There have been a number of threads on dentistry lately, but this one is based on the eye-opening article,“Is Dentistry a Science?” in The Atlantic. The answer to the titular question is, surprisingly, “Not so much.” This is due in part, the article says, to the historical separation of medicine and dentistry which dates back to the 19th century. An evidence-based approach, that is, basing diagnosis and treatment on rigorous clinical evidence and not intuition and such, has long been standard in medicine. An evidence-based approach to dentistry only began in the 1990s and has not yet gained traction. Thus
The upshot is that over-treatment is rife:
Evidence-based dentistry would probably mean less income for dentists, so I can imagine why it’s been slow to catch on.
I still trust my dentist, who generally takes a cautious approach to treatment. I get cleanings twice annually and floss because with my family history of gum disease, I’d rather err on the side of caution. But I’m uncertain now as to whether the many fillings I had in my childhood were really necessary. Micro-cavities, the article points out, will often heal on their own.
I’d say the practice of dentistry is not a science. Neither is the practice of medicine. There are however, science and scientists behind these professions. Some doctors particularly those those with medical school appointments at universities are doing science as well. Medical trials are science.
Another factor is that
Science, as currently practiced, is flawed and the way studies are done loses data
If a dentist repairs a cavity, and in real time they see the decayed region, pack it, and the pain goes away, that only gets fuzzily recorded.
This is one reason why I think studies show spine surgery no better than physical therapy - overall, this might be true, but if a spine surgeon repairs a specific broken piece in your back it’s doing something no physical therapy can accomplish.
I’d say the practice of medicine is more scientific, if you will, than dentistry. I wouldn’t have said so before reading the article, as I’d been under the impression that dentistry was subject to the same level of rigorous clinical studies as medicine is. It’s not. In fact, it’s not even close.
A dentist who was a friend of a friend once explained to me that this was basically true, but that the six-month recommendation was used on the assumption that if they recommended cleanings every 12 months, people would slack off and only go every 24 months. That sounds less like a lack of science than a paternalistic view of patients (with, maybe, some marketing thrown in). There’s also some variance among individuals: FWIW I seem to be one of those people for whom the calculus builds up pretty quickly, so I look forward to those twice-a-year cleanings.
A while back, a colleague of mine told me that his wife (a doctor) said that when doctors ask people about their alcohol consumption, they assume everyone is lying by a factor of two. So the recommendation to have no more than two drinks per day is reduced to one.
There’s medical/dental science, and there’s practice.
My personal fave is that you should brush your teeth for two minutes. It doesn’t matter if you are using an electric tooth brush that spins thousands of RPMs a minute, or a manual TB wherein you might get a couple of hundred strokes in if that.
Two minutes is a long-ass time to brush. It does make me wonder where the real diminishing returns are. Lets go with a manual tooth brush and say you get in two strokes a seconds, that is 240 strokes. How many strokes does each row of teeth need? Does the tenth stroke remove more food bits than the ninth?
I don’t know… I kind of suspect that there are dentists who work in a research capacity, and they do real science, just like research-oriented physicians do.
But there’s not a whole lot in the way of science going on in the everyday practice of most dentists or doctors- they’re looking at symptoms and devising treatment plans, and 95% of what they see is commonplace stuff with standard, usually effective treatments- a cavity, or a sinus infection, or allergies, or high blood pressure, or gum disease.
I guess the question is whether the findings of the research dentists filter down to the everyday practicing dentists like standards of care, treatment guidelines and diagnostic criteria do to doctors? I don’t know the answer to that- my suspicion is that either the answer is no, or that while there’s research being done, there’s not much of it that’s actionable by your average dentist, except in the realm of improved materials and equipment.
Well, it kinda depends on what the OP considers science. And what the OP considers that a medical professional does that is supported by this definition of science.
E.g. nelliebly is shot on the way to the grocery store. The ambulance takes them to the emergency room and the physician digs the bullet out, stops the bleeding, and stitches nellie up. With infection fighting antibiotics and monitored recovery time, nellie survives. Has there been a volume of rigorous scientific studies supporting that each one of those steps were optimal? Except for the use of antibiotics, I kinda doubt it.
My point being that the practice of medicine and dentistry encompass procedures that are not always within the strict definitions of science, they are more like technology. They work because they have been tried and found to work.
That’s no different than “you should eat five portions of fruit and vegetables per day”. It’s advice that is simple to communicate, simple to remember and will improve population health if people attempt to adhere.
It’s not a scientific statement or meant to be one.
It’s actually both that less research is done and that that research does not reach dentists. The article, which is actually an interesting read (Really!), says that little federal funding is available to dentistry research as compared to medical research.
And what research is being done–that evidence-based dentistry–isn’t getting picked up. Apparently, dentists simply don’t read dental journals.
Those treatment plans you refer to often involve unnecessary, occasionally painful, and invariably expensive treatment. Nor is it without consequence:excessive drilling increases the likelihood of needing a root canal and crown.
You’ll be relieved to know that I just returned from the grocery store without bullet holes. And of course there have been studies that improved the medical treatment I would have received if some jerk with a shirt shot me. Every medication developed since 1962 and used to treat me, including the Ondansetron that kept me from vomiting post-surgery, would have undergone scientific studies and clinical trials, and if you want to see voluminous, see the paperwork entailed there. If the bullet lodged perilously close to spinal cord nerves, minimally invasive surgery might save my ability to walk–also proven safe and effective through voluminous scientific studies.
