Dentists' knowledge of non-surgical root canal treatment, a systematic review.

OBJECTIVES: Dental practice is based upon dentists' cognitions, knowledge being foundational. Knowledge is attained through education and perception. Although knowledge is modulated by beliefs, attitudes, preferences, and behaviors, it is essential to evidence-based practice. Cross-sectional studies uniformly demonstrate that community NSRCT is of sub-optimal quality worldwide, is lack of knowledge a problem? Our purpose was to measure dentists' knowledge of root canal treatment (NSRCT). DATA: Quantitative and qualitative data were extracted: purpose, topics assessed, authors cited knowledge sources, number of dentists studied, number of questions, authors descriptors of knowledge level,% correct answers by question, authors recommendations. SOURCES: OVID Medline, EMBASE, Web of Science, and hand-searching. STUDY SELECTION: Studies which had measured dentists' knowledge of non-surgical root canal treatment that was valuable, reliable, and had practical implications which could be implemented. A total of 51 papers from 19 countries measured the knowledge of 15,580 dentists using 445 questions on 29 root canal treatment topics. CONCLUSIONS: 'Gold standards' were from literature, external bodies, or expert consensus in 47, 31, and 2 papers respectively. Levels of knowledge by percentage correct answers among studies were poor to moderate and varied considerably. The mean, for the 50 studies where overall study percentages could be calculated, was 57 %, standard deviation 17 %, and a range of 16 % to 82 %. Authors' adjectives describing knowledge levels were generally negative. Additional education was advised in 49 papers, but without evidence that education was inadequate; 6 papers recommended increased use of protocols; only 5 papers advocated research on the cause of lack of knowledge. CLINICAL SIGNIFICANCE: Dentists' root canal treatment knowledge was found to be poor to moderate, as well variable. This may constrain quality of care. However, provision of information without attention to dentists' cognitions and motivations may not be successful. Educational strategies and goals should be re-evaluated. Evidence-based practice faces many barriers.

Knowledge changes after applying evidence-based dentistry educational interventions to dental students: A systematic review.

PURPOSE: To critically evaluate the evidence on knowledge changes observed after the application of evidence-based dentistry (EBD) educational interventions to dental students. METHODS: We included studies that assessed EBD knowledge after applying educational interventions to undergraduates. Studies that evaluated post-graduate students or professionals, that exclusively described educational interventions, programs, or the application of curriculum revisions were excluded. Electronic databases (PubMed, Embase, Scopus, and Web of Science), unpublished gray literature, and manual searches were performed. Data concerning "perceived" and "actual knowledge" was extracted. The quality of the studies was appraised according to the Mixed Methods Appraisal Tool. RESULTS: The 21 selected studies enrolled students at different stages, and the intervention formats were diverse. The educational interventions could be categorized into three modalities, that is, regular, EBD-focused disciplines or courses, and other educational interventions including one or more of the EBD principles, methods, and/or practices. Despite the format, knowledge was generally improved after the implementation of educational interventions. Overall, perceived and actual levels of knowledge increased considering EBD general concepts, principles, and/or practices, and concerning the "acquire" and "appraise" skills. Among the selected studies, two were randomized controlled trials, while most were non-randomized or descriptive studies. CONCLUSIONS: EBD-related educational interventions seem to improve dental students' perceived and actual knowledge, according to literature with a high risk of bias. Therefore, more complete, methodologically rigorous, and longer-term studies are still recommended to confirm and expand the current knowledge.

Evidence-based dentistry: Knowledge, Practice, Confidence and Attitude amongst Malaysian dental undergraduate students: A Multi-institutional study.

INTRODUCTION: Evidence-based dental practice provides patient-centred, compatible and efficient interventions and forms the basis for health profession education. So far, there is a paucity of data about Malaysian undergraduate dental education and the role of evidence-based dentistry in it. The current research aimed to study the level of knowledge, attitude, practice and confidence of dental undergraduate students in Malaysia towards evidence-based dental practice. METHODS: This cross-sectional study included final-year undergraduate dental students (N = 645) who completed a pre-tested self-administered questionnaire that analysed the domains of perceived knowledge, practice, critical appraisal and attitude towards evidence-based dentistry. We further explored the association between these domains with the type of curriculum, sex, prior research experience and EBD training. RESULTS: A total of (n = 526) students participated (response rate of 81.55%). About 92% knew about evidence-based dentistry. Whilst 58% had undergone formal training in evidence-based dentistry, 90% of the respondents showed an overall positive attitude towards evidence-based dentistry. However, only 45% of them practised it most of the time. Schools with an integrated curriculum showed more willingness and practised evidence-based dentistry more frequently (p < 0.001). More than 50% of the participants rated their confidence in appraisal as moderate. CONCLUSION: Our findings revealed that Malaysian dental undergraduate students who are well aware of evidence-based dentistry displayed a positive attitude towards it. The type of dental curriculum had a significant association with practice and attitude towards evidence-based dental knowledge and practice.

