He@lth Information on the Internet

Guide to dental resources on the Internet

Web sites to help dentists keep up-to-date with advances in dentistry and
to manage patients with complex needs and demands.

This article is the second in a series of articles on the subject of dental resources on the Internet. Keeping up-to-date with
advances in dentistry and being able to manage patients who have complex needs and demands is a challenge for practising
dentists. Dentists are inundated with information about new techniques, procedures, materials and products. The Internet is
rapidly becoming a valuable source of information for all healthcare professionals, as well as for patients. However,
information on the Internet can be uncontrolled and is generally unevaluated and seeking the relevant information can be
time consuming, confusing and frustrating. Busy practitioners looking for evidence for patient care need resources that have
been identified and validated if the Internet is going to be a practical tool for evidence-based dentistry. There are, however,
a number of well-developed, highly credible and useful resources available online that provide evidence-based information.

Currently, many healthcare decisions wide. It produces and disseminates oral health and there are direct links to
are based principally on values and systematic reviews of healthcare the abstracts. This Web site provides
opinions – opinion-based decision- interventions and promotes the search information about ways to get
making. This is now changing. As the for evidence in the form of clinical trials involved with Cochrane and also lists
pressure on resources increases, and other studies of interventions’. A information about courses in
decisions will have to be made major product of the collaboration is evidence-based practice in dentistry.
explicitly and publicly. The healthcare the Cochrane Database of Systematic
decision-maker (i.e. anyone who Reviews <www.nelh.nhs.uk/ Centre for Evidence-Based
makes decisions about groups of cochrane.asp> which is a rapidly Dentistry
patients or populations) will have to growing collection of regularly
practise evidence-based decision- updated, systematic reviews of the The Centre for Evidence-Based
making. Every decision will have to be effects of healthcare, maintained by Dentistry <www.cebd.org> is a
based on a systematic appraisal of the contributors to the Cochrane comprehensive Web site dedicated to
best evidence available. First of all, Collaboration. In systematic reviews developing and promoting evidence-
the best evidence available relating to evidence is included or excluded on the based dentistry world-wide. This
a particular decision must be found. basis of explicit quality criteria to organisation, based in Oxford, is a
Thus, as the pressure on resources minimise bias. Data are often combined central resource for dentists interested
increases, there will be a transition statistically, with meta-analysis in evidence-based practice. It is well
from opinion-based decision-making techniques, to increase the power of the organised and has good links to other
to evidence-based decision-making. findings of numerous studies each too centres, books and journals, teaching
Evidence-based healthcare is an small to produce reliable results tools, guideline sites, search sites and
approach to decision-making in which individually. The database is published discussion lists. In the tools section,
the clinician uses the best evidence in the Cochrane Library, which is freely there are aids for teaching and learning
available to decide upon which available to NHS staff, patients and the evidence-based skills. This useful site
treatment option best suits the patient. public in England through the NeLH. also offers a link to the Journal of
This article will focus upon evidence- The abstracts of the Cochrane Reviews Evidence-Based Dental Practice.
based dentistry and the Web sites can be browsed or searched and
which we have found to be the most provide a valuable source of healthcare Centre for Evidence-Based
helpful for learning, teaching and information. Medicine
practising evidence-based care.
Also based in Oxford is the Centre
The Cochrane Oral Health Group for Evidence-Based Medicine
The Cochrane Collaboration <www.cebm.net>. This extensive Web
The Cochrane Oral Health Group
‘The Cochrane Collaboration <www.cochrane-oral.man.ac.uk>, based site provides authoritative inform-
<www.cochrane.org> ‘is an international in Manchester, ‘aims to produce ation on a range of issues related to
non-profit and independent organis- systematic reviews which primarily evidence-based healthcare and
ation, dedicated to making up-to-date, include all randomised controlled provides support and resources to
accurate information about the effects trials … in oral health’. This Web site anyone who wants to make use of
of healthcare readily available world- lists reviews and protocols relevant to them. Of particular interest here is the

