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LETTERS nally published as a supplement to the British Dental Journal. In June 1997, JADA published an article on evidencebased periodontal treatment.1 The authors of that report described the evidence-based approach and summarized the findings of a workshop on diagnosis, nonsurgical and surgical therapies as well as dental implants. They noted that “the evidence-based approach strives to strengthen clinical experience through systematic evaluation of available information, which allows the clinician and patient to benefit from the amassed data.” The authors also noted that not all evidence is given the same weight. The double-blind, placebo-controlled clinical trial is generally regarded as the top of the hierarchy in scientific research. Case reports and animal studies are of lesser value, the authors observed, noting that case reports are not designed to provide unbiased estimates of treatment efficacy. They said, too, that animal studies can be used to improve designs of human clinical trials. EBDs is not new to dentistry. The expansion of scientific knowledge is and always has been a goal of the profession. The ADA supports the expansion of the scientific base on which dental care is built. To this end, the Association continuously conducts research, facilitates investigations and incorporates current scientific information in programs and policies. It should be noted that the practice of dentistry uses both scientific evidence and clinical

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consensus to guide treatment planning. Dentists, through their professional education and postdoctoral education mandated by state boards, are taught to assess their patients as individuals, not simply as part of a population. The value of scientific data cannot be understated. But clinical judgment—the ability to assess and interpret the unique set of circumstances and conditions each patient presents—is of vital importance. Good dental care accounts for the needs of the individual patient, as assessed by the attending dentist. 1. Jeffcoat MK, McGuire M, Newman MG. Evidence-based periodontal treatment: highlights from the 1996 World Workshop in Periodontics. JADA 1997;128:713-23.

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As one who has experienced a lot of actinic keratosis and a few basal cell lesions, I feel the article “Basal Cell Carcinoma: What Dentists Need to Know,” by Drs. Bob Rishiraj and Joel B. Epstein (March JADA), might have been more instructive if illustrations of the early lesions were presented. When these lesions are recognized early, cryotherapy is usually adequate. Treatment rarely results in any of the disfiguration these patients have surely experienced. This area is one where dentists can definitely make a difference in counseling younger patients regarding sun exposure and recognition of early lesions. Jim Murtaugh, D.D.S., M.S. Oklahoma City

Authors’ reply: We appreciate the comments received from Dr. Murtaugh regarding our article. In this report, we attempted to review known risk factors and clinical findings of basal cell carcinoma. We attempted to emphasize the need to recognize the presence of changes in the skin, particularly as dental providers may have the opportunity to closely observe exposed risk sites in a dental environment. The case reports presented included a range of patients in whom basal cell carcinoma was diagnosed on recognition after evaluation in a dental environment or with oral/dental complaints. While the cases presented demonstrate some of the advanced changes that can occur with progression of lesions, the emphasis was on early recognition and early therapy. We agree with Dr. Murtaugh that early recognition is of the essence, and that early recognition allows less complex therapy. As stated in our article, we agree that dental providers have the opportunity to identify lesions at an early stage, when less complex therapy can result in cure of individual lesions, and that patients who have had basal cell cancers should be carefully examined during dental visits. We thank Dr. Murtaugh for emphasizing the importance of recognizing early lesions. Bob Rishiraj, B.Sc., D.D.S. Vancouver, British Columbia, Canada Joel B. Epstein, D.M.D., M.S.D., F.R.C.D.(C) Vancouver

JADA, Vol. 130, May 1999 Copyright ©1998-2001 American Dental Association. All rights reserved.