Accepting uncertainty

Derek Richards
Editor, Evidence-based Dentistry

Evidence-Based Dentistry (2004) 5, 59. doi:10.1038/sj.ebd.6400283

In this issue Nigel Pitts finishes his series

of articles about the jigsaw of Evidence-

based dentistry and its three broad

domains of research, dissemination and

implementation, and we have a range of

systematic reviews and randomised con-

trolled trials covering issues from the use

of radiographs in epidemiology, the long-

evity of restorations to appliances to treat

temporomandibular pain dysfunction

and sleep apnoea. Yet as the evidence

base of dentistry is explored through the

work of The Cochrane Oral Health group

and other researchers using systematic

reviews and conducting good quality

research using robust study designs, we

are discovering that there are relatively

few certainties about the practice of

dentistry.

But this is nothing new, for as clin-

icians we are faced with uncertainties in

practice from day to day as patients

present with a range of unpredictable

and untimely conditions. Perhaps for the

clinician, being able to acquire the skills

to recognise, understand and master this

uncertainty is one of the more important

skills. To do this we need to be able to

recognise our own skill, expertise and

knowledge base. I hope that in our own

way this journal helps in this regard.

For me the ongoing tension between

what is known and what is unknown,

what is certain and what is uncertain, is a

driving force for evidence-based practice.

It is also one of the core skills of evidence

practice, critical appraisal, that helps the

individual understand and deal with

uncertainties in the existing evidence-base.

The latest version of the General

Dental Council’s document The First Five

Years:1 sets out the Council’s require-

ments on the content and scope of the

5-year programme for dental undergrad-

uates. It states clearly that undergradu-

ates ‘should be able to evaluate the

evidence and critically assess its rele-

vance to treatment planning, advice

and treatment provision’. This document

also includes references to developing

other key evidence-based skills such as

literature searching and basic under-

standing of statistics. However there are

a vast number of learning objectives

contained within this document repre-

senting a crowded curriculum. I for one

would welcome a move towards a more

problem-based approach to learning

within dental schools. I believe that not

to do so perpetuates the traditional

didactic approach which leads to dentists

feeling as this individual in a quote from

a paper by Baldwin et al:2

I feel that a career in dentistry, does not

tax the intellect or stimulate the indivi-

dual (who is obviously of above average

intelligence) leading to a moribund

professional life y. with very little

variety.

A problem-based approach recognises

uncertainty and consequently helps peo-

ple understand and come to terms with

it. For it is worth remembering that it is

some time since Benjamin Franklin

noted that ‘‘In this world, nothing is

certain but death and taxes.’’ And that

uncertainty is also recognised by pure

scientists, for it was in 1927 that the

German physicist Heisenberg developed

the Uncertainty Principle which, put

simply states; that the more precisely

the position of a particle is given, the less

precicisely once can say what its moment

is. This was an important moment in

physics and the development of quan-

tum theory. I find it interesting that we

can accept readily uncertainty in a pure

science like physics which has given us

Heisenberg’s Uncertainty Principle, yet

we have much more difficulty accepting

uncertainty in Health Sciences.

1. General Dental Council. The First Five Years: A
Framework for Undergraduate Dental Education,
2nd edn. General Dental Council, London; 2002.

2. Baldwin PJ, Dodd M, Rennie JS. Postgraduate
dental education and the ‘new’ graduate. Br Dent J
1998; 185:591–594.

www.nature.com/ebd 59

EDITORIAL


	Accepting uncertainty
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