An interesting article titled “Is the Evidence Supporting Dental Procedures Strong? A Survey of Cochrane Systematic Reviews in Oral Health” by Clovis Mariano Faggion Jr. appears in J Evid Base Dent Pract, vol. 12, pp. 131-134, 2012. The article sets out to explore Cochrane systematic reviews and whether or not they provide useful information for use in dentistry. The author set out to look at the quality of evidence for Cochrane systematic reviews published in dentistry. The evidence was considered inadequate when authors described weak or insufficient evidence or when no studies were selected for the review.
A total of 120 systematic reviews were looked at for 20 topics. The author did have some creative interpretation to assess the reviews. He states:
“The full text of articles was, however, scrutinized to assess the risk of bias of included primary studies; methodological issues, such as allocation concealment and blinding, were usually not reported or were performed in a part of the primary studies sample. Some can argue that using stricter criteria would probably categorize almost all systematic reviews as providers of inadequate evidence. In other words, for some reviews, the attitude when scoring evidence as adequate was optimistic.”
The author states:
“Over the years, many Cochrane and paper-based systematic reviews have been published in the dental literature. The conclusions of this work reveal the sad reality of the lack of reliable information for clinical decision making. For most fields, it is not clear whether therapy that is widely performed throughout the world is, in fact, effective.”
The author goes on to describe how patients can’t wait around until strong and reliable evidence is found. However, he does argue for transparent decisions in regard to weak evidence and states
“The maintenance of unproved clinical treatments based only on the previous experience of the clinician with regard to effectiveness is far from acceptable.”
Clearly more efforts should be made to assess evidence and the current level of evidence should be made more transparent to patients.