TOPIC 4
EVIDENCE-BASED
DENTISTRY
DDM - 5A
EVIDENCE BASED
DENTISTRY
According to American Dental Association (ADA)
An approach to oral health care that requires the
judicious integration of systematic assessment of
clinically relevant scientific evidence, relating to
patient’s oral and medical conditions and history,
with the dentist’s clinical expertise and the
patient’s treatment needs and preferences.
DIFFERENCE BETWEEN EVIDENCE BASED
PRACTICE AND TRADITIONAL PRACTICE
EVIDENCE BASED PRACTICE TRADITIONAL PRACTICE
Uses best evidence Unknown basis of evidence
Systematic appraisal of quality of Limited/incomplete appraisal of quality
evidence of evidence
Objective, transparent, less biased Subjective, opaque, potentially biased
Acceptance of levels of uncertainty Black and white conclusions
BEST PRACTICE
Derived from evidence-based care
It is an important tool in helping the dental team provide high
quality care, treatment, and therapy to their patients
“knowledge is most recent and relevant evidence and the
foundation for best practice”
EXAMPLES OF EVIDENCES:
1. Researches
2. Studies
3. Trial testing
GOALS OF
EVIDENCE BASED
DENTISTRY
A. BEST EVIDENCE/RESEARCH
B. THE TRANSFER OF RESEARCH TO USE IN PRACTICE
C. FILTER THE IMMENSE AMOUNT OF INFORMATION THAT EMERGES IN
THE LITERATURE
D. ACT AS AN EFFECTIVE METHOD OF KEEPING UP WITH THE MOST
CURRENT RESEARCH
E. PROVIDE INFORMATION ON HOW SIMILAR CASES HAVE BEEN
TREATED
ABILITY TO INTERPRET
THE LITERATURE
01. 02. 03.
Not all evidences are significant Associations refer to the While causal factor or causality is
to clinical care. relationship between an the event or condition that plays
New evidences are not exposure and a disease that the role of producing an
necessarily better. implies the exposure might cause occurrence of a disease
the disease
FIVE STEPS PROCESS FOR FINDING
AND EVALUATING CLINICAL
EVIDENCE
1. Develop a clear and answerable question
2. Search the best available evidence
3. Critically assess the evidence
4. Apply the result to your particular situation
5. Evaluate the process and the results
EBD: 5 A'S
who are the patients?
P patient, population, or problem
What is the problem?
What do we do to them?
Intervention, prognostic factor, or
I
exposure
Whatare they exposed to?
Comparison to intervention (if
C What do we compare the intervention with?
appropriate)
What happens?
Outcome you would like to measure
O What is the outcome?
or achieve
FOUNDATIONAL ELEMENTS OF
EVIDENCE-BASED DECISION
MAKING
SCIENTIFIC EVIDENCE
CLINICAL EXPERTISE AND JUDGEMENT
PATIENT’S PREFERENCES AND VALUES
a. Essential
EBD relies on the best available scientific
research to guide clinical decisions.
Sources include systematic reviews,
SCIENTIFIC EVIDENCE
randomized controlled trials (RCTs),
cohort studies, and meta-analyses.
Evidence ensures that treatment choices
are effective, safe, and up-to-date.
a. Valuable and limiting
A clinician's experience, skills, and
intuition
CLINICAL EXPERTISE & Expertise allows for personalized
JUDGEMENT treatment
Personal bias and outdated practices can
limit decision-making if not aligned with
current evidence.
a. An important consideration in decision-
making
Patients' goals, cultural beliefs, financial
capacity, and comfort levels should be
PATIENT’S PREFERENCES respected.
& VALUES Shared decision-making ensures that
treatments align with what is realistic
and acceptable for the patient.
Ethical care requires informed consent
and consideration of patient autonomy.
SYSTEMATIC REVIEW
It is the gold standard in evidence-based care
Systematic reviews are carefully synthesized research evidence
designed to answer focused clinical questions.
Also, it implements recently developed scientific methods to
summarize results from multiple research studies.
RANDOMIZED CONTROLLED TRIALS
Prospective studies that measure the effectiveness of a new
intervention or treatment.
A study design that randomly assigns participants into an
experimental group or a control group.
Prospective, comparative, quantitative study/experiment performed
under controlled conditions with random allocation of interventions
to comparison groups.
Good randomization will "wash out" any
population bias
Easier to blind/mask than observational
ADVANTAGES studies
Results can be analyzed with well known
statistical tools
Populations of participating individuals
are clearly identified
Expensive in terms of time and money
Volunteer biases: the population that
DISADVANTAGES participates may not be representative of
the whole
Loss to follow-up attributed to treatment
Single-blind: Participants don’t know
their group assignment.
BLINDING Double-blind: Both participants and
researchers don’t know the assignments.
Triple-blind: Even the data analysts are
unaware of group assignments.
COHORT STUDY
A study that makes observations about association between
exposures and risk factors and the subsequent development of a
disease
It is a study of a group who are exposed to variable interest, and
which are followed up over time to determine who develops the
outcome of interest and whether the outcome is associated with
the exposure
Establish Temporal Relationships
STRENGTHS Ethical & Feasible
Long-Term Data Collection
Time Consuming & Expensive
Confounding Factors
LIMITATIONS Loss to Follow up
No Randomization
CASE CONTROL STUDY
A study wherein patients who already have a specific condition is
compared to those who have not
Researchers identify possible exposures by looking back in time
Often rely on medical records and patient recall data for data
collection
EXPERT OPINION
Expert opinion, or consensus guidelines, is considered the lowest
level of evidence. This can include recommendations made by
experienced professionals in the field, but because it is not based
on controlled studies or systematic reviews, it carries a higher risk
of bias and is more subjective.
CHARACTERISTICS
OF EXPERT OPINION
Subjective Nature: It is based on the personal judgment,
clinical experience, and expertise of an individual or group of
professionals. Unlike systematic reviews or randomized
controlled trials (RCTs), expert opinion doesn’t systematically
aggregate data from multiple studies.
Limited or No Data: Often, expert opinion is called upon
when there’s a lack of higher-level evidence on a topic,
especially in emerging areas where research may be scarce.
Influenced by Experience: Experts in a field may base their
recommendations on years of experience with patients,
knowledge of evolving techniques, and clinical reasoning.
Context-Specific: It can be tailored to a specific clinical
scenario or patient, but may not be applicable to the general
population.
MEDICAL CENTER
THANK YOU
VERY MUCH!
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