A standardized protocol for the comprehensive assessment of dental hygiene work.

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.

An umbrella review of systematic reviews examining the relationship between type 2 diabetes and periodontitis: Position paper from the Canadian Dental Hygienists Association.

Previous research has confirmed strong associations between periodontitis and diabetes mellitus (DM), supporting DM as a risk factor for periodontal disease and suggesting a bidirectional relationship. Causal relationships have not been confirmed. Aim: The aim of this paper is to review the most current evidence of the nature of this relationship and examine whether non-surgical periodontal therapy (NSPT) significantly lowers glycemic (HbA1c) control. Methods: The PICO question was, "For individuals with type 2 diabetes mellitus (T2DM) and periodontitis, will non-surgical periodontal therapy (NSPT), as compared to no treatment, improve the individual's glycemic control as measured by HbA1c." Only systematic reviews (SRs) with or without a meta-analysis (MA) of randomized controlled trials (RCTs) or umbrella reviews of SRs and MAs of RCTs published in the English language between 2007 and 2019 were included. Several databases were searched as per their protocols. Quality assessments were conducted by both authors using the PRISMA checklist. The Bradford Hill criteria were used to determine evidence for causality. Results: Of 54 records retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 5 SRs/MAs and 3 umbrella reviews of SRs/MAs were selected. All 5 SRs/MAs reported reductions in HbA1c levels 3 months following NSPT, but effect sizes were small and 2 were not statistically significant. The 3 umbrella reviews consistently reported small reductions in HbA1c, but high levels of heterogeneity and moderate to high risk of bias. The Bradford Hill criteria failed to support a causal relationship between periodontitis and T2DM. Conclusions: Whether NSPT compared with no treatment in persons with T2DM improves the individual HbA1c remains unclear as does the exact nature of the relationship between periodontitis and T2DM.

La recherche précédente a confirmé de fortes associations entre la maladie parodontale et le diabète sucré (DS), appuyant le DS comme facteur de risque de la maladie parodontale, et la suggestion d'un lien bidirectionnel. Des associations causales n'ont pas été confirmées. Objectif: Le présent document vise à examiner les données probantes les plus actuelles pour examiner la nature de ce lien et déterminer si la thérapie parodontale non chirurgicale (TPNC) diminue considérablement la régulation glycémique (HbA1c). Méthodologie: La question PICO était : « Les personnes souffrant de diabète sucré de type 2 (DST2) et de parodontite verront-elles une amélioration de leur régulation glycémique, telle que mesurée par la HbA1c, s'ils ont une thérapie parodontale non chirurgicale (TPNC) par rapport à ne pas obtenir de traitement? ¼ Seules les revues systématiques (RS) avec méta-analyses (MA) d'essais contrôlés randomisés (ECR) ou des examens-cadres de RS/MA d'ECR publiés en anglais entre 2007 et 2019 ont été inclus. Les recherches ont été effectuées dans plusieurs banques de données selon leurs protocoles respectifs. Des évaluations de la qualité ont été effectuées par les 2 auteures au moyen de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer les preuves de causalité. Résultats: Parmi les 54 dossiers repérés après l'élimination des doubles et des études qui ne répondaient pas aux critères d'inclusion, 5 RS/MA et 3 examens-cadres de RS/MA ont été sélectionnés. Les 5 RS/MA ont tous indiqué des réductions dans les niveaux de la HbA1c, 3 mois après la TPNC, mais l'ampleur de l'effet était faible et 2 d'entre elles n'étaient pas statistiquement significatives. Les 3 examens-cadres ont indiqué de façon uniforme de petites réductions dans la HbA1c, malgré des taux élevés d'hétérogénéité et un risque de biais de modéré à élevé . Les critères de Bradford Hill n'ont pas réussi à appuyer une relation causale entre la parodontite et le DST2. Conclusions: Il n'est toujours pas clair si la TPNC chez les personnes souffrant de DST2 améliore leur HbA1c, par rapport à ne recevoir aucun traitement, comme demeure inconnue la nature exacte du lien entre la parodontite et le DST2.

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and cardiovascular diseases: Position paper from the Canadian Dental Hygienists Association.

