576 JADA, Vol. 137 http://jada.ada.org May 2006 Michael Glick, DMD Editor E-mail “glickm@ada.org” COMMENTARY EDITORIAL Dental-lore–based dentistry, or where is the evidence? M any articles in the dental literature propose treatment protocols based on findings from only a handful of par- ticipants, yet the “findings” in such articles are used to generalize treatment to all patients. Other proto- cols extrapolate data from medical texts and apply them to the practice of dentistry. We also use protocols that have been passed down through generations of dentists, without chal- lenging their validity. How often do we ask ourselves why we still adhere to specific guidelines that we were taught many years ago? A well-known and still-used recommendation is to wait six months after a patient’s myocardial infarction (MI) before providing dental care. The ratio- nale behind this protocol is that these patients are at a very high risk of experiencing another acute coronary event within the next half year. This specific protocol is based on a study published al- most 30 years ago. In that study, the authors attempted to deter- mine the risk associated with major surgery for patients with im- paired cardiovascular status. 1 It is not clear, nor is it explained, how it is possible to compare the risk of adverse outcomes from surgery under general anesthesia for cardiac patients with routine outpatient dental care for the same types of patients. Furthermore, post-MI medical care and car- diac evaluation in 2006 differ greatly from those rendered in the 1970s. We know that for a patient with diabetes, the risk of experi- encing an initial MI is the same as the risk of experiencing a second MI is for a patient without diabetes. Thus, using the rationale for the “six months post-MI” protocol, we would have to wait six months to treat a patient with diabetes. It is almost as reasonable as asking what the difference is between an elephant. The erroneous belief that this is the safe protocol to be used in dentistry has prevented necessary dental care for a large co- hort of patients. More recent data suggest that it might be safe to treat a patient who has had an MI after waiting only one month after the MI. 2 Why do we practice the way we do, and who determines that what we do is the best way to do it? There may be several reasons for this dental-lore phenomenon, but some can be traced back to our dental education. For example, sometimes there was poor calibra- tion between didactic and clinical instructors. Every faculty mem- ber on the clinical floor might have been reluctant to change a time- tested procedure based on new information taught in dental How often do we ask ourselves why we still adhere to specific guidelines that we were taught many years ago? EDITORIAL Copyright ©2005 American Dental Association. All rights reserved.