Effectiveness of The Wikipedia Collaboration of Dental Schools' Training Programme: a new Paradigm for Teaching and Learning of Evidence-Based Dentistry.

BACKGROUND: The Wikipedia Collaboration of Dental Schools (WCODS) is a student-led initiative that aims to publish high quality scientific, evidence-based dental content on the Wikipedia online encyclopaedia by equipping its members to use research, critical appraisal and writing skills to create accurate content. In 2019, the Collaboration launched a standardised training programme developed by Wikimedia-trained committee members, academic dental school staff and the Cochrane Oral Health global community. OBJECTIVE: To evaluate the effectiveness of this training programme in ensuring WCODS editors follow the processes underpinning Evidence-Based Dentistry (EBD). METHOD: A cohort of dental students and staff (n=136) from six dental schools in the UK and Malaysia took part in a standardised and structured training programme at the annual WCODS training meeting. Participants' abilities and their perceived levels of confidence in carrying out critical analysis of the literature were measured using pre- and post-training surveys, and competency assessments. RESULTS: Participants' skills in conducting literature searches, critical appraisal of the findings and creating and editing a Wikipedia page improved after training. CONCLUSION: The training programme provided participants with the skill set and confidence to apply best practice to create and edit Wikipedia entries. This Collaboration intends to recruit more contributors to improve global oral health literacy using the free online Wikipedia encyclopaedia.

Senior dental students' perceptions of evidence-based dentistry.

INTRODUCTION: This study aimed to assess senior dental students' knowledge and attitudes regarding evidence-based dentistry (EBD), their use of the current literature and considerations for patient preferences. MATERIALS AND METHODS: A modified Knowledge, Attitudes, Access, and Confidence Evaluation (KACE) survey was administered to collect data from senior dental students at the University of Maryland School of Dentistry (UMSOD). The chi-squared test was used to compare the correct response rates of each question in the knowledge of scientific evidence domain. Spearman's rank correlation coefficient was conducted to examine correlations between students' knowledge of scientific evidence and their confidence in appraising the study qualities. RESULTS: 61 seniors (out of 130) answered all survey questions. Participants displayed an intermediate level of knowledge of EBD. Only 15% of participants correctly answered to the most appropriate design; the distribution of responses appeared significantly different amongst the questions in the basic knowledge section (chi-squared test, p < .0001). There was no or very weak correlation between students' knowledge of scientific evidence and their confidence in appraising study qualities (Spearman's ρ = 0-0.18). The participants highly valued the use of the current literature and patient preferences. However, their preferred sources of scientific evidence were the Internet excluding Cochrane reviews (60%) and colleagues (56%). Forty per cent of participants rarely or never used textbooks. CONCLUSION: Whilst seniors felt confident in evaluating study qualities and implementing EBD in routine practice, their understanding of the study design was poor. Seniors' preferred sources of scientific evidence were non-peer-reviewed Internet sources and colleagues.

Dental Students' Knowledge, Attitude, and Confidence toward Evidence-based Dentistry: A 5-year Retrospective Study.