Previous position papers have confirmed associations between periodontal disease and cardiovascular disease. Causal associations have not been confirmed and have been the source of much confusion for oral health professionals and the public. Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease. Methods: 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 NSPT, lower their risk for cardiovascular diseases?" 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. Results: Of 53 cardiovascular disease studies retrieved, 7 met the inclusion criteria, of which 6 contained MAs. Results were mixed for various periodontal interventions lowering the risk for cardiovascular outcomes. Only one SR used cardiovascular events as a direct outcome; the other 6 used various surrogate measures. Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal disease and cardiovascular disease.

Les énoncés de position précédents ont confirmé des liens entre la maladie parodontale et les maladies cardiovasculaires. Des associations causales n'ont pas été confirmées et ont été la source de beaucoup de confusion pour les professionnels de la santé buccodentaire et la population. But: Étudier s'il y a suffisamment de preuves qu'un lien de causalité existe entre la maladie parodontale et les maladies cardiovasculaires. Méthodologie: La question PICO était : « Les adultes en bonne santé générale, qui ont reçu un diagnostic de parodontite, auront-ils une réduction de leur risque de maladies cardiovasculaires s'ils reçoivent une thérapie parodontale non chirurgicale (TPNC), en comparaison à ne pas recevoir de thérapie parodontale non chirurgicale? ¼ 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 d'essais cliniques. Des évaluations de la qualité ont été menées par les 2 auteurs à l'aide de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer la preuve de causalité. Résultats: Dans les 53 études repérées sur la maladie cardiovasculaire, 7 répondaient aux critères d'inclusion, et parmi celles-ci, 6 comprenaient des MA. Les résultats en matière de diminution du risque d'effets cardiovasculaires étaient mixtes selon les différentes interventions parodontales effectuées. Une seule RS a utilisé les effets cardiovasculaires comme résultat direct, les 6 autres ont employé diverses mesures de remplacement. Conclusions: L'analyse de critère de Bradford Hill n'a pas réussi à appuyer un lien de causalité entre la maladie parodontale et les maladies cardiovasculaires.

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and adverse pregnancy outcomes: A position paper from the Canadian Dental Hygienists Association.

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. Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal disease and adverse pregnancy outcomes. Methods: 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. Results: 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. Conclusion: 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. Objectiv: Étudier s'il y a suffisamment de preuves qu'un lien de causalité existe entre la maladie parodontale et les effets indésirables de grossesse. Méthodologie: 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? ¼ 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. Résultats: 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. Conclusion: 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.

An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal microbes and respiratory diseases: Position paper from the Canadian Dental Hygienists Association.

Previous position papers have confirmed to varying degrees associations between periodontal microbes and respiratory tract infections such as nosocomial or hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), and chronic obstructive pulmonary diseases (COPD). Causal relationships have not been confirmed and have been the source of much confusion for the medical and oral health professions. Aim: To investigate whether sufficient evidence exists for a causal relationship between periodontal microbes and respiratory diseases, with a focus on HAP and VAP. Methods: The PICO question was "For patients in hospitals, nursing homes or long-term care facilities who are at high risk for respiratory infections, will an oral care intervention such as toothbrushing, administration of antimicrobial agents, and/or professional care, as compared to no oral care intervention (or usual oral care) reduce the risk for respiratory infections?" Only systematic reviews (SRs) with or without a meta-analysis (MA) 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. Results: Of 47 respiratory studies retrieved, after elimination of duplicates and studies not meeting inclusion criteria, 10 SRs were selected, 9 of which included MAs. Although there was evidence that administration of chlorhexidine gluconate (CHX) reduced the risk for VAP, none existed for HAP. Limitations included inconsistencies among studies in population groups, CHX concentration, frequency of administration, number of applications, and insufficient evidence for use of povidone iodine or toothbrushing in ventilated patients. While some studies reported other patient-centred outcomes (i.e., ICU mortality, length of ICU stay or duration of mechanical ventilation), findings were positive only for cardiac surgery ventilated patients, who did not meet the inclusion criteria. Conclusions: Bradford Hill criteria analysis failed to support a causal relationship between periodontal microbes/oral health care and respiratory diseases such as pneumonia.

