Evidence based dentistry

Question 1

Be able to define evidence and Evidence Based Dentistry​

Be able to discuss the process of evidence based practice (5 A’s)​

Be able to discuss why dentists should take an evidence-based approach to their clinical practice and professional role​

Be competent in structuring a clinical question using PICO framework​

Question 2

What is evidence based dentistry

Answer 2

An approach to oral health care that requires the judicious integration of:​

-systematic assessments of clinically relevant scientific evidence, relating to the patients oral and medical condition and history, together with the​

-dentists clinical expertise and​

-the patients treatment needs and preferences​

Question 3

What are the 5 As

Answer 3

Ask
Align
Acquire
Appraise
Apply

Question 4

What is the process of evidence based practice

Answer 4

How to ask the clinical questions in a focused way so that you can FIND the evidence and APPRAISE the evidence [ASK-BDS1]​

Search for and retrieve evidence [ALIGN/ACQUIRE- BDS2]​
-Know where to go for good evidence​
-Be sure that you get all of it​
-And you understand the strengths and weaknesses of different sources​

Critically appraise the evidence for validity and clinical relevance [APPRAISE-BDS3/4]​
-Is it good evidence?​
-Is it important from a clinical point of view? ​

Applying this evidence to patient treatment/care [APPLY-BDS3+]​
-Does it apply to my patients?​

Reflection​
-Can I do things differently next time?​

Question 5

What are some decisions and questions where evidence would be required

Answer 5

-Placing a stainless steel crown versus conventional restoration ?​
-Analgesia before treatment to reduce post-operative pain?​
-Powered versus manual tooth brush ?​
-Recommending flossing to your patients?​
-Is there any difference in effectiveness when undertaking root canal treatment in one visit compared to over several visits?​
-What are the effects on pain and complications?​
-What is the optimal interval for dental check-ups?​

Question 6

What is evidence

Answer 6

Evidence is the available body of facts or information to show whether a belief or statement is true or valid

Question 7

Study of 1000 patients treated in primary care in Australia​

Looked at 22 most common conditions seen in primary care​

What proportion of patients received evidence-based care for ​

Coronary heart disease – ​

Alcohol dependence –

Answer 7

Coronary heart disease – 90%​

Alcohol dependence – 13%

Question 8

Why should you practice evidence based dentistry

Answer 8

Professionally: It is part of your professional role and a requirement of your regulatory body (GDC)​

Personally: you should be informed on how to spot a scare story/ fad/ pseudo-science to avoid you (or your loved ones) being ripped off, duped, wrongly treated, sub-optimally treated, exposed to harmful practices​

Question 9

What can clinicians use to make decisions

Answer 9

Clinical experience
Text books
Patient groups
Teachers
Healthcare research
Popular media

Question 10

What do the public believe about healthcare decisions​

Answer 10

Research funding and efforts are coordinated and prioritized​

The progress of research is steady and upwards​

The results of research are systematically applied to clinical practice​

All clinical practice is evidence based​

Question 11

What is peer review

Answer 11

The system through which scientists/ researchers decide which research studies should be published in a scientific journal​

Eg British Dental Journal; British Medical Journal; The Lancet; Nature ​

Question 12

How does peer review work

Answer 12

When researchers or a team of researchers finish their work, they usually will write a “paper” presenting their methods, findings and conclusions.​

This paper is sent to a scientific journal to be considered for publication​

The editor decides if the topic is suitable for their journal then sends the paper to peer reviewers (other scientists working in the same area who have expertise on the topic). The peer reviewers​
-Comments on the validity of the study (design, methods, results)​
-Judge importance​
-Judge originality​
-Should the paper be published/ improved/rejected ​

Peer review means that to some extent the research has passed the scrutiny of other scientists, and is considered valid, important and original.​

Peer review is also used to assess applications for grant funding.​

Question 13

What are the issues with peer review

Answer 13

Corruption​

Cant prevent fraud, plagiarism or duplication (only in more obvious cases)​

Quality of the review process​

Skills of the reviewer​

Time-consuming

Question 14

What makes bad research

Answer 14

Not needed ​
-No more research is required as we have the answer​

Poor design​
-Wrong design​
-Inappropriate control/ comparison group​
-Biased (many issues)​

Poorly reported​

Not reported​

Question 15

How to ask the questions in a focused way so that you can FIND the evidence and APPRAISE the evidence

Answer 15

POPULATION​
-How would I describe a group of patients similar to this one?​

INTERVENTION​
-What is being “done” to the patients​
-Could be an exposure (eg carcinogen)​

COMPARISON​
-What are we comparing to?​

OUTCOME​
-Desired or undesired​

Question 16

What clinical guidelines should dental professional follow

Answer 16

NICE
SIGN
SDCEP

Question 17

A child presents with a carious primary molar. How do you manage this?

Answer 17

Complete removal of carious tissue before restoring tooth?​

Seal in caries?​

Does the Hall Technique for sealing in caries offer long-term benefits over current GDP practice?​

Population​
-Children with caries in primary teeth​

Intervention​
-Hall technique​

Comparison​
-Current practice​
-Removal and restoration (eg)​

Outcomes​
-Rate of failure

Question 18

When researching for evidence we should consider, have the authors used:

Answer 18

Population​

Intervention​

Comparison​

Outcome​

That are relevant to your question

Question 19

WHAT IS THE PICO:
A child patient requires a dental extraction via General Anaesthetic (GA). Some surgeons administer Local Anaesthetic (LA) intra-operatively to reduce post-operative pain​

…but anecdotally some report this is distressing, uncomfortable, causes excessive dribbling and inadvertent lip/cheek biting

Answer 19

Population: Children undergoing dental general anaesthetic​

Intervention: Local Anaesthetic intra-operatively​

Comparison: placebo / no treatment​

Outcome: post-operative pain/distress​
-Bleeding​
-Cardiac ​
-Lip biting/cheek biting​
-Satisfaction​
-anxiety

Question 20

FORM A PICO
The common cold causes enormous morbidity worldwide and the search for simple and effective preventive or therapeutic agents has been elusive. Even if vitamin C might have modest effects in restricted population groups, that could be important from a public health point of view.​

There has been 70 years of conflicting evidence around the benefit of Vitamin C in preventing the cold and in shortening the number of “sick days”. Some have suggested that high doses may be more effective

Answer 20

Population: In the general population (adults/children/males/females)​

Intervention: Vitamin C (dosage/ frequency)​

Comparison: Placebo/ No treatment​

Outcome: Incidence of cold/ days sick with cold

Question 21

GENERATE PICO:
A 35 year old patient attends for a routine appointment and asks you if she should purchase a powered toothbrush (~£100)- She wants to know if it will improve her oral health…

Answer 21

Population: In the general population (adults/children)​

Intervention: powered toothbrush (different types)​

Comparison: manual toothbrush​

Outcome: decay/ periodontitis/ plaque/ gingivitis

Question 22

What are the criticisms of evidence based dentistry

Answer 22

The tendency of a group of young, confident and highly numerate medical academics to belittle the performance of experienced clinicians using a combination of epidemiological jargon and statistical sleight-of-hand or ​

the argument, usually presented with near-evangelistic zeal, that no health-related action should ever be taken by a doctor, a nurse, a purchaser of health services, or a policy maker, unless and until the results of several large and expensive research trials have appeared in print and approved by a committee of experts.