AIM: The purpose was to assess dental students' knowledge, attitude, and confidence toward evidence-based dentistry in five graduating Doctor of Dental Surgery (DDS) classes. MATERIALS AND METHODS: All dental students (class of 2019, 2020, 2021, 2022, and 2023) enrolled in the D3 research design course were required to take a pre-Knowledge, Attitude, and Confidence in Evidence-based Dentistry (KACE) survey. On completion of the 11-week course, a post-KACE survey was distributed to compare the differences in the three domains of evidence-based dentistry (EBD). For the knowledge domain, the responses from the 10 questions were converted to either correct (1) or wrong (0) so that the compiled scores could range from 0 to 10. The attitudes and confidence domains used a five-point Likert scale. The compiled attitude score was a sum of the responses from 10 questions yielding a range from 10 to 50. For confidence, the compiled score ranged from 6 to 30. RESULTS: The mean knowledge scores of all classes together before and after training were 2.7 and 4.4, respectively. Overall, there was a statistically significant difference between pre- and post-knowledge indicating an improvement in knowledge associated with the training (p < 0.001). The mean attitudes of all classes together before and after the training were 35.3 and 37.2, respectively. Overall, there was a statistically significant improvement in attitude (p < 0.001). The values of mean confidence of all classes together before and after the training were 15.3 and 19.5, respectively. Overall, there was a statistically significant improvement in confidence (p < 0.001). CONCLUSIONS: A dental curriculum emphasizing Evidence-based practice (EBD) resulted in increased knowledge acquisition, improved attitude, and confidence toward EBD of dental students. CLINICAL SIGNIFICANCE: Educational initiatives emphasizing evidence-based dentistry increase students' knowledge acquisition, improved attitude, and confidence toward EBD that may also translate to active implementation of EBD in their future practices.

Adaptation and validation of the Berlin questionnaire of competence in evidence-based dentistry for dental students: a pilot study.

BACKGROUND: The purpose of this pilot study was to create a valid and reliable set of assessment questions for examining Evidence-based Dentistry (EbD) knowledge. For this reason, we adapted and validated for dental students the Berlin Questionnaire (BQ), which assesses Evidence-based Medicine (EbM) abilities. METHODS: The Berlin Questionnaire was validated with medical residents. We adapted it for use in a dentistry setting. An expert panel reviewed the adapted BQ for content validity. A cross-sectional cohort representing four training levels (EbD-novice dental students, EbD-trained dental students, dentists, and EbM-/EbD-expert faculty) completed the questionnaire. A total of 140 participants comprised the validation set. Internal reliability, item difficulty and item discrimination were assessed. Construct validity was assessed by comparing the mean total scores of students to faculty and comparing proportions of students and faculty who passed each item. RESULTS: Among the 133 participants (52 EbD-novice dental students, 53 EbD-trained dental students, 12 dentists, and 16 EbM-/ EbD-expert faculty), a statistically significant (p < 0.001) difference was evident in the total score corresponding to the training level. The total score reliability and psychometric properties of items modified for discipline-specific content were acceptable. Cronbach's alpha was 0.648. CONCLUSION: The adapted Berlin Questionnaire is a reliable and valid instrument to assess competence in Evidence-based Dentistry in dental students. Future research will focus on refining the instrument further.

Effect of training on evidence-based practice to undergraduate dental students: pre and postexperimental study.

BACKGROUND: Evidence-based practice (EBP) training is essential for undergraduate students in making sound clinical decisions during patient care. However, EBP training is not included in the curriculum of undergraduate dental students in India and there is a dearth of research that assessed the effectiveness of EBP training in India. Hence, this study aimed to assess the effectiveness of EBP training to dental undergraduate students. METHODS: Final year undergraduate students and interns of a dental institution participated in this pre and postexperimental study. All the participants received a 2-day workshop (didactic lectures, hands-on and group activities) in a classroom setting. A validated 35 item instrument titled EBP Knowledge, Attitudes, Access and Confidence questionnaire was used for the outcome assessment of EBP training. RESULTS: Fifty undergraduate students (33 interns and 17 final year) participated in the study. Statistically significant improvement was observed in six out of 10 items related to EBP knowledge. All the items related to attitude showed a significant positive change in scores. Only four out of nine items related to accessing evidence showed a statistically significant change. Participants reported moderate confidence gain in critical appraisal skills. CONCLUSION: The current study demonstrated moderate improvement in the effectiveness of EBP training in improving EBP knowledge, accessing evidence and critical appraisal skills.

Evaluating outcomes of computer-based classroom testing: Student acceptance and impact on learning and exam performance.

