evidence-based decision-making is really
about having a spirit of curiosity and inquiry with a tiny bit of skepticism
sprinkled over top. As the distinguished Lieutenant Commander data from Star Trek
who would say the most elementary and valuable statement in science the
beginning of wisdom is I do not know and practitioners can use the spirit of I do
not know to not only solve clinical problems but to improve business
strategies and operations and their practices I’ll share with you an example
of how I use this technique recently with my good friend Dr. Benton who also
happens to be my sister and is a pediatric dentist my sister insists that
rubber dams make your fillings last longer however I was thinking about this
the other day and I was curious and my slightly skeptical brain started
thinking. Is that really true because the reality is that many dentists
actually don’t use rubber dams. In fact one study reported that only about half
of dentist even use them in root canal treatments. So I begin my search and sure
enough I find a Cochrane systematic review just on this topic. The review
includes four small trials totaling 1037 participants and found that in fact
using rubber dam does improve survival time of restorations compared to cotton
roll isolation. Cochrane reviews are considered to be the gold standard of
systematic reviews nonetheless it is actually very important to continue
evaluating a systematic review for quality. At this point I can either
critically appraise the systematic review myself by answering these
questions. What are the results? Are the results valid? and will the results help
me in caring for my patients? However I could also move on in my research to
look for a critical summary remember that’s like the food critic review food
critics go to restaurants on your behalf and with their extensive knowledge of
the culinary arts and restaurant tourism they evaluate and rate the quality of
the food, ambiance, and even service. They then summarize that information and
report it back to you so that you can make a decision about whether you want
to go to that restaurant or not. Critical summaries are a lot like this people who
are highly skilled and research design and statistics read and evaluate the
scientific literature on your behalf in this process they rate the studies on
their level of quality and bias they summarize their findings and report them
to you so that you can make a decision on whether you want to implement that in
your practice or not. Examples of pre appraised evidence are
critical summaries and evidence-based guidelines critical appraisal is a very
important step in the practicing of evidence-based decision-making as all
research is susceptible to bias and flaws. It’s actually probably better if I
do move on and try and look for the food critic review because number one it’s a
little bit faster and honestly probably a better quality evaluation too because
it’s done by someone who’s an expert in study design and statistics. The
conclusion is that there is some evidence to suggest that a rubberdam
improves restoration longevity especially in children but that there
wasn’t a ton of studies that were included in the review which means that
more studies could change future results. So that’s how used evidence-based
approach to make my decision about whether I should implement a clinical
technique in my practice or not but you can really use this approach for lots of
different things in your life like for instance if you’re wondering what type
of material might you might want to use in your practice or if you should order
a diagnostic test for one of your patients or maybe you’re considering
buying a new piece of technology for your office you can use that approach to
decide whether that would even be a good investment for you. Another way I like to
apply evidence-based dentistry is to help me in improving efficiencies within
the operations of my dental practice with many people working in a dental
office sometimes it happens that providers have different philosophies of
care and this can be really confusing and frustrating and stressful for both
patients and staff and in the end can be very inefficient if every providers
approaching care differently. Developing clinical care guidelines for a dental
practice can help promote efficiency and continuity of care. An example of how I
did this in my own practice is applying systematically into care the
evidence-based guideline on antibiotic prophylaxis for the Prevention of
prosthetic joint infections or PJI. I took the EBD guideline that was released
recently and summarized it into a formal written policy for the practice to
follow based on the EBD guideline it says it is the clinical
practice of sprout oral health to not prescribe antibiotics prior to down
procedures for patients with prosthetic joint implants for the Prevention of PJI. Some of you might think wow this is a lot of work and it probably will be at
first but like anything else the more you practice the more like a habit it
becomes however. There are ways to share the work with your dental team I would
submit to you that you can actually train your dental team to participate
and support the EBD process in your practice taking time to educate them on
how to identify and communicate sound science to patients deepens their
commitment to dentistry and also to your practice it also improves continuity of
care and communication and can ultimately distribute the burden of work.
One model for engaging staff in the EBD process is to provide them with an EBD
training program there are many excellent EBD workbooks on this topic in
my practice we’ve used a model where staff complete sections of an EBD
workbook for each chapter that they complete including the end chapter
homework questions they receive $100 at the end of completing the book they
review their own topic of interest and then present that topic to the rest of
the dental team for that they receive another hundred dollars by the time
they’ve completed the entire training program they received approximately
$1,200 and they’re empowered and articulate and most importantly can help
patients and family understand the science behind what they do it’s really
fun to watch their transformation. So as a recap searching and appraising
evidence is a skill and like any other skill you build speed and proficiency
with time the skill has a wide application including answering clinical
questions, improving practice efficiency, evidence-based decision-making can also
be supported by your dental team by teaching them how and where to find
reliable health information and how to communicate complex concepts to patients.
I hope that you’ve enjoyed what you’ve learned and that you’re one step closer
to the wisdom of I do not know. for more EBD resources, visit EBD.ADA.org