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Evidence-based oral and maxillofacial surgery

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Dr.Ghazanfar Hassan/ Dr. Mirza Arsalan Baig

Dr.Ghazanfar Hassan/ Dr. Mirza Arsalan Baig

Mon. 26 May 2014

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Oral and maxillofacial surgery (OMFS) is a unique specialty that deals with the gentle structures of the facial skeleton, the oral cavity, and the neck. It requires dual skills in surgery and in dentistry. It is a demanding specialty that covers a broad spectrum extending from oral malignancies, facial injuries, facial deformities, and facial reconstruction to impacted third molars, dental implants, and generally minor oral surgery.

Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences. Its practice means integrating the best available external evidence from research with an astute clinician’s assessment of the individual patient’s circumstances. Doctors should use both clinical expertise and external research evidence; neither alone is enough. Otherwise, practice risks becoming tyrannized by evidence, because even excellent external “average” evidence may be inappropriate for an individual patient.

It is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral and medical health. Along with the surgeon's professional skill and expertise, it allows surgeons to stay up-to-date on the latest procedures and patients to receive improved treatment. A new paradigm for dental surgical education, designed to incorporate current research into education and practice was developed to help practitioners provide the best care for their patients.

"For the integration of best research evidence with clinical expertise and patient values”, the new model set by Evidence based OMFS, utilizes a systematic process to incorporate current research into practice. The evidence-based process requires the surgeons to develop skills to; formulate information needs/questions into four part questions to identify the patient, intervention, comparison and outcomes. Conduct an efficient computerized search of the literature for the appropriate type and level of evidence, Critically appraise the evidence for validity with an understanding of research methods, apply the results of the evidence to patient care or practice in consideration for the patient's preferences, values and circumstances, evaluate the process and your performance through self-evaluation.

The evidence-based OMFS has incorporated core competencies required by OMFS education programs. These competencies focus on graduates to become lifelong learners and consumers of current research findings and require students to develop skills that are reflective of evidence-based OMFS.

A surgeon’s learning curve for using the evidence-based process can be steep, but there are continuing education courses, workshops and tools available to simplify the integration of current research into practice.

Without the current best evidences, practice risks becoming unjustified. Studies that provide external evidence for clinical practice applications can be grouped according to their design. Although the design to get the best evidence depends mainly on the question we want to answer, it is generally accepted that meta-analyses and systematic reviews of randomized, controlled trials (RCTs), and RCTs themselves, have the greatest relevance to the clinical setting. Randomized, controlled trials and meta-analyses, when designed, executed, and reported properly, are considered to provide the highest-quality evidence for the majority of clinical or interventional questions. Cohort studies, case-control studies, case series, basic and laboratory research, expert opinions, and nonsystematic reviews comprise the remaining research designs. The OMFS literature suffers from a relative shortage of high-quality evidence. More, larger, adequately powered, and better reported RCTs are required. Journals, Institutions and oral and maxillofacial surgeons should all cooperate in the achievement of this objective.

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