Evidence-based dentistry in clinical practice

doi:10.14219/jada.archive.2004.0024

The Journal of the American Dental Association

Volume 135, Issue 1, January 2004, Pages 78-83

https://doi.org/10.14219/jada.archive.2004.0024 Get rights and content

ABSTRACT

Background

Evidence-based dentistry, or EBD, is not a new concept for the dental profession in the United States. The American Dental Association has long relied on credible scientific evidence in setting policy and communicating with dentists and the general public. EBD provides an approach to oral health care that follows a process of systematically collecting and analyzing scientific evidence to answer a specific clinical question.

Overview

The authors discuss applications of systematic review findings to everyday clinical practice and explore the implications of EBD for dental education, clinical research and the provision of care to patients.

Conclusions and Practice Implications

In developing appropriate treatment plans, dentists should combine the patient’s treatment needs and preferences with the best available scientific evidence, in conjunction with the dentist’s clinical expertise. To keep pace with other health professions in building a strong evidence-based foundation, dentistry will require significant investments in clinical research and education to evaluate the best currently available evidence in dentistry and to identify new information needed to help dentists provide optimal care to patients.

Section snippets

IDENTIFYING BEST EVIDENCE

The emphasis on assessing the strength of the evidence for any given question increased substantially in the 1990s, as it grew increasingly obvious that single studies were insufficient to answer such questions. Replication is the basis for scientific discovery. In medicine, expert opinions and even information based on case studies are not considered to be sufficiently strong or credible evidence in the decision-making process. Rather, the collective knowledge gleaned from reviewing all

MODELS FOR CLINICAL DECISION MAKING

Dentists have been trained to rely on knowledge gained from experience (both successes and failures) and to learn from colleagues when providing oral health care to patients. Most dental students are trained under the auspices of the so-called master teacher or clinician. Unfortunately, dental academicians have yet to develop a formula for training so-called master clinicians. As a result, dental students are taught by several inconsistent and sometimes contradictory teachers, and are trained

EVIDENCE-BASED CLINICAL PRACTICE

Using three examples below, we illustrate how dentists can use model 3 when making clinical decisions.

IMPLICATIONS OF EBD

Scientific evidence, when collected and analyzed systematically, can provide useful and current information to dental practitioners. However, scientific evidence by itself is insufficient for dentists to provide appropriate dental care. By necessity, dentists also should consider patients’ circumstances and preferences regarding outcomes when recommending treatments.

The ADA definition of EBD, included within the Association’s EBD policy statement,¹ is explicitly addresses the need to

CONCLUSION

In the evidence-based approach to clinical decision making, dentists incorporate the best scientific evidence—evidence that is critically appraised in systematic reviews—with clinical experience and their patients’ preferences for treatment outcomes. The dental profession should define clinically relevant questions, commission systematic reviews to answer those questions and, when evidence is not available, advocate for good-quality clinical research to be conducted to provide the answers.

