Policy on Evidence-Based Dentistry

Introduction: Dentistry has evolved as a profession that has uniquely and successfully combined science with the art of healing. Building on this foundation, the dental profession has maintained a strong commitment to sound science, public service and an ethical obligation to protect the patient’s health.

Over the last few decades, a process for reviewing scientific evidence emerged in medicine and other health fields that relies on systematic approaches to summarize the large volume of literature that health care providers need to assimilate into clinical practice. With rapidly evolving science and technology, dentistry has also faced the complex demands of integrating and effectively implementing changes in treatment modalities that can arise from new scientific evidence.

To address these challenges, the dental profession has endorsed an evidence-based approach to clinical practice and oral health care, which is commonly known as evidence-based dentistry (EBD). The American Dental Association (ADA) continues to pursue a leadership role in the field of EBD to help clinicians interpret and apply the best available evidence in everyday practice.

Definition of Evidence-Based Dentistry: The ADA defines the term “evidence-based dentistry” as follows:

Evidence-based dentistry 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 the patient's treatment needs and preferences. (Trans. 2001:462)

In adopting this definition for EBD, the ADA recognizes that treatment recommendations should be determined for each patient by his or her dentist, and that patient preferences should be considered in all decisions. Dentist experience and other circumstances, such as patients’ characteristics, should also be considered in treatment planning. EBD does not provide a “cookbook” that dentists must follow, nor does it establish a standard of care. The EBD process must not be used to interfere in the dentist/patient relationship, nor is it to be used as a cost-containment tool by third-party payers.

ADA Center for Evidence-Based Dentistry: The Association supports the concept of evidence-based dentistry developed through systematic examination of the best available scientific data. In 2007, the Association established the ADA Center for Evidence-Based Dentistry to provide leadership in implementing ADA programs and initiatives related to EBD.

To realize its vision of disseminating the best available evidence and helping practitioners implement EBD, the ADA Center for Evidence-Based Dentistry works in collaboration with the Council on Scientific Affairs to convene expert panels that review the collective research evidence and develop evidence-based recommendations on key clinical issues. The Association will continue developing evidence-based clinical recommendations and working with collaborative groups to conduct systematic reviews, critically appraising the reviews and policies developed by other organizations, and developing mechanisms for translating and disseminating information to the membership.

Practicing Evidence-Based Dentistry: The goal of EBD is to help practitioners provide the best care for their patients. This process uses clinical and methodological experts to synthesize all of the evidence relative to a defined “question of interest,” and is published as a systematic review. The evidence is integrated with clinical experience and other factors relevant to specific patient needs and preferences. This characteristic of the EBD process is clearly explained in the classical definition of evidence-based medicine as “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research” (Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. 1996. Evidence based medicine: what it is and what it isn't. BMJ 312: 71–2).

Simply stated, evidence-based medicine is “the integration of the best research evidence with clinical expertise and patient values” (Sackett et al. Evidence-based Medicine. New York: Churchill Livingstone; 2000). Though this process was originally developed in medicine, its principles apply to all health care fields, including dentistry, and they are followed rigorously by the ADA Center for EBD.

EBD Resources: Detailed information on EBD, evidence-based clinical recommendations, systematic reviews, critical summaries of systematic reviews, EBD terminology, courses/workshops and other resources are available at the website of the ADA Center of Evidence-Based Dentistry. Concise, user-friendly EBD resources from the ADA Center for EBD and other organizations are useful informational resources that can assist practitioners with integrating the best available evidence with clinical expertise and the needs and preferences of the individual dental patient.