Computer-based testing (CBT) has made progress in health sciences education. In 2015, the authors led implementation of a CBT system (ExamSoft) at a dental school in the U.S. Guided by the Technology Acceptance Model (TAM), the purposes of this study were to (a) examine dental students' acceptance of ExamSoft; (b) understand factors impacting acceptance; and (c) evaluate the impact of ExamSoft on students' learning and exam performance. Survey and focus group data revealed that ExamSoft was well accepted by students as a testing tool and acknowledged by most for its potential to support learning. Regression analyses showed that perceived ease of use and perceived usefulness of ExamSoft significantly predicted student acceptance. Prior CBT experience and computer skills did not significantly predict acceptance of ExamSoft. Students reported that ExamSoft promoted learning in the first program year, primarily through timely and rich feedback on examination performance. t-Tests yielded mixed results on whether students performed better on computerized or paper examinations. The study contributes to the literature on CBT and the application of the TAM model in health sciences education. Findings also suggest ways in which health sciences institutions can implement CBT to maximize its potential as an assessment and learning tool.

Teaching Evidence-Based Practice: Considerations for Dental Education.

The motivation for teaching evidence-based practice is that, through the use of high-quality clinically relevant evidence, clinicians will make rationale decision that optimally improve patient health outcomes. Achieving that goal requires clinicians who are able to answer patient care-relevant clinical questions efficiently, which means that they must be able rapidly to retrieve, assess, and apply evidence of direct relevance to their patients. Educational programs designed to accomplish this vary in their effectiveness. This article reviews the evidence on educational approaches that may be beneficial when developing educational programs for both dental students and practicing dentists.

The Keeper of the Meaning and the Era of Evidence Based Dentistry.

The AAPD has stated that the clinical practice of pediatric dentistry has to be driven by science and evidence-based dentistry (EBD). However, our specialty must recognize the need for both EBD and age proven clinical experience. An amalgam of art and science is required, each respecting the other's important contribution and recognizing that neither alone is as good as the whole. Being a Keeper of the Meaning means handing on the values of the past to the future. The foundations of patient care are composed of both EBD and past clinical experience. Over time the clinician develops clinical intuition based on these foundations which results in optimum patient care. Pediatric dentistry will remain as much an art form as a science for the foreseeable future. There are clinical techniques and approaches successfully used for scores of years that the scientific method might never be able to validate but that doesn't necessarily mean that they don't have great value. The greatest weakness of the EBD movement is that there is no measure for clinical skill and experience. And yet, clinical success equals clinical skill and experience.

Knowledge, Attitude, and Behavior toward Evidence-based Dentistry among Dental Professionals in Jodhpur Rajasthan, India.

INTRODUCTION: Rendering quality care to the patient, dentists needs to update their skills and knowledge with latest diagnostics and treatment modalities. Evidence-based dentistry can provide best-known treatments. AIM: To assess knowledge, attitude, and practice of oral healthcare professionals toward evidence-based dentistry among dental professionals. MATERIALS AND METHODS: A cross-sectional study was conducted for a period of 3 months from April 2017 to June 2017 in Jodhpur city, Rajasthan, India. The data were collected by using closed-ended questionnaires. A total of 240 study subjects participated in the survey, which include dental practitioners and dentists attached to the two private dental colleges in the Jodhpur. Chi-square test was used to determine significant difference among the three groups. RESULTS: Statistically significant difference among the three groups (academicians, practitioners, and academicians into dental practice) was found with regard to awareness of dentists about extracting journals, review publications, and databases relevant in carrying out evidence-based practice (EBP); 72.4% of academician felt lack of personal time was one of the major perceived barriers and about 50.7% of academician believe that learning skills of evidence-based dentistry helps them to utilize evidence-based dentistry in daily practice. CONCLUSION: Majority of the oral health practitioners were not aware about the concept of evidence-based dentistry. The regulatory body of dental sciences in India should make some necessary changes in the dental curriculum to include the concept of evidence-based dentistry in detail. CLINICAL SIGNIFICANCE: To improve the clinical expertise of the dental professional, to aid dental professional to reach best decision regarding dental treatment of the patient, to improve patient safety, and to improve the success rate of dental treatments, evidence-based dentistry should be the integral part of everyday dental practice.

Use of scientific evidence by dentists in Brazil: Room for improving the evidence-based practice.

