Abstract
The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health. After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs.
Highlights
After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based
“there is no model or description of clinical reasoning to explain the complicated cognitive and interactive process used by dentists.”2 “practitioners are commonly unaware of their model since it represents the unquestioned norm, and they are unaware of how this model influences the way they reason.”[3]
The implicit biomedical model, whose roots go back to the 19th century, stems from an interpretation of health that is based on positivism, the leading paradigm of that period
Summary
“Theories are integral to healthcare practice, promotion, and research. The choice of theory, often unacknowledged, shapes the way practitioners and researchers collect and interpret evidence.”1 – P. In the late 20th century, Evidence-Based Medicine (EBM) emerged, defined as “the integration of best research evidence with clinical expertise and patient values.”[20,21] The argument was that “intuition, unsystematic clinical experience, and pathophysiological rationale are insufficient grounds for clinical decision making” 21: “EBM refers to making medical decisions that are consistent with evidence, and to serve as a neutral arbiter among competing views.”[22] Dentistry was quick to adopt this concept.[23] Today, a large proportion of dentists claim to have adopted an evidence-based approach in their clinics,[24] and “the majority of U.S dental school graduates in the twenty-first century will have been exposed to the acquisition, assessment, and implementation of scientific evidence in the practice of dentistry.”[24]. It is interesting to note that some of the reasons alternative dentists reject the biomedical model are “a genuine interest and belief in holistic health versus tooth-oriented practice, boredom with conventional dentistry, ego gratification and financial motivation.”[37]
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