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BACKGROUND: Work-related musculoskeletal disorders are prevalent in dental hygienists. Although engineering controls and ergonomic training is available, it is unclear why this intransigent problem continues. One possible barrier is that a comprehensive, standardized protocol for evaluating dental hygiene work does not exist. OBJECTIVE: This study aimed to generate a valid and reliable observational protocol for the assessment of dental hygiene work. METHODS: An iterative process was used to establish and refine an ecologically valid video acquisition and observation protocol to assess key activities, tasks, and performance components of dental hygiene work. RESULTS: Good inter-rater reliability was achieved across all variables when the final coding scheme was completed by three independent raters. CONCLUSIONS: This work provides an exemplar of the process required to generate a comprehensive protocol for evaluating the work components of a particular job, and provides standardized nomenclature for use by scientists and practitioners interested in understanding and addressing the pervasive issue of work-related disorders in dental hygienists.

Background The authors’ objective in this systematic review was to describe the evidence for preventive and rehabilitative interventions for musculoskeletal disorders in oral health care. Types of Studies Reviewed The authors conducted systematic search, screening, and eligibility processes to identify experimental, quasiexperimental, observational, and survey research studies in which the investigators either directly evaluated or predicted the effects of preventive or rehabilitative interventions on the reduction of musculoskeletal symptoms in oral health care professionals. Results The authors identified and screened 3,571 unique abstracts, assessed 256 full-text articles for eligibility, and included 34 articles in the review. Investigators in 17 experimental studies described the results of preventive or rehabilitation interventions and in 17 survey research studies predicted or correlated preventive or protective techniques to a reduction in musculoskeletal symptoms. The primary techniques evaluated in the studies included equipment modification, ergonomic training, and physical exercise. Conclusions and Practical Implications The evidence suggests that magnification loupes and indirect-vision techniques have a positive effect on the reduction of musculoskeletal symptoms. In terms of evaluating intervention efficacy, other techniques have mixed evidence or are limited by low-level study design.

Previous position papers have confirmed associations between periodontal disease and adverse pregnancy outcomes. Causal associations have not been confirmed and have been the source of much confusion for the profession and public.To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes.The PICO question was "For adults in good general health who are diagnosed with periodontal disease, will receiving non-surgical periodontal therapy (NSPT), as compared to not receiving non-surgical periodontal therapy, lower their risk for adverse pregnancy outcomes?" Only systematic reviews (SRs) with or without meta-analyses (MAs) of randomized controlled trials published in the English language between 2007 and 2019 were included. Databases searched included PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, Cochrane Registry of Systematic Reviews, and Clinical Trials Registry. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality.Of 37 records retrieved for adverse pregnancy outcomes, 9 met the criteria for inclusion and were analysed. None showed that NSPT lowers the risk for adverse pregnancy outcomes.Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and adverse pregnancy outcomes based on the most current evidence available.Les énoncés de position précédents ont confirmé des associations entre la maladie parodontale et les effets indésirables de grossesse. Des associations causales n’ont pas été confirmées et ont été la source de beaucoup de confusion pour la profession et la population.Étudier s’il y a suffisamment de preuves qu’un lien de causalité existe entre la maladie parodontale et les effets indésirables de grossesse.La question de PICO était : « Les adultes en bonne santé générale, qui ont reçu un diagnostic de maladie parodontale, auront-ils une réduction de leur risque d’effets indésirables de grossesse s’ils reçoivent une thérapie parodontale non chirurgicale (TPNC), par rapport à ne pas recevoir de thérapie parodontale non chirurgicale? » Seules les revues systématiques (RS) avec ou sans méta-analyse (MA) d’essais comparatifs randomisés publiés en anglais entre 2007 et 2019 ont été incluses. Les recherches de bases de données ont été effectuées, entre autres, dans PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, le registre de revues systématiques Cochrane et le registre des essais cliniques. Des évaluations de la qualité ont été menées par les deux auteurs à l’aide de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer la preuve de causalité.Dans les 37 dossiers repérés sur les effets indésirables de grossesse, 9 répondaient aux critères d’inclusion et ont été analysées. Aucun dossier n’a montré que la TPNC réduit le risque d’effets indésirables de la grossesse.Les critères d’analyse de Bradford Hill n’ont pas réussi à appuyer un lien de causalité entre la maladie parodontale et des effets indésirables de grossesse selon les preuves les plus récentes offertes.

