Based on evidence-based dentistry (EBD) being a relatively new concept in dentistry, the attitudes, perceptions and level
of awareness of dentists regarding EBD, and perceived barriers to its implementation into daily practice, were compara-
tively analysed in six countries of the FDI (World Dental Federation-Federation Dentaire Internationale)-European Regio-
nal Organization (ERO) zone (France, Georgia, Poland, Portugal, Slovakia and Turkey). For this purpose, a
questionnaire, The Relationship Between Dental Practitioners and Universities, was developed by the FDI-ERO Working
Group and applied by National Dental Associations (NDAs). A total of 850 valid responses were received, and cumulative
data, comparisons between countries and potential impact of demographic variables were analysed. Regarding EBD, simi-
lar percentages of respondents reported that they know what it is (32.8%) and they practice (32.1%). Most respon-
dents believed that EBD is beneficial (89.1%); however, they had different thoughts regarding who actually benefited
from EBD. Of the participants, 60% believed that dentists experience difficulties in implementing EBD. Although lack
of time, lack of education and limited availability of evidence-based clinical guidelines were among the major barriers,
there were differences among countries (P < 0.05). Significant differences were also observed between countries regarding
certain questions such as where EBD needed to be taught (P < 0.05), as both undergraduate and continuing education
were suggested to be suitable. Age, practice mode and years of practice significantly affected many of the responses
(P < 0.05). There was a general, positive attitude toward EBD; however, there was also a clear demand for more
information and support to enhance dentists knowledge and use of EBD in everyday practice and a specific role for the
NDAs.
to transfer this to everyday practice2. Thereby, resolv- another study conducted among dentists in Kuwait, it
ing the discrepancies between clinical research and was revealed that the overall awareness of EBD was
dental practice might be possible4. low, and clinical decisions appeared to be mostly
Evidence-based dentistry provides significant advan- based on the clinicians own judgment rather than on
tages to dentists, patients, the dental team and dental evidence-based sources. A majority of respondents
practice1,5. Dentists who make evidence-based clinical highlighted the need for education in EBD12. Positive
decisions have been shown to be able to continuously attitudes towards EBD were also observed among
improve their clinical skills and performance. They dental professionals in Sweden9. Although these stud-
can improve the quality and outcomes of the treat- ies attempted to assess awareness and implementation
ment by making decisions based on the best evidence of EBD among different groups of clinicians, to the
with regard to treatment outcomes and cost-effective- best of the authors knowledge, there is limited evi-
ness after considering patient preferences1,4,6,7. The dence regarding awareness and perceptions of den-
patients, who know that they will be treated in an evi- tists, from different countries within the FDI-ERO
dence-based practice, can feel more confidence and zone, towards EBD.
trust in their dentist1,8. With regard to the dental Therefore, the primary aim of this study was to per-
team, staff confidence, trust and personal satisfaction form a comparative evaluation of the awareness, atti-
can be increased by implementation of evidence-based tudes and practice of EBD, and perceived barriers to
practice. Thus, clinicians can provide interventions its use, by dentists in France, Georgia, Poland, Portu-
that are scientific, safe, efficient and cost-effective. gal, Slovakia and Turkey. The potential factors affect-
Evidence-based practice is a widely accepted term ing the perception, attitudes and practice of dentists
in medical fields worldwide; in dentistry, however, it were also analysed.
has evolved over the past two decades and is still an
emerging concept4,6,9. Although the concept appears
METHODS
fundamentally simple and reasonable, dentists have
been slow to translate current science into dental A questionnaire, The Relationship Between Dental
practice10,11. A number of studies have been Practitioners and Universities, was developed by the
performed to investigate the extent and mode of prac- World Dental Federation-European Regional Organi-
titioners adoption of EBD and the described barriers zation (FDI-ERO) Working Group to determine the
to its implementation in countries around the perceptions, awareness and attitudes of dentists
world4,9,12,13. regarding EBD and the implementation of EBD in
In several studies conducted among general dental daily practice. The questionnaire had an introductory
practitioners, a low level of familiarity with evidence- section describing the background of the questionnaire
based practice was found. Most respondents currently and its aims (Figure 1).
