What is evidence based dentistry(EBD) ?
EBD or Evidence Based Dentistry is an approach which combines various factors like current scientific knowledge, patient needs and experience of dental surgeon to make better treatment plan which are in best interest of the patient.
According to The American Dental Association, EBD can be defined as “an approach to oral healthcare that requires the judicious integration of systemic assessments of clinically relevant scientific evidence, relating to patients oral and medical condition and history, with the dentist’s clinical expertise and the patient’s treatment needs and preferences.”
What is the need for EBD?
With new innovations in the fields of materials and equipment, our understanding and acceptance of new scientific theories are updating at a very fast pace, this unfortunately can be seen as a gap between commonly followed clinical practice and the scientific evidence from research.
Following the practice of EBD not only benefits the patient but also the clinician, the dental surgeon gets updated with the latest scientific evidence which promotes self-growth of the clinician along with providing best available treatment to the patient.
Internet the double-edged sword!
It is true that information can be accessed in a few clicks in today’s era of technology, Information is accessible over the internet and it can be viewed by both patient as well as the dentist. However credibility of randomly available information is questionable. The patient might not be aware about which source is trustable and hence it might mislead the patient which would affect the decision-making of the patient.
Therefore patients and doctors must understand that every piece of information must not be trusted blindly, one should prefer peer-reviewed articles rather than some random advice written by an anonymous person.
Which information to trust?
A peer-reviewed journal article can be classified as a credible source but among the hierarchy of evidence based approach, Meta-Analysis and Systematic review must be ranked among the top reliable sources, followed by Randomized Control Trials(RCT), non Randomized Controlled Trials, Cohort studies, case control studies, crossover studies and case reports.
A certain treatment or procedure can be considered good enough to be followed if enough scientific evidence suggests its benefits; this could include a well-designed RCT along with a systematic review or meta-analysis.
The quality of the article can be graded with help of GRADE system, which will evaluate the article in respect of the quality, study design, bias, precision, consistency etc. This would help to evaluate and grade the article and provide a table of assessment which will suggest the quality of the study/analysis.
Limitation of clinical practice using scientific data
A major limitation is lack of information available which is of high quality and is reliable, another barrier is the tedious process of reading through plethora of articles available, which is often difficult to do in a running dental setup.
Advantages for following EBD
It might sound difficult but often the difficult roads lead to most fruitful trees, following the scientific evidence for any treatment not only improves knowledge but it also improves the outcome of the treatment which is beneficial for the patients and this is of utmost importance because as doctors it is our duty to provide what is in best interest of the patient, and this certainly should not be limited because of lack of knowledge or awareness on side of the dentist.
Personal experience and conclusion on following EBD in today’s world
To offer the best and acceptable treatment to the patient I always follow the approach of evidence based dentistry in my clinical practice, sometimes it is difficult to take out time out of my schedule to refer some articles for some special and different cases I encounter in my practice, but I choose not to follow any treatment protocol blindly without good evidence even though I regularly have to invest time in reading and updating myself with the latest and most acceptable approaches.
With this I would like to conclude with patient care should never be doctor centred but a perfect combination of patients need, patient’s decision, scientific evidence and doctor’s clinical expertise.
Dr. Navneet Kaur
Currently working as Research Intern in Oral Biology Department at Rutgers School of Dental Medicine, New Jersey.