I have written on several occasions in the past few years about the relationship of research to, for want of a better word, reality. My original foray was in 2006 when the editorial 'Asking the right questions' caused some raised eyebrows at that year's IADR Conference and didn't make me many new friends.1 The purpose was to draw attention to the fact that most reviews of research reported there was insufficient evidence in any particular field of enquiry and concluded that the only solution was further research. As a consequence, this raised further concerns as to how research was organised and conducted and whether the aims of studies were actually investigating matters of practical relevance.
Championing the cause then, as now, was Professor Liz Kay who is currently President of the BDA but who also, significantly, in the meanwhile has become the editor of our own publication Evidence-Based Dentistry (EBD).Her passion for translating research into practice has led many initiatives including urging practitioners to engage in the research process by posing questions that need answering in order to improve patient care. Under Liz's editorship in 2021, we began publishing systematic reviews in EBD for the first time. A huge response shows we have clearly tapped into a rich vein of material enabling us to publish 22 to date, with more in the pipeline. In turn, this will lead to EBD becoming a hybrid journal with open access content from 2023.
While the expansion of exposure of systematic reviews is welcome, what is striking when reading them is that little has changed in the 16 years since I first dipped my toe in the murky shallows of the research ocean. The conclusions are still broadly the same; not enough studies of sufficient, consistent quality and that further work is needed. As an example in a review into the effectiveness of fissure sealants in the current issue of EBD, the authors concluded: 'The certainty of the evidence for the comparisons and outcomes in this review was low or very low, reflecting the fragility and uncertainty of the evidence base […] given the importance of prevention for maintaining good oral health, there exists an important evidence gap pertaining to the caries-preventive effect and retention of sealants in the primary dentition, which should be addressed through robust RCTs'.2
This in turn prompted Manas Dave to write in BDJ Team in order to inform our DCP colleagues in particular that: 'The RCTs included in this systematic review were of high risk of bias and heterogeneous, resulting in limited conclusions that could be drawn. However, most studies did suggest a direction of sealants being favourable (compared to no sealants). Clinical guidelines currently recommend the use of fissure sealants in both primary and permanent teeth for the prevention of dental caries and this practice should be continued.'3
The expansion of exposure of systematic reviews is welcome, what is striking when reading them is that little has changed
Manas' observations regarding guidelines take us on to a further consideration in the intimately connected scheme of things. At what point does and should this rather shuffling, less than robust system of evidence sifting become strong enough to be included in guidance?
In the genesis of the UK approach to the COVID-19 pandemic, the scientists shared the full stage with the politicians and were lauded for their wisdom based on available up-to-date knowledge of the emerging evidence. Politics informed by science. Who remembers that? Yet in the wake of the deftly managed pandemic, that self-congratulatory approach seems less keenly applied when it comes to, for example, the government's own reviews. Surely Delivering better oral health version 4 published last autumn might have formed an integral part, if not provided the kernel, of changes to the NHS dental contract?4 A systematic review of that matter would, I suspect, throw up the deduction that there was insufficient evidence of any influence and that a further document was needed. QED.
This is the first opportunity the BDJ has had to extend our condolences to the Royal Family on the passing of Her Majesty Queen Elizabeth II. Celebrating our 150 years of publication, it is astonishing to realise that this has now taken place during the reigns of seven British monarchs: Victoria, Edward VII, George V, Edward VIII, George VI, Elizabeth II and Charles III, but that for nearly half of that time it has been during the reign of Queen Elizabeth II. Thank you Ma'am, for everything.
Hancocks S. Asking the right questions. Br Dent J 2006; 200: 649.
Gugnani N, Gugnani S. Are sealants effective in preventing caries in primary molars? Evid Based Dent 2022; 23: 60-61.
Dave M. EBD spotlight: Sealants for preventing dental caries in primary molars. BDJ Team 2022; 9: 46-47.
Hancocks S. Here's a revolutionary idea. Br Dent J 2021; 231: 423.
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Hancocks OBE, S. QED. Br Dent J 233, 437 (2022). https://doi.org/10.1038/s41415-022-5048-2