Evidence Based Dentistry (EBD) is an approach to making clinical decisions in oral healthcare. It moves past relying solely on methods learned in dental school or personal experience, instead demanding continuous learning and adaptation based on high-quality research. This method ensures that the care patients receive is grounded in the most current scientific understanding of what works best for their specific condition. EBD elevates the standard of care.
Defining Evidence Based Dentistry
Evidence Based Dentistry is formally defined by the American Dental Association as a practice that requires the measured integration of three distinct components. The first component is the best available scientific evidence, which refers to valid and clinically relevant research findings. The second component is the dentist’s own clinical expertise, incorporating their learned skills, judgment, and experience. The final and equally important component is the patient’s needs, preferences, and values.
This approach fundamentally differs from traditional practice, which often relied heavily on anecdotal evidence, personal observations, or techniques passed down through training. EBD mandates that a dentist remain constantly updated on current research findings and techniques to ensure patients receive the most effective treatment possible. The best evidence must be tempered by the patient’s unique health profile and their personal goals for treatment.
The Steps of Evidence Based Practice
Dental professionals follow a structured, five-step methodology when applying EBD, often referred to as the “Five A’s.” The process begins with “Ask,” where the clinician converts a patient’s problem into a focused, answerable question, typically structured using the PICO framework: Patient, Intervention, Comparison, and Outcome.
The next step is “Acquire,” involving an efficient search of professional literature to find high-quality evidence. The dentist then moves to “Appraise,” critically evaluating the scientific studies for their validity, trustworthiness, and relevance to the patient’s situation. This appraisal assesses the study’s design and methodology to determine if the findings are useful in a clinical setting.
The fourth step is to “Apply” the evidence, integrating research findings with clinical experience and patient preferences to formulate a treatment plan. The final step, “Assess,” requires the dentist to evaluate the effectiveness of the chosen treatment and reflect on the overall process. This cyclical assessment ensures continuous professional learning and refinement of practice.
Understanding the Hierarchy of Evidence
The Hierarchy of Evidence provides a framework for rating the trustworthiness of scientific studies, often represented as a pyramid. Study designs that minimize the risk of bias are placed at the top. Studies lower on the pyramid, such as expert opinion or case reports, are considered the weakest evidence because they lack systematic control and can be easily influenced by bias.
At the top of the hierarchy, representing the highest level of reliability, are Systematic Reviews and Meta-Analyses. A systematic review is a comprehensive summary of multiple research studies addressing a specific clinical question. When a systematic review includes a meta-analysis, data from multiple trials are statistically pooled to produce a single, more precise estimate of a treatment’s effect.
The next highest level of evidence is the Randomized Controlled Trial (RCT), the gold standard for testing intervention effectiveness. In an RCT, participants are randomly assigned to a treatment or control group, ensuring outcome differences are attributed to the treatment. For therapy or prevention questions, systematic reviews of RCTs or individual, high-quality RCTs provide the strongest data for clinical decisions.
Why EBD Matters to Patients
EBD provides tangible benefits to patients by improving the quality, predictability, and personalization of their oral healthcare. Basing a treatment recommendation on the best available science increases the likelihood of a successful and long-lasting outcome. This scientific foundation helps move treatment away from trial-and-error methods, reducing the risk of unnecessary or ineffective procedures.
EBD also supports the process of informed consent, which is crucial for patient autonomy. By integrating scientific evidence and patient preferences, EBD ensures that treatment options are presented with a clear explanation of their risks, benefits, and alternatives. This transparency empowers patients to actively participate in decision-making, fostering trust and ensuring the final treatment plan aligns with their personal values.