Evidence-Based Dentistry

“A Timeline of Change”

Gail Redman, D.D.S.

Numerous dentists were experimenting with a variety of technical procedures.

Work was elementary and done by trial and error.

This formed the foundation of the traditional approach to dentistry.

Past: 1875

Past: 1960’s to 1980’s

G.V. Black’s principles for cavity preparation with some modification for inlay preparation are strongly advocated.

“Extension for prevention” was the motto.

Past: Sealants

First adaptation of the etching technique that included pits and fissures was reported in 1967.

It was theorized that sealants were a preventive measure but no conclusive research demonstrated long-term effectiveness.

One of the first approaches to minimally invasive dentistry.

Clinical Example

Patient presents with small occlusal carious lesion.

Before Evidence-Based Dentistry

Example of preparation based on “extension for prevention”.

Using Evidence-Based Principles

Outline form achieved without extension for prevention.

Notice conservation of tooth structure.

Finished Restoration

Present: EBD Techniques Taught Today

We now know that instead of destructive removal of tooth structure, preventive and minimally invasive restorations have very positive outcomes.

Sealants placed over carious and non-carious lesions are effective at preventing further decay.1

Only 10% of sealed incipient lesions progress to full carious lesions, compared with over 50% when not sealed.2

1. Beauchamp J, Caufield PW, Crall JJ, Donly K, Feigal R, Gooch B, Ismail A, Kohn W, Siegal M, Simonsen R; American Dental Association Council on Scientific Affairs. 2008. Evidence-based clinical recommendations for the use of pit-and-fissure sealants: A report of the American Dental Association Council on Scientific Affairs. Journal of the American Dental Association 139(3):257–268.

2. Heller KE, Reed SG, Bruner FW, Eklund SA, Burt BA. 1995. Longitudinal evaluation of sealing molars with and without incipient dental caries in a public health program. Journal of Public Health Dentistry 55(3):148–153.

Present: Extension for Prevention?

G.V. Black’s principles no longer apply.

EBD replaces traditional treatment modalities.

Minimal preparation for adhesive and amalgam restorations is supported by research. 2,3,4

4. Walker JD, Jensen ME, Pinkham JR. A clinical review of preventive resin restorations. ASDC J Dent Child 1990;57:257-9.

3. Almquist TC, Cowan RD & Lambert RL. Conservative amalgam restorations. J Prosthet Dent. 1973; 29:524-528.

2. Cloyd S, Gilpatrick RO & Moore D. Preventive resin restorations vs. amalgam restorations: A three-year clinical study. J Tennessee Dent Assoc. 1992; 77(4):36- 40.

Preparation treats only carious fissures and preserves maximum

amount of tooth structure.

Present:Expansion of EBD

EBD is present in dental school curriculums today.

EBD has started to influence clinical choices for practicing dentists.

Future

The American Dental Association will continue to educate dentists on evidence-based dentistry and promote research and systematic reviews.

Expansion of evidence-based clinical recommendations.

Dentists will practice dentistry based on principles backed by current research.

EBD in dental schools

• 90% teach their students the basic principles of EBDM.

• 90% are providing EBDM didactics

• 55% of schools have integrated EBDM education into their preclinical and clinical curriculum

EBD in dental schools

• 100% teach students to do clinical queries

• 70% used focused clinical questions

• 80% apply EBDM to their clinical education program and patients

New accreditation Standards - CODA

• 2-21 Graduates MUST be competent to access, critically appraise, apply, and communicate scientific and lay literature as it relates to providing evidence-based patient care.

• Intent: The education program should introduce students to the basic principles of clinical and translational research, including how such research is conducted, evaluated, applied, and explained to patients.

New accreditation standards - CODA

• 5-2 Patient care must be evidence-based, integrating the best research evidence and patient values.

• Intent: The dental school should use evidence to evaluate new technology and products and to guide diagnosis and treatment decisions.