I’d also argue that technology IS science, and medical technology inarguably so. They work because “they have been tried and found to work,” yes, but they’ve been tried and proven via clinical studies.
Technology is basically science made practical, so yeah, no arguing needed.
I guess my question is really whether or not there is a need for the same amount of scientific inquiry relative to dental practice. It seems considerably limited in scope relative to say… being a GP. You look in someone’s mouth, identify cavities, and treat those cavities by removing the decay and filling in the missing material.
There’s not a lot of alternatives to rule out for tooth decay, so the real question is extent, and it doesn’t really matter a whole lot from what I gather if they could tell ahead of time- maybe they could identify needed root canals better and save you a trip to the dentist, but that’s about it.
They have existing procedures that work adequately well, so there’s no big call to do it better.
I’d compare this to say… getting orthopedic repairs done. There’s not a big diagnosis component in most cases, and it’s more of a… mechanical procedure where they fix the issue. The main changes over time come in surgical technique and materials - sutures, screws, etc… and in post-surgical treatment- PT and continuous motion, etc…
See, that’s the way most of us think: the dentist said “I have decay around that filling and need a crown. Simple. Dang, that’s $2,000 I was saving for something else, but OK, better get it done.” Does it really need a crown? Could the filling be replaced or even repaired? You can’t even find out much by googling, since unlike medicine, few studies are done. Furthermore, treatment is NOT as cut-and-dried as you believe:
You might seek a second opinion if your dentist recommended full mouth reconstruction, but you probably wouldn’t for a crown or a root canal. Patients of an unethical dentist cited in the article spent tens of thousands of dollars each on unnecessary dental work. And some dental work can lead to issues requiring further work.
I don’t know about you, but I’m not inclined to spend an extra $1000 here and there that I don’t have to–if I had that kind of money to spend,. Nor do I want to spend the time or go through the discomfort of unnecessary treatment.
You’re still talking about an education and compliance problem, not an actual science-based problem. The study basically identifies that a lot of dentists don’t follow the published guidelines in varying degrees.
It’s not a matter of knowing when to drill and fill and when not to in the sense of writing treatment guidelines, but rather whether that has been effectively communicated to dentists, and whether they abide by those guidelines.
Now if the study had been along the lines of determining after 10 years, which of two competing styles of drilling and filling worked better for cavities of a certain depth, that would be the sort of science we’re discussing here.
But that’s precisely the point! Actually, the first study shows that Swiss dentists don’t follow the Swiss guidelines. Why cite a Swiss study and a guy writing for* Readers Digest* instead of more extensive research? Answer: There isn’t any. A ten-year study would be great: it just doesn’t exist.
No long-term studies
Almost no studies, period
Few dentists bothering to follow guidelines (Why bother?)
Dentistry may be a science, but it’s certainly not a very rigorous one, and in too many cases, it seems to be driven by profit, not evidence-based principles. That should be a concern for everyone.
I don’t know if this is a hijack, but a lot of the technology and methods at the dentist also seem curiously old school.
I have an uncomfortable bite, because I have had a couple of fillings and the process for checking the bite still relies on the patient being able to tell whether it’s OK (while their mouth is still partially numb), and contact paper.
It should be 3D imaging and an algorithm for finding the best fit by now…
Science is an extremely vague word. Witness Christian Science and Scientology.
Do some dentists unethically exaggerate to increase profits? Yes, as do some journalists. It’s considered reasonable to get a second opinion in all types of medicine. If you think a dentist is lying or incompetent, get a second opinion.
Is dentistry evidence based medicine? To a large extent, yes. I think it’s easy for middle class and up people to discount dentistry if they have average phenotypical dentition. But dentists and dental surgeons also deal with some nightmarish developmental disorders, as well as reconstructive/plastic surgery for accident victims and disfigured veterans.
These guys would probably argue the point that there are “Almost no studies, period.”.
The issue isn’t whether or not studies are being done, or anything like that, but rather if rank and file dentists are getting the word or paying attention. I also suspect that for many of them (the non-crooked ones), most academic research isn’t really relevant, as where their particular part of the dental profession is concerned, the research isn’t really pertinent. If you’re some kind of specialist- say… a pediatric endodontist or orthodontist or something, you’re much more likely to be up on the latest techniques than your average garden variety dentist.
This isn’t limited to dentists either; if you’re a civil engineer who designs roads, that’s something that’s been figured out for a LONG time. Maybe there are some concrete admixtures that are new or something, but in general, that’s a mature technology, so you may not be so up on the latest research. But if you’re a structural engineer working on cutting edge architecture, you’re probably way more up on the materials research and structural engineering research than the guy designing residential roads out in the suburbs.
Same thing if you’re a developer. If you’re working for some software company whose product is written in Visual Basic, because it’s a 20 year old product, you’re not as likely to be up on the very latest in terms of artificial intelligence, machine learning or big data analysis. You’re just probably chugging along doing your job. But if you’re working in certain positions for Google, you’re going to be up on that stuff, if not doing the research yourself.
In other words, I suspect that part of the contention that dentistry is not an evidence or science-based field is due to the fact that you’re interacting with something of a backwater section of the field, at least in terms of research.
And of course there have been studies that improved the medical treatment I would have received if some jerk with a shirt shot me. Every medication developed since 1962 and used to treat me, including the Ondansetron that kept me from vomiting post-surgery, would have undergone scientific studies and clinical trials, and if you want to see voluminous, see the paperwork entailed there. If the bullet lodged perilously close to spinal cord nerves, minimally invasive surgery might save my ability to walk–also proven safe and effective through voluminous scientific studies.