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Evidence Based Dentistry 
Rasha Adel Ragab 
Assistant Lecturer – Cairo University
Evidence-Based Medicine (EBM) 
The integration of the best research evidence 
with our clinical expertise and our patient’...
the American Dental Association (ADA) defines 
"evidence-based dentistry" (EBD) as:
“to encourage the ordinary dental 
practitioner in primary dental care to 
look for and make sense of the evidence 
availa...
● Production of evidence through research and 
scientific review 
● Production and dissemination of evidence-based 
clinic...
Ask 
Acquire 
FIVE STEPS OF EBD 
Assess 
Apply Appraise
1. Ask 
Asking a Clear and Focused Questions 
Use PICO to Create a Search Question 
Population / Intervention / Comparison...
2. Acquire 
Finding the Evidence
Online databases; MEDLINE via PubMed; 
http://www.ncbi.nlm.nih.gov/pubmed,
Are topical fluoride treatments effective in 
reducing caries in children?” 
P: Children 
I: Topical fluoride 
C: No topic...
What constitutes the highest 
levels of evidence ?
What is the difference between; ….
“Systematic Review” 
1. Collect all published evidence on a question 
2. Rank on value-based score card 
• Human > animal>...
“Meta analysis” 
1. Collect results and analysis from all 
available studies 
2. Re-analyze pooled results based 
upon com...
Possible Outcomes 
1. The evidence supports a particular treatment as being 
effective. 
2. The evidence does not support ...
3. Appraise 
Critically Appraising the Evidence 
Critical appraisal is the process of carefully 
and systematically examin...
To assess whether a reported 
piece of research is good enough 
to be used in decision making
Trustworthiness 
Validity 
Results 
Relevance
Validity 
• Validity defines the strength of the final 
results and whether they can be regarded as 
accurately describing...
Validity 
Internal External
When critically appraising research; 
it is important to first look for biases in the 
study; that is, whether the finding...
Key sources of bias in clinical trials 
Selection bias 
Biased allocation to comparison groups 
Performance bias 
Unequal ...
External validity 
(Outcome) 
Asks the question of generalizability: To what 
populations, settings, treatment variables a...
Reliability 
• Reliability describes the repeatability 
and consistency of a test. 
• Results; Pvalue: the probability of ...
Clinical Relevance 
 Outcome (External validity) 
Applicability... Increase with inc. ext. validity 
Cost… Inc. cost  ...
4. Apply 
Use the best identified valid and relevant 
evidence in patient care
5. Assess 
Assess how well the previous steps worked
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
Introduction to Evidence Based Dentistry
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Introduction to Evidence Based Dentistry

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Evidence Based Dentistry

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Introduction to Evidence Based Dentistry

  1. 1. Evidence Based Dentistry Rasha Adel Ragab Assistant Lecturer – Cairo University
  2. 2. Evidence-Based Medicine (EBM) The integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.
  3. 3. the American Dental Association (ADA) defines "evidence-based dentistry" (EBD) as:
  4. 4. “to encourage the ordinary dental practitioner in primary dental care to look for and make sense of the evidence available in order to apply it to every day problems.”
  5. 5. ● Production of evidence through research and scientific review ● Production and dissemination of evidence-based clinical guidelines ● Implementation of evidence-based, cost-effective practice through education and management of change ● Evaluation of compliance with agreed practice guidance through clinical examination and outcomes focused incentives.
  6. 6. Ask Acquire FIVE STEPS OF EBD Assess Apply Appraise
  7. 7. 1. Ask Asking a Clear and Focused Questions Use PICO to Create a Search Question Population / Intervention / Comparison / Outcome
  8. 8. 2. Acquire Finding the Evidence
  9. 9. Online databases; MEDLINE via PubMed; http://www.ncbi.nlm.nih.gov/pubmed,
  10. 10. Are topical fluoride treatments effective in reducing caries in children?” P: Children I: Topical fluoride C: No topical fluoride O: Caries
  11. 11. What constitutes the highest levels of evidence ?
  12. 12. What is the difference between; ….
  13. 13. “Systematic Review” 1. Collect all published evidence on a question 2. Rank on value-based score card • Human > animal>laboratory • Prospective>observational>retrospective>case report • Double blind>cohort comparisons • Controlled>non controlled • Randomized > non randomized • Replicated>non replicated “Gold Standard” double blind, randomized, controlled clinical trials
  14. 14. “Meta analysis” 1. Collect results and analysis from all available studies 2. Re-analyze pooled results based upon common “meta” statistics 3. Develop an overall conclusion based upon the overall grouped “meta analysis”
  15. 15. Possible Outcomes 1. The evidence supports a particular treatment as being effective. 2. The evidence does not support a particular treatment as being effective. 3. The evidence appears to support, but is not completely definitive for a particular treatment. 4. There is inadequate evidence to support or refute a particular treatment at this time. Unfortunately, most dental systematic reviews result in either 3 or 4
  16. 16. 3. Appraise Critically Appraising the Evidence Critical appraisal is the process of carefully and systematically examining research to judge its trustworthiness, and its value and relevance in a particular context.
  17. 17. To assess whether a reported piece of research is good enough to be used in decision making
  18. 18. Trustworthiness Validity Results Relevance
  19. 19. Validity • Validity defines the strength of the final results and whether they can be regarded as accurately describing the real world.
  20. 20. Validity Internal External
  21. 21. When critically appraising research; it is important to first look for biases in the study; that is, whether the findings of the study might be due to the way the study was designed and carried out, rather than reflecting the truth. A study which is sufficiently free from bias is said to have internal validity
  22. 22. Key sources of bias in clinical trials Selection bias Biased allocation to comparison groups Performance bias Unequal provision of care apart from treatment under evaluation Detection bias Biased assessment of outcome Attrition bias Biased occurrence and handling of deviations from protocol and loss to follow up
  23. 23. External validity (Outcome) Asks the question of generalizability: To what populations, settings, treatment variables and measurement variables can this effect be generalized?”
  24. 24. Reliability • Reliability describes the repeatability and consistency of a test. • Results; Pvalue: the probability of chance of error, should not exceed 0.05
  25. 25. Clinical Relevance  Outcome (External validity) Applicability... Increase with inc. ext. validity Cost… Inc. cost  dec. ext. validity
  26. 26. 4. Apply Use the best identified valid and relevant evidence in patient care
  27. 27. 5. Assess Assess how well the previous steps worked

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