So... Where's the Evidence Base?

Mention Evidence Based Dentistry (EBD) to me during final year at Dental School and to be honest I would probably have rolled my eyes at you. 

Caught up in learning specific studies and statistics it was easy to forget the importance of an evidence base. 

However, a lot of what we do in dentistry has little or NO evidence base. The main problem is that here isn't much independent funding out there to produce unbiased evidence to draw conclusions from. 

My DF1 scheme requires me to produce a project implementing evidence based dentistry in practice, so I recently attended a study day with Dominic Hurst about EBD. Here I shall summarise what I learnt from the day.

What is Evidence Based Dentistry (EBD)

Using clinical experience, research and patient preferences and values in shared decision making and implementing them in practice.

So what is shared decision making? 
It is involving the patient is the decision making process so that they can make a more informed choice. A good way to do this would be using an option grid or decision aids e.g. why choose root canal treatment over an extraction.  

How to implement EBD in practice

1. Identify a clinical problem - what needs improving in your practice?

2. Find the best evidence available and adapt it to your practice 
    - ask a question
    - search for systematic reviews e.g. Cochrane 
    - appraise the evidence

3. Assess the barriers to using EBD in practice e.g. time constraints, patients, GDPs, practice environment etc

4. Assess how to overcome those barriers

5. Implement changes

6. Monitor implementation - evaluate outcomes

So what evidence is there?

There are lots of different types of evidence available out there.

The Hierarchy of Evidence shows the level of validity of each type of evidence; however, it is important to keep in mind that not all questions are best answered by the highest hierarchy of evidence i.e. systematic reviews.

The hierarchy follows below:

The Hierarchy of Evidence

Guidelines - although a lot of guidelines out there to follow but bare in mind that a lot are not evidence based but are based on expert opinion.

Some useful guidelines out here:

When searching for evidence you can break out searches into 4 different domains to find the evidence most suitable for your problem (i.e. PICO):


When assessing evidence validity, you should take into consideration:
  • Whether the trial was randomised, non-randomised, matching, statified etc.
  • Is the trial blinded? And to what extend: single, double, triple or quadruple? 
  • What statistical analysis is used to draw conclusions? Mean difference, relative risk, absolute relative risk, number needed to treat (NNT) etc

What is the difference between audit, research and evaluation?

Research is when you are 'creating' new knowledge. For NHS research, it must follow a set protocol. 

Audit is when you use predetermined standards set according to research in order to assess current practices and involves cycles of analysis. See my previous blog post about audit here

Evaluation is where you answer the question: 'What standards do we achieve?' 

I hope you have found this post useful. Please see one of my previous posts with evidence based survival rates of common dental restorations here. 

Is there anything else you would like to know about Evidence Based Dentistry? Please leave your comments in the section below!

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