Introduction to EBD & Research for Dental Specialists

Seminar 1: Introduction to Evidence-Based Practice & Research in Dental Specialties

1. Introduction to clinical problems in dental specialties

2. Overview of Evidence-Based Practice (EBP)

3. Understanding the importance of EBP in diagnosing and treating patients

4. Steps in the EBP process

5. Formulating answerable clinical questions (PICO)

6. Overview of Research Study Designs

7. Practical Activity: Create a PICO question based on a clinical case from your specialty

Readings: 

• FDI Evidence-based Dentistry (EBD) https://www.fdiworlddental.org/evidence-based-dentistry-ebd

• Brignardello-Petersen R, Carrasco-Labra A, Glick M, et al. (2014) A practical approach to evidence-based dentistry: I. The Journal of the American Dental Association 145(11): 1105–1107. Link

• Richards, D., 2000. Asking the right question right. Evid. Based. Dent. 2, 20.

• Isaacs, D., Fitzgerald, D., 1999. Seven alternatives to evidence based medicine. BMJ 319, 1618.

• Dos Santos, A.P.P., Raggio, D.P., Nadanovsky, P., 2020. Reference is not evidence. Int. J. Paediatr. Dent. 30, 661–663.

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Seminar 2: Searching for the Best Evidence

1. Importance of literature search in EBP

2. Strategies to search medical literature effectively

3. Databases and resources for finding evidence (PubMed, Cochrane, TRIP, OpenEvidence etc.)

4. Reading and understanding research articles

5. Practical Activity: Conduct a literature search based on the PICO question created in the previous class

Readings: 

• Levin KA (2005) Study design I. Evidence-based dentistry 6(3): 78–79. Link

• Grimes, D.A., Schulz, K.F., 2002. 01 An overview of clinical research: the lay of the land. Lancet 359, 57–61.

• Brignardello-Petersen R, Carrasco-Labra A, Booth HA, et al. (2014) A practical approach to evidence-based dentistry: II: How to search for evidence to inform clinical decisions. Journal of the American Dental Association 145(12): 1262–1267. Link

• Crislip, M., 2010. Causation and Hill’s Criteria. Science-Based Medicine.

Complementary readings: 

• Hill AB (1965) THE ENVIRONMENT AND DISEASE: ASSOCIATION OR CAUSATION? Proceedings of the Royal Society of Medicine 58(5): 295–300. Link

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Seminar 3: Critical Appraisal and Application of Evidence in Dental Practice

1. Introduction to critical appraisal: What it is and why it's important

2. Assessing the validity, importance, and applicability of the evidence

3. Statistical significance vs clinical significance

4. Tools for critical appraisal (e.g., EQUATOR Network, CASP, PRISMA, STARD, STROBE, CONSORT, GRADE)

5. Translating Evidence into Practice: individual clinical expertise vs. patient values and expectations

6. Practical Activity: Critically appraise a research paper on TMD; discuss how the findings could be implemented into practice

7. Follow-up and evaluation of the evidence-based approach in practice

Readings: 

• Brignardello-Petersen, R., Carrasco-Labra, A., Shah, P., Azarpazhooh, A., 2013. A practitioner’s guide to developing critical appraisal skills: what is the difference between clinical and statistical significance? J. Am. Dent. Assoc. 144, 780–786. Link

• Brignardello-Petersen R, Carrasco-Labra A, Glick M, et al. (2015) A practical approach to evidence-based dentistry: III: how to appraise and use an article about therapy. The Journal of the American Dental Association 146(1): 42–49.e1. Link

• Carrasco-Labra A, Brignardello-Petersen R, Glick M, et al. (2015) A practical approach to evidence-based dentistry: VI: How to use a systematic review. The Journal of the American Dental Association 146(4): 255–265.e1. Link

• Carrasco-Labra A, Brignardello-Petersen R, Glick M, et al. (2015) A practical approach to evidence-based dentistry: VII: How to use patient management recommendations from clinical practice guidelines. The Journal of the American Dental Association 146(5): 327–336.e1. Link

Website to locate reporting guidelines: https://www.equator-network.org/

Complementary readings: 

• Brignardello-Petersen R, Carrasco-Labra A, Glick M, et al. (2015a) A practical approach to evidence-based dentistry: IV: how to use an article about harm. The Journal of the American Dental Association 146(2): 94–101.e1.

• Brignardello-Petersen R, Carrasco-Labra A, Glick M, et al. (2015b) A practical approach to evidence-based dentistry: V: how to appraise and use an article about diagnosis. The Journal of the American Dental Association 146(3): 184–191.e1.

• Carrasco-Labra A, Brignardello-Petersen R, Azarpazhooh A, et al. (2015) A practical approach to evidence-based dentistry: X: How to avoid being misled by clinical studies’ results in dentistry. The Journal of the American Dental Association 146(12): 919–924.

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Final Seminar: Critical Appraisal Presentations

Each resident present a complete evidence-based practice exercise in 15 minutes. This seminar ties together all prior learning: question formulation, study design selection, literature search, evidence selection, critical appraisal, and clinical decision-making.

Presentation Structure (15 minutes)

1. Define the Question 

   1. State your clinical problem from your specialty

   2. Present your PICO question

   3. Explain why this matters for patient care

   4. Example: "In adult patients with dental implants, does chlorhexidine rinse reduce peri-implantitis compared to saline?"

2. Identify Best Study Design

   1. Name the design you will search for (RCT, cohort, case-control, cross-sectional, case report)

   2. Explain why this design answers your question best

   3. Example: "I will search for randomized controlled trials because they provide the strongest evidence to compare treatment effects."

