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Evidence-Based Dentistry. “A Timeline of Change”. Gail Redman, D.D.S. Past: 1875. 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.
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Evidence-Based Dentistry • “A Timeline of Change” Gail Redman, D.D.S.
Past: 1875 • 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: 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 Preparation treats only carious fissures and preserves maximum amount of tooth structure. 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. 3. Almquist TC, Cowan RD & Lambert RL. Conservative amalgam restorations. J Prosthet Dent. 1973; 29:524-528. 4. Walker JD, Jensen ME, Pinkham JR. A clinical review of preventive resin restorations. ASDC J Dent Child 1990;57:257-9.
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.