Sir, Dr Gibson makes an excellent point about the importance of art in dentistry (BDJ 2005; 199: 247). Regarding evidence-based dentistry (EBD) however, there is a misunderstanding. By definition (and by practice), EBD does not dictate what to do. Instead, it offers decision support by providing the best evidence available to integrate both with patient preferences and with a professional's highly developed skills and art. Developing skills and art are not by-passed but instead, are an essential aspect of delivering high quality patient care.1 There are parallels with periodontics. Many clinicians use plaque indices in patient care. However, few would blindly apply the values of the indices to assessing oral hygiene without considering other issues such as when the patient last brushed their teeth, their susceptibility to periodontal diseases, etc. Numbers alone do not make decisions.

What EBD does provide is the best available evidence for effectiveness and harms and tries to quantify the probability of achieving such outcomes where the data are available. Alternatively, it might own up to a lack of good evidence if this is the case. Such evidence is derived by stripping away accumulated bias and opinion, objectively assessing research quality and by including the totality of evidence, whether randomised, observational study or qualitative research. Each professional and each patient must make their own decisions on how to apply this information since it will be different for each particular circumstance. Decisions are therefore also more individual than generic. Now if Dr Gibson would prefer not to have such information available to aid decision making, that would be surprising.