3. Search for Evidence 

   1. Name the databases you used (PubMed, Cochrane, TRIP)

   2. Share your search terms

   3. State how many papers you found

   4. Explain your selection criteria

   5. Example: "I searched PubMed with [keywords]. I found 47 papers. I selected papers published in the last 10 years, written in English, involving adult patients."

4. Select the Evidence

   1. Present 1-2 papers you selected

   2. Give the citation and key details (authors, year, number of patients)

   3. Briefly state the main findings

5. Critically Appraise the Evidence 

You can use CASP or any other tool

5. 1. Using simple questions, assess the paper:

      1. Validity (Was the study done well?)

         1. Was assignment to treatment groups random?

         2. Were groups similar at the start?

         3. Were patients followed up?

         4. Were results measured the same way in all groups?

   2. Importance (Was the effect large?)

      1. Did the main finding matter clinically?

      2. How certain are we of the results?

   3. Applicability (Can I use this for my patient?)

      1. Are the study patients similar to my patient?

      2. Can I deliver this treatment in my setting?

6. Apply to Your Patient and Clinical Judgment 

   1. Describe a specific patient from your practice

   2. State the patient's values and preferences

   3. Integrate: the evidence + patient values + your clinical experience

   4. Answer your original question

   5. Explain what you will do and why

The systems is broken

F. Schwendicke, S.E. Uribe, N.S. Jakubovics, The Science System at the Limit: A Call to Action for Considerate Publishing, J. Dent. Res. https://doi.org/10.1177/00220345251349804.

Chalmers, I., Bracken, M.B., Djulbegovic, B., Garattini, S., Grant, J., Gülmezoglu, A.M., Howells, D.W., Ioannidis, J.P.A., Oliver, S., 2014. How to increase value and reduce waste Research: increasing value, reducing waste 1: when research priorities are set. Lancet 383, 156–165.

Recommended books

Richards D (2008) Evidence-Based Dentistry : Managing Information for Better Practice. London; Chicago: Quintessence Pub.

Schulz K and Grimes DA (2018) Essential Concepts in Clinical Research: Randomised Controlled Trials and Observational Epidemiology. 2nd ed. London, England: Elsevier Health Sciences.

Moher D, Altman D, Schulz K, et al. (2014) Guidelines for Reporting Health Research: A User’s Manual. John Wiley and Sons Ltd.

Dental Clinics Special issue LINK

Position papers

FDI Evidence-based Dentistry (EBD) https://www.fdiworlddental.org/evidence-based-dentistry-ebd

TMJ Readings

General reviews

Brignardello-Petersen R (2017) No evidence of association between articular status and clinical symptoms in patients with temporomandibular joint disorders. Journal of the American Dental Association .

Delcanho R, Val M, Guarda Nardini L, et al. (2022) Botulinum Toxin for Treating Temporomandibular Disorders: What is the Evidence? Journal of oral & facial pain and headache 36(1): 6–20.

Greene CS and Manfredini D (2020) Treating Temporomandibular Disorders in the 21st Century: Can We Finally Eliminate the “Third Pathway”? Journal of oral & facial pain and headache 34(3): 206–216.

González-González, A.M., Herrero, A.J., 2021. A systematic review of temporomandibular disorder diagnostic methods. Cranio 1–13.

Kandasamy S and Greene CS (2020) The evolution of temporomandibular disorders: A shift from experience to evidence. Journal of oral pathology & medicine: official publication of the International Association of Oral Pathologists and the American Academy of Oral Pathology 49(6): 461–469.

Manfredini D, Saracutu OI, Ferrari Cagidiaco E, et al. (2023) EPA Consensus Project Paper: The Relationship Between Prosthodontic Rehabilitations and Temporomandibular Disorders. The European journal of prosthodontics and restorative dentistry. DOI: 10.1922/EJPRD_2484Manfredini05.

Neff A, McLeod N, Spijkervet F, et al. (2021) The ESTMJS (European Society of Temporomandibular Joint Surgeons) Consensus and Evidence-Based Recommendations on Management of Condylar Dislocation. Journal of clinical medicine research 10(21). DOI: 10.3390/jcm10215068.

Patel K, Eley KA, Cascarini L, et al. (2023) Temporomandibular disorders-review of evidence-based management and a proposed multidisciplinary care pathway. Oral surgery, oral medicine, oral pathology and oral radiology 136(1): 54–69.

Ohrbach, R., Greene, C., 2022. Temporomandibular Disorders: Priorities for Research and Care. J. Dent. Res. 220345211062047.

Racich MJ (2018) Occlusion, temporomandibular disorders, and orofacial pain: An evidence-based overview and update with recommendations. The Journal of prosthetic dentistry 120(5): 678–685.

Uribe S (2011) The impact of imaging technologies on temporomandibular joint disorder diagnosis. Evidence-based dentistry 12(4): 113–114.

Zagury JG, Ananthan S, Quek SYP, et al. (2023) Myofascial Temporomandibular Disorders at a Turning Point: Pragmatic or Evidence-Based Management? Dental clinics of North America 67(2): 335–348.

Temporomandibular Disorders (TMD): From Research Discoveries to Clinical Treatment [WWW Document], n.d. URL https://www.nationalacademies.org/our-work/temporomandibular-disorders-tmd-from-research-discoveries-to-clinical-treatment?trk=feed_main-feed-card_feed-article-content (accessed 3.17.23).