Les exposés de position précédents ont confirmé à des degrés différents les associations entre les microbes parodontaux et les infections des voies respiratoires telles que la pneumonie nosocomiale ou de contamination hospitalière (PCH), la pneumonie sous ventilation assistée (PVA) et les maladies pulmonaires obstructives chroniques (MPOC). Les relations de cause à effet n'ont pas été confirmées et ont été la source de beaucoup de confusion pour les professions médicales et de santé buccodentaire. Objectif: Déterminer s'il existe suffisamment de preuves qu'une relation de cause à effet existe entre les microbes parodontaux et les maladies respiratoires, en mettant l'accent sur la PCH et la PVA. Méthodologie: La question de PICO était : « Chez les patients hospitalisés, en maisons de soins infirmiers ou en établissement de soins de longue durée qui sont à risque élevé de subir des infections respiratoires, le fait d'obtenir une intervention de soins buccodentaires telle que le brossage dentaire, l'administration d'agents antimicrobiens ou de soins professionnels, par rapport à ne pas obtenir une intervention de soins buccodentaires (ou des soins buccodentaires habituels) réduira-t-il le risque d'infections respiratoires? ¼ Seules les revues systématiques (RS) avec ou sans méta-analyse (MA) d'essais contrôlés randomisés, publiées en anglais entre 2007 et 2019, ont été comprises. Les bases de données consultées comprenaient PubMed, MEDLINE, EbscoHost, CINAHL, Scopus, le Registre de revues systématiques Cochrane, et le Registre des essais cliniques. Les évaluations de la qualité ont été menées par les 2 auteurs à l'aide de la liste de vérification PRISMA. Les critères de Bradford Hill ont été utilisés pour déterminer les preuves de causalité. Résultats: Sur les 47 études respiratoires relevées, après élimination des doublons et des études ne répondant pas aux critères d'inclusion, 10 RS ont été sélectionnées, dont 9 comprenaient des MA. Bien que des preuves existaient que l'administration de gluconate de chlorhexidine (CHG) avait réduit le risque de PVA, il n'en existait aucune pour les PCH. Les limites comprenaient des incohérences parmi les études auprès des groupes de population, la concentration de CHG, la fréquence d'administration, le nombre d'applications, et l'insuffisance de preuves pour l'utilisation de povidone-iodine ou de brossage dentaire chez les patients ventilés. Bien que certaines études aient fait état d'autres résultats centrés sur le patient (p. ex., mortalité en USI, durée du séjour en USI ou durée de la ventilation mécanique), les résultats n'étaient positifs que pour les patients de chirurgie cardiaque ventilés qui ne répondaient pas aux critères d'inclusion. Conclusion: L'analyse des critères de Bradford Hill a échoué à soutenir un lien de cause à effet entre les microbes parodontaux ou les soins de santé buccodentaire et les maladies respiratoires telles que la pneumonie.

Characterization of Tasks and Time Efficiency of Dental Hygiene Students During Clinical Training.

Purpose: Dental hygiene graduates often experience significant psychological stress while transitioning from the educational setting to clinical practice environments. 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 dental hygiene education programs. Each participant was video recorded while providing patient care during 3 sessions, 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 education/training time points and by patient type.Results: Fifty-three videos were analyzed from nineteen participants. 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 the patient visit more quickly by the third time point, the percentage of non-dental hygiene activities did not decrease, and there were no associations between patient category type and the duration of the patient visit.Conclusion: Patient visits were roughly three times the length of the typical dental hygiene care appointment, 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 a successful transition to clinical practice.

Prevention and rehabilitation of musculoskeletal disorders in oral health care professionals: A systematic review.

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.

Identifying an Optimal Sampling Method to Estimate Postural Risk in a Dynamic Work Task.

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.

Systematic review and meta-analysis on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.

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.

Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis by means of scaling and root planing with or without adjuncts.

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.

Critical thinking in patient centered care.

UNLABELLED: 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.

Keeping current: a commitment to patient care excellence through evidence based practice.

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.

Translating evidence-based decision making into practice: appraising and applying the evidence.

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 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.