If you had mentioned evidence based dentistry (EBD) to me during my time at dental school, I most likely would have rolled my eyes. Caught up in learning specific studies and statistics, it was easy to forget the importance of having scientific evidence behind every treatment and decision. However, evidence is key to delivering good patient outcomes in dentistry.
What exactly is EBD and how can you implement this theory in your day-to-day practice?
What Is Evidence Based Dentistry?
EBD involves using clinical experience and research as the foundation of your practice and combining evidence with patient preferences and values to achieve shared decision-making. Many national dental councils promote EBD as the gold standard of treatment. The U.K. General Dental Council‘s “Standards for the Dental Team,” for instance, requires all dental professionals to base their treatment decisions on “current evidence and authoritative guidance.” Research and evidence are both fairly self-evident, but what is shared decision-making?
The shared decision-making process includes the patient in informed treatment choices. For example, a dental professional could present a patient with clinical evidence on procedure success rates, risks, benefits and costs to help them decide between a root canal or an extraction. The Faculty Dental Journal of the Royal College of Surgeons of England shares guidelines for shared decision-making based on recent recommendations from the National Health Service, including asking about the patient’s home care abilities and checking that they understand the information you have shared.
Starting Your Journey Toward EBD
You can begin implementing EBD in your office before you involve your patients. Identify a clinical problem that needs improvement and seek the best evidence available for a solution by:
• Asking a question
• Searching for systematic reviews
• Evaluating the evidence you find
Public Health England lays out this model in a report on evidence-based dentistry with examples of using evidence to convince patients of the oral risks of alcohol and tobacco.
Searching for Evidence
Once you know the value of evidence, it’s time to acquaint yourself with reliable methods for finding it. Some useful databases include the Scottish Dental Clinical Effectiveness Programme, which organizes literature by topics like dental amalgams and antibiotic prophylaxis. Cochrane is the international leader in evidenced-based health care recommendations. A quick way to keep up with dental research day to day is The Dental Elf, a daily blog run by consultants and trainees in dental public health.
Other places where you can find published evidence include the British Dental Journal Open, PubMed and Google Scholar, but you will need to use your own appraisal skills to evaluate the content. Look carefully at the sample size of a study or group publishing a paper to judge whether the evidence being presented is robust and reliable.
Evaluating Research Findings
There are many different types of evidence available in sources like dental journals and dental society reports. Systematic reviews, case-controlled studies and randomised, controlled clinical trials are examples of types of evidence that are valid depending on the question you aim to answer.
The University of Canberra shares a diagram of the hierarchy of evidence. The scale ranks the validity of each type of evidence from systematic reviews at the top to “expert opinion” at the bottom. It is important to keep in mind that not all questions are best answered by the highest level of evidence. A review may not be readily available, or the review you find may be lacking in authority.
Putting EBD Into Practice
When searching for evidence, it helps to divide your research into four categories, also known as the PICO process: population, intervention, comparison and outcome.
For example, a few years ago I wanted to know which material was most effective for Class V restorations. My PICO search included:
• Population: Patients with Class V cavities
• Intervention: Composite filling material
• Comparison: Glass ionomer cement (GIC)
• Outcome: Failure of restoration
Using this array, I searched the literature and found a systematic review showing greater longevity with composite compared to GIC. As a result, I changed my care methods to reflect the literature. (It is still important to consider additional factors that may be relevant for an individual patient. For example, if moisture tolerance and/or fluoride release from GIC is desirable, that will play a role in decision-making.)
Ultimately, using up-to-date evidence in clinical practice can improve the scientific rigor behind your care decisions. If you share your knowledge with your patients, this can strengthen a patient’s trust in you and your level of care.