Introduction: The Rapid Upper Limb Assessment (RULA) is an ergonomic assessment tool used to screen for risk of musculoskeletal injury due to working posture. The RULA is traditionally applied once during a work task to approximate overall risk. No method exists for estimating a RULA score for work requiring frequent shifts in posture across an extended period of time. Purpose: The goal of this study was to identify an optimal sampling method for applying the RULA across a long time-period that accurately represents overall risk. Methods: Four right-handed female dental hygiene students were video recorded from three angles while performing hand scaling during patient clinic visits (88.97 minutes on average). RULA was continuously scored across the entire session, updating the score when a significant postural shift lasting for more than 15 seconds occurred. A time-weighted average (TWA) RULA score was calculated. Three sampling methods were evaluated: equivalent interval samples, random samples, and random samples selection weighted within “clock positions.” Each method was compared to the TWA using a paired samples t-test and percent difference. Results: TWA RULA across the four students ranged from 3.4 to 4.3. Preliminary sampling averages using 10 samples were all within 0.2 of the TWA. Further iterations evaluating various sample sizes is ongoing. Discussion: Preliminary results suggest that all three sampling methods provide a reasonably accurate approximation of the TWA score at the sampling rate tested. Future iterations of this analysis will be continued to identify the minimum required sampling rate to meet our TWA criterion.

PURPOSE: The purpose of this study was to characterize the duration of dental hygiene activities and tasks and explore efficiency within appointments by students in educational programs. METHODS: Right-handed female dental hygiene students were recruited from two educational programs. Each participant was video recorded during 3 patient visits, once per term, over 3 consecutive terms. Activities, tasks, and student postures and positions were coded across the patient visit. Descriptive analyses were conducted to characterize overall durations and distributions across each category. Time spent on non-dental hygiene related activities was compared to other durations, as well as across the training time points and by patient type. RESULTS: Fifty-three videos were analyzed from nineteen students. The average patient visit length was 155.06 ± 35.63 minutes; approximately half the visit was dedicated to instrumentation activities. Nearly 20% of the visit was categorized as activities or tasks unrelated to education or patient care. Although most participants completed patient visits more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there was no association between patient category type and duration of patient visit. CONCLUSION: Patient visits were roughly three times the length of typical clinic visit, indicating a disconnect between training and practice. In addition to spending more time on hand scaling tasks, participants spent a lot of time on equipment setup and interacting with or waiting for faculty members. These findings have implications for improving efficiency in educational settings, particularly to facilitate successful transition to clinical practice.

Background A panel of experts convened by the American Dental Association Council on Scientific Affairs presents an evidence-based clinical practice guideline on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Methods The authors developed this clinical practice guideline according to the American Dental Association's evidence-based guideline development methodology. This guideline is founded on a systematic review of the evidence that included 72 research articles providing clinical attachment level data on trials of at least 6 months' duration and published in English through July 2014. The strength of each recommendation ( strong , in favor , weak , expert opinion for , expert opinion against , and against ) is based on an assessment of the level of certainty in the evidence for the treatment's benefit in combination with an assessment of the balance between the magnitude of the benefit and the potential for adverse effects. Practical Implications and Conclusions For patients with chronic periodontitis, SRP showed a moderate benefit, and the benefits were judged to outweigh potential adverse effects. The authors voted in favor of SRP as the initial nonsurgical treatment for chronic periodontitis. Although systemic subantimicrobial-dose doxycycline and systemic antimicrobials showed similar magnitudes of benefits as adjunctive therapies to SRP, they were recommended at different strengths ( in favor for systemic subantimicrobial-dose doxycycline and weak for systemic antimicrobials) because of the higher potential for adverse effects with higher doses of antimicrobials. The strengths of 2 other recommendations are weak : chlorhexidine chips and photodynamic therapy with a diode laser. Recommendations for the other local antimicrobials (doxycycline hyclate gel and minocycline microspheres) were expert opinion for . Recommendations for the nonsurgical use of other lasers as SRP adjuncts were limited to expert opinion against because there was uncertainty regarding their clinical benefits and benefit-to-adverse effects balance. Note that expert opinion for does not imply endorsement but instead signifies that evidence is lacking and the level of certainty in the evidence is low.

