Evidence-Based Practice Definition•

“the conscientious, explicit and judicious use of current best evidence in making decisions about individual patients.”

• “integrating individual clinical expertise with the best available external clinical evidence from studies while considering your patient’s values.”

Clinical Experience Patient’s wants, desires & values

External Clinical Evidence

(Sackett et al. BMJ, 1996; 312: 72-3)

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ADA Definition of Evidence-Based Dentistry

• 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.

ADA Policy on Evidence-Based Dentistry

Why does Dentists need Evidence-based Practice?

• From the Evidence-based Dentistry Guidelines of the New Zealand Dental Association:

The use of evidence-based dentistry may help reduce the variation in patient care and outcomes that appears to be associated with four factors: the quality of science underlying clinical care, the quality of clinical decision making, variations in the level of clinical skill and the large and increasing volume of literature

Background / Foreground Information

• Background Information – general information on a clinical topic

• Foreground Information – Specific information for a clinical decision action

• The greater your experience with the condition the less background and the more focused foreground information will be needed

The Forest and the Trees

• 2 aspects of Evidence-Based Dentistry in your clinical career:

1. Maintaining your general level of knowledge – keeping up with new clinical developments and trends

2. Being able to find the best evidence to assist you find the best answer for specific, patient focused questions

Types of Clinical Questions

• Clinical questions usually fall into one of four main categories:

• Etiology / Harm : identifying associations, risk factors and causes of a disease

• Diagnosis: selecting tests that accurately detect a disease

• Therapy / Prevention : selecting effective interventions to treat or prevent a disease

• Prognosis: predicting the probable outcome of a disease or treatment

Sample questions:

• Etiology / Harm : Are teenagers who frequently drink soda at risk for developing dental caries?

• Diagnosis: What is the best method that dentists can use to identify early carious lesions?

• Therapy / Prevention : Should teenagers and young adults with asymptomatic impacted wisdom teeth have them removed?

• Prognosis: How long will a dental implant last in an adult patient with no periodontal disease?

What Studies for Which Clinical Questions??

Type Of Question Type of Study

Clinical Examination Prospective, blind comparison to gold standard

Diagnostic Testing Prospective, blind comparison to gold standard

Prognosis Cohort Study > Case Control > Case Series

Therapy RCT is the only way to answer these questions

Etiology / Harm Cohort Study > Case Control > Case Series

Prevention RCT > Cohort Study > Case Control > Case Series