Use of evidence-based decision-making in private practice for emergency treatment of dental trauma: EB case report.

OBJECTIVE: This article illustrates the use of the evidence-based process in clinical practice to answer questions that arose when a patient presented with dental trauma. BACKGROUND: The patient had avulsion of the maxillary right central incisor and lateral luxation and alveolar bone fracture partially encasing the roots of the maxillary left central and lateral incisors. At the emergency treatment the dentist replanted the teeth but had 2 questions regarding the impending treatment for the patient regarding the optimal timing of root canal therapy and splint duration that would result in the best outcome and prognosis for healing. METHOD: The evidence-based process was used to help answer the clinical queries. Two focused clinical (PICO) questions were written, and 2 separate searches were conducted for each PICO question. Four databases were searched for systematic reviews, meta-analyses, critical summaries and practice guidelines. RESULTS: A total of 3 systematic reviews, 8 practice guidelines, 1 critical summary, and 1 Cochrane protocol were found. CONCLUSION: For replanted avulsed teeth, with closed apices, successful periodontal healing is improved when elective extirpation of the pulps occurs within 14 days. Second, guidelines recommend a flexible splint for up to 2 weeks for avulsed teeth with an extension of 2 to 4 weeks possibly needed for lateral luxation and with breakdown of marginal bone. However, evidence shows that an association between short-term splinting and an increased likelihood of functional periodontal healing, acceptable healing, or decreased development of replacement resorption, appears inconclusive and that the types of splint and the fixation period are not significant variables when related to healing outcomes. The evidence-based method was efficient, and very helpful in optimizing the management of the emergency dental treatment.

Efficiently accessing the evidence for dental practitioners.

This preconference workshop was designed to introduce the evidence-based dentistry (EBD) Champions to resources available for accessing dental evidence and to provide hands-on searching to begin to develop the necessary skills to efficiently access the best, most current research for clinical decision making. This presentation focused on 2 different approaches for accessing evidence for practice. Strategy 1 focused on using synthesized research, including systematic reviews, EBD article reviews, and critical summaries. Strategy 2 focused on using the PubMed Clinical Queries feature, "Find Systematic Reviews" to search for synthesized research, ie, systematic reviews, EBD articles, and meta-analyses. Although not discussed in the preconference session, PubMed also provides access to individual research studies, such as individual randomized controlled trials.

Translating evidence-based decision making into practice: appraising and applying the evidence.

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next steps are to determine the credibility and usefulness of the evidence and to apply the evidence to patient care. The purpose of this article is to discuss those steps by reviewing the critical appraisal criteria used to assess the methodological quality of a study. A case scenario will be used to demonstrate how appraising the evidence helps to answer questions and how to translate the evidence into everyday practice. Characteristics of an evidence-based practice and educational tips are provided along with a glossary of terms related to appraising the literature. Together, the two articles can serve as a primer for integrating EDBM into your practice. Generally, the most frequently asked clinical questions are related to the effectiveness of a certain technique, medication, diagnostic test, treatment, material, or product. The type of scientific evidence may include systematic reviews and critically appraised topics; clinical practice guidelines and protocols; article reviews; pharmaceutical and drug interaction information; and individual studies addressing questions about therapy, prevention, diagnosis, prognosis, and harm/etiology. Once the most current evidence has been found, the next step in the EBDM process is to understand what you have and its relevance to your patient.

Translating evidence-based decision making into practice: EBDM concepts and finding the evidence.

This is the first of 2 articles that focuses on strategies that can be used to integrate an evidence-based decision making [EBDM] approach into practice. The articles will focus on EBDM methodology and enhancing skills, including how to find valid evidence to answer clinical questions, critically appraise the evidence found and determine if it applies. In addition, online resources will be identified to supplement information presented in each article. The purpose of this article is to define evidence-based decision making and discuss skills necessary for practitioners to efficiently adopt EBDM. It will provide a guide for finding evidence to answer a clinical question using PubMed's specialized searching tools under Clinical Queries.

Dental practice websites: creating a Web presence.

