapse that can occur between practitioners acknowledging evidence and considering it in treating patients.
"They gave the example of James Lind, correlating Vitamin D and scurvy," she said. "It took 50 years." Also noted, Dr. Walters said, was "the correlation between sudden infant death syndrome and having babies sleep on their stomachs."
In dentistry, Dr. Walters pointed to the use of sealants in adults as an example of evidence not trickling down to the practice level. "Like with the incipient decay," she said. "You can actually seal that area and basically starve out the bacteria from doing further damage. You really preserve tooth structure. It seems kind of counterintuitive to what you learned in school, but all the evidence shows that is the way to do it."
Dr. Weyant addressed that very topic in his presentation: "Six percent of dentists would not put sealant on a tooth that had a noncavitated carious lesion even if there was no radiographic evidence that it went past the enamel," he said. "Ninety-six [percent] would not do it if it touched the dentin, and in routine practice less than 40 percent of dentists use sealants at all. So the model of 'show them the evidence and the behavior follows' is not necessarily operable in all cases."
Dr. Dincer, for one, welcomes the challenges of connecting the best evidence to treatment options. Her enthusiasm for EBD only grew after the conference, she said, and she is very eager to learn more of its principles.
"You need to be very thorough and conscious about how to find the evidence," Dr. Dincer said. "It's the first step. We basically got it there in the EBD Champions Conference. But how to use the evidence? How to apply it and how to appraise it?"
Other 2013 champion conference speakers and moderators included Drs. Christopher Smiley, Elliott Abt, Jane Gillette, Jane Forrest, J. Leslie Winston, Brian Novy, James Zahrowski, Robert Compton, Janet Clarkson, Brian Kennedy, Partha Mukherji and Paul Benjamin and John Rugh, Ph.D.
The sessions were broken into introductory information about EBD, adapting to change and sharing resources as a Champion. Topics included Making Evidence Work in Practice: Communicating the Evidence with Your Patient and the Role of the Dental Team in Implementing EBD, Dr. Gillette; The Evidence of Emerging Issues: Providing Patient Care with Limited or Insufficient Evidence, Dr. Zahrowski; and Promoting EBD through Practice-Based Research Networks (PBRNs), Dr. Benjamin.
EBD content is accessible from the ADA Center for Evidence-based Dentistry website. For information about continuing education courses in EBD, contact Erica Vassilos, ADA Center for Evidence-based Dentistry manager, at 1-312-440-2523 or firstname.lastname@example.org.