JCDA - Canadian Dental Association

ecently 2 and I would advise all
to have a close look at this article.
Be careful of jumping on the EBD
bandwagon. While it is a laudable
goal, I have always felt that there are
decades of solid research required in
many fields before we can draw conclusions
based on meta-analyses.
Dr. Mark Antosz
Calgary, Alberta
References
1. Cochrane Review Abstracts. J Can Dent Assoc
2008; 74(4):333–36.
2. Papadopoulos MA, Gkiaouris I. A critical
evaluation of meta-analyses in orthodontics.
Am J Orthod Dentofacial Orthop 2007;
131(5):589–99.
CDA Responds
Thank you for your letter regarding
the Cochrane Review Abstracts
published in JCDA and the practise
of evidenced-based dentistry (EBD).
CDA collaborates with the
Canadian Cochrane Network and
Centre to reprint abstracts from
selected Cochrane Reviews that
will be of interest to Canadian
dentists. These reviews have been
prepared by the Cochrane Oral
Health Group within the Cochrane
Collaboration. Systematic reviews
prepared by the Cochrane
Collaboration are considered to be
the highest quality systematic reviews
available due to the protocols
and processes in place. Reviews
prepared and published by other
organizations may not have gone
through such a rigorous and thorough
process.
In a systematic review, evidence
on a topic has been systematically
identified, appraised and summarized
according to predetermined
criteria. Meta-analysis is a statistical
technique that summarizes the results
of several studies into a single
estimate, giving more weight to
results from larger studies. As you
have referenced, meta-analyses can
produce misleading results if done
poorly, hence the need for good
critical appraisal skills.
––– Letters –––
EBD is the integration of the best
available clinical evidence, clinical
judgment and patient values and
circumstances. The introduction
of EBD has had a mixed reception
within the dental community. Some
experienced clinicians rejected this
new approach and criticized the
focus on evidence from randomized
controlled trials (RCTs) and systematic
reviews of RCTs. There is now an
understanding that evidence from
the most appropriate study design is
required to answer the clinical question
being asked. In the absence of
clinical studies, the best available
evidence will be the opinion of experts
— including free thinkers and
innovators.
As policy makers often rely on
the current best available evidence
to make decisions about the care of
individuals or the delivery of health
services, it is important that the
dental profession support the dental
research effort that provides the
sound evidence base for the practise
of dentistry.
Dr. Euan Swan
Manager, Dental Programs
Canadian Dental Association
Article on Chlorinated Pools
Has Ripple Effect in Thailand
was very interested to read the
I case study on tooth erosion from
swimming in improperly chlorinated
pools. 1
I live in Thailand and have been
swimming at a local pool 2 to 3 times
a week for the last 3 years. Like the
woman in the case study, I always
do front crawl and it is impossible
not to get water in your mouth when
you breathe. I have always noticed
that my teeth felt “on edge” after
being in the pool, but never thought
anything more of it until recently
when, very rapidly, my teeth became
super sensitive and I noticed an obvious
discolouration. I was amazed
at how quickly they deteriorated
after that. I guess that with the
eroded enamel there is less protec-
574 JCDA • www.cda-adc.ca/jcda • September 2008, Vol. 74, No. 7 •
tion and the erosion rate escalates.
I am 32 years old with no previous
fillings or dental work, but now I am
going to need veneers or some other
treatment.
The pool that I (used to) go to is
also used for offshore safety training
where helicopters drop down life
rafts for trainees wearing boiler
suits. When I complained about
the chlorine levels at the pool, the
staff openly admitted to using more
than the recommended levels (and
obviously not enough alkali to balance
the pH) due to the pool’s heavy
usage. Incidentally, they use stabilized
chlorine as opposed to chlorine
gas.
I will be dropping off a copy of
the article to the pool staff because I
don’t want others to suffer the same
dental problems I have experienced.
Hopefully this will result in some
corrective action.
I thought your readers might be
interested to hear of another case
and know that the article is helping
by raising awareness.
Mr. David Brent
Thailand
Reference
1. Dawes C, Boroditsky CL. Rapid and severe
tooth erosion from swimming in an improperly
chlorinated pool: case report. J Can Dent Assoc
2008; 74(4):359–61.
One of the Authors Responds
was surprised but pleased to
I learn that our article was read in
a country as far from Canada as
Thailand.
Our aim in writing the case report
was to alert dental practitioners
to the fact that improperly chlorinated
swimming pools may be a
danger to the teeth of their patients.
It is a great credit to JCDA that it
makes its content freely available
on the Internet, which allowed Mr.
Brent to determine the cause of his
own dental erosion problem.
More recent correspondence
with Mr. Brent suggests that the
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