Date Presented 04/05/19 A longitudinal multicohort study was conducted to evaluate the impact of task training on upper-extremity musculoskeletal discomfort in health professional students. Differential effects on pain and grip strength were noted in dental hygiene students as compared to OT students. This study validates that repetitive task training has a negative impact on health and illuminates a need for development and implementation of preventive interventions for dental hygiene students. Primary Author and Speaker: Shawn Roll Contributing Authors: Naoko Kono, Jane Forrest, Wendy Mack

This is the second of 2 articles that focus on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice. The previous article 1 provided an overview of EBDM concepts and identified strategies for finding evidence to answer clinical questions, the first 2 steps in the evidence-based process. The next steps are to determine the credibility and usefulness of the evidence and to apply the evidence to patient care. The purpose of this article is to discuss those steps by reviewing the critical appraisal criteria used to assess the methodological quality of a study. A case scenario will be used to demonstrate how appraising the evidence helps to answer questions and how to translate the evidence into everyday practice. Characteristics of an evidence-based practice and educational tips are provided along with a glossary of terms related to appraising the literature. Together, the two articles can serve as a primer for integrating EDBM into your practice. Generally, the most frequently asked clinical questions are related to the effectiveness of a certain technique, medication, diagnostic test, treatment, material, or product. The type of scientific evidence may include systematic reviews and critically appraised topics; clinical practice guidelines and protocols; article reviews; pharmaceutical and drug interaction information; and individual studies addressing questions about therapy, prevention, diagnosis, prognosis, and harm/etiology. Once the most current evidence has been found, the next step in the EBDM process is to understand what you have and its relevance to your patient.

– The management and immediate treatment of an avulsed permanent tooth will determine the long-term survival of the tooth. The aim of this study was to evaluate the knowledge of oral health professionals on the new guidelines for emergency treatment of avulsed teeth. A 12-item questionnaire was distributed among general dentists, specialists, dental hygienists and dental assistants attending Continuing Education courses at the School of Dentistry, University of Southern California, between 2003 and 2004. This study reports only on the general practitioners who comprised 83% of the participants. The results revealed an uneven pattern of knowledge among them regarding the emergency management of an avulsed tooth. Statistically significant associations were related to the participants’ previous dental trauma education and their age. In conclusion, there is a need to improve the knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth.

This study assessed the opinion of oral health care professionals regarding the predictability of initial endodontic treatment, expected long-term outcome and the importance of placing a coronal coverage after completion of treatment. An eight-item questionnaire was distributed among oral health care professionals. There were 49% of participants who responded that the expected retention rate of teeth 5 to 10 yr after endodontic treatment was more than 90%, whereas 44% responded that such retention rate was between 70 to 80%. The majority of the participants also responded that the need for additional treatment, such as retreatment, apical surgery or extraction, was expected to occur within the first 3 yr after endodontic treatment if initial treatment has failed. About 87% of participants responded that placing coronal coverage after completion of endodontic treatment in premolars and molars was very important for long-term tooth retention and 92% responded that overall, endodontic treatment was a predictable procedure with long-term tooth retention rate. Statistically significant associations were found between years of experience and expected rate of retention for both the total group of respondents (p < 0.001) and for general practitioners when examined separately (p < 0.002). Statistically significant associations were only found for general practitioners between years of experience and their responses regarding the need for additional treatment (p < 0.05) and overall predictability of endodontic treatment (p < 0.02). A trend was found between the professionals' years of experience and their opinion regarding the importance of coronal coverage. Of the group who had more than 20 yr of experience, about 87% considered coronal coverage to be very important for long-term tooth retention. In conclusion, it appears that most clinicians participating in this study consider endodontic therapy to be a predictable procedure with long-term tooth retention rate. Their opinions also reflect the variations that currently exist in the literature regarding the reported outcome of endodontic treatment.

