Evidence-based diagnosis and clinical decision making

Abstract

The application of evidence-based dentistry to diagnosis should result in a reduction of errors in decision making. The frequency of errors is dependent not only on the accuracy of a diagnostic test for pathology, but also on the prior chance of disease being present. If this chance is low and below a certain threshold, then, for example, applying a diagnostic test can result in more decision errors and therefore inappropriate treatment than omitting to use the test. In deciding on the usefulness of a diagnostic test an additional factor to take into account is the relative value of the possible health states resulting from diagnosis and subsequent therapy. These can be determined by eliciting from the patient the numerical values of the possible dental health conditions using a visual analogue scale technique. Clinical decision analysis can then be carried out to calculate the most appropriate diagnostic strategy for the patient. Clinical decision analysis is starting to influence the development of guidelines for the diagnostic use of radiographs although its application in dentistry needs further refinement and development.

Implant-associated cracked teeth: case series

“…In addition, the diagnosis of cracked teeth is not straightforward because the symptoms are diverse, and crack lines may be difficult to identify (Kang et al 2016). Thus, the detection of the dentinal crack requires a valid gold standard method (Tsesis et al 2010a;Tsesis et al 2010b;Mileman and van den Hout 2009). In the present study, the gold standard method selected for verification of the cracked tooth was confirmation by visual examination using magnification and illumination and removal of coronal restorations for observation and staining using methylene blue dye when indicated (Kang et al 2016).…”

Classifying scientific evidence as the basis for evidence-based decision making: is strength of evidence absolute?

“…Since the introduction of LOE, several other organizations have adopted various classification systems, most of which share a lot in common (Bossuyt & Leeflang 2008;Gutmann 2009;Mileman & van den Hout 2009;Reitsma et al 2009;Rosenberg & Donald 1995;Suebnukarn et al 2010;Sutherland & Matthews 2004;Zwahlen et al 2008;Burns et al 2011; Canadian Task Force on the Periodic Health 1979). To-date, classification systems such as the system presented by the "Oxford Centre for Evidence-Based Medicine" (Oxford Centre for Evidence-based Medicine -The Oxford 2011) attempt to provide comprehensive hierarchical grading for classifying scientific evidence (Bossuyt & Leeflang 2008;Gutmann 2009;Mileman & van den Hout 2009;Reitsma et al 2009;Rosenberg & Donald 1995;Suebnukarn et al 2010;Sutherland & Matthews 2004;Zwahlen et al 2008;Burns et al 2011; Canadian Task Force on the Periodic Health 1979; Tsesis et al 2009). …”

“…The traditional hierarchical systems of classifying the evidence primarily use the study design as the basis for the grading process (Bossuyt & Leeflang 2008;Gutmann 2009;Mileman & van den Hout 2009;Reitsma et al 2009;Rosenberg & Donald 1995;Suebnukarn et al 2010;Sutherland & Matthews 2004;Zwahlen et al 2008;Burns et al 2011; Canadian Task Force on the Periodic Health 1979; Tsesis et al 2009). A clinical study may be experimental (interventional) or observational.…”

“…These observations are done either by looking forward and gathering new data (prospective), or by collecting already existing data (retrospective studies) (Sutherland 2001). As an example of the levels of evidence, in practically all LOE classification systems Randomized controlled trials (RCTs) are considered as a high LOE, as opposed to Case reports and Case series that are considered as a low LOE (Bossuyt & Leeflang 2008;Gutmann 2009;Mileman & van den Hout 2009;Reitsma et al 2009;Rosenberg & Donald 1995;Suebnukarn et al 2010;Sutherland & Matthews 2004;Zwahlen et al 2008;Burns et al 2011; Canadian Task Force on the Periodic Health 1979; Sutherland 2001; Tsesis et al 2009). …”

“…It has been stated that "not all evidence is created equal" (Cochrane Consumer Network -Levels of evidence), and it has been recommended to grade the available literature by the strength of evidence as determined by the methods used to minimize bias within a study design (Cochrane Consumer Network -Levels of evidence; Bossuyt & Leeflang 2008;Gutmann 2009;Mileman & van den Hout 2009;Reitsma et al 2009;Rosenberg & Donald 1995;Suebnukarn et al 2010;Sutherland & Matthews 2004;Zwahlen et al 2008). A cornerstone of this appraisal process is the use of hierarchical systems for classifying the evidence.…”