evidence based dentistry lecture ebd current activities eaph... · 02/12/2002 1 evidence based...

02/12/2002 1

Evidence Based Dentistry

Current International Developments and

TrendsAsbjorn Jokstad

University of Oslo, Norway

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A rapidly changing society• The production of new

knowledge is at maximum in historical context

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Dental journals in circulation

0100200300400500600700800900

1000

1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000

N=933

Source: Ulrich’s International Periodicals Directory

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A rapidly changing society

• The production of new knowledge is at maximum in historical context

• Incessant replacements of established ideas and concepts

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Dentists’ daily situation: An information overload

Meetings/ courses

Colleagues

Advertising- producers- colleagues

Dental literature “Vitenskap

”

WWW

Patients & (-groups)

Dental‘science’700 journals: 25 000 articles/yr

Popular magazines & Media

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Applying EBM in dental practice

1. Learn how to practice evidence-based dentistry –Books –Seminars–Internet

• Online link banks• Online courses• Online resources• Articles

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8

A rapidly changing society• The production of new knowledge

is at maximum in historical context

• Incessant replacements of established ideas and concepts

• Information technology has improved the potential for information transfer to everybody

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Applying EBM in dental practice

1. Learn how to practice evidence-based dentistry

2. Seek and apply evidence-based dentistry summaries generated by others

• Journals that critically appraise primary studies

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Online secondary publication - EBD:

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Online secondary publication - EBDP:

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Applying EBM in dental practice

1. Accept and apply practice protocols, policies and guidelines based on evidence-based principles

2. Seek and apply evidence-based dentistry summaries generated by others

• Journals that critically appraiseprimary studies

• Systematic reviews• Cochrane Collaboration • NHS R&D • Literature

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The Cochrane Collaboration

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Cochrane Oral Health Group

• 250 members from 25 countries• Specialist trials register ~14,000 entries• Systematic reviews: near 90• OHG offers help to complete reviews

Contact: Emma.Tavender@man.ac.uk

http://www.cochrane-oral.man.ac.uk

15

0

50

100

150

200

250

1981

-19

85

1986

-19

90

1991

-19

95

1996

-20

00

2001

-20

02

(Cumulative)

N=225

Systematic reviews in dentistry

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Topics (n=236)• Pain & pharmacotherapy (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluoride issues (n=17)• Orthodontics (n=16)• Implant-related (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

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1st. Pan-European IADR meeting, Cardiff, 25 September 2002

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Topics (n=236)• Pain (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluorides (n=17)• Orthodontics (n=16)• Implant-based prosthetics (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

Guided tissue regeneration

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1st. Pan-European IADR meeting, Cardiff, 25 September 2002

11

Topics (n=236)• Pain (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluorides (n=17)• Orthodontics (n=16)• Implant-based prosthetics (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

RestorativeDentistry

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1st. Pan-European IADR meeting, Cardiff, 25 September 2002

11

Topics (n=236)• Pain (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluorides (n=17)• Orthodontics (n=16)• Implant-based prosthetics (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

1st. Pan-European IADR meeting, Cardiff, 25 September 2002

19Dental caries

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1st. Pan-European IADR meeting, Cardiff, 25 September 2002

11

Topics (n=236)• Pain (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluorides (n=17)• Orthodontics (n=16)• Implant-based prosthetics (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

Water fluoridation

NHS CRD Report 18Synopsis:Br Med J 2000;321:855-9

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1st. Pan-European IADR meeting, Cardiff, 25 September 2002

11

Topics (n=236)• Pain (n=51)• Periodontology (n=31)• Restorative dentistry (n=28)• Caries (n=23)• Fluorides (n=17)• Orthodontics (n=16)• Implant-based prosthetics (n=11)• Antibiotics, acupuncture, apnea, infection

control, oral medicine, sealants, sedation, treatment decisions, toxicology,TMD...

Impacted third molars

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1980 1990 2000

USA

1980: NIH Consensus dev. Conf. For removal of third molars

1995: AAOMS Parameters of Care

1995: BAOMS Pilot Clinical Guidelines

1996: NHS R&D. National guidelines

1991: AAOMS Parameters of Care

1994: Workshop on the managem. of patients with third molar teeth

1997: FDS RCS(Eng)

1993: Health Care Evaluation Unit, UK

1998: Effectiveness Matters 3(2)

UK 2000: SIGN Guidelines

2000: NICE Guidelines

2000: NHS R&D HTA Programme

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We have learned:

Systematic reviews and guidelines are not necessarily known to the community of dental practitioners

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Who’s responsibility to disseminate new research findings to the community of dental practitioners?

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Who’s responsibility for disseminating new research findings to the community of dental practitioners?

… and verify that this is also implemented?

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Applying EBM in dental practice

3. Accept and apply practice protocols, policies and guidelines based on evidence-based principles

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Agency for Healthcare Research & Quality, USA

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SIGN, UK

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www.fdiworldental.org

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02/12/2002 32

Thank you for your

kind attention