Evidence-Based Oral Health: A Clinician’s Guide

Posted on Feb 6, 2025 in Medicine & Health

Evidence-based oral health focuses on the systematic and rational integration of evidence from scientifically and clinically relevant oral health studies, the clinician’s clinical experience, and the patient’s needs and preferences.

Formulating a Focused Question: PICO

Use the PICO framework (Patient/Problem, Intervention, Comparison, Outcome) to formulate a focused question.

Critical Analysis Based on Hierarchy of Evidence

Base your critical analysis on the hierarchy of evidence, including meta-analyses, systematic reviews, randomized controlled trials (RCTs), cohort studies, case-control studies, case series, and animal studies.

Evaluating Therapeutic Interventions

When evaluating therapeutic interventions, seek the highest level of evidence to ensure the intervention is useful, effective, and causes no harm. Randomized controlled trials (RCTs) are often the most powerful.

Key Considerations for Evaluating Therapeutic Studies:

  1. Randomization: Ensure adequate randomization of patients to study groups. Inadequate randomization can exaggerate treatment effects.
  2. Patient Attrition: The study should begin and end with the same number of patients. Clearly describe any patient loss during the study. A loss of more than 20% is generally considered inadequate.
  3. Blinding: Implement blinding of patients, clinicians, and study personnel to ensure the test is stricter.
  4. Group Similarity: Groups should be similar at the start and treated similarly throughout the study.
  5. Response Variables: Assess appropriate response variables, including primary variables (important for the patient) and secondary endpoints (assessing early changes in the disease).
  6. Applicability: Ensure the results are applicable to your patients by establishing the risk-benefit ratio.

Diagnostic Evidence

Keep in mind that no diagnostic test is 100% accurate. The best tests have high sensitivity and high specificity.

Key Considerations for Evaluating Diagnostic Tests:

  1. Independent Comparison: Ensure an independent and blinded comparison between the experimental test and the standard diagnostic reference.
  2. Sample Inclusion: Include all patients undergoing the diagnostic test in clinical practice in the selected sample.
  3. Influence on Decision-Making: The results of the diagnostic test should not influence the decision-making process.
  4. Detailed Methods: The reference test methods must be described in detail.
  5. Patient Benefit: The study results of diagnostic tests should benefit the patient if the mode of treatment is changed.

Etiological Factors

When considering etiological factors, keep in mind:

Key Considerations for Evaluating Etiological Factors:

  1. Clearly Defined Groups: Clearly define the study groups and ensure they are similar with respect to other possible factors besides the factor of study.
  2. Consistent Measurement: Measure both exposure and effect the same way in both study groups.
  3. Sufficient Follow-Up: Track sufficiently long and completely.
  4. Temporal Relationship: Ensure a correct temporal relationship (applies to cohort studies).
  5. Dose-Response Gradient: Determine the dose-response gradient.
  6. Plausibility: Ensure the partnership makes sense by ruling out other explanations, having a biological explanation according to current knowledge in basic sciences, and having important clinical relevance in clinical practice.

Prognostic Factors

The best type of study for prognostic factors is the cohort study, except for rare diseases or very long durations, in which case case-control studies are acceptable.

Key Considerations for Evaluating Prognostic Factors:

  1. Representative Sample: Select a representative patient sample, ensuring patients are at a similar point in the course of the disease.
  2. Sufficient Follow-Up: Track sufficiently long and completely.
  3. Objective Variables: Use objective and unbiased response variables.
  4. Adjust for Confounding Factors: Adjust for other important prognostic factors, as factors such as age may interfere with the appearance of effect associating the true prognostic factor.