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Randomised controlled trials (RCTs) are recognised as the highest level of original evidence and provide essential evidence for dentists to practice evidence-based dentistry. By analysing the top 100 most-cited RCT reports in orthodontics, this study aimed to determine popular research topics, key authors, countries, journals, and their impacts.
A comprehensive search was performed in the Web of Science (WoS) electronic database to identify the top 100 most-cited RCT reports in orthodontics. Publication and citation data were retrieved and further analysed and visualised using R Biblioshiny. The primary themes of the 100 articles were also determined. Additionally, the correlation between number of years since publication and citation counts was examined.
The top 100 most-cited RCT reports were published between 1992 and 2018, contributed by 419 authors across 22 journals, with an average citation count of 93.48. The US led with the highest number of publications (28) and citations (2552), followed by the UK (22 and 2061) and Australia (8 and 912). Notably, 20 of the top 24 authors with at least 4 publications are from the UK. The primary focus areas of the articles included early Class II treatment (n = 14), obstructive sleep apnoea (n = 14), demineralisation (n = 12), and pain and quality of life (n = 12). Besides, a positive correlation was found between the number of years since publication and citation counts (P < .001).
The top 100 most-cited RCT reports in orthodontics encompass a wide range of topics with varying focus areas across different time periods. This analysis recognises the contributions of scholars and offers valuable insights into the research trends within the field of orthodontics.
The Translation of Research Central Tendencies in Clinical Practice: Power and Limitations of Statistics
2023, Seminars in Orthodontics
The clinician's ability to provide evidence-based orthodontics is directly related to their adeptness at dissecting published research, which in turn is heavily dependent on the proper understanding of the tenets of research design and biostatistics. Using relevant clinical examples, we discuss key principles affecting the translation of the results of single research studies into clinical practice, including effect modifiers and confounders, study design, central tendency and outliers. The application of the same scrutiny to higher level meta-epidemiological evidence is also illustrated in addition to a detailed discussion of the applicability and limitations of prediction studies. We conclude by highlighting how the particulars of publishing undermine the ultimate goal of transparency in dissemination of research findings and how they may restrict the ability to critically scrutinize and build upon seminal landmark studies that, just like other research, are limited by the original research design and statistical protocols employed.
“Airway Friendly” orthodontics! Are you serious?
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It seems that controversies have been and still are an intrinsic part of orthodontics even proceeding Edward Angle. And like the extraction/expansion debate it seems to be never ending. A few decades ago, the controversies seemed less egregious like claims for more superior results using passive-self-ligating brackets. Now we have some newer challenges with potentially more harm like some pretentious claims about expansion, extractions and early treatment effects on “airway.” Some questions this paper addresses are: Are the TMD apostates now the airway friendly orthodontists? How can ostensibly meaningful, passionate, and intelligent people (i.e., orthodontists) and groups have so much dissonance?
Level of evidence and characteristics of clinical studies published in leading prosthodontics journals
2023, Journal of Prosthetic Dentistry
Data on the level of evidence and the characteristics of studies published in peer-reviewed prosthodontic journals are lacking.
The purpose of this study was to investigate the characteristics and level of evidence (LOE) scores of studies published in 3 leading peer-reviewed prosthodontic journals.
Clinical studies published in the Journal of Prosthetic Dentistry (JPD), the Journal of Prosthodontics (JP), and the International Journal of Prosthodontics (IJP) in 2013 and 2020 were included in the analysis. Abstracts, letters to the editor, book reviews, and animal and laboratory studies were excluded from the investigation. For each study, design, type and LOE scores (Levels 1 to 5), publication year, impact factor (IF) of the journals, geographic origins of the first and corresponding authors, and funding status were recorded. Level 1 and Level 2 were defined as high evidence (HE), and Level 3, Level 4, and Level 5 were defined as low evidence (LE). Descriptive statistics and logistic regression analysis were performed (α=.05).
Among the 439 studies included in the analysis, the proportion of HE and LE studies was 14.1% and 85.9%, respectively. According to univariate and multivariate analysis results, year of publication (P=.010 and P=.029), geographic origin of the corresponding author (P<.001), and funding status (P<.001 and P=.002) were significantly associated with the LOE of a study. However, the journal IF was not associated with LOE (P=.328).
