eb lecture_ 5th grade
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Dr. Hicham Nuaimi
BDS, Specialist Diploma in Operative and Esthetic DentistrySpecialist Diploma in Implantology Science
Master in Operative and Esthetic Dentistry (Holding )
EVIDENCE B SED
DENTISTRY
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Every day, consciouslyand unconsciouslywe
make the decisions of treatment plan regarding
our patients' care.
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How can I make a decision:
Clinical experiences
Discussion with colleagues, Supervisor, etc
Text books
Journal articles( literatures)
previous educational experiences.
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HISTORY
The evidence-based took hold in the medical field.
Formally introduced in the 1990s by DavidSackett and Gordon Guyatt of McMaster
University.
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SO THAT
Dentists are challenging to manage patient needs and
demands.
In addition keeping the advances in dentistry and
medical dental Science up to date, and relevant
literature that apply daily practice knowledge.
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DEFINITIONS
Evidence-based Dentistry requires the
integration of the best research evidence with
our clinical expertise and our patients unique
values and circumstances.PatientValues
ClinicalExpertise
Bestresearchevidence
EBD
SutherlandS.,JCanDentAssoc2001;67:204-6
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DEFINITION
EBD is an approach to oral health care that requires the
judicious integration of systematic assessments of
clinically relevant scientific evidence, relating to the
patient's oral and medical condition and history, with the
dentist's clinical expertise and patient's treatment needsand preferences
The American Dental Association (ADA)
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ADVANTAGES OF EBD?
Filters the information that emerges in the
literature
keeps up with the most updated research
Provides information on how similar cases
treated
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OUTLINE
Definition of EBD.
What is Evidence Based Practice.
Steps of Evidence Based Dentistry.
Levels of Evidence in EBD.
The Stages in Evidence Based Practice.
References.
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WHAT IS EVIDENCE BASED
PRACTICE?
is integrating the scientific basis for clinical care with
unbiased reviews and the best available scientific
evidence with clinical experience to allow thepractitioner critically assess research data, clinical
guidelines >>> to correctly identify the clinical
problem with high-quality intervention to outcome for
future improvement.
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EBD reducingprofessional autonomy.
SO THAT
Prof practitioners can positively use EBD tosupport their decision-making process and
encourage the publics trust in treatment
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What is the literature?
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1. PRIMARY LITERATURE
Researches published in a peer-reviewed
journal contain original research data or
preliminary reports.
The intended audience are researchersand
specialists, not the general public.
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2. SECONDARY LITERATURE
Researches that consists of organized works
and reference of the primary literature.
Ex, review articles (specifically meta-analysis and systematic reviews).
The intended audience are colleagues
within or without the respective discipline.
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3. TERTIARY LITERATURE
textbooks, encyclopedia articles, and
guidebooks or handbooks, that provide an
overview of key research and an
introduction to principles and practices.
an excellent resource for students.
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primary and secondary literature are the
core for EBD.
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OUTLINE
Definition of EBD.
What is Evidence Based Practice.
Steps of Evidence Based Dentistry.
Levels of Evidence in EBD.
The Stages in Evidence Based Practice.
References.
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EBD PROCESSINGSTEPS
1. Asking answerable questions
2. Finding the best evidence
3. Critically appraising the evidence
4. Applying a decision
5. Evaluation
Heneghan C, Badenoch D.Evidence-based medicine toolkit. 2d ed. Malden, MA:Blackwell, 2007
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STEP1
Asking answerable questions focused,
searchable, clinical , PICO
Patient, Problem, Population (subjects)
Intervention or therapy (study groups)
Comparison, Control, Context (studygroups)
Outcome (results)
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MESH SEARCH TERMS
In the sample clinical question, the key conceptsor
PICO parts must be identified with their MeSH terms:
Key Concept MeSH Term
P Children All Child 0-18 years (limit)
I School who based programs
Fluoride varnish
School health services
Topical fluoride
C Implied Implied
O Reduced incidence of dentalcaries
Dental caries
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PRACTICE CASE STUDY A
patient, a 50 years old man with moderateperiodontitis, who was recently diagnosed with type2 diabetes mellitus. His glycosylated hemoglobin is12%, which places him in the category of poorly
controlled diabetes. He is worried that his diabeteswill increase his chance of losing his teeth. Hewants to know the impact diabetes now has on hisoral health.
Evidence-Based Decision Making : A Translational
Guide for Dental Professionals, 2009
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CLINICAL QUESTION: CASE STUDY A
What impact will Type 2 diabetes mellitus haveon the oral health, specifically tooth loss, of a 50years old man with moderate periodontitis?
P= 50 years old man with moderateperiodontitis?
I= Type 2 diabetes mellitus
C= Implied
O= Tooth Loss
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CASE STUDY A: MESH SEARCH TERMS
In the practice case study, the key conceptsor PICO
parts must be identified with their MeSH terms:
Key Concept MeSH Term
P 50 years old man withmoderate periodontitis
Middle Aged: 45-64 years
(limit)
Periodontitis
I Type 2 Diabetes Mellitus Diabetes Mellitus, Type 2
C Implied Implied
O Tooth Loss Tooth Loss
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PRACTICE CASE STUDY B
A partnership between your community dental clinic
and the dental school is establishing an oral cancer
screening program as part of an outreach initiative.
To justify the new program, you must find researchthat supports the objective to increase patients
chance of early oral cancer detection.
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CLINICAL QUESTION: CASE STUDY B
Do community oral cancer screening programs increasea patients chance of early oral cancer detection?
P= AdultsI= Community oral cancer screenings
C= No screenings
O= Increase a patient
s chance of early oral cancerdetection
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CASE STUDY B: MESH SEARCH TERMS
In the practice case study, the key conceptsor PICO parts
must be identified with their MeSH terms:
Key Concept MeSH Term
P Adult Adult: 19-44 years(limit)
I Community
Cancer Screening
Community Health Services
Early Detection of Cancer
C Implied Implied
O Early DetectionOral Cancer
Already Stated
Mouth Neoplasms
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Can I just search using free-text and ignoreMeSH?
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NO,if we use just free-text
The search will be >>>>>> limited to just thephrases you have entered
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SO THAT Boolean operators
AND, OR, NOT
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The AND operator: Esthetic restoration ANDFunctional restoration
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The OR operator: Esthetic restoration ORFunctional restoration
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The NOT operator: Esthetic restorationNOTFunctional restoration
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dental caries
AND CHX will retrieve allarticles containing these two terms when theyappear together
AND will REDUCE the number of hits inyour search
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Esthetic post OR Metal post willretrieve all articles containing these two
terms regardless of whether they appear
together or notOR will INCREASE the number of hits in
your search
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Thank You.
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