Evidence-based dentistry involves making treatment decisions based on the best available evidence, patient wishes, and the dentist’s experience. It follows a five-step process and uses a hierarchy of evidence types, with meta-analysis being the most reliable. Lower levels include case-control studies and animal research.
Evidence-based dentistry is the practice of making treatment decisions based on the best available evidence about a particular problem, the dentist’s experience, and the patient’s wishes. The practice outlines five basic steps when assessing a patient’s condition: question, find, evaluate, evaluate, and act. There is also a hierarchy of evidence types that a dentist can use to delineate more desirable from less desirable information when researching a problem. It is a methodical way to consider and choose the best treatments when practicing dentistry.
The hierarchy used in evidence-based dentistry has seven levels of information and research. The highest tiers are: meta-analysis, systematic review, randomized controlled trial, and cohort study. Lower levels include case-control study, case series or case report, and animal research or laboratory study. High-level evidence is believed to provide the best solution to a patient care question. The lower the level of the hierarchy, the less reliable the information collected.
Meta-analysis is the top level of the hierarchy of evidence-based dentistry. It consists of a pool of data collected from multiple small-scale studies. When this information is not available, the next level in the hierarchy is systematic review. This method covers a wider and more international range of search results found through a strictly systematic search.
When the higher levels of the hierarchy are not available to the doctor, the next step is to look for randomized controlled trials, which contain evidence from a range of clinical trials. The next step is to refer to a cohort study, which considers a group of people who have a similar condition to the patient. A case-control study can then be consulted. This involves comparing a control group without the condition in question with previously gathered information about a group that had the problem.
The next level, case series or case reports, involves examining the files of patients who have previously received the treatment in question in order to learn common reactions and determine if it is the appropriate method for the current patient. When research is unavailable at any of these levels, the medical professional will typically resort to animal research or laboratory study. While findings at this level do not necessarily apply directly to human subjects, they reflect a level of research that may be sufficient to determine the appropriate course of treatment.
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