Evidence Based Dentistry

Question 0

How is evidence collected and stored?

Answer 0

• profusion of evidence (2 million articles published annually in 20,000 biomedical journals)
• means of storing, retrieving and giving out info constantly changing
• increasing pressure to ensure that clinical practice is based on evidence

Question 1

What is evidence based medicine?

Answer 1

• The integration of best research evidence with clinical expertise and patient values
• The use of current best evidence from clinical care research in the management of individual patients (the patient must want to have the treatment done, doesn’t matter how much evidence there is if they don’t want it).

Question 2

How do you practice evidence based dentistry?

Answer 2

1. Identify the problem
2. Search for evidence
3. Interpret/make sense of evidence
4. Act on evidence

Question 3

When looking at evidence make sure:

Answer 3

• There’s a good sample size
• the types of intervention are comparable (if looking at which procedure is best for a certain type of thing)
• what’s the main alternative and what’s the impact of it
• what outcome is of interest (complications, healthcare spend

Question 4

What are reliable sources of evidence?

Answer 4

• cochrane reviews
• evidence based bulletins
• guidelines
• National Institute for Health and Care (NICE)
• reviews of the best available evidence

Question 5

What’s a systematic review?

Answer 5

• has a clear inclusion/exclusion criteria
• systematic search
• summarise findings in literature
• beware of publication bias

Question 6

What’s a meta-analysis?

Answer 6

• pooling of statistical data
• increases the power to reject the null hypothesis
• may or may not be included in a systematic review

Question 7

What is publication bias?

Answer 7

• occurs when the publication of research results depends on their marker and direction (vested interest)
• positive result bias (authors are more likely to submit and editors more likely to accept positive than negative results
• negative results should be reported so others don’t carry out the same study and get the same negative results
• outcome reporting bias occurs when several outcomes within a trial are measured but are reported selectively depending on the strength and direction of those results
• avoiding or detecting bias

Question 8

What are guidelines?

Answer 8

• expert body reviews evidence
• produce concise summaries of recommended actions on basis of evidence
• should check who’s published them
• what methods did they use?
• are the guidelines to a high standard?
• have they been updated?
• if there are too many guidelines practitioners don’t know which to follow
• guideline appraisal-assess how the guideline has been developed

Question 9

What are bulletins?

Answer 9

• rapid and widespread dissemination of evidence to a wide audience
• can be systematic reviews, guidelines of elements of both

Question 10

How do you critically appraise?

Answer 10

• systematic approach to reading papers
• what is the level of evidence?
• does it apply to me/my patients?
• will it change my clinical practice?
• don’t trust papers just because they’re published
• don’t make decisions on the abstract
• understand the methodology and analysis
• is it robust?
• is statistical analysis appropriate?
• is it applicable?

Question 11

What’s the cochrane oral health review group?

Answer 11

• one of 50 cochrane review groups
• international network of healthcare professionals, researchers and consumers
• prepare, manage and disseminate systematic reviews of randomised controlled trials in oral health
• oral health is broadly conceived to include the prevention, treatment and rehabilitation of oral, dental and craniofacial diseases and disorders
• over 90 published systematic reviews on oral and dental topics to date