1. Evidence-Based Practice Definition
•
“the conscientious, explicit and judicious use of current best evidence
in making decisions about individual patients.”
• “integrating individual clinical expertise with the best available
external clinical evidence from studies while considering your
patient’s values.”
(Sackett et al. BMJ, 1996; 312: 72-3)
External Clinical Evidence
Clinical Experience Patient’s wants, desires & values

2. PROPERTIES
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5. ADA Definition of Evidence-Based Dentistry
• Evidence-based dentistry (EBD) is 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.
ADA Policy on Evidence-Based Dentistry

6. Why does Dentists need Evidence-
based Practice?
• From the Evidence-based Dentistry Guidelines of the New
Zealand Dental Association:
The use of evidence-based dentistry may help reduce the
variation in patient care and outcomes that appears to be
associated with four factors: the quality of science underlying
clinical care, the quality of clinical decision making, variations
in the level of clinical skill and the large and increasing volume
of literature

8. Background / Foreground Information
• Background Information – general information on
a clinical topic
• Foreground Information – Specific information for
a clinical decision action
• The greater your experience with the condition
the less background and the more focused
foreground information will be needed

9. The Forest and the Trees
• 2 aspects of Evidence-Based Dentistry in your
clinical career:
1. Maintaining your general level of knowledge
– keeping up with new clinical developments
and trends
2. Being able to find the best evidence to assist
you find the best answer for specific, patient
focused questions

10. Types of Clinical Questions
• Clinical questions usually fall into one of four
main categories:
• Etiology / Harm : identifying associations, risk
factors and causes of a disease
• Diagnosis: selecting tests that accurately detect a
disease
• Therapy / Prevention : selecting effective
interventions to treat or prevent a disease
• Prognosis: predicting the probable outcome of a
disease or treatment

11. Sample questions:
• Etiology / Harm : Are teenagers who frequently
drink soda at risk for developing dental caries?
• Diagnosis: What is the best method that dentists
can use to identify early carious lesions?
• Therapy / Prevention : Should teenagers and
young adults with asymptomatic impacted
wisdom teeth have them removed?
• Prognosis: How long will a dental implant last in
an adult patient with no periodontal disease?

12. What Studies for Which Clinical
Questions??
Type Of Question Type of Study
Clinical Examination Prospective, blind comparison to
gold standard
Diagnostic Testing Prospective, blind comparison to
gold standard
Prognosis Cohort Study > Case Control >
Case Series
Therapy RCT is the only way to answer
these questions
Etiology / Harm Cohort Study > Case Control >
Case Series
Prevention RCT > Cohort Study > Case
Control > Case Series