Principles of evidence-based decision-making

Evidence-based medicine is defined as “the conscientious, explicit and judicious use of current best evidence about the care of individual patients integrated with clinical expertise and patient values to optimize outcomes and quality of life”. In the hierarchy of study designs used in clinical research, randomized controlled trials (RCTs), prospective controlled trials (CTs) and meta-analyses or systematic reviews (SRs) of RCTs are considered to provide the highest level of evidence. Conversely, uncontrolled studies like case series and case reports, as well as retrospective studies, due to the features of the study design and many methodological aspects that may somehow affect the outcomes, are considered to have a higher level of bias as compared to RCTs. The latter are specifically designed to minimize the experimental bias in any steps of the study procedures, so as to provide the most reliable possible outcomes. Since the volume of published information is steadily increasing, it is extremely important to assess the level of evidence of the publications, in order to discern which information should be relied upon to formulate an evidence-based treatment plan and provide the patients with the most accurate, up-to-date and trustworthy information. The purpose of this chapter is to provide the basis of the evidence-based dentistry in order to facilitate clinicians in their daily decision-making process.