As a health sciences major, I enrolled in a course called Evidence-Based Practice. Every week, we would learn new skills to apply to the ultimate objective: choose a clinical topic in our field and evaluate the literature to make a (hypothetical) treatment decision. As an undergraduate student with little exposure to clinical research papers, the assigned task seemed overwhelming. The truth is, learning how to evaluate literature is a skill that takes effort and time to develop, but doing so is critical. Evidence-based dentistry is so important, in fact, that it is listed as one of ADEA’s entry-level competencies for graduates entering into practice. Despite this, new dentists struggle to implement it into their practices. The two most frequently cited obstacles are lack of time and insufficient background knowledge to evaluate research critically. If you are unfamiliar with evidence-based dentistry, here are some things to help get you acquainted.
What is evidence-based dentistry?
Evidence-based dentistry is the integration of a dentist’s personal expertise with scientific evidence in order to guide patient care. While experience is unquestionably valuable in a dentist’s practice, making decisions based solely on personal clinical expertise has some drawbacks. It doesn’t take into account new and emerging technologies, materials or methods. It may even be based on outdated or suboptimal practices that recent evidence has proven ineffective. Relying on experience alone strips the clinician of the chance to evaluate and apply the best current findings. This can consequently deny the patient the best possible care.
How can you implement evidence based-dentistry into your studies and practice?
- Designate time to read every week. Although you may think that evidence-based dentistry can wait until you are actually practicing, you should get in the habit of reading now. Set aside a couple of hours every week to get familiar with the current literature. The ADA Center for Evidence-Based Dentistry, Journal of Evidence-Based Dental Practice, and Nature’s Evidence Based-Dentistry provide great summaries of studies that can help you get acquainted with clinical research. These summaries also give appraisals of the literature, which can help train you in what to look for when performing your own literature evaluations.
- Decide on a topic: Eventually, you’ll need to apply your skills to clinical use. To address a specific clinical problem, the PICO approach can help you narrow down your search. To formulate a PICO question, the following four things need to be defined:
For example, my PICO question looked at (P) middle-aged patients (I) salvaging a decaying tooth by endodontic treatment (C) compared to extraction and implantation (O) and the long-term cost and survival rates of both treatment modalities.
- Locate the evidence: There are many databases available for locating scientific publications. PubMed or the Cochran Database are useful for general searches.
- Evaluate the literature: “Evidence” may be easy to find, but not all is reliable. Identifying flaws in study design, evaluating statistical analyses and recognizing publication bias may not come easily at first. Luckily, there are many online worksheets that can guide you through the literature appraisal process. The Center for Evidence-Based Medicine has worksheets for different kinds of study designs which can be found here.
Evidence-based dentistry assists practitioners in fulfilling our duty to provide the best care to our patients. This way, we can give them the most efficient, cost-effective and satisfactory treatments possible. Following these steps will help you begin to establish a foundation that will serve you far into the future.
~ Khaled Oudeh, Cleveland State University ’17, predental