Evidence Based Dentistry Through Shared Clinical Research Data

As dentistry increasingly moves towards evidence-based and literature-based decision making for patient care, dental software has absolutely failed to keep up. Unlike in medicine, there is a lack of competing vendors who spur improvements in decision support dentistry. Few practices have or consider decision support software for clinical care. To support this critical information need, Epi-Info was modified to enable evidence-based dentistry across clinical research databases.

Dental schools, on the other hand, are earlier to adopt cost-saving innovations because they handle large numbers of dental students. As a result, dental schools have led the way in developing straightforward, integration-ready evidence databases that could enable software for decision support. Cochrane Collaboration reviews frequently do not include non-double blind studies or tentative findings, which restricts the knowledge available to dentists and does not fit the ADA’s definition of evidence-based research including all relevant medical information. Because of the ethics of dentistry, double-blind studies are less likely, and inappropriate in some cases.

Three researchers at Case Western Reserve University School of Dental Medicine collaborated to create a database for Evidence-Based Dentistry that would specifically encourage and allow dental schools throughout the United States to participate in improving practice and use of clinical research.

One major part of their effort was to define and provide metadata for a range of variables and fields of data. This effort provides a software interoperability standard that could be the basis for many systems to improve evidence-based data tracking and decisions. The prototype was designed for orthodontics in particular, but the authors stress that the method can be easily applied across fields.

As electronic records take hold in dentistry, this kind of effort and interoperability foresight will become more and more important in evaluation and selection of electronic health records for dentistry. Defined data fields that support dental tasks and decisions will be the basis for ongoing adoption, use and transfer of health data.

 

Lessons Learned:

  • Existing databases and reviews for evidence-based dentistry are insufficient.
  • Modification of the Epi-Info form has been done to create evidence-based dental records for orthodontics; the same method could be used for all other dental specialties.
  • As electronic records become the norm, standard data and interoperable, well-defined data in software will become more and more crucial as a selection and evaluation tool for purchasers.
  • Decision support and evidence-based dentistry go hand in hand, and dental schools will likely lead the transition to software capture and use, but improved standards of care will result.

Fisher, M. A., Beeson, D. C., & Hans, M. G. (2009). Dental practice network of U.S. dental schools. Journal of Dental Education, 73, 12, 1387-93.