1. Evidence-Based Dentistry Presenter’s Name

2. What does EBD mean?

3. © 2013 American Dental Association, All Rights Reserved 3 Three Components of EBD Is an approach to oral health care Is a method to acquire, understand and apply the most current science Evidence Patients’ needs & preferences Clinical Expertise

4. © 2013 American Dental Association, All Rights Reserved 4 The Clinician’s Role  Information  Data  Statistics  Knowledge  Judgment  Values  Decisions Informs

5. © 2013 American Dental Association, All Rights Reserved 5 Acknowledging the Difference Evidence-Based Practice Uses best evidence Systematic appraisal of quality of evidence Objective, transparent, less biased Acceptance of levels of uncertainty Traditional Practice Unknown basis of evidence Limited/incomplete appraisal of quality of evidence Subjective, opaque, potentially biased Black and white conclusions

6. © 2013 American Dental Association, All Rights Reserved 6 The Value of Evidence-Based Practice

7. © 2013 American Dental Association, All Rights Reserved 7 Barriers to change Time Access Complexity of information

8. What is evidence?

9. © 2013 American Dental Association, All Rights Reserved 9 What is pre-appraised evidence? Clinical practice guidelines Critical summaries of systematic reviews Systematic reviews

10. © 2013 American Dental Association, All Rights Reserved 10 Systematic reviews Implementation into clinical practice 1. Clinical Practice Guidelines 2. Critical summaries of systematic reviews 3. Independent appraisal of systematic reviews (and/or other trials) Tiered approach to finding evidence-based information

11. How do I find the best evidence-based information to guide my practice?

13. © 2013 American Dental Association, All Rights Reserved 13 ADA clinical practice guidelines

14. 600-800 words Summarizes a systematic review Critical appraisal Clinical implications Critical Summaries

15. © 2013 American Dental Association, All Rights Reserved 15 What are the levels of primary evidence? Randomized Controlled Trial Controlled study without randomization Non-experimental studies (i.e. cohort and case-control) Expert committee reports or opinions or clinical experience of respected authorities

16. How does EBD work?

17. © 2013 American Dental Association, All Rights Reserved 17 The EBD Process AskAccessAppraiseApplyAssess

18. Population or Problem Step 1: Framing the Answerable Question Intervention Comparison (Optional) Outcome

19. Framing the question Increase chances of finding the answer Know when you’ve found the answer Help to find it quickly Identify search terms

20. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Population

21. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Population

22. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Intervention

23. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Intervention

24. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Comparison

25. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Comparison

26. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Outcome

27. In patients with periodontal disease, will short-term systemic antibiotics, when compared to surgery, reduce pocket depth? Outcome

28. AskAccessAppraiseApplyAssess

29. Formulate question (PICO) Develop list of search terms Guidelines and Summaries NO Systematic Reviews NO Primary Studies EBD website ebd.ada.org YES STOPSTOP EBD website and PubMed YES STOPSTOP PubMed (Clinical Studies) YES STOPSTOP SEARCH STRATEGY

30. AskAccessAppraiseApplyAssess

31. © 2013 American Dental Association, All Rights Reserved 31 Other levels of evidence PopulationInterventionOutcomeControlOutcome

32. AskAccessAppraiseApplyAssess

33. 1.Are the results valid? Quality Are the studies well designed and executed? What types of studies are there? Quantity How many studies are there? What are the population sizes? Consistency How consistent are their results?

34. 1.Are the results valid? 2.What are the results? Certainty of the effect Magnitude of the effect

35. 1.Are the results valid? 2.What are the results? 3.Can the results be applied to my patient? Is the population similar? Is the provider similar? Is the setting similar?

36. AskAccessAppraiseApplyAssess

37. EBD Champions 2.0 Implementing Science in Practice

39. "Perhaps the best course of my dental career.“ "Highly recommend the program... a great means of extending the practice of EBD." Advanced Evidence- Based Dentistry Workshop: Assessin g the Quality of Evidence

40. The better the research, the more confident the decision. Victor Montori, Mayo Clinic Evidence alone is never sufficient to make a clinical decision. Victor Montori, Mayo Clinic External clinical evidence can inform, but can never replace, individual clinical expertise. David Sackett

41. THANK YOU! ADA Contact: ebd@ada.orgebd@ada.org