The aims of this paper are to present the findings from the scientific literature that discuss strategies that can contribute to a "best practices" treatment plan model for effectively integrating Evidence-Based Decision Making (EBDM) into curricula. MEDLINE, CINAHL, and HealthSTAR databases were searched, as was the Cochrane Database of Systematic Reviews. Studies and articles, ranging from systematic reviews to articles proposing models and recommendations for how to implement EBDM into curricula and faculty development were reviewed. Several common themes emerged and form the basis for a treatment plan model. The first step in developing any treatment plan is a thorough assessment of the current situation or problem. Recognizing that there are multiple phases to the assessment of an educational system, the focus of this paper will be to understand which teaching and learning strategies are most effective. These, in turn, will inform faculty of needed curricular changes and skill development training, requisites in order for them to prepare students to be successful in providing patient care using the best available evidence. Elements of a suggested treatment plan will be presented with the caveat that each dental school will need to develop an implementation plan based on an assessment of its own environment and needs.

The purpose of this study was to compare the effectiveness of intramuscular and intranasal midazolam used as a premedication before intravenous conscious sedation. Twenty-three children who were scheduled to receive dental treatment under intravenous sedation participated. The patients ranged in age from 2 to 9 years (mean age, 5.13 years) and were randomly assigned to receive a dose of 0.2 mg/kg of midazolam premedication via either intramuscular or intranasal administration. All patients received 50% nitrous oxide and 50% oxygen inhalation sedation and local anesthetic (0.2 mL of 4% prilocaine hydrochloride) before venipuncture. The sedation level, movement, and crying were evaluated at the following time points: 10 minutes after drug administration and at the times of parental separation, passive papoose board restraint, nitrous oxide nasal hood placement, local anesthetic administration, and initial venipuncture attempt. Mean ratings for the behavioral parameters of sedation level, degree of movement, and degree of crying were consistently higher but not significant in the intramuscular midazolam group at all 6 assessment points. Intramuscular midazolam was found to be statistically more effective in providing a better sedation level and less movement at the time of venipuncture than intranasal administration. Our findings indicate a tendency for intramuscular midazolam to be more effective as a premedication before intravenous sedation.

This is the second of a two-part series addressing the use of evidence-based decision making (EBDM) in the use of home bleaching. In Part 1, a case scenario demonstrated the skills involved in (1) structuring a clinical question and (2) conducting an online search using PubMed.1 Part 2 demonstrates the third and fourth steps in the EBDM process, i.e., (3) critical appraisal to assess the validity of a study and (4) applying that information to clinical decision making. This 4-step approach to EBDM recognizes that clinicians can never be completely current with all conditions, medications, materials, and products. Thus, EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. Citation Forrest JL, Miller SA. Evidence-Based Decision Making in Action: Part 2 – Evaluating and Applying the Clinical Evidence. J Contemp Dent Pract 2003 February;(4)1:042-052.

This article is the fourth of a feature series that focuses on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice or curriculum. The previous articles provided an overview of EBDM methodology and skills; introduced PICO, a systematic process for asking clinical questions; and identified strategies for finding evidence to answer these questions. The next step is to determine the credibility and usefulness of the evidence. The purpose of this article is to review the critical appraisal criteria used to assess the methodologic quality of a study or review article that can assist you in making these initial judgments. Through the case scenario, we will demonstrate how an appraisal of the evidence helps us answer our patient's concern, bringing the EBDM approach full circle. Educational tips and learning activities are provided, with online resources related to appraising the literature. J Evid Base Dent Pract 2002;2:178-85

The purpose of this article is to introduce evidence-based concepts and demonstrate how to find valid evidence to answer clinical questions. Evidence-based decision making (EBDM) requires understanding new concepts and developing new skills including how to: ask good clinical questions, conduct a computerized search, critically appraise the evidence, apply the results in clinical practice, and evaluate the process. This approach recognizes that clinicians can never be completely current with all conditions, medications, materials, or available products. Thus EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. In Part 1, a case scenario demonstrates the application of the skills involved in structuring a clinical question and conducting an online search using PubMed. Practice tips are provided along with online resources related to the evidence-based process. Citation Forrest JL, Miller SA. Evidence-Based Decision Making in Action: Part 1 - Finding the Best Clinical Evidence. J Contemp Dent Pract 2002 August;(3)3: 010-026.