This study investigated the use of scientific evidence and the practice of evidence-based dentistry (EBD) among dentists working in Brazil. An online questionnaire was emailed to dentists registered with Brazilian state dental councils. The questionnaire assessed the demographic, educational, and work characteristics of the sample, along with habits in reading scientific articles and other updating resources. Data were analyzed descriptively and by using Bonferroni, Kruskal-Wallis, ANOVA, and T-test statistical methods (α = 0.05). A total of 795 responses were received between June, 2015 and January, 2016. The response rate was not calculated because it was not possible to determine precisely how many dentists received these e-mails. Over 77% of the responding dentists completed postgraduate training. They referred mainly to books, scientific or clinical journals, conferences, and short-term courses for updating their knowledge. Dentists who reported having a habit of reading scientific journals (60.9%) showed a preference for reading case reports, clinical research articles, and literature reviews. Most dentists (77.5%) reported changing their clinical behaviors or procedures based on information gleaned from journal articles. The types of articles that led them to change their clinical practices were primarily clinical research articles and case reports. Working in the public sector was also associated with a lower prevalence of a habit of reading scientific journals and practicing EBD (i.e., self-reported practice). The results suggest that dentists are interested in reading journal articles, especially those addressing clinical outcomes, and that there is room for improving the practice of EBD, particularly in the public sector.

Evidence-based dentistry skill acquisition by second-year dental students.

INTRODUCTION: Identification and assessment of Evidence-based dentistry (EBD) outcomes have been elusive. Our objective was to describe EBD skill acquisition during the second (D2) year of pre-doctoral dental education and student competency at the end of the year. METHODS: The first and fourth (final) curricular-required EBD Exercises (ie, application of the first 4 steps of the 5-Step evidence-based practice process applied to a real or hypothetical situation) completed by D2 students (n = 151) during 2014-2015 and 2015-2016 were evaluated to measure skill acquisition through use of a novel rubric with measures of performance from novice to expert. Exercises were evaluated on the performance for each step, identification of manuscript details and reflective commentary on manuscript components. Changes in performance were evaluated using the chi-square test for trend and the Wilcoxon signed-rank test. RESULTS: Seventy-eight per cent of students scored competent or higher on the Ask step at the beginning of the D2 year; scores improved with 58% scoring proficient or expert on the fourth Exercise (P < .001). Most students were advanced beginners or higher in the Acquire, Appraise and Apply steps at the beginning of the D2 year, with minimal growth observed during the year. Identification of manuscript details improved between the first and fourth Exercises (P = .015); however, depth of commentary skills did not change. DISCUSSION: Unlike previous investigations evaluating EBD knowledge or behaviour in a testing situation, we evaluated skill acquisition using applied Exercises. CONCLUSION: Consistent with their clinical and scientific maturity, D2 students minimally performed as advanced beginners at the end of their D2 year.

Evidence-based dentistry can effectively be taught to dental care professional students - A mixed methods study.

BACKGROUND: Little research exists in the teaching of evidence-based dentistry (EBD) to students in the fields of dental hygiene, dental nursing and orthodontic therapy. This study aims to analyse the effect of a 1-day EBD programme on knowledge and confidence whilst also gaining insight into students' experience of the intervention. METHOD: A mixed methods study was utilised with explanatory sequential design. The population consisted of dental hygiene (DH), dental nursing (DN) and orthodontic therapy (OT) students (N = 44). The intervention consisted of a 1-day active learning EBD programme, delivered via group projects and lectures. In the initial quantitative phase, a standardised questionnaire pre- and post -intervention measured changes in confidence for all participants, whilst change in knowledge was measured for DH and OT students only. Following this, focus groups were scheduled for all members of each discipline 3 months post-intervention for DN and 2 months post-intervention for DH and OT students. Semi-structured focus group schedules were drawn up, and groups organised according to the outcomes of quantitative data analysis. Qualitative results were analysed using a deductive adaptation of Burnard's thematic content analysis. RESULTS: Forty-two students took part (94.45%) in this study. Median knowledge scores increased from zero to two of five (P < .001), whilst median confidence score doubled from four to eight of eight (P < .001). Results of thematic content analysis were coincident with quantitative results; however, it also provided constructive feedback regarding design and content of the course. CONCLUSIONS: A 1-day bespoke programme in EBD increased students' confidence and knowledge in EBD skills. However, the findings further suggest that two successive half-day training sessions instead of one full-day training, tied in with coursework that requires the application of the acquired skills, may increase the learning experience further.