seek advice from their peer colleagues when faced This introduction was followed by nine closed
with clinical uncertainties. Furthermore, only a small questions aiming to analyse implementation of EBD
number of dentists could correctly define EBD and the into daily dental practice. In general, the issues
various terms used in the field of EBD. The major focused on whether the dentists are familiar with
barrier reported, by general dentists, to the practising EBD; if EBD is implemented in daily practice; if it is
of EBD was lack of time; however, a desire to find taught and, if so, when [e.g. undergraduate dental
out more information on EBD was also observed4,12. education (UDE) or continuing dental education
In a study conducted by Madhavi et al.14 to evaluate (CDE)]; if there are obstacles to its effective imple-
EBD in orthodontics, it was reported that orthodon- mentation in practice; and if there is a perceived role
tists generally had positive attitudes towards evidence- in the field of EBD for the National Dental Associa-
based practice. However, understanding the concept tions (NDAs), as expressed by the individual dentists
was poor, and awareness and understanding were (e.g. organising courses, developing clinical guidelines
influenced by age and educational level. Other barri- and others) (The questionnaire is shown in Figure 1).
ers identified to practising EBD were the publication The study was conducted in six countries of the FDI-
of ambiguous literature, lack of clinical guidelines and ERO zone (France, Georgia, Portugal, Slovakia, Tur-
practical demands of work. key and Poland), volunteered by their NDAs. The
Other studies were also conducted to evaluate the survey was either placed on the websites of each of
levels of awareness and implementation of EBD these NDAs or was emailed to the member dentists
among dentists in different countries8,9,12. As an by the relevant NDAs. Participants of the survey were
example, EBD was not a well-known concept among voluntary responders.
Malaysian dental practitioners. However, a majority The data were entered on a spreadsheet and the fre-
of the respondents had positive attitudes, interest and quency distribution of the responses was calculated. For
a desire to learn further information about EBD8. In data analyses, the chi-square test was used (P < 0.05)
128 2015 FDI World Dental Federation
Implementation of EBD into practice
using the SPSS Statistics for Windows Version 19.0 comparison of age groups. Similarly, years of practice
(IBM Corp., Armonk, NY, USA). was categorised as 010, 1120, 2130 and 31.
For analysis of cumulative data from the six coun- In the questionnaire, kind of practice was evalu-
tries, the percentage of responses to each question- ated under three categories, as follows: (i) General
naire item was calculated. To compare awareness, practice, or Specialist in dentistry; (ii) Private or pub-
perceptions, practice and perceived barriers of dentists lic or Public and private; and (iii) Solo practice, or
from different countries towards EBD, pairwise com- Solo practice in a medical clinic, or Group practice (in
parisons of countries were performed using the chi- a dental clinic with other dentists), or Group practice
square test (P < 0.05). (in a medical clinic with other dentists), or University
The potential factors, including age, gender, years of faculty member (private university), or University fac-
practice and type of practice, affecting the perception, ulty member (public university). In the third category,
attitudes and practice of dentists were also analysed to obtain an adequate sample size for statistical analy-
using the chi-square test (P < 0.05). From the question- sis, the subcategories were combined into Solo prac-
naire, age of the respondents was obtained and cate- tice, Group practice or University faculty member,
gorised as 2030, 3140, 4150 and 51 for which enabled us to evaluate further the potential
(b)
3. Do you believe that evidence-based dentistry should be taught in:
a) Undergraduate dental education (UDE)
b) Continuing dental education (CDE)
c) No idea for UDE
d) No idea for CDE
e) No idea for both
5. If yes, who benefits from evidence-based dentistry and its implementation to dental practice?
a) Dentists
b) Patients
c) Public
d) Dental profession
e) Others (please specify)
7. If yes, what are the barriers to implementation of evidence-based dentistry into practice?
(more than one option)
a. Lack of time
b. Lack of financial incentives
c. Lack of necessary education on evidence-based dentistry
d. Lack of necessary publications on evidence-based dentistry
e. Lack of necessary web sites on evidence-based dentistry
f. Lack of evidence-based clinical guidelines for dental care
g. Lack of evidence-based clinical decision support systems
h. Limited evidence available in the dental field
i. Lack of awareness on evidence-based dentistry
j. Lack of continuing education courses on evidence based dentistry
k. Evidence-based dentistry being perceived as time consuming
I. Lack of practical ways to reach to best evidence
m. Limited knowledge regarding the quality of evidence {approval of evidence)
n. Others (please specify) ...................................................................................... ........
