What “Evidence-Based” Actually Costs a Dentist

It is a comfortable phrase until the evidence contradicts something you were taught, something you have charged for, or something you told a patient last week.

By Kirti Chopra, DDS, FAGD

General dentist, Rittenhouse Square, Philadelphia · Kois Center Graduate with Honors

For decades, patients with an artificial hip or knee were told to take antibiotics before a dental cleaning. Dentists prescribed them, physicians expected them, patients arranged them, and the practice was so entrenched that many people still carry a card about it in their wallet.

The evidence did not support it. When the American Dental Association's expert panel examined the question, the resulting guidance, first issued in 2014 and updated since, was unambiguous:

“In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended before dental procedures to prevent prosthetic joint infection.”

American Dental Association, antibiotic prophylaxis guidance

That is what evidence-based practice looks like from the inside. Not a marketing adjective, a reversal. A generation of clinicians had to stop doing something they had been taught was careful, explain to patients why the advice had changed, and absorb the reasonable question of why they had been doing it in the first place.

Which is why I am wary of the phrase when it appears on a practice website. It is used to mean modern, or thorough, or gentle. What it actually describes is a willingness to be wrong in public.

The Part Nobody Advertises: The Evidence is Uneven

Dentistry has areas where the research is genuinely strong, and areas where it is thin, short-term, or drawn from studies too small to settle anything. Both exist in the same mouth, sometimes in the same treatment plan.

An honest use of the term means being able to say which is which: that this recommendation rests on good long-term data, and that the other rests on a handful of studies with a few years of follow-up, and that this other one rests mostly on my judgement and what I have seen hold up. All three can be defensible. Presenting the third as though it were the first is not.

“The evidence supports this” and “I believe this, and the evidence does not contradict it” are different sentences. Patients deserve to know which one they are getting.

This is the part that makes the phrase expensive. It obliges you to hold your own preferences to the same standard you would apply to someone else's, and to notice when a technique you like is one you like because it is yours.

It does not mean adopting whatever is newest

New materials and techniques arrive constantly, arriving with confident claims and thin data. Being evidence-based means putting a new option through the same test as an established one: is there reason to believe this is better for this situation, or is the case for it mainly that it is recent?

Novelty is not evidence. Neither is a manufacturer's study, a compelling lecture, or the fact that a technique photographs well.

It does not mean always choosing the smallest option

This one is more tempting, and it is the trap I watch for in my own thinking. Conservative treatment is very often the right answer; when a smaller restoration can reliably do the job, there is no argument for removing more tooth than necessary.

But minimal intervention is a principle, not a verdict. A more definitive treatment better serves some situations because it is more predictable or more durable, and choosing the smaller option regardless is not evidence-based reasoning. It is a preference wearing the costume of one.

What it looks like in an actual decision

Two patients arrive with what appears to be the same problem: a chipped upper front tooth, similar size, similar position.

The first has a healthy mouth, no wear elsewhere, a bite that distributes force evenly, and a clear mechanical explanation for the chip. Composite bonding is well supported here; it is reversible, it removes essentially nothing, and there is no reason to do more.

The second has the same chip, and an examination finds wear on the opposing teeth, a bite that loads the front teeth in a way they were not designed for, and two restorations elsewhere that have already been replaced once. Bonding that chip would be technically easy and would very likely fail, because the force that caused it has not gone anywhere.

Same complaint, same tooth, opposite conclusions, and neither conclusion came from a preference for conservative or comprehensive treatment. They came from two different sets of findings.

That is the whole practical content of the phrase. It is not a philosophy that produces a signature style. It is a discipline that prevents one.

What to expect from a dentist who works this way

Three things, in my experience, and none of them involve the word.

They will tell you why, in terms of your findings rather than in general principles. They will distinguish between what is established and what is their judgement, without being asked. And at some point they will say that they do not know, or that reasonable clinicians disagree, or that the honest answer is to watch it and look again, because a clinician who is never uncertain is not tracking the evidence, only their own confidence.

The advertisement is the easy part. The uncomfortable conversations are the practice.

Kirti Chopra, DDS, FAGD, is a general dentist practising in Rittenhouse Square, Center City Philadelphia, with a focus on cosmetic and comprehensive dentistry. She earned her DDS at the Indiana University School of Dentistry, where she was inducted into Omicron Kappa Upsilon, and graduated with honors from the Kois Center. She holds Fellowship in the Academy of General Dentistry and is an AACD Accreditation Candidate. Colleagues refer her cases involving worn dentition, failing restorations, and bite problems. More at https://kirtichopra.com/about-dr-kirti-chopra/

REFERENCE

1. American Dental Association. Antibiotics to prevent prosthetic joint infection. Clinical practice guideline first issued 2014; guidance subsequently updated.