CommentaryWhy dentists don't like to change
Section snippets
Background
The way evidence-based dentistry is supposed to work seems very straightforward. An established, respected clinical and research source provides a recommendation based on evidence gathered in sufficient quantity and quality. The needed materials are at hand. When the dentist sees and understands the new information, he or she is expected to incorporate the findings into clinical practice—but there the process seems to fall apart. Generally, nothing happens to change the dentist's previous
Barriers to change
It's important to understand that several factors contribute to the process of making a change in clinical care behaviors. A small sample of practitioners was gathered in a qualitative investigation into what factors determine the choice a dentist makes in treatment planning for the use of a sealant for noncavitated carious lesions. The determining factor that emerged was personal clinical experience. Essentially, practitioners who had had a bad experience with a new method or material seemed
Illustration
While they are in dental school, dentists learn that carious lesions should be removed and the tooth restored, leaving no infected tooth structure to cause future problems. The consequences foreseen if the dentist leaves any problematic areas behind trigger an emotionally charged response that dictates the choice to remove all caries and restore the tooth.
In the sealant guideline investigation, the dentists apparently found that this emotionally compelling argument was too strong for any
Analysis and recommendation
The study found that publishing evidence-based guidelines is unlikely to produce the immediate changes in practice that are desired. Instead, it's necessary to overcome long-held beliefs and personal clinical observations that contradict the evidence. To promote acceptance of evidence-based recommendations will require overcoming the emotional aspect of the decision-making process.
It's essential to identify the emotional target and relocate it when emotions and logic are in conflict. If the
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Carney KK: Why we change: Kirk vs. Spock, CDA J 46:5-6, 2017
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