Evidence-Based Pediatric Dentistry

Preface
T h e Sc i e n c e a n d A r t o f E v i d e n c e -
Based Pediatric Dentistry

Donald L. Chi, DDS, PhD

Editor

Evidence-based pediatric dentistry involves a delicate balance between three factors:

appropriate application of the best available science, craft knowledge accumulated
through clinical experiences and patient values. The goal is to deliver care that opti-
mize outcomes. Evidence-based dental practice is a value-free proposition: clinicians
have the autonomy to make independent treatment and intervention decisions. This
autonomy is bounded by an ethical obligation of nonmaleficence (do no harm) by keep-
ing up-to-date on the relevant scientific literature that continues to expand, change,
and evolve and is relevant in delivering the highest quality care.
The Internet has democratized science, making it easier for clinicians to communi-
cate scientific literature, but barriers to science persist. There is a proliferation of basic,
clinical, and translational studies in pediatric dentistry. Researchers from around the
world are testing novel ideas and generating new knowledge, increasing the potential
to transform disease prevention strategies, care delivery, and child health outcomes.
Almost all studies are available online, some at no-cost through PubMed Central or
Open Access. However, access to most publications costs money. A small number
of clinicians affiliated with universities or hospitals can bypass these fees. Clinicians
in practice are likely to search for free articles. Furthermore, assessing the quality of
publications has become increasingly difficult, especially with the growing number
of predatory journals and advertiser-sponsored articles that are free. These publica-
tions may not be peer-reviewed and may endorse commercial products of unknown
quality or clinical approaches that are not evidence based. Thus, many clinicians
have difficulties keeping current on the best available science, which is a significant
barrier to evidence-based pediatric dental practice.
In this issue of the Dental Clinics of North America, our goal is to present trainees,
clinicians, researchers, and policymakers with the most up-to-date science on

Dent Clin N Am 61 (2017) xi–xii

http://dx.doi.org/10.1016/j.cden.2017.04.001 dental.theclinics.com
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important topics pertaining to pediatric dentistry. We highlight approaches for which

there is empirical evidence and how the field can build on this knowledge.
In the first two articles, Iida and Finlayson and colleagues focus on prenatal and
postnatal oral health interventions, with an emphasis on behavioral interventions,
focusing on expectant and new mothers. Next, da Fonseca and Avenetti review the
literature on the social determinants of pediatric oral health. Northridge and colleagues
provide examples of intergenerational and social interventions aimed at improving pe-
diatric health.
The next two articles focus on vulnerable populations. Tiwari and Albino review the
literature on the effects of acculturation on the oral health of ethnic and racial minority
children with an emphasis on evidence-based minority oral health interventions.
Glassman focuses on children with special health care needs and reviews the meth-
odologic challenges of classifying and identifying children who are in greatest need of
interventions, focusing on disease prevention and management.
The pediatric dentistry workforce is at the frontline of implementing evidence-based
practices and policies. Mertz and colleagues review the workforce literature with an
emphasis on innovative evidence-based models of pediatric dental care delivery.
Edelstein argues in favor of additional integration between pediatric dentistry and
other related fields, including nutrition and social work, to address limitations of the
existing workforce model.
The remaining articles highlight emerging issues in evidence-based pediatric
dentistry. Chi describes the public health implications of topical fluoride refusal in pe-
diatric dental practice, with emphases on clinical strategies and future research prior-
ities. Divaris reviews the emerging literature on genomics and the potential for
evidence-based precision dentistry approaches tailored to the profiles of children.
Cruz and Chi examine two Medicaid dental class-action lawsuits to demonstrate
how research evidence is used in the legal process and present a new conceptual
model to help guide future evidence-based policymaking. We hope this issue will stim-
ulate continued dialogue on how to improve the science and art of evidence-based
pediatric dentistry.

Donald L. Chi, DDS, PhD

Department of Oral Health Sciences
School of Dentistry
University of Washington
Box 357475
B509 Health Sciences Building
Seattle, WA 98195-7475, USA
E-mail address:
dchi@uw.edu