CE0783: Use and Abuse of the Term "Evidence-Based"

Philippe Hujoel, DDS, MS, MSD, PhD

Course Description:

All dental information presented to us is apparently becoming evidence-based. Insurance companies, professional organizations, and dental schools all have an interest in using the term evidence-based dentistry (EBD). But what is evidence-based dentistry? Is it a set of lies dictated by powerful stakeholder? While there are ongoing turf battles among stakeholders regarding the exact definition of the term evidence-based-dentistry, the fundamentals of an evidence-based approach to dental practice are straightforward; ask questions, find evidence, and attach a degree of belief in the identified evidence. The latter aspect can be particularly controversial. Attaching a degree of belief to evidence is inherently subjective and open to manipulation. This course will introduce the tools of evidence-based dentistry and illustrate how evidence-based principles can be used and abused by the various stakeholders.

Morning: Question formulation and evidence searching and assessment

PICO is a commonly used mnemonic to identify the four elements of a clinical question: (1) the Patient, (2) the Intervention, (3) the Control, and (4) the Outcome. Important considerations in assessing the meaningfulness of a PICO question include the specified patient characteristics, whether a surrogate or true outcome is specified, and whether the comparison group is contrived. Subsequent to formulating a PICO question, evidence needs to be located and assessed. What degree of belief can be put in the identified evidence? One contribution of evidence-based methodology to clinical practice is the classification of evidence according to a 5-level pyramid.

Afternoon: Common abuses in generating or interpreting evidence

Cherry-picking results, ignoring competing explanations, losing track of the sequence of events (what happened when?), or suppressing evidence are examples of methods that can be used to misrepresent evidence. The afternoon session will focus on illustrating the most common abuses of scientific methodology in dental research.

Course Objectives - As a result of attending this course, the participant should be able to:

• Formulate a PICO question
• Find evidence
• Provide the level of evidence of a study
• Recognize common scientific abuses in published evidence

Instructor:

PHILIPPE HUJOEL is a Professor with appointments in the UW School of Dentistry and the UW School of Public Health and spends one day per week in a private periodontal practice. He received his dental degree at the Free University of Brussels in Belgium, his MSD in Periodontics and PhD in Epidemiology at the University of Washington, and his MS in Biostatistics at the University of Michigan. He is currently involved in projects including a randomized controlled trial on the effect of chlorhexidine rinses on tooth loss, the validity of surrogate markers and clinical significance, the potential effects of dental treatments on systemic health, the long-term effects of periodontal surgery on quality of life and tooth loss and the health-effects of very low dose radiation.

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