This article is the third of a feature series that focuses on strategies to integrate an evidence-based decision-making (EBDM) approach into your practice or curriculum. The first article provided an overview of EBDM methodology and skills, and the second article introduced PICO, a systematic process for asking clinical questions. The purpose of this article is to demonstrate how to find valid evidence to answer these questions. Knowing which segment of the literature is appropriate for clinical decision making and how to quickly retrieve this information is important to evidence-based practice. Steps involved in structuring and conducting the search will be outlined, along with a discussion of the type of question and type of evidence for which you will be searching. A case scenario will demonstrate the application of the skills involved. Educational tips and learning activities are provided, as are online resources related to searching the literature and levels of evidence.

This article is the second of a feature series that focuses on strategies that can be used to integrate an evidence-based decision-making (EBDM) approach into your practice or curriculum. The first article provided an overview of EBDM methodology and skills, introduced readers to evidence-based concepts, and identified related online resources. The purpose of this article is to discuss PICO, a systematic process for converting information needs/problems into clinical questions so that they can be answered. Two case scenarios outline the sequential steps in this process and demonstrate the application of the skills involved. Educational tips and learning activities are provided, along with online resources that supplement the information on learning how to ask a good question.

This paper describes the design, development, and administration of a Web-based survey to determine the use of the Internet in clinical practice by 450 dental professionals. The survey blended principles of a controlled mail survey with data collection through a Web-based database application. The survey was implemented as a series of simple HTML pages and tested with a wide variety of operating environments. The response rate was 74.2 percent. Eighty-four percent of the participants completed the Web-based survey, and 16 percent used e-mail or fax. Problems identified during survey administration included incompatibilities/technical problems, usability problems, and a programming error. The cost of the Web-based survey was 38 percent less than that of an equivalent mail survey. A general formula for calculating breakeven points between electronic and hardcopy surveys is presented. Web-based surveys can significantly reduce turnaround time and cost compared with mail surveys and may enhance survey item completion rates.

Internet use in dentistry is increasing. The authors surveyed dentists to determine how they are using the Internet to support patient care and how useful they perceive the Internet to be.The authors sent a 25-question survey to 455 subscribers to the Internet Dental Forum, an Internet discussion list. Participants completed the survey through a Web page or by e-mail during an 18-day period in December 1998. The survey included questions about when they began using the Internet and their motivations for doing so, their positive and negative experiences, where they use the Internet and why, their use of information resources--including electronic information resources--and demographics.The authors received 314 surveys from 438 participants, a 72 percent response rate. Participants reported demographic characteristics similar to national averages and were highly computer-literate. Most considered the Internet essential for their practice and had increased their Internet use for professional reasons over time. Ninety-seven percent of respondents used the Internet at home, and 68 percent used it in the office. Only 5 percent used the Internet in the treatment area. The primary reason cited by participants for using the Internet was to keep up in general, followed by to answer patient-specific questions and to provide patient education. Reduction of professional isolation was one of the most frequently cited advantages of using the Internet.The authors found that some dentists use the Internet to support clinical practice and that it helped dentists adopt new techniques for patient treatment and obtain information on new materials or products.The Internet appears to support clinical practice mostly indirectly, by helping users keep up in general, rather than by answering specific clinical questions.

The desire to improve the oral health of clients begins with the hygienist's commitment to keeping current with useful scientific knowledge. The challenge is mastering the skills to discriminate between the many claims and what actually has been shown to be effective. One approach is through evidence-based decision-making (EBDM), which helps practitioners find relevant clinical evidence when it is needed for treatment decisions and for answering client questions. The purpose of this article is to discuss EBDM and its use in practice, potential challenges, future developments and resources that will assist in keeping current.