Web technology provides an opportunity for dentists to showcase their practice philosophy, quality of care, office setting, and staff in a creative manner. Having a Website provides a practice with innovative and cost-effective communications and marketing tools for current and potential patients who use the Internet. The main benefits of using a Website to promote one's practice are: Making office time more productive, tasks more timely, follow-up less necessary Engaging patients in an interactive and visual learning process Providing online forms and procedure examples for patients Projecting a competent and current image Tracking the usage of Web pages. Several options are available when considering the development of a Website. These options range in cost based on customization of the site and ongoing support services, such as site updates, technical assistance, and Web usage statistics. In most cases, Websites are less expensive than advertising in the phone book. Options in creating a Website include building one's own, employing a company that offers Website templates, and employing a company that offers customized sites. These development options and benefits will continue to grow as individuals access the Web and more information and sites become available.

Evidence-based decision making in action: Part 2--evaluating and applying the clinical evidence.

This is the second of a two-part series addressing the use of evidence-based decision making (EBDM) in the use of home bleaching. In Part 1, a case scenario demonstrated the skills involved in (1) structuring a clinical question and (2) conducting an online search using PubMed.1 Part 2 demonstrates the third and fourth steps in the EBDM process, i.e., (3) critical appraisal to assess the validity of a study and (4) applying that information to clinical decision making. This 4-step approach to EBDM recognizes that clinicians can never be completely current with all conditions, medications, materials, and products. Thus, EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible.

Evidence-based decision making in action: Part 1--Finding the best clinical evidence.

The purpose of this article is to introduce evidence-based concepts and demonstrate how to find valid evidence to answer clinical questions. Evidence-based decision making (EBDM) requires understanding new concepts and developing new skills including how to: ask good clinical questions, conduct a computerized search, critically appraise the evidence, apply the results in clinical practice, and evaluate the process. This approach recognizes that clinicians can never be completely current with all conditions, medications, materials, or available products. Thus EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. In Part 1, a case scenario demonstrates the application of the skills involved in structuring a clinical question and conducting an online search using PubMed. Practice tips are provided along with online resources related to the evidence-based process.

The anatomy of evidence-based publications: article summaries and systematic reviews. Part I.

The term evidence-based has become a popular phrase in the title of many articles. Some articles discuss the process, whereas others lead readers to believe that evidence-based methodology was used in conducting the research or in presenting a synthesis of the findings, which may not be the case. The purpose of Part I of this two-part report is to define evidence-based decision-making (EBDM), discuss the evolution of the evidence based movement, and to describe the distinguishing characteristics of evidence-based publications. In doing so, articles using an evidence-based format, article summaries found in evidence-based journals and systematic reviews, such as those published by the Cochrane Collaboration, will be presented. Part II reviews the findings from the Cochrane Review on manual versus powered toothbrushing for oral health and discusses the strengths and weaknesses of systematic reviews.

Manual versus powered toothbrushes: a summary of the Cochrane Oral Health Group's Systematic Review. Part II.

PURPOSE: A systematic review examining the clinical effectiveness of power versus manual toothbrushes was conducted by the Cochrane Collaborations Oral Health Group. Their review examined clinical trials conducted through 2001 and used international standards to identify, access, evaluate, analyze, and report the data. Part I of this series discussed distinguishing characteristics of evidence-based publications, such as systematic reviews, whereas this report provides a summary of the Cochrane Review, its importance to the profession, and discusses the strengths and limitations of systematic reviews. METHODS: Search strategies to identify published clinical trials on power toothbrushes were developed, and manufacturers were contacted for additional published and unpublished information. Trials were selected based on pre-established criteria; including whether they compared power versus manual toothbrushes used a randomized research design tested products in the general population without disabilities, provided data on plaque and gingivitis, and were at least 28 days in length. Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis levels were expressed as standardized mean differences for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between power and manual toothbrushes as the measure of effectiveness. RESULTS: Searches identified 354 trials, of which 29 met inclusion criteria. These trials involved 2.547 participants who provided data for meta-analysis. Results indicated that for both plaque and gingivitis, all types of power toothbrushes worked as well as manual toothbrushes, however only the rotating oscillating toothbrush consistently provided a statistically significant though modest benefit over manual toothbrushes in reducing plaque (7%) and gingivitis (17%). None of the battery powered toothbrush studies met the inclusion criteria. CONCLUSION: The Cochrane systematic review used international standards to examine more than 30 years of published studies. A concern is that only one type of electric toothbrush, the rotating oscillating toothbrush consistently demonstrated a statistically significant benefit over manual toothbrushes, and the majority of studies did not meet the standards for inclusion in moving forward it will be important to conduct methodologically sound studies demonstrating the ability of power toothbrushes to reduce the incidence and prevalence of caries and periodontal disease.