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Evidence-Based Dentistry
Hope Saltmarsh
Jane Gillette
Julie Frantsve-Hawley
What does EBD mean?
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
Clinical expertise
Patient preferences
& needs
Evidence
EBD
• Is an approach
to oral health
care
• Is a method to
acquire,
understand and
apply the most
current science
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
What is evidence?
Strong
Weak
What are the levels of evidence?
Systematic Reviews
RCT’s
Cohort study
Case control study
Case series
Case report
Expert opinion
Animal research
Bench-top research
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
What is the Level
of evidence
What is the Quality
of this evidence
Does this apply to my patient?
How strongly
should I
recommend
this to my
patient?
Patient
Can it apply to
the patient?
Treatment
decisions
Complaint
Signs
Symptoms
Answerable
question
Search for
best evidence Critical appraisal
of evidence Clinician
You and your patient make the final decision You and your patient make the final decision
Is this different from what I am doing now?
1%
9%
16%
21%
34%
26%
35%
40%
42%
0% 10% 20% 30% 40% 50%
Manufacturers ' claims
Experience in dental school
Comparative pricing data
CE courses
Hands-on workshops
Laboratory data on key attributes
Published clinical studies
Input from peers
Expert opinions
When selecting dental products, how valuable do you find each of the
sources of information below?
% indicate the “very valuable” only
2008 PPR Reader Survey
How does EBD work?
Ask answerable
questions
Access the best
evidence
Appraise the
evidence
Apply evidence to
patient care
The EBD Process
Assess/evaluate
treatment outcomes
Acknowledging the difference
Evidence-Based Practice
Uses best evidence
Systematic appraisal of quality of evidence
Objective, transparent, less biased
Acceptance of levels of uncertainty
Traditional Practice
Unknown basis of evidence
Limited/incomplete appraisal of quality of evidence
Subjective, opaque, potentially biased
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
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
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.
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?
- Providing the tools you need
ebd.ada.org
Clinical Recommendations
Systematic Review
Systematic Review
Systematic Review
ebd.ada.org
ebd.ada.org
Supported by a grant from the NLM and the NIDCR
(Grant Number G08 LM008956)
TRANSITION TO JANE
GILLETTE
• “Thank you for the privilege and honor to participate in this meeting, one of the best I’ve attended and one that I believe will produce a lot of fruit in academia, education, research, and practice.”
• “I really enjoyed this experience and initiation into being a champion for EBD. There are high expectations for me to disseminate this information in my dental school, component societies and study clubs. I feel this has been a good preparation for me to go home and start working on this.”
• “Excellent program. The passion in the presenters has to be contagious!”
ADA/Forsyth Evidence-Based Dentistry Course
•5 days
•Critical appraisal
•Research Designs
•Statistics
•Advanced searching techniques
Certificate: in Evidence-Based
Dentistry from the Forsyth Institute
ADA/Forsyth EBD Course
Other Educational Opportunities
nature.com/ebd/journal
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