Original Article Croft LK, Nunn ME, Crawford LC, Holbrook TE, McGuire MK, Kerger MM, et al. Patient preference for ultrasonic or hand instruments in periodontal maintenance. Int J Periodontics Restorative Dent 2003;23(6):567-73. Level of Evidence 4 Purpose To determine a possible preference for hand instruments or ultrasonic instruments in periodontal maintenance Source of Funding Information not available Type of Study/Design Cross-sectional survey

There are several online resources for those who would like to learn more about evidence-based practice/health care, improve their knowledge of research methodology and statistics, and develop skills in each of the steps of evidence-based decision making. In addition, a range of course offerings and centers that have links to additional sites, including calendars or training agendas of workshop offerings are provided. You may want to bookmark the Web sites you find particularly interesting since they are periodically updated with new course listings and dates.

The purpose of this section of the ADA Champions Pre-Conference is to review the basics of Evidence-based dentistry (EBD), research designs and levels of evidence, and identify the skills necessary for clinicians to efficiently use an evidence-based approach in practice. This session of the pre-conference preceded the session on the skills needed to define a clinical question and search for the evidence to answer that question.

This is the first of 2 articles that focuses on strategies that can be used to integrate an evidence-based decision making [EBDM] approach into practice. The articles will focus on EBDM methodology and enhancing skills, including how to find valid evidence to answer clinical questions, critically appraise the evidence found and determine if it applies. In addition, online resources will be identified to supplement information presented in each article. The purpose of this article is to define evidence-based decision making and discuss skills necessary for practitioners to efficiently adopt EBDM. It will provide a guide for finding evidence to answer a clinical question using PubMed's specialized searching tools under Clinical Queries.

The American Dental Hygienists' Association (ADHA) National Dental Hygiene Research Agenda (NDHRA) is a working document that guides research efforts of the dental hygiene profession. The purpose of this study was to update the NDHRA to reflect current research priorities aimed at meeting national health objectives and to systematically advance dental hygiene's unique body of knowledge.Forty-nine dental hygiene experts and key opinion leaders representing all domains of the profession, participated in the Delphi study to update and gain consensus on the NDHRA. The study was carried out electronically in 3 phases: a development phase, 2 rounds of mailed questionnaires to gain consensus on topics during the second phase, and a third phase to prioritize topics. Responses were analyzed using descriptive statistics and instrument reliability was analyzed using the Pearson Product Moment Correlation Coefficient and Cronbach's Alpha for internal consistency.One hundred twelve topics reflecting the research agenda categories were identified during Phase I. Through Phase II, 36 topics were eliminated and consensus was reached on 42 of the remaining 76 topics. Return rates of 95% and 100% were achieved for the 2 survey rounds. Instrument reliability was established at .76 and internal consistency at .87. During Phase III participants attempted to rank the 42 topics as to their level of priority, however results of this phase were not usable.Each category comprising the NDHRA was represented by the 42 topics. Thus, consensus on the national agenda was achieved. Ideally, identified priorities on the revised NDHRA will be used to direct future research efforts, identify research funding initiatives, and guide education and practice.

MSDs are so prevalent among dental professions that they are considered an occupational problem. Often the culprits in MSDs are poor body alignment and faulty movement mechanics that place abnormal stress on pain-sensitive tissue that becomes chronic if not corrected. As preventive specialists, dental hygienists need to be aware of their own potential health risks and take action to prevent or minimize injuries that can shorten their careers. In changing habits, the focus must be on you and your position. Once your position is established, adjust the patient, the patient's chair, and the use of your equipment to accommodate your alignment. Increasing the use and proficiency of indirect vision may also allow you to maintain a neutral spine and avoid awkward positions.

