EBD Lec 1 PDF

Evidence-based dentistry Lecture 1: Introduction Evidence-based dentistry The term evidence based dentistry has evolved from the evidence- based medicine which is defined as: The integration of the best research evidence with clinical experience and patient value...

Evidence-based dentistry Lecture 1: Introduction Evidence-based dentistry The term evidence based dentistry has evolved from the evidence- based medicine which is defined as: The integration of the best research evidence with clinical experience and patient values Or The conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients Evidence-based dentistry Defined by the ADA as: “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, together with the dentist’s clinical expertise and the patient's treatment needs and preferences” EBD is about providing individualized dental care based on the most current scientific knowledge History of the evidence-based movement In 1991, David Sackett and Gordon Guyatt of McMaster university has formally introduced EBM as a methodical way to incorporate the best available evidence into the decision making process for clinical practice and patient treatments. In November 1992 marked the beginning of the Cochrane collaboration” the opening of Cochrane center” In 1995, Dr. Alan Lawrence and Dr. Derek Richards established a Centre for Evidence‐based Dentistry in Oxford, UK; and they introduced the journal Evidence‐Based Dentistry More and more journals, websites and data bases followed. Today, most dentists must have heard about and are required to apply EBD  Why study evidence-based dentistry: Traditional patient care problems: No systematic process Decision based only upon clinical experience and “hunches”. Weakened profession due to lack of research, and limited knowledge acquirement Disease centered cure Generalized approach for similar cases despite individual differences between patients Less efficient and more expensive Why study evidence-based dentistry: Why provide Evidence-based patient care: To do what’s ETHICALLY right Better treatment outcome Patient centered care Case Customized approach Cost effective Affords transparent pathway for diagnosis, treatment and outcome Strengthen profession due to constant pursuit of knowledge and research. Evidence-based process Ask 1. Ask: What’s the medical problem 2. Acquire: Acquire the most relevant research available Assess Acquire 3. Appraise: Critically appraise, evaluate the evidence 4. Apply: Apply evidence to patient care 5. Assess: Apply Appraise Assess the impact of practice and patient care  Hierarchy of evidence Clinical practice Strongest guidelines Lowest evidence Meta- analysis bias Randomized controlled trials Cohort studies Case-control study Cross sectional studies Highest bias Weakest Animal trials and in vitro studies evidence Case reports, opinion papers and letters “clinical experience” EBD limitations Time consuming Requires access to medical literature Requires knowledge of statics High-level evidence may not exist for many cases. Publication bias Conflicts of interests You can only apply it to 5 to 15% of cases you experience, since most cases rely on textbook knowledge However one should not rely 100% on textbook knowledge some doubt is always good. Evidence-based decision making process Identify clinical problem Search for evidence Discard Update evidence Make sense of Store the evidence Patients’ Available values and Act based on resources preferences evidence Thank you