Self-Perceived Knowledge, Skills, Attitudes, and Use of Evidence-Based Dentistry Among Practitioners Transitioning to Dental Educators.

Dental practitioners transitioning to dental educators (PTEs) have an integral role in dental education. While PTEs intrinsically apply some form of evidence-based dentistry (EBD) in patient care, it may not be a standardized, systematic approach. The aims of this study were to determine the self-perceived knowledge, skills, attitudes, and behaviors of PTEs regarding EBD at one U.S. dental school and to identify areas where formal calibration may be warranted to facilitate their competence and confidence as dental educators. Participants voluntarily completed a 32-question survey regarding their EBD training and self-perceived EBD skills in several areas: use of the clinical evidence pyramid; systematic, objective, and critical appraisal of the evidence; application of the evidence to patient care; and integrating clinical expertise, scientific evidence, and patient's preferences to formulate a treatment plan. The PTEs were invited to participate in the anonymous survey during regularly scheduled calibration sessions held between May and July 2014. After study information was distributed, 100% of the attendees (n=43) completed the survey. The percentage of total PTEs at the school could not be calculated. Of the responding PTEs, 69% rated themselves better than satisfactory (70% proficiency) in their knowledge, skills, and attitudes regarding EBD skills application. However, only 33-42% of the respondents indicated that they frequently used the evidence pyramid and systematically, objectively, and critically appraised the evidence, even though 65% indicated they applied the evidence to improve patient care over 70% of the time. In addition, the participating PTEs identified a need for more frequent use of formal EBD skills. Providing case-based EBD projects involving PTEs as mentors may provide more opportunities for the judicious and effective use of these important skills and may improve PTEs' self-perceived confidence.

New curricular design in biostatistics to prepare residents for an evidence-based practice and lifelong learning education: a pilot approach.

AIM: To develop, implement and evaluate an innovative curriculum in biostatistics in response to the need to foster critical thinking in graduate healthcare education for evidence-based practice and lifelong learning education. METHODOLOGY: The curriculum was designed for first-year residents in a postgraduate endodontic programme using a six-step approach to curriculum development to provide sufficient understanding to critically evaluate biomedical publications, to design the best research strategy to address a specific problem and to analyse data by appropriate statistical test selection. Multiple learner-centred instructional methods and formative and summative assessments (written tasks, simulation exercises, portfolios and pre-post knowledge tests) were used to accomplish the learning outcomes. The analysis of the achievement of the group of students and a satisfaction survey for further feedback provided to the residents at the end of the curriculum were used for curriculum evaluation. RESULTS: All residents demonstrated competency at the end of the curriculum. The correct answer rate changed from 36.9% in the pre-test to 79.8% in the post-test. No common errors were detected in the rest of the assessment activities. All participants completed the questionnaire demonstrating high satisfaction for each independent category and with the overall educational programme, instruction and course in general. CONCLUSIONS: The curriculum was validated by the assessment of students' performance and a satisfaction survey, offering an example of a practical approach to the teaching of statistics to prepare students for a successful evidence-based endodontic practice and lifelong learning education as practicing clinicians.

Evidence-Based Practice Knowledge, Perceptions, and Behavior: A Multi-Institutional, Cross-Sectional Study of a Population of U.S. Dental Students.

The aim of this study was to help inform faculty and curriculum leaders in academic dental institutions about the knowledge, skills, perceptions, and behavior of an institutionally diverse population of dental students with respect to evidence-based practice (EBP). A survey utilizing the validated Knowledge, Attitudes, Access, and Confidence Evaluation instrument developed by Hendricson et al. was conducted in 2012 with fourth-year dental students at seven geographically dispersed U.S. dental schools. The survey addressed elements of EBP knowledge, attitudes toward EBP, behavior in accessing evidence, and perceptions of competence in statistical analysis. A total of 138 students from the seven schools participated. A slight majority of these students correctly responded to the knowledge of critical appraisal questions. While the students demonstrated positive attitudes about EBP, they did not report high levels of confidence in their critical appraisal skills. The findings also showed that the students accessed various sources of evidence with differing frequencies. The most frequently accessed resources were colleagues, the Internet (excluding Cochrane Database of Systematic Reviews), and textbooks. The results of this study help to identify areas for improvement in EBP education in order to advance dental students' preparation to become evidence-based practitioners.