Background Conduct a systematic review and meta-analysis on nonsurgical treatment of patients with chronic periodontitis by means of scaling and root planing (SRP) with or without adjuncts. Methods A panel of experts convened by the American Dental Association Council on Scientific Affairs conducted a search of PubMed (MEDLINE) and Embase for randomized controlled trials of SRP with or without the use of adjuncts with clinical attachment level (CAL) outcomes in trials at least 6 months in duration and published in English through July 2014. The authors assessed individual study bias by using the Cochrane Risk of Bias Tool and conducted meta-analyses to obtain the summary effect estimates and their precision and to assess heterogeneity. The authors used funnel plots and Egger tests to assess publication bias when there were more than 10 studies. The authors used a modified version of the US Preventive Services Task Force methods to assess the overall level of certainty in the evidence. Results The panel included 72 articles on the effectiveness of SRP with or without the following: systemic antimicrobials, a systemic host modulator (subantimicrobial-dose doxycycline), locally delivered antimicrobials (chlorhexidine chips, doxycycline hyclate gel, and minocycline microspheres), and a variety of nonsurgical lasers (photodynamic therapy with a diode laser, a diode laser, neodymium:yttrium-aluminum-garnet lasers, and erbium lasers). Conclusions and Practical Implications With a moderate level of certainty, the panel found approximately a 0.5-millimeter average improvement in CAL with SRP. Combinations of SRP with assorted adjuncts resulted in a range of average CAL improvements between 0.2 and 0.6 mm over SRP alone. The panel judged the following 4 adjunctive therapies as beneficial with a moderate level of certainty: systemic subantimicrobial-dose doxycycline, systemic antimicrobials, chlorhexidine chips, and photodynamic therapy with a diode laser. There was a low level of certainty in the benefits of the other included adjunctive therapies. The panel provides clinical recommendations in the associated clinical practice guideline.

The term evidence-based has become a popular phrase in the title of many articles. Some articles discuss the process, whereas others lead readers to believe that evidence-based methodology was used in conducting the research or in presenting a synthesis of the findings, which may not be the case. The purpose of Part I of this two-part report is to define evidence-based decision-making (EBDM), discuss the evolution of the evidence based movement, and to describe the distinguishing characteristics of evidence-based publications. In doing so, articles using an evidence-based format, article summaries found in evidence-based journals and systematic reviews, such as those published by the Cochrane Collaboration, will be presented. Part II reviews the findings from the Cochrane Review on manual versus powered toothbrushing for oral health and discusses the strengths and weaknesses of systematic reviews.

A systematic review examining the clinical effectiveness of power versus manual toothbrushes was conducted by the Cochrane Collaborations Oral Health Group. Their review examined clinical trials conducted through 2001 and used international standards to identify, access, evaluate, analyze, and report the data. Part I of this series discussed distinguishing characteristics of evidence-based publications, such as systematic reviews, whereas this report provides a summary of the Cochrane Review, its importance to the profession, and discusses the strengths and limitations of systematic reviews.Search strategies to identify published clinical trials on power toothbrushes were developed, and manufacturers were contacted for additional published and unpublished information. Trials were selected based on pre-established criteria; including whether they compared power versus manual toothbrushes used a randomized research design tested products in the general population without disabilities, provided data on plaque and gingivitis, and were at least 28 days in length. Six reviewers independently extracted information in duplicate. Indices for plaque and gingivitis levels were expressed as standardized mean differences for data distillation. Data distillation was accomplished using a meta-analysis, with a mean difference between power and manual toothbrushes as the measure of effectiveness.Searches identified 354 trials, of which 29 met inclusion criteria. These trials involved 2.547 participants who provided data for meta-analysis. Results indicated that for both plaque and gingivitis, all types of power toothbrushes worked as well as manual toothbrushes, however only the rotating oscillating toothbrush consistently provided a statistically significant though modest benefit over manual toothbrushes in reducing plaque (7%) and gingivitis (17%). None of the battery powered toothbrush studies met the inclusion criteria.The Cochrane systematic review used international standards to examine more than 30 years of published studies. A concern is that only one type of electric toothbrush, the rotating oscillating toothbrush consistently demonstrated a statistically significant benefit over manual toothbrushes, and the majority of studies did not meet the standards for inclusion in moving forward it will be important to conduct methodologically sound studies demonstrating the ability of power toothbrushes to reduce the incidence and prevalence of caries and periodontal disease.

The purpose of this article is to introduce evidence-based concepts and demonstrate how to find valid evidence to answer clinical questions. Evidence-based decision making (EBDM) requires understanding new concepts and developing new skills including how to: ask good clinical questions, conduct a computerized search, critically appraise the evidence, apply the results in clinical practice, and evaluate the process. This approach recognizes that clinicians can never be completely current with all conditions, medications, materials, or available products. Thus EBDM provides a mechanism for addressing these gaps in knowledge in order to provide the best care possible. In Part 1, a case scenario demonstrates the application of the skills involved in structuring a clinical question and conducting an online search using PubMed. Practice tips are provided along with online resources related to the evidence-based process.

