Evidence Based Dentistry

Question 1

Define EBD

Answer 1

An approach to dental care that requires systematic assessment of clinically relevant scientific evidence

Question 2

What is the relevance of EBD in dentistry?

Answer 2

disseminates high quality, relevant research to dental practitioners, which they can use to help support their decision making when treating patients

Question 3

What are the 5 A’s of EBD?

Answer 3

1. ask
2. acquire
3. appraise
4. apply
5. assess

Question 4

Limitations of EBD

Answer 4

1. poor implementation
2. challenge on clinical freedom and autonomy
3. legal
4. not always improved outcomes

Question 5

What are clinical guidelines?

Answer 5

a set of recommendations informed by systematic reviews of evidence

aimed at promoting effective clinical practice

Question 6

PICO

Answer 6

Patient, problem or population
e.g., for a child living in a fluoridated area

Intervention
e.g., would a fluoridated toothpaste

Comparison
e.g., when compared to a non-fluoridated toothpaste

Outcomes
e.g., provide additional caries reduction

Question 7

Levels of Evidence

Answer 7

1. systematic review; randomised control trials
2. cohort
3. case-control
4. case series
5. narrative review; editorials

N/A. case reports; epidemiology; animal studies

Question 8

Guidelines are…

Answer 8

statements that include recommendations intended to optimise patient care

informed by systematic reviews of evidence

assessments of the benefits and harms of alternative treatment options

Question 9

EBD Guidelines

Answer 9

> SIGN 138
3rd molars
prevention pre-school
prevention 6-16 years
NICE
3rd molars
implants
dental recall
head and neck cancer
infective endocarditis
SDCEP
sedation
decontamination
caries
prescribing
emergency dental care
oral health assessment
bisphosphonate use
ADA-EBD
fissure sealants
topical fluoride
fluoride supplementation
non-fluoride caries preventive agents
Royal College of …
Specialist societies

Question 10

Importance of EBD Guidelines

Answer 10

1. improve patient outcomes
2. aid dentist/patient communication
3. aid training
4. help in managing rare conditions
5. reduce variations in clinical practice

Question 11

Purpose of guidelines

Answer 11

1. promote effective health care by reinforcing good clinical practice
2. promote change in professional practice where it does not comply with best practice

Question 12

When are guidelines developed

Answer 12

> when there is uncertainty
when clinical practices vary widely
when there is excessive morbidity, disability, mortality from a particular disease
when treatment offers a good chance of reducing morbidity, disability, mortality

Question 13

Issues with guidelines include…

Answer 13

> poor implementation
outcomes may improve but not consistent
challenge clinical freedom
legal standing

Question 14

Critical appraisal is the process of…

Answer 14

assessing and interpreting evidence through the systematic consideration of its validity, relevance and results

Question 15

Questions considered when appraising studies

Answer 15

> is the study valid
what are the results of the study
are the results relevant to my problem

Question 16

Barriers to changing working practice

Answer 16

1. knowledge and attitudes of the dentist
2. patient factors
3. dental practice environment
4. educational environment
5. wider health system
6. social environment