March 2012 Volume XLVIII Number 2
What is Evidence-based Dentistry?
Affiliate Trustee Jane Gillette
As practitioners we are confronted almost daily with an exhausting amount of often conflicting health information. Evidencebased dentistry (EBD) is an approach to dental healthcare that utilizes high-quality and reliable evidence, along with professional expertise and patient’s values.
The example above in which research findings vary greatly from study to study is all too common. There are many reasons science sometimes fails us including:
1. Lack of an a priori question
2. Lack of a proper control
3. Lack of randomization
a. Lack of blinding (both investigators and/or subjects)
b. Selection bias: only selecting studies that support the topic of interest
c. Publication bias: the fact that more studies with positive results get published
d. Conflict of interest
e. Measurement bias: observer, responder and instrument bias
5. Lack of statistical "power"
6. Small sample size
7. The use of surrogate outcomes (i.e. using "attachment loss" instead of tooth survival as an end point of a study)
8. Confounding: when the association of an exposure (i.e. smoking) and the outcome (i.e. cardiovascular disease) is mixed up with the real effect of another exposure (i.e. periodontal disease) and the same outcome (i.e. cardiovascular disease)
9. Even the way statistics are presented in a study can make a finding appear more significant than it really is!
Because researchers are evil (that’s a joke), we cannot consider the results of just one study to be enough to base decisions regarding our patient’s health. Instead we must look at the total body of evidence on a particular subject. Clearly, busy dentists do not have the time (and sometimes expertise) to critically appraise every relevant study published on a particular topic of interest. Luckily, there is a very rigorous scientific technique by which researchers can combine results from many individual studies. This process is called a "systematic review" (sometimes accompanied by "meta-analysis") and is considered to be the very highest quality of scientific evidence available.
Since even accessing and reading systematic reviews can be burdensome in modern life, there are many organizations that specialize in producing short summaries and quality assessments of systematic reviews. Examples of free websites that specialize in this are:
The ADA: http://EBD.ADA.org
The Cochrane Collaboration: http://www.cochrane.org
The DARE database: http://www.crd.york.ac.uk/crdweb/
The TRIP database: http://www.tripdatabase.com/
Additionally, the AAPD and the ADA’s Center for Evidence-based Dentistry have many quality membership services. In 2010, both the AAPD and the ADA offered introductory and advanced courses in EBD. The 2010 ADA Evidence-based Dentistry Champion course was attended by many AAPD members including Drs. Catherine Flaitz, Lindsay Robinson, Jane Gillette, Bhagwati Mistry, Shukan Kanuga, Emily Day, Noel Aymat and John Gawlik. The ADA is currently accepting applicants for the 2011 course. Interested candidates should apply via http://EBD.ADA.org.
The utilization of the most current high-quality and unbiased evidence is not a substitution for professional expertise or patient autonomy, but simply a complement and enhancement to the delivery of high-quality, value-based health care.
Coming Soon: An All-New aapd.org!
The current incarnation of http://www. aapd.org has been in service since 2002. While it still serves as the primary source for children’s oral health information on the Internet, we decided it was time for an upgrade! AAPD staff and AmericanEagle.com have been hard at work updating and redesigning the site with an all new look and feel and upgraded functionality. The new site should start appearing in your browser windows later this year. Here are some new features you can look forward to:
Enhanced Navigation - We’ve reorganized the AAPD website to group similar pages into fewer, clearer categories for easier navigation of the site.
Central Placement of Find a Pediatric Dentist - Consistently one of the most popular features of the AAPD site, the new design allows users to search for pediatric dentists directly from the homepage with no additional navigation.
Enhanced Search Functions - The new site search feature will pull results by category and will feature an improved index for better results.
Easy Sharing of AAPD News and Promotions - Real Simple Syndication (RSS) feeds and e-mail sharing buttons will allow members to keep up to date more easily on news and promotional updates and share them with patients and colleagues.
Mobile Site for Smartphones - This special slimmed-down version of the site will allow smartphone users quick access to the most-used features of the site to reduce tedious scrolling in small-sized phone browsers. Access to the full site will also be available.
These are just a few of the features you can look forward to from the new site when it launches. Additional new features on the site will continue rolling out throughout the year, in addition to a special site designed specifically for patients and consumers.
For more information, please contact AAPD Magazine and Website Editor Tom McHenry at email@example.com.