Evidence based dentistry etc

Question 1

What is evidence-based medicine

Answer 1

Using the best evidence to make decisions about diagnoses and treatment. Involves systemic location, appraisal and implementation of existing evidence.

Question 2

Why do we need evidence-based dentistry

Answer 2

1. Duty to the patient e.g. ethically and professionally have to do what’s best.
2. Patient’s expectations are changing e.g. want compensation, better quality, etc.
3. Greater need for healthcare and new interventions e.g. due to aging pop.
4. New evidence/data about existing stuff

Question 3

EBD benefits

Answer 3

1. Information is clearer for the patient so expectations are realistic.
2. Less damage caused by the dentist
3. Limited resources used more efficiently.
4. Clinical benefits/effectiveness of treatment assessed.
5. Kept up to date.

Question 4

The steps to carrying out evidence-based healthcare

Answer 4

1. Finding a good question
2. Collecting evidence
3. Appraising the evidence
4. Implementing the evidence

Question 5

Defining the question for EBD

Answer 5

Needs to be specific to a healthcare problem or treatment. Should be searchable, realistic and important.

Question 6

Collecting evidence for EBD/levels of evidence

Answer 6

Good quality evidence e.g. from Cochrane library, systemic research, online databases.
Level 1 = strong from 1+ SR
level 2 = strong from 1+ RCT
Level 3 = good non-randomised trials
Level 4 = non-experimental, from 2+ research groups
Level 5 = expert opinion

Question 7

Appraising the evidence in EBD

Answer 7

Assessing the quality of the evidence e.g. the research method, conduct, and design. Using systemic review to appraise the evidence and levels of evidence.
RCT = group all start at baseline and then either given treatment or not, followed over a period of time and groups compared at the end.
Synthesizing the results e.g. into a Forrest plot, meta-analysis, statistical summary of results.

Question 8

Implementing the evidence in EBD

Answer 8

Advice, payment or treatment shouldn’t be carried out without evidence.

Evidence can be used on one patient or one tooth,
Evidence can be turned into a clinical guideline/pathway
Evidence can be used to influence payment structure

Question 9

Hypothesis testing research design

Answer 9

Hypothesis already present. Uses SR or RCT/ experimental or non-experimental testing etc. to collect data (quantitative)

Question 10

Hypothesis synthesizing research design

Answer 10

Qualitative - looking at how people think and behave e.g. using surveys and focus groups.

Quantitative:

• Case series e.g. looking at a group with a disease and seeing if there are any similarities.
• Surveys to see if there is a pattern between data.

Still, need to test the hypothesis.

Question 11

Types of research/studies, in order of strongest evidence to weakest.

Answer 11

1. Meta-analysis
2. Systemic review
3. RCT
4. Cohort study
5. Case-control study
6. Case series/case reports
7. Animal/lab studies

Question 12

Types of research/studies, in order of strongest evidence to weakest.

Answer 12

1. Meta-analysis
2. Systemic review
3. RCT
4. Cohort study
5. Case-control study
6. Case series/case reports
7. Animal/lab studies

Question 13

Meta-analysis

Answer 13

Statistical analysis of all the data and making one conclusion.

Question 14

Systemic review

Answer 14

Looking at all the RCTs and secondary data and compiling them into one big study e.g. adding up the test group numbers.
Looks at prevention, treatment, and rehabilitation too.

Question 15

Systemic review benefits

Answer 15

Can find results quickly.
Kept up to date.
Less bias and random error.
Reviewers report better e.g. more structured and documented.
Each stage is peer-reviewed.
Assesses validity, applicability, and implications of results

Question 16

Randomised control trial

Answer 16

A group all at the same baseline split randomly into 1 receiving treatment and 1 not. Groups followed over a set time and treated the same and then results compared.
Starting group size is bigger than end because people drop out - this needs to be documented so can see if it is due to the study.
Better if blind trial.
Tells us that results are due to intervention only.

Question 17

Cohort studies

Answer 17

Follow-up.
Group of people with suspected exposure to something or not recalled after a given time to see if there is an outcome or not for both groups.
Groups are not similar at the start and may not be treated the same over the set time.

Question 18

Case-controlled studies

Answer 18

Study people with and without the disease and then look back to see potential risk factors.
Bad because is susceptible to bias and people w the disease will remember events differently to those without the disease.

Question 19

Cross-sectional analytical study

Answer 19

Study w a hypothesis. Studies existing disease and risk factor at a set time.
Can’t determine cause and effect.
People may have died so isn’t representative of the whole population.
Quick and cheap.

Question 20

Ecological studies

Answer 20

Comparing between populations/groups and not individuals.
Cheap, easy and data is available.
Can’t prove cause and effect.

Question 21

What is validity and how can it be compromised

Answer 21

Validity is the degree to which research results are correct and generalized.
Sometimes have to make compromises so that the study is realistic and ethical etc. The reader determines if the compromises affected the validity of the results so that they’re not useful.

Question 22

Threats to validity

Answer 22

Random and systematic errors.
Selection error
Information error
Confounding

Question 23

Selection error

Answer 23

The sample might not represent everyone.
Bias e.g. one group might be more represented.
Some people don’t want to/can’t respond so won’t be represented in the study.