Web technology provides an opportunity for dentists to showcase their practice philosophy, quality of care, office setting, and staff in a creative manner. Having a Website provides a practice with innovative and cost-effective communications and marketing tools for current and potential patients who use the Internet. The main benefits of using a Website to promote one's practice are: Making office time more productive, tasks more timely, follow-up less necessary Engaging patients in an interactive and visual learning process Providing online forms and procedure examples for patients Projecting a competent and current image Tracking the usage of Web pages. Several options are available when considering the development of a Website. These options range in cost based on customization of the site and ongoing support services, such as site updates, technical assistance, and Web usage statistics. In most cases, Websites are less expensive than advertising in the phone book. Options in creating a Website include building one's own, employing a company that offers Website templates, and employing a company that offers customized sites. These development options and benefits will continue to grow as individuals access the Web and more information and sites become available.

Health care providers can enhance their critical thinking skills, essential to providing patient centered care, by use of motivational interviewing and evidence-based decision making techniques. Background and Purpose The need for critical thinking skills to foster optimal patient centered care is being emphasized in educational curricula for health care professions. The theme of this paper is that evidence-based decision making (EBDM) and motivational interviewing (MI) are tools that when taught in health professions educational programs can aid in the development of critical thinking skills. This paper reviews the MI and EBDM literature for evidence regarding these patient-centered care techniques as they relate to improved oral health outcomes. Methods Comparisons between critical thinking and EBDM skills are presented and the EBDM model and the MI technique are briefly described followed by a discussion of the research to date. Conclusions The evidence suggests that EBDM and MI are valuable tools; however, further studies are needed regarding the effectiveness of EBDM and MI and the ways that health care providers can best develop critical thinking skills to facilitate improved patient care outcomes.

This session of the conference addressed the status of incorporating the evidence-based process and principles into curricula and how to effectively advocate for its acceptance. To date, most proponents are still Bfighting[ an uphill battle when looking at how to integrate this decision-making approach into the dental school culture. Two of these proponents discuss the approach at their respective institutions while a third presents a Btreatment plan[ based on a review of the current scientific literature and the successful implementation of evidence-based decision making into curricula. Dr. Richard Stevenson, Chair of the Division of Restorative Dentistry at the UCLA School of Dentistry, discusses BWhat Are the Obstacles in the Dental School Environment,[ which include the dissemination of best evidence in research formats and placing the responsibility of obtaining, implementing, and evaluating the outcomes on the clinician alone. Efforts to implement change are presented acknowledging that the clinical educational component is key to using an evidence-based approach in private practice. Dr. Ralph Katz, Professor and Chair of the Department of Epidemiology and Health Promotion at the NYU College of Dentistry, follows with a discussion of BThe Importance of Teaching Critical Thinking Early in Dental Education: Concept, Flow, and History of the NYU 4-Year Curriculum[ or how he fondly refers to it as the BMiracle on 24 Street: the EBD Version.[ Dr. Katz takes us through the evidence-based building process that occurs throughout the students’ education based on 3 principles: teach it early and large, teach it repeatedly, and teach it Bat the right level.[ While the skill of critical thinking related to the assessment of the professional literature is just one of many skills needed to practice evidence-based dentistry, he argues that it is one of the essential and fundamental skills needed by dentists in order to practice evidence-based dentistry I and one that is Bunder-valued by the profession, at-large[ as well as Bunder-taught in all dental schools.[ Dr. Forrest concludes with presenting the common themes running throughout the medical and dental literature that identify the required components of a successful curriculum and dental school environment. These include the need to teach evidence-based (EB) theoretical principles and all five skills in the EB process, the need to use relevant clinical scenarios in teaching the application of skills, and most importantly, the need to transition classroom simulations to routine practice on the clinic floor in making patient care decisions. Faculty development and support for making and implementing curricular changes also were identified as crucial elements, as was the importance of having the needed resources, time, and infrastructure.