8. What is the role of Notional Denial Associations in improvement of the implementation of evidence
based dentistry in practice? (more than one option)
a. Creating awareness
b. Developing evidence based clinical guidelines
c. Developing evidence based clinical decision support systems
d. Organizing continuing education courses on evidence based dentistry
e. Negotiating with the authorities for financial incentives to foster implementation of evidence
based dentistry into practice
f. Attempts to overcome the barriers to implementation of evidence-based dentistry into practice
g. Others (please specify)
h. None
9. Do you believe that dental faculties and National Dental Associations can collaborate for
implementation of evidence-based dentistry into practice?
a) Yes b) No d) No idea
Thank you very much for your kind time and support
Figure 1. (Continued)
impact of mode of various practice models on the gender, years of practice and type of practice were
perceptions and attitudes towards EBD. different, and therefore the distribution of respon-
dents according to these demographic variables was
calculated on the basis of response rates. Regarding
RESULTS
age, responders were evenly distributed between 20
A total of 850 responses were received from France, and 50 years of age; in addition, 21.2% (n = 178) of
Georgia, Portugal, Slovakia, Turkey and Poland. dentists were 51 years of age. Gender was also
Demographic characteristics of participants, expr evenly balanced, although female dentists were
essed as number and frequency (percentage), are slightly more represented (n = 441; 52.9%). Most
given in Table 1. Of the 850 valid responses dentists who responded to the questionnaire were
obtained, most were from Portugal (n = 352; general practitioners (n = 675; 81.6%), working solo
41.4%), followed by Turkey (n = 209; 24.6%) and (n = 400; 48%) and in private practice (n = 644;
Poland (n = 145; 17.1%). Response rates to age, 77.5%).
130 2015 FDI World Dental Federation
Implementation of EBD into practice
Table 1 Demographic data (n = 850) faculties and NDAs can collaborate for effective
implementation of EBD into practice.
Characteristics Number Frequency (%)
Country
France 52 6.1 Data based on individual countries
Georgia 28 3.3
Portugal 352 41.4 Varying numbers of dentists from the six participating
Slovakia 64 7.5 countries responded to the question About evidence
Turkey 209 24.6
Poland 145 17.1
based dentistry (Table 3a,b). Over 42% of Portu-
Age (years) guese dentists practice EBD and there was no dentist
2030 years 203 22.2 in that country who had no idea about EBD
3140 years 235 28.1
4150 years 222 26.5
(Table 3a). The percentage of dentists from Turkey
51 years 178 21.2 who gave the response I practice was significantly
Gender lower (P < 0.05) than those in France, Portugal and
Male 393 47.1
Female 441 52.9
Poland (Table 4; Figure 3). All Portuguese dentists
Years of practice learned about EBD during their UDE, whereas more
010 years 323 39.3 than half of Georgian and French dentists were
1120 years 235 28.7
2130 years 185 22.3
trained in EBD during CDE. Statistical comparison of
31 years 87 10.5 countries regarding the question Has EBD been
Kind of practice taught to you in generally revealed significant differ-
General practitioner 675 81.6
Specialist 152 18.4
ences between counties (Table 4). In all countries, at
Kind of practice least half of the respondents believed that EBD
Private 644 77.5 should be taught in UDE (Table 3a). All dentists
Public 39 4.7
Private and public 148 17.8
from Portugal and Georgia who were questioned
Kind of practice thought that EBD is beneficial, and 7690% of den-
Solo 400 48 tists from other countries agreed. Only one-third of
Group practice 365 44
University 62 7.6
French, Georgian and Slovakian dentists had been
Others 3 0.4 taught that dentists get most benefits from imple-
menting EBD, whereas this was the opinion of nearly
99% of Portuguese colleagues (Table 3a). Except for
dentists from Portugal, about 2529% of the respon-
dents from five countries had been taught that
Overall data from six countries
patients benefit from EBD and its implementation in
Table 2 presents the response to each question given dental practice. The benefits of EBD to the public
by the total study group without stratification and dental profession were most frequently reported
according to demographic variables. Regarding EBD, by Turkish dentists (26.3% and 26.9%, respectively).
