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Evidence based dentistry
Transcript of Evidence based dentistry
Approach based on good science, without RCT, often more suitable in resource poor settings Parachute Approach
Potts et al BMJ 2006; 333: 701-3 Evidence from lower down hierarchy isn’t necessarily wrong
‘Lack of evidence of benefit’ is not the same as ‘evidence of lack of benefit’
Ethics of controlled trial where evidence exists that treatment has some benefit What if there’s no ‘good’ evidence? A hierarchy of evidence…. Two types of evidence
Primary – original studies
Secondary – reviews of published research
The higher up the hierarchy, the more robust the evidence is Hierarchy of evidence Learning Dentistry - October 2012 Critical appraisal is a way of rapidly assessing papers
Validity – are results true and believable?
Bias – any factor that could change the study results in a non-random way Appraising research Centre for Evidence Based Dentistry, 2012 Question
Evaluate An evidence based approach Assessing manufacturer’s claims for new materials, techniques and equipment
Assessing claims of other dentists
Interpreting studies in the scientific literature Understanding evidence and the dentist Offering patients treatment that has been rigorously tested
Giving patients information about advantages and disadvantages of different treatments
Supporting health policy based on sound evidence
Knowing what best practice is, keeping up-to-date To put it simply… American Dental Association
http://ebd.ada.org/about.aspx ‘an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences’ Evidence Based Dentistry is… ‘All health care professionals need to understand the principles of EBP, recognise it in action, implement evidence-based policies, and have a critical attitude to their own practice and to evidence. Without these skills professionals will find it difficult to provide 'best practice'
(http://www.biomedcentral.com/1472-6920/5/1) Sicily statement on Evidence Based Practice University of Toronto
‘the integration of best research evidence with clinical expertise and patient values’ Evidence Based Medicine is… Learning Dentistry - October 2012 Professor Deborah White An Introduction to Evidence Based Dentistry Learning Dentistry - October 2012 Recommended references EBD is an essential element of professional behaviour
Appraisal techniques exist to evaluate scientific work
Good evidence is still lacking for many treatments – common sense needed
Caution needed when introducing new treatments where evidence base is weak Summary ‘many papers published in medical journals are misleading because of methodological weaknesses’
‘Huge sums of money are spent annually on research that is seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation’
Altman D, 1994 But how do we know what is best practice? 1 Systematic reviews and meta-analyses
2 Randomised controlled trials
3 Cohort studies
4 Case-control studies
5 Cross sectional studies
6 Case reports
7 Expert opinion
8 Anecdotal Centre for Evidence Based Dentistry website:
http://www.cebd.org.home National Institute for Clinical Health & Excellence (NICE): http://www.nice.org.uk The Cochrane Collaboration: http://www.cochrane.org American Dental Association - Evidence Based Dentistry: http://ebd.ada.org BMJ 1994;308: 283-284 http://www.nice.org.uk/ National Institute for Health and Clinical Excellence (NICE)