APRIL 2005 3
He@lth Information on the Internet
CATbank. ‘The CATbank is a storage interventions and to publish the provides generic training in conduct-
and retrieval facility for a collection of results as simply as possible. ing systematic reviews in oral
CATs (Critically Appraised Topics)’. Information comes from systematic healthcare.
A CAT is a document that is created reviews, meta-analyses, randomised
in response to a clinical question. It trials and high quality observational National Institute for Clinical
summarises an individual item of studies. Excellence (NICE)
evidence and presents the results in
an easily understood form. CONSORT NICE <www.nice.org.uk> issues
guidance on current ‘best practice’ to
The CONSORT statement the NHS. It issues ‘recommendations
Evidence-Based Dentistry
<www.consort-statement.org> ‘is an on treatments and care using the best
Evidence-Based Dentistry important research tool that takes an available evidence’. It has guidelines
<www.nature.com/ebd> is a joint evidence-based approach to improve on wisdom tooth removal and dental
publication of the British Dental the quality of reports of randomized recall frequency.
Association and the Nature trials’. It provides guidelines for
Publishing Group. It helps clinicians reporting the findings of a randomised Scottish Intercollegiate
keep abreast of the best available control trial. It includes a 22-item Guidelines Network (SIGN)
evidence in the latest developments in checklist and a flow diagram which
various aspects of clinical dentistry. will enable readers to understand A collection of evidence-based clinical
The review articles are summarised exactly what happened in a guidelines <www.sign.ac.uk> all of
succinctly and are commented on by randomised control trial in a quick and which can be downloaded free of
experts. Subscriptions to the journal organised way. The guidelines help the charge, covering a wide range of
include online access to all issues from reader judge the eligibility and the topics from all the medical specialties.
1988. Non-subscribers have access to relevance of the study’s findings.
abstracts online. Netting the Evidence
CASP Netting the Evidence <www.
PubMed nettingtheevidence.org.uk> ‘is
CASP (Critical Appraisal Skills
PubMed <www.ncbi.nlm.nih.gov/ Programme) <www.phru.nhs.uk/casp/ intended to facilitate evidence-based
entrez> is a service of the U.S. casp.htm> is a UK project which aims healthcare by providing support and
National Library of Medicine. It to develop skills in critical appraisal access to helpful organisations and
‘includes over 15 million citations of evidence about the effectiveness useful learning resources, such as an
for biomedical articles back to the of the delivery of evidence-based evidence-based virtual library,
1950’s. These citations are from healthcare. CASP offers workshops, software and journals’. The site is well
MEDLINE and additional life introducing people to the ideas of organised into the relevant subject
science journals. PubMed includes evidence-based medicine, systematic areas and links to each topic are
links to many sites providing full reviews and the Cochrane available on each page.
text articles and other related Collaboration. There is also a
resources.’ The MEDLINE database network which aims to share ideas SUMMARY
is the primary component of and good practice on how to find
PubMed, covering medicine, evidence of clinical effectiveness, The Internet is an important source of
nursing, dentistry, veterinary critically appraise it and act on this information for all healthcare
medicine, healthcare systems and evidence. professionals; as well as for the
preclinical sciences. It includes consumers of healthcare. There are a
references to articles from 1966 to number of well-developed, highly
International Centre for reliable and useful resources available
the present. New citations are added Evidence-Based Oral Health
weekly. The database has an easy to online that provide excellent
use, integrated, text-based search The International Centre for Evidence- evidence-based information.
and retrieval system. Based Oral Health Although these sites are good, there is
<www.eastman.ucl.ac.uk/iceph> is still a need to work through these
based at the Unit of Periodontology, sites separately. Future developments
Bandolier may include the creation of a ‘super-
Eastman Dental Institute, University
Bandolier <www.jr2.ox.ac.uk/bandolier> College London. It is ‘a research-based site’ which contains all the relevant
is ‘an independent journal about organisation developing the best information to save trawling through
evidence-based healthcare’. The evidence for prevention, diagnosis several different sites.
electronic version has over one million and treatment in oral healthcare with The principles of evidence-based
visitors per month and is a source of a particular interest in periodontal dentistry – finding the best information
high quality information for diseases and implantology’. This Web quickly when it is needed, assessing its
healthcare professionals and patients. site provides several fully quality and determining its relevance –
The impetus behind Bandolier was to downloadable systematic reviews and will help clinicians to use research
find information about evidence of the other publications focusing on evidence in making all their important
effectiveness of healthcare periodontology. The centre also everyday clinical decisions.

4 APRIL 2005