Evidence-Based Dentistry

Hope Saltmarsh

Jane Gillette

Julie Frantsve-Hawley

What does EBD mean?

What is EVIDENCE-BASED DENTISTRY?

According to the ADA…

Evidence-based dentistry (EBD) is an approach

to oral health care that requires the judicious

integration of systematic assessments of

clinically relevant scientific evidence, relating to

the patient’s oral and medical condition and

history, with the dentist’s clinical expertise and

the patient’s treatment needs and preferences.

Three Components of EBD

Clinical expertise

Patient preferences

& needs

Evidence

EBD

• Is an approach

to oral health

care

• Is a method to

acquire,

understand and

apply the most

current science

Evidence-Based Dentistry Is NOT….

• Cookbook dentistry

• A standard of care

• A mandate of what must be done

• A substitute for clinical judgment

The Value of Evidence-Based Practice

What is evidence?

Strong

Weak

What are the levels of evidence?

Systematic Reviews

RCT’s

Cohort study

Case control study

Case series

Case report

Expert opinion

Animal research

Bench-top research

How much is enough?

Do we need an RCT to

answer this question:

Will using a parachute save

lives?

Group 1: Jump with

parachutes

Group 2: Jump without

parachutes?

Use your judgment

What is the Level

of evidence

What is the Quality

of this evidence

Does this apply to my patient?

How strongly

should I

recommend

this to my

patient?

Patient

Can it apply to

the patient?

Treatment

decisions

Complaint

Signs

Symptoms

Answerable

question

Search for

best evidence Critical appraisal

of evidence Clinician

You and your patient make the final decision You and your patient make the final decision

Is this different from what I am doing now?

1%

9%

16%

21%

34%

26%

35%

40%

42%

0% 10% 20% 30% 40% 50%

Manufacturers ' claims

Experience in dental school

Comparative pricing data

CE courses

Hands-on workshops

Laboratory data on key attributes

Published clinical studies

Input from peers

Expert opinions

When selecting dental products, how valuable do you find each of the

sources of information below?

% indicate the “very valuable” only

2008 PPR Reader Survey

How does EBD work?

Ask answerable

questions

Access the best

evidence

Appraise the

evidence

Apply evidence to

patient care

The EBD Process

Assess/evaluate

treatment outcomes

Acknowledging the difference

Evidence-Based Practice

Uses best evidence

Systematic appraisal of quality of evidence

Objective, transparent, less biased

Acceptance of levels of uncertainty

Traditional Practice

Unknown basis of evidence

Limited/incomplete appraisal of quality of evidence

Subjective, opaque, potentially biased

Black and white conclusions

Let’s adapt -- It’s a paradigm shift!

A change of perspective on a subject

It’s true!

SCIENCE Changes!!

EBD is a way to keep up with this change

Past – Present - Future

Is what we learned in school still true?

Medical Publishing

Annually:

20,000 journals

17,000 new books

MEDLINE:

4,000 journals

6 million references

400,000 new entries yearly

Barriers to change

• Time

• Access

• Complexity of

information

Did you know…

…that fluoride varnish is effective in caries

prevention?1

… that sealants placed on a non-cavitated

lesion reduce caries progression?2

1. ADA Council on Scientific Affairs, “Professionally applied topical fluoride evidence–based

clinical recommendations, JADA 137, Aug 2006; 1151-59

2. ADA Council on Scientific Affairs. Use of pit and fissure sealants: evidence-based clinical

recommendations. JADA 2008;139(3):257-68.

Try and you can climb that wall!

Formulate your question

Search the secondary sources

Search the primary sources

Use it in your treatment decision

Where can I find evidence?

- Providing the tools you need

ebd.ada.org

Clinical Recommendations

Systematic Review

Systematic Review

Systematic Review

ebd.ada.org

ebd.ada.org

Supported by a grant from the NLM and the NIDCR

(Grant Number G08 LM008956)

TRANSITION TO JANE

GILLETTE

• “Thank you for the privilege and honor to participate in this meeting, one of the best I’ve attended and one that I believe will produce a lot of fruit in academia, education, research, and practice.”

• “I really enjoyed this experience and initiation into being a champion for EBD. There are high expectations for me to disseminate this information in my dental school, component societies and study clubs. I feel this has been a good preparation for me to go home and start working on this.”

• “Excellent program. The passion in the presenters has to be contagious!”

ADA/Forsyth Evidence-Based Dentistry Course

•5 days

•Critical appraisal

•Research Designs

•Statistics

•Advanced searching techniques

Certificate: in Evidence-Based

Dentistry from the Forsyth Institute

ADA/Forsyth EBD Course

Other Educational Opportunities

nature.com/ebd/journal

THANK YOU!

Visit ebd.ada.org

ADA Contact: ebd@ada.org