Dental Medicine

The American Dental Association Center for Evidence-Based Dentistry Definition of EBD:

Evidence-based dentistry (EBD) is an approach to oral healthcare 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 about providing personalized dental care based on the most current scientific knowledge.

Before EBP, clinical decision making was typically based on training and provider intuition. But with the increasing awareness of patient-centered care, and with the ability to access medical research on the internet, it was determined that better care could be provided by incorporating the latest research evidence and patients needs and preferences into care.

One of the goals of EBP is to minimize the time it takes to put evidence into practice. Previous research has estimated that it takes roughly 17 years for research evidence to reach clinical practice.

Image from UNC Libraries https://guides.lib.unc.edu/evidence-based-dentistry

This Guide addresses the first 3 steps of the Process:

Step 1 is Ask the question.  The PICO tool is used to formulate a searchable clinical question

Step 2 is Acquire the Best Evidence by selecting appropriate databases and an effective search strategy

Step 3 is to Appraise the Evidence based on validity and importance

The 5 A’s for EBD are identified in:

Richards D, Clarkson J, Matthews D, Niederman R. Evidence-Based Dentistry: Managing Information for Better Practice. London; Chicago: Quintessence Pub; 2008.

This image “The 5 A’s” by the Medical Library Association Dental Section can be reused under the CC BY-NC-SA license

Background versus Foreground Questions:

Background questions are usually asked because of the need for basic information and seeks established general knowledge that you yourself don’t know but the profession as a whole does.

Some examples are: 

"What is chronic periodontitis?"

"What causes dental cavities?"

You can usually consult textbooks to answer background questions. 

Foreground questions directly inform clinical decision making. They are usually related to a specific clinical scenario or a patient.  These questions tend to be more specific and complex compared to background questions. 

We typically use a framework to help us formulate the foreground or clinical question. There are many frameworks available but the most common is PICO. This framework helps us to focus on a research question but it also helps us identify which keywords to use in our literature search.

Image from https://hslib.jabsom.hawaii.edu/ebm

An example PICO question is:

In patients with bruxism, does treatment with Botox relieve pain, compared to Occlusal Splints?

Different types of clinical questions have certain kinds of studies that best answer them. The chart below lists the categories of clinical questions and the studies you should look for to answer them.

from: https://guides.hshsl.umaryland.edu/c.php?g=109874&p=743649

image from https://musc.libguides.com/ebd/PICOTT#loaded

Heirarchy of Evidence

image from https://commons.wikimedia.org/wiki/File:Research_design_and_evidence.svg

To acquire the evidence, you will search for your concepts in databases.  See the 'Databases' tab on the left side for suggested databases to search for Dentistry.  A concept table may be helpful for organizing and documenting your search.

Critical appraisal is the systematic evaluation of clinical research papers in order to establish Validity, Reliability & Applicability.

Critical Appraisal (explained in 4 minute video)

How to Read a Paper (ebook)

Critical appraisal worksheets are tools to help you appraise the evidence.  These are sources of Critical Appraisal Tools.