Today I will provide you with an overview of the approach and skills we
teach in the ADA evidence-based dentistry training programs let me start
by noting the basic motivation that led to the development of evidence-based
dentistry in 2001 the Institute of Medicine published their review of the
American healthcare system wherein they concluded that major problems existed in
how care was being delivered in the United States. The basic premise of the
IOM report was that in America the health care that patients receive should
be based on the best relevant scientific knowledge however presently we are
falling far short of that goal they went on to say that much of delivered
healthcare actually harms patients or fails to deliver its potential benefit
they characterize the U.S. health care as suffering from three main features
the overuse of treatments that are known not to provide patient benefit, the under
use of treatments known to be helpful to patients and the misuse or
misapplication of treatment that led to patients receiving less than the full
potential benefit of treatment. In the 1990s Dr. David Sackett and Gordon Guyot
and others developed an approach to the delivery of health care that emphasized
the use of current best evidence in the treatment of every patient this came to
be known as evidence-based medicine and was defined as the conscientious
explicit and judicious use of current best evidence in making decisions about
the care of individual patients the EBM approach they developed relied on three
essential features any treatment provided to a patient should be based on
an understanding of the current best evidence interpreted by the physician or
dentist using his or her expert clinical judgment and ultimately based on each
patient's specific needs and preferences the use of this approach in clinical
practice became known as the individual patient care model and functions as
follows a dentist during the treatment of a patient and based on his or her
expert clinical judgment encounter circumstances that suggest that more
information may be a benefit in making a final decision about the best approach
to care for this patient once the question is clearly framed the next step
is to search for information that answers that question
searching quickly and efficiently for relevant evidence is a basic EBD
skill taught in our introductory EBD training courses. Often such searches
lead to retrieving several sources of evidence and a quick assessment will
suggest which evidence is of the highest quality finally the best evidence can
then be used to inform treatment planning and should be used in a
conversation with the patient on what treatment options would be best and lead
to the most desirable outcomes of care. The ability to quickly search for
high-quality evidence and evaluate evidence quality in direct support of
treatment decisions is a basic skill required and can be learned in any basic
EBD training program let's quickly review these basic EBD skills the
rapidly changing areas of clinical practice requires us to be on top of
current issues and evidence to that end the EBD asks dentists to be curious about
what new developments are happening that may impact patient care and how
employing these new developments can be used to optimize care. This curiosity
leads to the dentist asking questions about what is the current best evidence
related to potential new therapies or new approaches to diagnosis it can also
lead to questions that can help inform patients about their prognosis or
possible harms that may be experienced from various approaches to treatment.
Efficiently retrieving the relevant information needed to answer such
questions can easily be learned with the ongoing expansion of online resources
searching and retrieving evidence is now easier than ever
EBD training programs will help dentists understand where high quality evidence
is located and how to quickly access that information the general approach is
to search several well-regarded online sites that maintain high-quality
clinical evidence and feature easy to use search engines of course not all
evidence available online is of equal quality so EBD emphasizes as a core
skill three dimensions that contribute to evidence quality and determine its
value in patient care. To say that evidence is valid means that the
evidence based on high-quality science and the results and conclusions offered
are true. In other words did the investigators who conducted the study
and created the evidence use the most appropriate methods ensuring adequate
control for bias and other issues that will prevent
various conclusions once it can be determined that evidence is valid the
next question one should ask is does this evidence apply to my patients this
requires a dentist to make an informal assessment of things such as how similar
are the patients in this study to my patients it is the severity of the
disease found in the patients in the study similar to the ones that I treat
once the relevance of the evidence to one's own patients is determined the
final question one needs to consider is if I adopt this approach to care will it
likely lead to better outcomes for my patients in other words if I use this
treatment or diagnostic technique will it offer a substantial clinical benefit
compared to other treatment options or even to no treatment. Most high-quality
evidence summarizes the benefits that various treatments offer and allows the
dentist to quickly make such a determination. Once valid, relevant, and
important evidence is obtained the dentists can then take that information
into consideration when developing treatment options and provide the basis
for discussion and informed consent with the patient when ultimately arriving in
an approach to care the ultimate goal of an evidence-based approach to practice
is to make sure that we as dentists are basing our decisions about patient care
on the best available evidence and with an understanding that in so doing we are
improving the likelihood that our patients will enjoy the best possible
outcomes from the treatment we provide. For more EBD information
visit EBD.ADA.org