Question 24

Information error

Answer 24

When the difference between groups’ results isn’t large enough or study measurements aren’t correct.
Decrease by increasing sample size and by reducing bias e.g. don’t use recall data and make measurements more objective and standardized.

Question 25

Confounding

Answer 25

When the results/relationship can be completely explained by another factor. Risk of this happening increases as the level of evidence decreases. Reduce risk by changing the design or analysis etc. of the study.

Question 26

Evidence based prevention in children - caries

Answer 26

Risk assessment = - Previous disease/dental history - Diet - SES - Systemic illness/saliva/bacteria - Fluoride use/tooth brushing Toothbrushing - Motivator was having fresh breath and good appearance e.g. relate caries to diet not brushing. - Morning brushing > evening - The effect increases w [F], frequency and technique. Diet - No evidence that diet advice is effective - Use a diet diary

Question 27

Preventing oral diseases in adults

Answer 27

Recommend smoking cessation Diet advice e.g. eat less sugar Preventative treatments e.g. fluoride varnish High F toothpaste, mouthwash, interdental brushes.

Question 28

Steps to the prevention of disease (primary, secondary, tertiary)

Answer 28

1. Stop healthy people from getting the disease 2. Halt the progression of the disease in people at risk or at an early stage. 3. Treat the symptoms for people w the disease to stop further complications etc.

Question 29

Ways to implement EBD

Answer 29

Clinical guidlines Payment structures On treatment decisions On management decisions

Question 30

Clinical guidelines and how they're used

Answer 30

Systematically developed from reviews of evidence and research. An example of clinical governance e.g. they influence the way a court judges the case (doesn't mean that following them means you avoid negligence and vice versa).

Question 31

+/- of clinical guidelines

Answer 31

Good = - The same standard of care for all specialties and dentists etc. - Interventions that are beneficial vs ineffective can be identified. Bad = - go out of date quickly - doesn't allow for freedom of choice/professional opinion or special cases or patient's preferences.

Question 32

Steps/stages of guideline development.

Answer 32

1. Scope and purpose 2. Stakeholder investment 3. Rigour of development 4. Clarity and presentation 5. Applicability 6. Editorial independence 7. Implementation

Question 33

what is NICE/its role?

Answer 33

The national institute of health and clinical excellence. Publishes guidance on the most recent best practice for the public, patient's and professionals to increase public confidence.

Question 34

An example of EBD clinical guidelines

Answer 34

Recall intervals: - Studies (by NICE and systemic reviews) = inconclusive for a 6-month interval. - Too short interval = waste of dentist's and patient's money and time and false positives more likely. - Too long interval = diseases not diagnosed early enough e.g. oral cancer. - Caries take 2-4 years to develop in permanent teeth so, for over 18s, maximum recall interval is 24 months. - Minimum interval = 3 months, for high-risk patients. - for under 18s, maximum interval = 12 months. - Review interval at next appointment.

Question 35

Smoking information

Answer 35

Most people want o stop but only 2% do. The dentist needs to check then smoking status of their patient every year, and always recommend quitting. Cigarettes burn really hot (60-700 degrees) and contain tar, nicotine, CO2, CO, acetone, arsenic (toxins, poisons, etc).

Question 36

Diseases and oral health problems associated w smoking

Answer 36

``` Pulmonary diseases e.g. bronchitis, COPD Cardiovascular problems - narrowing and stiffening of the arteries = increased blood pressure etc. Cancers Periodontal disease No healing e.g. of ulcers Aesthetics e.g. staining Trauma due to the heat (smoker's palate) ```

Question 37

Symptoms of smoking (oral)

Answer 37

Difficulty swallowing and speaking (numbness in the mouth) Hairy tongue and leukoplakia (white patch) Swellings in neck Bad breath Earache Ulcers don't heal.

Question 38

What is the dentist's role to their smoker patient

Answer 38

ASK, ADVISE, ACT

Question 39

Different definitions of health

Answer 39

``` Medical = absence of disease. Social = social, economic, political, environmental, phsycological well being. WHO = physical, emotional and social well-being Oral = Ability to speak, smell, eat, express emotions through facial expressions, etc without pain or disease. ```

Question 40

Key features of health promotion

Answer 40

Education, prevention, protection. | Can involve politica and environmental action.

Question 41

Examples of health promotion models

Answer 41

``` Ottowa Charter (WHO) Tannahill's model ```

Question 42

Ottawa charter (WHO)

Answer 42

Creating a public health policy that can be used everywhere e.g. prisons too. Empower the local community e.g. selling and buying locally sourced stuff. Develop personal skills - education and life skills. Creating supporting environments.

Question 43

Tannahill's model

Answer 43

Educate - influence attitudes. Prevent - e.g. using medical interventions. Protect - e.g. legislative, social measures.

Question 44

Benefits of health promotion

Answer 44

1. Cost much less to prevent than to treat illnesses etc. 2. Reduces the inequalities between poor and rich people. 3. Some conditions just need education/a change in behavior to treat them.