Evidence Based Dentistry - Clinical Decision Support in Dental Practice

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ADA(American Dental Association) define Evidence-based dentistry (EBD) [1]“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”.

EBD-CDSS are systems which are designed to help dentist at chair-side to implement evidence based dentistry. This clinical decision support system arranges available evidence from the given sources to facilitate clinical decision-making and also enhance effective transfer of knowledge to the patient at the point of care. “ADA created [2] “The Assess-Advise-Decide Approach” which is a patient-centered outcomes approach. For patients to decide their best course of action, clinicians’ need to advise based on what is assessed”. This makes it simple for any dentist to remember and apply in the daily practice with the use CDS at chair side. Assess and advice part comes under the role of dentist like to assess the history and chief complaint of the patient and then advise proper treatment along with its risks and benefits. The “decide” part of this approach is the role of the patient to finally select the best treatment option. One of the main reasons to use this system in dentistry [3] is to use the drug prescription application of CDS. This system provide appropriate dosing system for dental patients as in dental patients it became complicated to select dosage because of medical issues and other medications. Dr. Newman defined a challenge of EBD-CDS adoption is Engaging staff with EBD, like teaching staff how to access the information, sharing the new findings regularly at staff meetings and finally flexibility of dentist to adopt any EBD-CDS.

This system also provides clinicians, staff and patients with knowledge and specific information at appropriate times to enhance health care. There are many sources to access information in dentistry like Cochrane Oral Health Group, Medline and JEBDP etc. But there is still a huge need of research in this domain of medical informatics that will make it easier to access any EBD information by dentist for clinical decision support in a daily busy practice. It’s difficult to assess the information needed at chair side by the dentist as they are not expert at information retrieval from the huge database and sometimes it’s hard to know the proper question that they need to know.

According to authors of roadmap of CDS [4], there are many challenges for the worldwide adoption of CDS like lack of a common and portable clinical knowledge base that can be easily and widely used in electronic health and dental records (EHDRs).

Dr. Michael Newman, JEBDP editor said[5]"Clinical Decision Support tools and products are being developed and they will be widely used in the future," and "CDS is an essential resource that will make it easier for dental practitioners to keep up to date."


[1] http://www.ada.org/prof/resources/ebd/conferences_goals.pdf

[2] http://www.ada.org/prof/resources/ebd/conferences_assess.pdf

[3] Clinical Decision Support Complements Evidence-Based Decision Making in Dental Practice, Michael G. Newman, Journal of Evidence Based Dental Practice, Volume 7, Issue 1, Page 1.

[4] http://www.amia.org/inside/initiatives/cds

[5] http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=2766

Submitted by Vandana Kapoor