evidence-based decision-making is really about having a spirit of curiosity and
inquiry with a tiny bit of skepticism sprinkled over top. As the distinguished
Lieutenant Commander data from Star Trek who would say the most elementary and
valuable statement in science the beginning of wisdom is I do not know and
practitioners can use the spirit of I do not know to not only solve clinical
problems but to improve business strategies and operations and their
practices I'll share with you an example of how I use this technique recently
with my good friend Dr. Benton who also happens to be my sister and is a
pediatric dentist my sister insists that rubber dams make your fillings last
longer however I was thinking about this the other day and I was curious and my
slightly skeptical brain started thinking. Is that really true because
the reality is that many dentists actually don't use rubber dams. In fact
one study reported that only about half of dentist even use them in root canal
treatments. So I begin my search and sure enough I find a Cochrane systematic
review just on this topic. The review includes four small trials totaling 1037
participants and found that in fact using rubber dam does improve survival
time of restorations compared to cotton roll isolation. Cochrane reviews are
considered to be the gold standard of systematic reviews nonetheless it is
actually very important to continue evaluating a systematic review for
quality. At this point I can either critically appraise the systematic
review myself by answering these questions. What are the results? Are the
results valid? and will the results help me in caring for my patients? However I
could also move on in my research to look for a critical summary remember
that's like the food critic review food critics go to restaurants on your behalf
and with their extensive knowledge of the culinary arts and restaurant tourism
they evaluate and rate the quality of the food, ambiance, and even service. They
then summarize that information and report it back to you so that you can
make a decision about whether you want to go to that restaurant or not. Critical
summaries are a lot like this people who are highly skilled and research design
and statistics read and evaluate the scientific literature on your behalf
in this process they rate the studies on their level of quality and bias they
summarize their findings and report them to you so that you can make a decision
on whether you want to implement that in your practice or not.
Examples of pre appraised evidence are critical summaries and evidence-based
guidelines critical appraisal is a very important step in the practicing of
evidence-based decision-making as all research is susceptible to bias and
flaws. It's actually probably better if I do move on and try and look for the food
critic review because number one it's a little bit faster and honestly probably
a better quality evaluation too because it's done by someone who's an expert in
study design and statistics. The conclusion is that there is some
evidence to suggest that a rubberdam improves restoration longevity
especially in children but that there wasn't a ton of studies that were
included in the review which means that more studies could change future results.
So that's how used evidence-based approach to make my decision about
whether I should implement a clinical technique in my practice or not but you
can really use this approach for lots of different things in your life like for
instance if you're wondering what type of material might you might want to use
in your practice or if you should order a diagnostic test for one of your
patients or maybe you're considering buying a new piece of technology for
your office you can use that approach to decide whether that would even be a good
investment for you. Another way I like to apply evidence-based dentistry is to
help me in improving efficiencies within the operations of my dental practice
with many people working in a dental office sometimes it happens that
providers have different philosophies of care and this can be really confusing
and frustrating and stressful for both patients and staff and in the end can be
very inefficient if every providers approaching care differently. Developing
clinical care guidelines for a dental practice can help promote efficiency and
continuity of care. An example of how I did this in my own practice is applying
systematically into care the evidence-based guideline on antibiotic
prophylaxis for the Prevention of prosthetic joint infections or PJI. I
took the EBD guideline that was released recently and summarized it into a formal
written policy for the practice to follow based on the EBD
guideline it says it is the clinical practice of sprout oral health to not
prescribe antibiotics prior to down procedures for patients with prosthetic
joint implants for the Prevention of PJI. Some of you might think wow this is a
lot of work and it probably will be at first but like anything else the more
you practice the more like a habit it becomes however. There are ways to share
the work with your dental team I would submit to you that you can actually
train your dental team to participate and support the EBD process in your
practice taking time to educate them on how to identify and communicate sound
science to patients deepens their commitment to dentistry and also to your
practice it also improves continuity of care and communication and can
ultimately distribute the burden of work. One model for engaging staff in the EBD
process is to provide them with an EBD training program there are many
excellent EBD workbooks on this topic in my practice we've used a model where
staff complete sections of an EBD workbook for each chapter that they
complete including the end chapter homework questions they receive $100 at
the end of completing the book they review their own topic of interest and
then present that topic to the rest of the dental team for that they receive
another hundred dollars by the time they've completed the entire training
program they received approximately $1,200 and they're empowered and
articulate and most importantly can help patients and family understand the
science behind what they do it's really fun to watch their transformation. So as
a recap searching and appraising evidence is a skill and like any other
skill you build speed and proficiency with time the skill has a wide
application including answering clinical questions, improving practice efficiency,
evidence-based decision-making can also be supported by your dental team by
teaching them how and where to find reliable health information and how to
communicate complex concepts to patients. I hope that you've enjoyed what you've
learned and that you're one step closer to the wisdom of I do not know.
for more EBD resources, visit EBD.ADA.org