About Evidence-Based Dentistry
The American Dental Association defines the term "Evidence-based dentistry" as follows:
Evidence-based dentistry (EBD) is an approach to oral health care 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.
The 5 A's
5 Step EBD Process
The EBD process follows 5 steps:
- ASK- Converting information needs/problems into focused, answerable clinical questions.
- ACQUIRE- Conducting a search with maximum efficiency for finding the best evidence with which to answer the question.
- APPRAISE- Critically appraising the evidence for its validity and usefulness.
- APPLY- Applying the results of the appraisal or evidence, in clinical practice.
- ASSESS- Evaluating the process and examining outcomes in a clinical setting.
A well formed clinical question covers the following 4 areas identified by the acronym PICO.
- Patient or Population or Problem
- Intervention or exposure or prognostic factor
- Comparison or Control (not always included)
- Outcome of interest (not always included)
Levels of Evidence
When doing an evidence-based search, always start at the highest level of evidence. If you cannot find a Systematic Review, limit to a Review or a Meta-Analysis. If not available, limit to Randomized Controlled Trials (RCTs), etc.
Systematic Review Summary of two or more primary research studies that have investigated the same specific phenomenon or question. This scientific technique defines a specific question to be answered and uses explicit predefined criteria for retrieval of studies, assesment, and synthesis of evidence from individual RCTs and other well-controlled methods. Methods used in SRs parallel those of RCTs in that each step is thoroughly documented and reproducible.
Meta-Analysis The statistical process commonly used with systematic reviews that involves combining the data from multiple individual studies into one analysis.
Randomized Controlled Trial Involves at least one test/experimental treatment or inteverntion and one control treatment that can be a placebo treatment or no treatment
- Concurrent enrollment of subjects and follow-up of the experiemental test- and control-treated groups,
- Assignment of subjects to either the experimental treatment/intervention group or the control/placebo group through a random process, such as the use of a random-numbers table, and
- Follow-up of both groups to determine the outcome.
Cohort Study A study that makes observations about the association between a particular exposure or risk factor (e.g. tobacco use) and the subsequent development of a disease or condition (e.g. lung cancer). In these studies, subjects do not presently have the condition of interest (lung cancer) and are followed over time to see at what frequency they develop the disease/condition as compared with a control group that is not exposed to the risk factor (tobacco use) under investigation.
Case Control Studies Studies that make observations about possible associations between the disease of interest (lung cancer) and one or more hypothesized risk factors (tobacco use). Case control studies are retrospective in that subjects already have a certain disease or condition and are compared with a representative group of disease-free persons (controls) from the same population.
Case Reports A description of a single patient case report. These are observations and do not use a control group with which to compare outcomes.
Definitions from: Forrest J, Miller SA, Overman PR, Newman MG. (2009). Evidence-Based Decision Making: A Translational Guide for Dental Professionals. Philadelphia:Wolters Kluwer.