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Evidence-based dentistry (EBD) uses current scientific evidence to guide decision-making in dentistry. It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the dentist's professional skill and expertise, EBD allows dentists to stay up to date on the latest procedures and patients to receive improved treatment. A new paradigm for medical education designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.[Ref 1] It was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada in the 1990s. It is part of the larger movement toward evidence-based medicine and other evidence-based practices.
Best research evidence
The new model set by EBM uses a systematic process to incorporate current research into practice. The evidence-based process requires the practitioner to develop five key skills:
- Formulate information needs/questions into four part questions to identify the patient/problem (P), intervention (I), comparison (C), and outcomes (O), known mnemonically as the PICO questions.
- Conduct an efficient computerized search of the literature for the appropriate type and level of evidence.
- Critically appraise the evidence for validity with an understanding of research methods.
- Apply the results of the evidence to patient care or practice in consideration for the patient's preferences, values and circumstances.
- Evaluate the process and your performance through self-evaluation.[Ref 2]
The American Dental Association defined evidence-based dentistry like so:
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[Ref 3]
The American Dental Education Association (ADEA) has incorporated the definition of evidence-based dentistry into core competencies required by dental education programs. These competencies focus on graduates to become lifelong learners and consumers of current research findings and require students to develop skills that are reflective of evidence-based dentistry.[Ref 4]
A dentist's learning curve for using the evidence-based process can be steep, but there are continuing education courses, workbooks and tools available to simplify the integration of current research into practice.
Much less attention is paid to both the other two spheres of Evidence Based Dentistry; clinical expertise and patient values.
Clinical expertise plays a part in the successful outcomes of treatment with diagnostic skills preventing over and under-treatments, technical dental skills maximiing the longevity of surgical and restorative procedures and communication skills being core to patient management and perceived success.
Not all patients have the same priorities for their care. Understanding patient's individual needs, wants and circumstances gives the clinician a place from which to discuss treatment options available with the patient. This might be competing priorities between dentists/ therapists/ hygienists who generally aim for longevity and aesthetics and patients who may be more interested in keeping costs down, aesthetics or would prefer less invasive treatments.
Need for evidence based dentistry
Dental Graduates around the globe are, possibly up to date at the time they graduate but usually are fundamentally lacking in the understanding of trials /studies design and relevance/importance. Dental speciality training, however stresses evidence ~based outcomes results and methodologies.But this becomes out of date as new information and technology appear. Hence it is important, especially with regards to patient safety, for dentists to be able to keep up to date with developments. Having an understanding of how to interpret research results, and some practice in reading the literature in a structured way, can turn the dental literature into a useful and comprehensible practice tool. For this to happen, EBD learning absolutely needs to be at the heart of dental education. dental students can be taught EBD concept during their time in dental school so that the will develop ability to evaluate critically new knowledge and to determine its relevance to the clinical problems and challenges presented by the individual patient.They also acquire ability to interpret, assess, integrate, and apply data and information in the process of clinical problem solving, reasoning, and decision making. EBD is a life long learning process and help to develop ability to learn independently.
Evidence-based dental journals have been developed as resources for busy clinicians to aid in the integration of current research into practice. These journals publish concise summaries of original studies as well as review articles. These critical summaries, consist of an appraisal of original research, with discussion of the relevant, practical information of the research study.
Systematic reviews are also helpful for the busy practitioner because they combine the results of multiple studies that have investigated the same specific phenomenon or question.
- Innes, Nicola (April 2019). "How do we create, and improve, the evidence base?". British Dental Journal. 220(12): 651–5.
- Evidence-Based Medicine Working Group. Evidence-based medicine. A new approach to teaching the practice of medicine. JAMA 1992. 268: 2420–25.
- Sackett D, Straus S, Richardson W. Evidence-Based Medicine: How to Practice & Teach EBM. 2nd ed. London, England: Churchill Livingston. 2000.
- ADA Policy Statement on Evidence-based Dentistry. http://www.ada.org/en/about-the-ada/ada-positions-policies-and-statements/policy-on-evidence-based-dentistry Accessed 17 Aug 2010
- Competencies for the New General Dentist. http://waverleyoaksdental.com/files/ADEACompetenciesNewDentist.pdf Accessed 17 Aug 2010