Evidence Based Dentistry
Overview
PCC139A
Dr. Kim Morita
Evidence Based Decision Making
• A specific set of skills for
identifying, searching for and
interpreting clinical and scientific
evidence to be used for patient
care.
Scientific Evidence
Experience and Judgement
Patients Preferences
or Values
• An essential tool to improve
quality of care and to reduce the
gap between what we know,
what is possible and what we
do.
Clinical/Patient Circumstances
EBD Process
Ask good clinical questions
Conduct a computerized
search
Critically appraise the evidence
Evaluate the outcome
Apply the results in
clinical practice
Asking Good Questions
Foreground and Background Questions
Foreground
1. Specific and structured to
find a precise answer
2. PICO
Background
1. General knowledge
2. Broad
Four Types of PICO Questions
1. Therapy/Prevention
Determine the effects of treatments that avoid adverse events, improve function and are worth
the effort and cost
2. Diagnosis
The degree to which the test is reliable and useful
3. Harm/Etiology/Causation
Causes of a disease or condition including iatrogenic forms and to determine relationship
between risk factors, potentially harmful agents, and possible causes of a disease or conditions
4. Prognosis
PICO
Asking Good Questions
P
I
C
O
The first step to develop a well-built question is to
identify the patient problem or population
What you plan to do for the patient
• Therapy
• Diagnostic test
• Treatment
• Alternative intervention
• This should be specific and limited to one
alternative choice
• This specifies the results(s) of what you plan to
accomplish, improve or affect
• Should be measurable
PICO
Asking Good Questions
• Allows for a direct and focused single issue and outcome
• Facilitates the next step in the process, the computerized search
• (P)Patient/Population “In a patient with….
• (I) Intervention will…
• (C) Comparison …as compared to…”
• (O) Outcome
Patient/
Problem/
population
Intervention
Comparison
Outcome
Case A
RCT treated
anterior teeth
(without crown
coverage)
Internal bleaching
Bleaching trays
Increases tooth whiteness
Case B
Plaque
Electric toothbrush
Manual toothbrush
Removal of plaque
Case C
TMJ
Hard occlusal guard
Soft occlusal guard
Reduce symptoms
In a patient with anterior root canal treated teeth, will internal
Case A bleaching as compared with external bleaching trays increase
tooth whiteness?
In a patient with a moderate amount of plaque, will an electric
Case B toothbrush as compared to a manual toothbrush be more
effective in plaque removal?
In a patient with TMJ symptoms, will a hard occlusal guard as
Case C compared to a soft occlusal guard be more effective in reducing
TMJ symptoms?
Sourcing Evidence
Hierarchy of Evidence
Secondary research is filtered or synthesized publications of the primary
research literature.
Provides evidence for cause and effect. Random assignment
and can include blind or double blind strategy.
Observations about the association between a particular exposure or
a risk fact and the subsequent development of a disease or condition.
Retrospective in that the subjects already have a certain disease and are
compared with a control (disease-free) from the same population.
Collections of reports on the treatment of several patients, or a report of a
single patient. No statistical validity because these are observational and
do not use a control group with which to compare outcomes.
Image from:
§https://library.triton.edu/c.php?g=433673&p=3720267
Summary
• Understanding the evidence-based methodology and
distinctions allows clinician to judge the validity of sources
and relevance of findings.
• By integrating good science with clinical judgement and
patient preferences, clinicians enhance their decisionmaking ability and maximize the potential for successful
patient outcomes and care.
.
Reference
• 1. Forrest J, Miller S, Overman P, Newman M. Evidenced-Based Decision
Making: A Translational Guide for Dental Professionals. Philadelphia:
Lippincott Williams & Wilkins; 2009
• 2. Sackett D, Richardson W, Rosenberg W, et al. Evidenced-based Medicine:
How to Practice and Teach EBM. New York: Churchill Livingston; 1997