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Br Dent J 2016; 220: 651–655 http://dx.doi.org/10.1038/sj.bdj.2016.451

Providing the best clinical care involves using the best available evidence of effectiveness to inform treatment decisions; evidence that can be gained through research. Oral and dental research shares the same goals as the rest of healthcare research; to benefit people and patients, whether at an individual or a societal level. Clinical trials form the backbone of our clinical evidence in relation to the effect of interventions. Producing this evidence begins with trials and continues through synthesis of the findings towards evidence incorporation within comprehensible, usable guidelines, for clinicians and patients at the point of care. However, there is enormous wastage in this production process, with less than 50% of the published biomedical literature considered sufficient in conduct and reporting to be fit for purpose.

Over the last 30 years, independent collaborative initiatives have evolved to optimise the evidence in order to improve patient care. These collaborations each recommend how to improve research quality in a small way at many different stages of the evidence production and distillation process. When we consider these minimal improvements at each stage from an 'aggregation of marginal gains' perspective, the accumulation of small enhancements aggregates, greatly improving the final product of 'best available evidence'. The myriad of tools to reduce research quality leakage and evidence loss should be routinely used by all those with responsibility for ensuring that research benefits patients, ie those who pay for research (funders), produce it (researchers), take part in it (patients/participants) and use it (clinicians, policy makers and service commissioners).

Patients/participants and clinicians are well placed to suggest priority areas for research, based on experience, both as service users and clinical experience. Policy makers and service commissioners have a strong role to play in suggesting priority areas for research based on awareness of gaps in research to inform policy creation.