Although the number of HE studies in 3 leading prosthodontic journals has increased over time, the total number was still limited compared with LE studies. A further improvement in the overall LOE of clinical studies in prosthodontics is needed.
Comparison of 2 Invisalign tray generations using the Peer Assessment Rating index
2021, American Journal of Orthodontics and Dentofacial Orthopedics
This study aimed to establish if there is a significant difference in effectiveness between 2 generations of Invisalign trays in terms of Peer Assessment Rating (PAR) score reduction for finished patients from a graduate orthodontic clinic.
Forty-five pretreatment and posttreatment patients treated with the previous Invisalign material and 49 pretreatment and posttreatment patients treated with SmartTrack material were scored using the Peer Assessment Rating (PAR) index. Both groups were controlled for initial weighted PAR score, age, gender, and treatment time. The 2 generations were compared in regard to absolute reduction, percent reduction, and great improvement in PAR score.
The mean absolute reduction in weighted PAR score between the groups was not statistically significant (P = 0.526). The mean percent reduction in weighted PAR score between the groups was not statistically significant (P = 0.210). The proportion of great improvement between the groups was not significant (P = 0.526). Only 6 of the 8 components of occlusion had enough variation to be modeled. An absolute reduction in unweighted PAR score was not significantly different between the groups for maxillary anterior alignment, overjet, or mandibular anterior alignment (P = 0.996, 1.000, and 0.114, respectively). Percent reduction in unweighted PAR score was not significantly different between the 2 groups for an anteroposterior, overbite, or transverse (P = 1.000, 1.000, and 1.000, respectively) relationships.
Our study indicates that both generations of Invisalign aligners improved the malocclusion to a similar degree according to the PAR index. Patient-centric benefits of SmartTrack aligner should also be considered by the provider.
Using Evidence-Based Dentistry in the Clinical Management of Combined Periodontal Conditions
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Citation Excerpt :
Evidence-based medicine (EBM) was introduced as an attempt to eliminate bias in patient care management from diagnosis to treatment.1
This report proposes a framework to integrate evidence-based dentistry (EBD) in a systematic approach in the clinical management of a patient diagnosed with drug-induced gingival hyperplasia combined with generalized aggressive periodontitis.This report illustrates the case of a 37-year-old female who presented to the Department of Periodontology at Tufts University School of Dental Medicine with enlarged, tender, bleeding gums, and loose teeth combined with a history of uncontrolled hypertension treated with calcium channel blockers.
Incorporating the EBD process, a new 5-step framework is proposed: ask the clinical question, acquire and appraise the evidence, apply it in the clinical setting, and assess the subjective and objective outcomes. Articles on aggressive periodontitis and/or gingival enlargement were sought using the assistance of an expert librarian. The search was conducted on the PubMed, Embase, and Scopus databases.
Initial literature search identified 34 publications. Articles were reviewed by 2 clinicians, and 31 relevant articles were selected. Twenty-six of the references matched the levels of evidence initially agreed upon. Based on the scientific evidence, patient's chief complaint, and clinical expertise, a decision tree highlighting treatment options was compiled. The outcomes of the clinical management revealed that combined conditions can be successfully treated with nonsurgical therapy before proceeding with surgical therapy.
Within the limitations of this study, integrating EBD concepts was a reliable method to treat an atypical case, where 2 severe periodontal conditions were combined: drug-induced gingival enlargement and generalized aggressive periodontitis.

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Practical Science is prepared by the ADA Council on Scientific Affairs and Division of Science, in cooperation with The Journal of the American Dental Association. The mission of Practical Science is to spotlight what is known, scientifically, about the issues and challenges facing today’s practicing dentists.

Although Practical Science is developed in cooperation with the ADA Council on Scientific Affairs and the Division of Science, the opinions expressed in this article are those of the authors and do not necessarily reflect the views and positions of the Council, the Division or the Association.

View full text

Evidence-based dentistry in clinical practice

ABSTRACT

Background

Overview

Conclusions and Practice Implications

Section snippets

IDENTIFYING BEST EVIDENCE

MODELS FOR CLINICAL DECISION MAKING

EVIDENCE-BASED CLINICAL PRACTICE

IMPLICATIONS OF EBD

CONCLUSION

Int Dent J

Pain

ADA policy statement on evidence-based dentistry

And now, a few words for the other side

N Y State Dent J

Evidence-based versus experience-based decision making in clinical dentistry

J Am Coll Dent

The genome projects: implications for dental practice and education

J Dent Educ

Variation in dentists’ clinical decisions

J Public Health Dent

The future of dentistry: the evidence revolution

Br Dent J