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Substantial progress has been made since 1979 when the Canadian Task Force on the Periodic Health Examination set about generating ‘statements of evidence’ for ranking the validity of evidence about the effectiveness of preventative measures14. And, although their goal was to provide a way of rating the strength and quality of studies and link these to ‘grades of recommendations’, these ratings were based to a large extent on the type of study design with the randomised controlled trial as the highest level. Significantly, these grades of recommendation did not consider uncertainty around the results nor did they incorporate explicit judgements, such as for example the weighting of tradeoffs between harms and benefits, and how these might correlate with the strength of recommendations.

Guest Editorial - Grading the quality of evidence and strength of recommendations: the GRADE approach to improving dental Clinical Guidelines