What is gold standard and what is ground truth?

Clinical decision-making is complex and based upon accurate evaluation of clinical findings using diagnostic tests and reference standard data. Given that many aspects of dental examination are not direct measures, but rely on indirect measures, it is important for clinicians to understand the basic principles and terms used to assess the accuracy of diagnostic tests and to appropriately evaluate published literature regarding these tests. Luckily, there is a variety of readily available metric systems to assess the quality of diagnostic test studies and to help clinicians better understand evidence-based literature. Dentistry, or shall we say Clinical Dentistry, is becoming more complex and patients have been better informed. Importantly, health care has also shifted focus to emphasize evidence-based practice (EBP). EBP is considered the gold standard for health professional decision-making. No one can deny that the activities in the field of evidence-based Dentistry have grown exponentially in the last decade. However, we cannot forget that Pierre Fauchard (1678 1761) may have been the first to warn the dental field about the concept of evidence, taking into consideration the practices of the time. Fauchard and James Lind (1716-1790) were both concerned about the health of sailors dying of scurvy and, for this reason, conceptualized a “clinical trial” involving the use of vitamin C to counteract the disease. The former even tested techniques for the removal of caries, dental restoration and implants. The true meaning of evidence-based Dentistry is grounded in a solid understanding and application of clinical epidemiology principles to reduce any confusion that may exist due to academic training. Epidemiology is defined as the “Science of making predictions about individual patients or a group, by recounting clinical events in similar patients in order to ensure that the predictions are correct”. Clinical epidemiology is “a subfield that applies the principles and methods of epidemiology to study the occurrence and outcomes of disease in people with a given illness”.1