Evidence – based Dentistry Commentary (Manfredini et al., j Oral Rehabil 2018)
EVIDENCE-BASED DENTISTRY OR META-ANALYSIS ILLNESS? WHAT IS GOING ON IN BRUXISM AND TEMPOROMANDIBULARS FIELDS?
The core principles of evidence-based dentistry state that it should derive from a careful appraisal of the combined information drawn from the literature, from the clinical setting, and from patients’ needs and expectations.
We are all well aware of the many clinicians stating that a certain practice “works in their hands” and completely neglecting the literature or the patient’s needs. They practice outside of the EBD boundaries. Period.
On the other hand, this paper, written by six passionate friends usually involved in the field of research and clinical practice of TMDs, orofacial pain, and bruxism (and supported by many others behind the scenes!), wants to be a reminder that relying on literature alone is equally ineffective. We are living in an era in which writing systematic reviews has become a work…but it cannot be a work unrelated with the clinical practice! 
Publishing systematic reviews is a shortcut to notoriety due to the common idea that they are atop of the hierarchy of evidence and to the fact that writing a review, on average, requires much less time than to perform a primary research (few months vs potentially multiple years). Performing a review without any documented experience in clinical expertise may lead to an incorrect interpretation of primary research data, and to a forced adoption of meta-analyses that may be taken for granted by non-expert readers. Reviews are not necessarily atop of the EBD hierarchy, and they should be viewed as a filter or lens to interpret available findings. If the lens is distorted…good luck!
Is this a terrible problem? Actually, it isn’t. Is this overuse of meta-analysis a good faith attempt to contribute to an increased knowledge? Of course, we believe it is.
But, is it an ethical concern? Yes, it is!
Literature reviews are a search, not a research, and from EBD zealots we would expect researches! So, this is our alert message: please don’t forget that if we devalue the role of systematic reviews as a state-of-the-art summary of an argument, we are all indirectly supporting clinicians “working in their hands”!
Six friends (and many others behind the scenes)
PS. Take it as a constructive input!
