expertise. This article presents a clinical case scenario and, using a four-step, evidence-based approach, demonstrates how to (1) ask an evidence-based question; ( 2 ) search MEDLINE for the best evidence; (3) critically appraise the evidence; and (4) apply the evidence to the patient. The procedure is demonstrated with the sample question, Does bleaching of bonded porcelain veneers increase marginal leakage? A MEDLINE search strategy was developed for synonyms of the key words that best identify the problem, the intervention, and the outcome. The synonyms were combined using the Boolean operator "oI-'' to identify a "sensitive" (i.e., inclusive) universe of 140,000 journal articles. These categories were then combined using the Boolean operator "and" to identify the most "specific" (i.e. ¶ exclusive) four articles from among the 140,000. Finally, to find the best evidence, the articles were limited to "humans" and "randomized controlled trials." This identified one article. Critical appraisal of the limited data in this one article indicates that the methods are valid and statistically significant, but because of the methods employed, may not be clinically important. Evidence-based methods take one to the edge of the available information universe in about 15 minutes. The results can be both exhilarating and sobering. They can indicate the depth or limits of available information and suggest gaps in the knowledge-base that require further study. Most importantly, however, the results allow practitioners to communicate incisively and truthfully with patients and to make more informed clinical choices.Evidence-based clinical practice integrates the best available evidence with clinical Evidence-based health care methodologies are now being employed in
Dental schools face challenges and competing needs when they seek to initiate or expand their community dental programs. This article uses a dental school community clinic as a case study to frame the tensions between competing needs of educational requirements, access to dental care, financial viability, and service to the community that clinics must learn to manage if they are to be successful. The identification of competing needs provides community-oriented dental school clinics the ability to examine factors that come into play as communities and their environments change. The outcome of this assessment process is strategies that can facilitate the provision of a higher level of services more efficiently, while at the same time taking into account future limitations in availability of resources. The concluding section of this article presents a model for a community-based dental clinic that is directed more toward patient care, involves dentists/specialists as primary providers, allows postdoctoral residents to take on more responsibility, and allows dental students to provide patient care on a more regular and longitudinal basis.
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