How RDHs can build their credibility with science

The internet has created an unusual problem that isn’t often talked about: Everyone is now an expert in any given area and both patients and professionals believe they can Google their way to the truth on any given subject. Many of us have occasionally run into patients who seem to think they know more than we do on any given dental subject. Unfortunately, the internet provides a platform for those individuals who dish out a lot of misinformation or pseudoscience.

Christmas at my house illustrates this scenario well. A house guest of mine claimed that he had oral candidiasis and he recently visited a holistic store in Atlanta to confirm his findings. He stuck out his tongue and told me it used to have a thin white coating until he started his gut treatment for “candida overgrowth.” He also claimed that symptoms of candida overgrowth include headaches, joint pain and weird food cravings. When I looked at his tongue, I saw a slight coating, but it looked just like any other tongue that stares back at me while working in a patient’s mouth.

When talking to my house guest, I already knew (from reputable, professional sources) that in people with healthy immune systems, Candida is a normal member of the gut flora. The person who is treating him (a naturopathic doctor) apparently knows more about oral candidiasis than a dental professional, and it made me wonder if any white or yellow coating is classified as oral candidiasis by the naturopathic community. Try as I might, and feeling exasperated at times in conversation, I could only convince my house guest to Google more reliable websites. I gave him several examples like Medlineplus.gov, CDC.gov and MayoClinic.com.

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Succeeding with patients requires credibility. If you want to beat the internet and convince your patients you know what’s best for them, you need to keep up with the latest cutting-edge data, even though it’s not easy to do. How do you do it and what sources are credible? First and foremost, try to remain unbiased and objective when searching for information. Here’s a good example based on a question I’m frequently asked by parents of young adolescent patients who are about to enter orthodontic treatment. They ask me,  “do you recommend a powered toothbrush to reduce the future risk of cavities and gum disease over a regular toothbrush?” Instead of blurting out an answer, it might be best to give the question some thoughtful consideration, which may include the selection of reliable sources. I would suggest reading about what constitutes a “reliable” source of information at CDC.gov.

One of my favorite sources is The Dental Elf. It’s easy to search the website and you will find best available evidence that is based on strength and precision of research methods. Most of us don’t have the skills or time to appraise research papers. If I can’t find what I’m looking for on The Dental Elf, I’ll check Cochrane Oral Health, which also publishes summaries of the best quality research. Using resources that are recognized as having high standards of evidence-based oral healthcare decision-making resources is important for healthcare professionals. Generally speaking, healthcare practices that integrate knowledge and experience lead to better patient outcomes and safer and more efficient care.

Question: During orthodontic treatment, do I recommend a powered toothbrush to reduce the future risk of cavities and gum disease over a manual toothbrush?

Answer: I found a review on The Dental Elf that compared the effectiveness of powered and manual toothbrushes in maintaining oral health during orthodontic treatment. This summary provides more information than other resources because it includes randomized clinical trials (a higher source of evidence), but the trials used mostly powered toothbrushes with rotation-oscillation action. Risk of bias was low in only one of the RCTs.

Best available evidence is sometimes hard to interpret but allows you to take a top-down approach to locating best evidence. Always look for recent, high-quality, systematic reviews first, and if you don’t find any, move down to the next level of evidence to answer your question.

Best wishes for a very happy new year and happy science searching!