Evidence-Based Dentistry Utilizing the Resources Christopher J. Smiley,DDS Chairman, Dental Quality Alliance Member, ADA EBD Champions Conference Organizing Committee
What does EBD mean?
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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 • Is an approach to oral health care • Is a method to acquire, understand and apply the most current science
Clinical expertise
Evidence
EBD
Patient preferences & needs
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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
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What is evidence?
What are the levels of evidence? Strong
Systematic Reviews RCT’s Cohort study Case control study Case series Case report Expert opinion Animal research Bench-top research Weak
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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 How strongly should I recommend this to my patient?
What is the Level of evidence
What is the Quality of this evidence
Does this apply to my patient?
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You and your patient make the final decision
Complaint Signs Symptoms
Patient
Treatment decisions
Answerable question
Can it apply to the patient?
Critical appraisal of evidence
Clinician
Search for best evidence
Is this different from what I am doing now? 2008 PPR Reader Survey When selecting dental products, how valuable do you find each of the sources of information below? Expert opinions
42%
Input from peers
40%
Published clinical studies
35%
Laboratory data on key attributes
34%
Hands-on workshops
26%
CE courses
21%
Comparative pricing data
16%
Experience in dental school Manufacturers' claims
9% 1%
0%
10%
20%
30%
40%
50%
% indicate the “very valuable” only
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How does EBD work?
The EBD Process Ask answerable questions Access the best evidence Appraise the evidence Apply evidence to patient care Assess/evaluate treatment outcomes
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Acknowledging the difference Evidence-Based Practice
Traditional Practice
Uses best evidence
Unknown basis of evidence Limited/incomplete appraisal of quality of evidence
Systematic appraisal of quality of evidence Objective, transparent, less biased
Subjective, opaque, potentially biased
Acceptance of levels of uncertainty
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
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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
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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.
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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?
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- Providing the tools you need
ADA Center for EBD: Vision To improve oral health of the patient and public
Helping Practitioners Implement EBD
Disseminating the Best Available Scientific Information
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Sealants Topical Fluoride Oral Cancer Screening Fluoride Supplements Infant Formula
Critical Summaries of Systematic Reviews Database of Systematic Reviews
Education
EBD Web Site
Clinical Recommendations
Center for EBD - Initiatives
EBD Conferences
EBD Workshops
Champions Conference ADA Champions serve as resources to their local dental communities by promoting an evidence-based approach to patient treatment and disease prevention.
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Clinical Recommendations Best evidence
Best evidence
Best evidence
Best evidence
Clinical Recommendations
JADA, March 2008
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EBD Web Site Visit www.ebd.ada.org
Journals for Information on EBD Journal of Evidence-Based Dental Practice •
Co-sponsor of the Champions Conference
Others: •
Bandolier
•
Evidence-Based Dentistry
•
Evidence-Based Medicine Online
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Summaries of Systematic Reviews Resource
Information Available
EBD at ADA.org
•Summaries of dental systematic reviews published elsewhere •New ADA-sponsored critical summaries are under development
Database of Abstracts of Reviews of Effectiveness (DARE)
•Structured abstracts of systematic reviews; includes commentary on overall review quality
National Library for Health— Oral Health Specialist Library
•Structured abstracts of systematic reviews
Journal of Evidence-Based Dental •Summaries of dental systematic reviews, commentary and analysis Practice •Critical evaluations of published articles on various topics Evidence-Based Dentistry journal (UK)
•Systematic review summaries/analyses.
Evidentista (Pan American Centers for Evidence-Based Dentistry)
•Clinical questions and answers grouped by topic area
Centre for Evidence-Based Dentistry
•Evidence summaries from the Oral Health Specialist library grouped by topic and/or specialty area
Clinical Recommendations/Guidelines Resource
Information Available
National Guideline Clearinghouse
Clinical practice guidelines
Scottish Intercollegiate Guidelines Network (SIGN)
Clinical guidelines on dental topics available as full guidelines and in quick reference guide format
ADA Evidence-Based Clinical Evidence-based clinical recommendations on oral health topics, including topical fluoride and sealants Recommendations CDC Division of Oral Health
Guidelines developed by CDC and the Task Force on Community Preventive Services
Centre for Evidence-Based Dentistry
Guidelines and consensus statements
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Systematic Reviews Resource
Information Available
EBD at ADA.org
Abstracts of published systematic reviews on dental topics grouped by clinical topic areas, listed in A-Z format; full-text available for systematic reviews published by JADA
Cochrane Oral Health Group (affiliated with the Cochrane Collaboration)
Systematic reviews from the Cochrane Oral Health Group
PubMed Clinical Queries search page
Systematic review abstracts, plus links to fulltext copies where available.
EviDents Search Engine for EBD
Searchable resource for systematic review abstracts and other studies
"The greatest thing in this world is not so much where we are, but in which direction we are moving." Oliver Wendell Holmes
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THANK YOU! Christopher Smiley,DDS
[email protected]
ADA Contact:
[email protected]
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