Evidence-Based Dentistry

Utilizing the Resources

Christopher J. Smiley,DDS
Chairman, Dental Quality Alliance
Member, ADA EBD Champions Conference Organizing Committee

What does EBD mean?

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What is EVIDENCE-BASED DENTISTRY?

According to the ADA…

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.

Three Components of EBD

• Is an approach
to oral health Clinical
Evidence
care expertise

EBD
• Is a method to
acquire, Patient
preferences
understand and & needs
apply the most
current science

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Evidence-Based Dentistry Is NOT….

• Cookbook dentistry

• A standard of care

• A mandate of what must be done

• A substitute for clinical judgment

The Value of Evidence-Based Practice

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 What is
evidence?

What are the levels of evidence?

Strong

Systematic Reviews
RCT’s
Cohort study
Case control study
Case series
Case report
Expert opinion
Animal research
Bench-top research Weak

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How much is enough?

Do we need an RCT to
answer this question:
Will using a parachute save
lives?
Group 1: Jump with
parachutes
Group 2: Jump without
parachutes?

Use your judgment

How strongly
should I
recommend
this to my
patient?

What is the Level What is the Quality

of evidence of this evidence

Does this apply to my patient?

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 You and your patient make the final decision

Complaint
Treatment Patient Signs
decisions Symptoms

Answerable
Can it apply to question
the patient?

Critical appraisal Search for

of evidence best evidence
Clinician

Is this different from what I am doing now?

2008 PPR Reader Survey

When selecting dental products, how valuable do you find each of the
sources of information below?

Expert opinions 42%

Input from peers 40%

Published clinical studies 35%

Laboratory data on key attributes 34%

Hands-on workshops 26%

CE courses 21%

Comparative pricing data 16%

Experience in dental school 9%

Manufacturers' claims 1%

0% 10% 20% 30% 40% 50%

% indicate the “very valuable” only

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How does EBD work?

The EBD Process

Ask answerable
questions

Access the best

evidence

Appraise the
evidence

Apply evidence to
patient care

Assess/evaluate
treatment outcomes

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Acknowledging the difference

Evidence-Based Practice Traditional Practice

Uses best evidence Unknown basis of

evidence
Systematic appraisal of Limited/incomplete
quality of evidence appraisal of quality of
evidence
Objective, transparent, Subjective, opaque,
less biased potentially biased

Acceptance of levels of Black and white

uncertainty conclusions

Let’s adapt -- It’s a paradigm shift!

A change of perspective on a subject

It’s true!

SCIENCE Changes!!

EBD is a way to keep up with this change

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Past – Present - Future

Is what we learned in school still true?

Medical Publishing

Annually:
20,000 journals
17,000 new books

MEDLINE:
4,000 journals
6 million references
400,000 new entries yearly

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Barriers to change

• Time

• Access

• Complexity of
information

Did you know…

…that fluoride varnish is effective in caries

prevention?1

… that sealants placed on a non-cavitated

lesion reduce caries progression?2

1. ADA Council on Scientific Affairs, “Professionally applied topical fluoride evidence–based

clinical recommendations, JADA 137, Aug 2006; 1151-59
2. ADA Council on Scientific Affairs. Use of pit and fissure sealants: evidence-based clinical
recommendations. JADA 2008;139(3):257-68.

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Try and you can climb that wall!

Formulate your question

Search the secondary sources

Search the primary sources

Use it in your treatment decision

Where can I find evidence?

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 - Providing the tools you need

ADA Center for EBD: Vision

To improve oral health of the patient and public

Helping Practitioners
Implement EBD

Disseminating the Best

Available Scientific Information

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 Center for EBD - Initiatives

Recommendations
Sealants
Topical Fluoride

Clinical
Oral Cancer Screening
Fluoride Supplements
Infant Formula
EBD Web Site

Critical Summaries

Education
EBD Conferences
of Systematic Reviews

Database of
EBD Workshops
Systematic Reviews

Champions Conference

ADA Champions serve as resources

to their local dental communities by
promoting an evidence-based
approach to patient treatment
and disease prevention.

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Clinical Recommendations

Best evidence Best evidence Best evidence Best evidence

Clinical Recommendations

JADA, March 2008

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EBD Web Site

Visit www.ebd.ada.org

Journals for Information on EBD

Journal of Evidence-Based Dental Practice

• Co-sponsor of the Champions Conference

Others:
• Bandolier
• Evidence-Based Dentistry
• Evidence-Based Medicine Online

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 Summaries of Systematic Reviews
Resource Information Available
•Summaries of dental systematic reviews published elsewhere
EBD at ADA.org
•New ADA-sponsored critical summaries are under development
Database of Abstracts of Reviews •Structured abstracts of systematic reviews; includes commentary
of Effectiveness (DARE) on overall review quality
National Library for Health—
•Structured abstracts of systematic reviews
Oral Health Specialist Library
Journal of Evidence-Based Dental •Summaries of dental systematic reviews, commentary and analysis
Practice •Critical evaluations of published articles on various topics
Evidence-Based Dentistry journal
•Systematic review summaries/analyses.
(UK)
Evidentista (Pan American
Centers for Evidence-Based •Clinical questions and answers grouped by topic area
Dentistry)
Centre for Evidence-Based •Evidence summaries from the Oral Health Specialist library
Dentistry grouped by topic and/or specialty area

Clinical Recommendations/Guidelines

Resource Information Available

National Guideline
Clinical practice guidelines
Clearinghouse
Clinical guidelines on dental topics available as full
Scottish Intercollegiate
guidelines and in quick reference guide format
Guidelines Network (SIGN)

ADA Evidence-Based Clinical Evidence-based clinical recommendations on oral

Recommendations health topics, including topical fluoride and sealants
Guidelines developed by CDC and the Task Force on
CDC Division of Oral Health
Community Preventive Services
Centre for Evidence-Based
Guidelines and consensus statements
Dentistry

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Systematic Reviews
Resource Information Available
Abstracts of published systematic reviews on
dental topics grouped by clinical topic areas,
EBD at ADA.org
listed in A-Z format; full-text available for
systematic reviews published by JADA
Cochrane Oral Health
Group (affiliated with Systematic reviews from the Cochrane Oral
the Cochrane Health Group
Collaboration)
PubMed Clinical Systematic review abstracts, plus links to full-
Queries search page text copies where available.
EviDents Search Searchable resource for systematic review
Engine for EBD abstracts and other studies

"The greatest thing in

this world is not so
much where we are,
but in which direction
we are moving."
Oliver Wendell Holmes

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THANK YOU!
Christopher Smiley,DDS
smileydds@comcast.net

ADA Contact: ebd@ada.org

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