Evidence-based dentistry

Much less attention is paid to both the other two spheres of EBD, clinical expertise and patient values.[8]

Clinical expertise plays a part in the successful outcomes of treatment with diagnostic skills preventing over and under-treatments, technical dental skills maximizing the longevity of surgical and restorative procedures and communication skills being core to patient management and perceived success.

Not all patients have the same priorities for their care. Understanding a patient's individual needs, wants and circumstances gives the clinician a place from which to discuss treatment options available with the patient. This might be competing priorities between dentists, therapists, and hygienists who generally aim for longevity and aesthetics and patients who may be more interested in keeping costs down, aesthetics or would prefer less invasive treatments.

Given that "Patient needs and preferences" and "Dentist's clinical expertise" are variable and will differ among numerous clinicians and population, "Relevant scientific evidence" is of critical importance. Therefore, it is imperative that information referenced to are derived from high-quality, evidence-based research, which can be used to establish the guidelines for providing the best practices.

In essence, Evidence-based dentistry can allow clinicians to remain constantly updated on the newest techniques and procedures so that patients can continuously receive the best treatment possible.

The new model set by EBM uses a systematic process to incorporate current research into practice. The evidence-based process requires the practitioner to develop five key skills:

• Formulate information needs/questions into four part questions to identify the patient/problem (P), intervention (I), comparison (C), and outcomes (O), known mnemonically as the PICO questions.
• Conduct an efficient computerized search of the literature for the appropriate type and level of evidence.
• Critically appraise the evidence for validity with an understanding of research methods.
• Apply the results of the evidence to patient care or practice in consideration for the patient's preferences, values and circumstances.
• Evaluate the process and your performance through self-evaluation.[9]

The American Dental Association defined evidence-based dentistry like so:

Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.

— ADA[10]

The American Dental Education Association (ADEA) has incorporated the definition of evidence-based dentistry into core competencies required by dental education programs. These competencies focus on graduates to become lifelong learners and consumers of current research findings and require students to develop skills that are reflective of evidence-based dentistry.[11]

A dentist's learning curve for using the evidence-based process can be steep, but there are continuing education courses, workbooks and tools available to simplify the integration of current research into practice.

Dentists can prescribe medications upon initial registration.[13] This is important as evidence has shown that general practitioners prefer to refer to dentists for the management of dental emergencies.[14] Research has shown that there are potential limitations in the knowledge of dental students for conventional and complementary and alternative medications.[15][16]

Formed in 1993, the Scottish Intercollegiate Guidelines Network (SIGN) goals are to decrease the discrepancy in treatments and results, through the creation and dissemination of nationwide clinical guidelines encompassing recommendations for effective practice established on up-to-date evidence to improve the quality of health care for patients in Scotland.[17]

SIGN guidelines are established using a clear methodology[18] constructed on three fundamental principles, which are:

• Development is carried out by multidisciplinary, nationwide representative groups
• A systematic review is conducted to recognise and analytically evaluate the evidence
• Recommendations are clearly connected to the supporting evidence

As of 2009, SIGN has also adopted the practise of implementing[19] the GRADE methodology to all its SIGN guidelines.

Part of NHS Education for Scotland (NES), the Scottish Dental Clinical Effectiveness Programme (SDCEP)[20] is an initiative of the National Dental Advisory Committee (NDAC) which is an organisation of dental professionals, across all specialities, that functions as consultative wing to the Chief Dental Officer. Its main goal is to appraise the best available and pertinent information with regards to dentistry and convert it into guidelines which are easily comprehensible and executable.

The Scottish Dental Clinical Effectiveness Programme consist of a central group for Programme Development and multiple other groups for guideline development. With

the principal objective of developing guidance that delivers the best quality of patient care through supporting dental teams, the SDCEP uses the most suitable high-quality evidences from a plethora of sources to make guidelines recommendations.

Founded under the intention of NDAC to give a systematized methodology[21] when providing clinical guidance for the dental profession, the SDCEP has since become a crucial factor between the gold standard practice guidelines and dental education and practice.