What is Evidence-Based Dentistry?
According to the American Dental Association, 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. EBD is based on three important domains:
The best available scientific
Only when all three are given due consideration in individual patient care is EBD actually being practiced.1
When using EBD to solve clinical problems, it is important to remember that evidence alone is never sufficient to make a clinical decision; a hierarchy of evidence should guide clinical decision-making. EBD does not replace clinical experience or patient input, but provides an additional dimension to the decision-making process.
EBD is a five-step process:
Formulation of an answerable
clinical question (PICO)
Formulation of an
answerable clinical question:
A properly formed PICO question contains four elements:
Patient/Problem (P): Identify
the patient or problem. How would you describe the patient or problem to
Searching for the
Some sources of good evidence:
Oral Health Group (Cochrane Library)
Evidence Based Dentistry (Nature)
Databases for locating individual studies:
Web of Knowledge3, 4
Appraisal of the evidence for validity
The best evidence to use in EBD is systematic reviews. Systematic reviews of the literature are rigorous and explicit methods for searching and critically appraising a body of clinical research on a specific topic. Following systematic reviews in the hierarchy of evidence are randomized controlled trials (RCT). RCTs provide good cause-and-effect evidence on a study group. Of less importance when analyzing evidence are cohort studies, case control studies, case series/case reports, and ideas, editorials, or opinions.
Application of the
evidence in clinical practice
Some things to consider are:
Examine the methodology of the study.
Examine the interpretation of the study.
Based upon a thorough examination of the evidence, the clinical skills and practical knowledge already in place, and the needs of the patient, a practitioner can use the evidence to determine a course of treatment for a patient.
Evaluation of the
More information available in the Dental Library:
Forrest, Jane L. Evidence-based decision making: a translational guide for dental professionals. Philadelphia, PA: Wolters Kluwer; 2009. (WU 29 F77 2009)
Guyatt G. Users’ guides to the medical literature: a manual for evidence-based clinical practice. Chicago: AMA Press; 2002. (WB 100 G99u 2002)
Hackshaw, A. Evidence-based dentistry: an introduction. Oxford: Blackwell Munksgaard; 2006. (WU 20.5 H11e 2006)
Proceedings of the International Conference on Evidence Based Practice in Dentistry. (WU 100 In80 2001)
Richards D. Evidence-based dentistry: managing information for better practice. Chicago: Quintessence; 2008. (WU 100 Qu4 v. 41)
1. 1. ADA Center for Evidence-Based Dentistry. About EBD. http://ebd-ada.org/about.aspx
2. 2. Forest JL, Miller SA, Overman PR, Newman MG. Evidence-based decision making: a translational guide for dental professionals. Philadelphia, PA: Wolters Kluwer; 2009.
3. 3. LSUHSC Libraries Resource Guide – Evidence Based Practice. Louisiana State University Health Sciences Center. Libraries. http://www.lsuhsc.edu/no/library/resources/guides/EBM.html Updated September, 2010. Accessed September, 2010.
4. 4. Bushhousen E. Internet resources: Evidence-based dentistry. MLA News 2010 Jun/Jul; 50(6):10.
5. 5. Davis JPL, Crombie IK. The why and how of critical appraisal. In: Clarkson J, Harrison JE, Ismail AI, Needleman I, Worthington H. Editors. Evidence based dentistry for effective practice. London: Martin Dunitz; 2003. p. 43-57.