Evidence-based dentistry and health services research: is one possible without the other?

Barriers have been identified in the literature to the implementation of evidence-based practice in dentistry. A major concern is the lack of rigorous evidence for clinical practices. Little attention has been given to the lack of rigorous health services research. Evidence-based practice is more about effectiveness than efficacy and will influence the type of research that characterizes health services research (HSR) because it involves levels of data below that of the random controlled trials, involves questions about the appropriateness of care, and involves examining the structure, process, and outcomes of care. The need for HSR can be seen by examining the appropriateness of dental care and health-related quality of life outcomes. The conclusion to be drawn is that evidence-based dentistry needs HSR if it is to fulfill the promise currently held for it in the profession.