Dentistry - art or science? Has the clinical freedom of the dental professional been undermined by guidelines, authoritative guidance and expert opinion?

Abstract

The General Dental Council (GDC) requires dental practitioners to provide good-quality care based on current evidence and authoritative guidance. However, this leaves the dental practitioner in a sort of limbo as good quality is an ill-defined term allowing its precise meaning to be open to interpretation. This article sets out to demonstrate that the practice of dentistry is very much more of an art than a science and, as such, relies on individual skill and judgement. It will also show that the 'value' of current evidence as determined by published papers and authoritative guidance is questionable and should not be regarded by dental practitioners as the 'rule'. The interaction between a dentist and a patient essentially consists of clinical decision-making and the implementation of that decision and, therefore, it is essential to understand the nature of decision-making and the context in which implementation takes place. Practitioners should exercise their clinical judgement, putting the interests of the patient first and not feel constrained by the threat of sanctions from the GDC or other regulatory bodies.

Fig. 1

Relationship between the dentist-patient interaction and clinical guidelines, expert opinion, authoritative guidance and the General Dental Council

Fig. 2

Factors affecting clinical decision-making in restorative dentistry

Fig. 3

The scientific evidence pyramid, reproduced with permission from J-F Roulet, How to set up, conduct and report a scientific study, Stomatology Edu Journal, 2017