The comfort of peer review

There are three broad categories of sources of information. There are articles containing news and information which are written by authors who may, or may not, be experts in the field and, as such, the information may be incorrect. The Internet comes into this category. Then there are journals and magazines written by professionals and/or experts, but the expert may have views which are his/her own (as opposed to being scientifically based) and which they are free to express. The third category is the peer reviewed journal (also known as a refereed journal), in which articles are written by experts in their field and these are subject to reviewing by a number of experts in the field before the article is accepted, with suggestions for the amendments being made by the reviewers being incorporated. Alternatively, if the reviews are unfavourable, the article will be rejected. By this means, scientific credibility should be assured. Dental Update is an example of this although, it should be added that the Editorial Comment is not reviewed. I can write what I like, within reason!

I write because Dental Update has recently been confused with non peer-reviewed publications in an article,¹ although this error was recognized.² However, the question must be asked – how do readers work out whether a journal is peer reviewed or not? Alas, sometimes with difficulty! As a result, some journals have started publishing the names of the reviewers for the articles that they publish. I don't propose to go to such lengths with Dental Update but, while we presently publish a line at the bottom of the editorial page advising readers that each article has been peer reviewed, I am planning that this should be rather more bold in future issues.

So, why does it matter? I read, with horror, an extreme example of premeditated dental murder.³ In this, a mid-twenties female patient with a missing upper right canine tooth and a small midline diastema received six (severe) crown preparations in order to provide a bridge to replace the missing canine and close the diastema, all in the name of cosmetic improvement. She also received a number of zirconia veneers. Some gullible readers (which Dental Update subscribers are not!) of this particular article will have surmised that it is OK to carry out such treatment and may even have carried out similar destruction on their own patients. There was no mention of the risk of pulp death following crown preparation (estimated in one publication as 19% after 5 years⁴), let alone the risk to the periodontal tissues which is evident in a post-op illustration. There was no mention of the difficulties in obtaining a bond of zirconia to the tooth. Peer review by dentists who knew something about the subject would have rejected the article as unsound and misleading, sparing the readers. Indeed, I have rejected articles sent to this journal for that very reason, sometimes without seeking the views of an expert.

In summary, peer review is not an absolute guarantee with 100% trustworthiness, but it stands a better chance of reliability than publications in journals which are not peer reviewed. Reviewers, although carefully chosen, cannot always spot discrepancies, but the peer review process goes a long way. Readers should nevertheless be critical of what they read!