by Hope Saltmarsh, RDH, MEd
Do you know what evidence-based dentistry is? I thought I knew.
I have been using the word evidence-based for a few years now, thinking that I was properly talking about the idea that the practices I use or advocate are based on current research. I think that most of us think about evidence-based in this way. This thinking conjures up instant barriers like needing to understand statistics (Yikes!), needing to read studies filled with jargon making it difficult to do more than read the abstract and accept the conclusions. Haven’t we all experienced frustration with the endless announcements of the latest research that shows evidence which conflicts with that of the previous “latest research?”
Starting last fall, I discovered what evidence-based dentistry (EBD) actually is. In October, I was lucky enough to be accepted as a participant in the American Dental Association’s (ADA) Evidence-Based Dentistry course at Forsyth Institute. This was a weeklong, intensive course with about 30 participants from the United States and several other countries. Attendees were from diverse backgrounds, including academia, research, insurance, private practice, public health, and even journalism. I was the only hygienist in attendance. Our instructors were Dr. Derek Richards, Director of the Centre for Evidence-based Dentistry at Oxford and the editor of the Evidence-based Dentistry Journal, and Dr. Richard Neiderman, Director, Center for Evidence-Based Dentistry, Forsyth Institute. The next session will be November 1-5, 2010. You can find out more at www.ada.org.
It turns out that EBD is an approach to clinical practice that combines the best evidence, and your judgment and experience, and your patient’s values and circumstances to improve oral health. The evidence certainly doesn’t dictate how you practice but it can help inform your patient-centered clinical decisions.
How do we quickly determine what the best clinical evidence is?
There are two excellent journals that you can turn to for critical summaries of current research: The Journal of Evidence-Based Dental Practice and Journal of Evidence-Based Dentistry. Issue 1, 2010 of JEBD is free online at www.nature.com. I am sure you will quickly find information that you can use.
The National Library of Medicine and the National Institute for Dental Craniofacial Research awarded a grant to the ADA to develop a Web site that is a practical resource for evidence open to the public: ebd.ada.org.
At the Web site, systematic reviews and summaries are available that are grouped into 28 topic headings, including preventive dentistry, cariology and caries management, community oral health and health policy, oral and systemic health relationship, geriatric dentistry, periodontics, and pediatric dentistry. Click on a topic of interest, and you see a listing of recent systematic reviews linked to the article abstract.
There are all kinds of different study designs. Systematic reviews use “rigorous and explicit methods to search for and critically appraise the entire body of clinical research evidence related to a question.” (1) Systematic reviews (SR) are at the top of the pile for evidence. Yet, the quality of the evidence found in systematic reviews does vary.
An essential part of EBD is “critically appraising” the evidence. This is hard to do well and requires training. A tremendously important feature of the web-site is that a rigorous process is in place that facilitates the writing of critical summaries (CS) of the systematic reviews that are posted. You will see a little icon next to the title of a SR that has a critical summary. This means that you could click on the article, read a 1-page CS that clearly spells out the clinical question investigated, methods, conclusions, quality of review, strengths and weaknesses of the evidence, and tells you the clinical implications. You are also linked to the article abstract if you want to find out more.
I recommend that you test this new opportunity to quickly and easily add a dose of evidence-based dentistry to your own practice. Follow this link to the EBD website.
Click on the lower left image for Systematic Reviews & Summaries.
Under the Topic Index for Database of Systematic Reviews, click on Preventive Dentistry.
The 9th SR title displayed, under the first subheading Fluoride, is Fluoride supplements, dental caries and fluorosis: a systematic review. You will see a small icon beside the title that indicates a CS is available.
As you roll your cursor over the title, a box displays the following:
Review Conclusion: There is weak and inconsistent evidence that fluoride supplements prevent dental caries in primary teeth and consistent evidence that they prevent caries in permanent teeth; however, there is an increased risk for mild-to-moderate dental fluorosis associated with the use of supplements.
Critical Summary Assessment: A thorough systematic review of 12 trials finds evidence that fluoride supplements prevent caries but may be associated with the increased risk of fluorosis.
Evidence Quality Rating: Good
If you wish to read the full CS, click on the title. If you want to read the study, click on the linked title in the CS. This takes you to the abstract at PubMed.gov. Look over at the right of the page to see an icon that you can click to see the full text for free from the Journal of the American Dental Association (JADA). Click the icon and you can view/print the full article from the November 2008 issue of JADA.
I hope that I have piqued your interest in EBD and motivated you to visit the EBD website that was developed for all to use.
Hope Saltmarsh, RDH, MEd is an ADA Evidence Reviewer and 2010 EBD Champion. She can be contacted at email@example.com.
1 Richards D, Clarkson J, Matthews D, Neiderman R. (2008) Evidence-based Dentistry: Managing Information for Better Practice. Quintessence Publishing Co. pg. 8.