Introduction to Evidence-Based Dentistry

Evidence-Based Dentistry

• Evidence-based dentistry (EBD) integrates the best research evidence with clinical experience and patient values.
• Alternatively, it's the conscientious, explicit, and judicious use of current best evidence to make decisions about patient care.
• Defined by the American Dental Association (ADA) as an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, patient oral and medical conditions/history, dentist's clinical expertise, and patient treatment needs/preferences.
• EBD aims for individualized dental care based on current scientific knowledge.

What is Evidence-Based Medicine (EBM)?

• EBM comprises clinical judgment, relevant scientific evidence, and patient values/preferences.

History of the Evidence-Based Movement

• In 1991, David Sackett and Gordon Guyatt introduced evidence-based medicine (EBM) to incorporate the best available evidence into clinical decision-making.
• November 1992 saw the launch of the Cochrane Collaboration.
• In 1995, a Centre for Evidence-Based Dentistry was established in Oxford, UK, introducing the journal Evidence-Based Dentistry.

Why Study Evidence-Based Dentistry?

• Traditional Problems: Traditional patient care often lacks a systematic process, relying heavily on clinical experience and hunches. Limited research and knowledge acquisition, generalized approaches for similar cases despite individual differences, and less efficient/more expensive care are common issues.
• Benefits of Evidence-Based Care: Ethical treatment, improved outcomes, patient-centered care, customized treatment plans, cost-effectiveness, transparent diagnostic/treatment pathways, and professional growth due to consistent knowledge pursuit are crucial benefits.

Evidence-Based Process

• Ask: Identify the medical problem.
• Acquire: Seek relevant research.
• Appraise: Critically evaluate the evidence.
• Apply: Implement the evidence in patient care.
• Assess: Evaluate the impact on the patient and practice.

Hierarchy of Evidence

• The hierarchy ranks evidence sources based on their potential for bias, with clinical practice guidelines and meta-analysis at the top and clinical experience at the bottom.

EBD Limitations

• Time Consuming: Accessing medical literature and acquiring statistical knowledge is time-intensive.
• Limited Evidence: High-level evidence may not be available for every instance, and publication bias exists.
• Conflicts of Interest: Possible biases in the source of cited evidence.
• Applying to a Fraction of Cases: A relatively small proportion of cases will have conclusive, readily available EBD support. Textbooks remain important, but relying solely on them may lead to mistakes.

Evidence-Based Decision-Making Process

• Identify a clinical problem.
• Search for evidence.
• Evaluate the evidence.
• Consider patient values/preferences.
• Make a decision.
• Update knowledge (periodically).
• Use available resources (properly).