similar percentages of respondents reported that they About 70% of French and Polish dentists felt difficul-
know what it is (32.8%) and I practice (32.1%) ties in implementing EBD, which was in contrast to
(Figure 2). The reported level of learning of EBD Georgian dentists (30%) (Table 3a). Statistically sig-
was 41.9% and 29.3% for undergraduate dental nificant differences (P < 0.05) were found between
education and continuing dental education, respec- Georgia and Portugal, Portugal and Poland, and
tively. However, the majority of respondents (71%) Turkey and Poland (Table 4). Regarding the ques-
thought that EBD should be taught in UDE. A large tion what are the barriers to implementation of
proportion of the respondents (89.1%) believed that EBD into practice?, dentists from Slovakia reported
EBD was beneficial (Figure 2). However, 60% of lack of time as the most frequent barrier in imple-
the respondents believed that dentists experience dif- mentation of EBD. For Portuguese dentists, lack of
ficulties in implementing EBD, and they reported dif- time was not so important as in other countries
ferent barriers to implementation of EBD into (P < 0.001). In other countries, lack of necessary
practice. The most common reason for limited education on EBD was the most frequent response,
implementation was lack of necessary education, although lack of awareness was also emphasised
followed by lack of time. For the respondents, (Table 3a). The most frequently reported role of
NDAs were expected to improve the implementation NDAs in improvement of the implementation of
of EBD in practice by creating awareness (22.7%) EBD by French, Georgian, Slovakian and Polish
and organising continuing education courses on dentists was creating awareness. The most popular
EBD (21.3%). Desire for developing evidence-based response of dentists from Portugal and Turkey was
clinical guidelines was reported by 18.2% of the organising continuing education courses on EBD.
respondents, of whom 85% believed that dental About 90% of dentists from France, Georgia, Portu-
2015 FDI World Dental Federation 131
Yamalik et al.
gal and Poland believed that dental faculties and taught to younger dentists in UDE, whereas EBD was
NDAs can collaborate for implementation of EBD taught to older dentists in CDE, and a higher propor-
into practice, and 70% of dentists from Slovakia tion of young dentists practised EBD compared with
and Turkey agreed with this response (Table 3a). older dentists (Figure 4). Younger dentists more fre-
quently believed that generally EBD is beneficial
compared with older dentists, and this finding was
Data regarding the potential impact of variables on
statistically significant (P < 0.05) (Table 5). Lack of
perceptions and attitudes towards EBD
time was listed as a barrier more often among young
Data analyses with regard to the variables age and dentists. The lack of financial incentives seemed to
year of graduation from dental school revealed be less important for dentists with more years in
similar findings between countries regarding having practice compared with those with fewer years in
knowledge about EBD (Table 5). The statistical practice (Figure 5). Gender did not have significant
results of these two variables indicate that EBD was effect on the respondents awareness perceptions and
132 2015 FDI World Dental Federation
Implementation of EBD into practice
"Do you believe that generally EBD is benecial" "About evidence based denstry"
No idea
No idea
8.3% 13.9% I know
No what it is
2.6% 32.8%
Densts should
pracce it
21.2%
I pracce
Yes 32.1%
89.1%
(a) (b)
Figure 2. Frequency distribution of the total study population responses to (a) Do you believe that generally EBD is benecial? and (b) About evi-
dence based dentistry.
behaviour regarding EBD; however, the responses effective national/regional/global strategies for imple-
obtained from general practitioners were significantly menting EBD into practice.
different compared with those obtained from special- It was encouraging to note that when dentists were
ists in the aspects awareness (P = 0.002), practice asked about EBD, most respondents reported familiar-
(P = 0.004) and find EBD beneficial (P < 0.001). ity and positive attitudes. Furthermore, 89.1% believed
Specialists also reported that they had received educa- that EBD is beneficial. This finding, which is inconsis-
tion on EBD during CDE (40.3%) rather than UDE tent with previous studies4,8,9, is important because it
(15.3%) (Table 5). Dentists working in public health- might reflect the high demands of modern-day dentists
care services reported lack of time as the significantly for best practice and clinical decision making. How-
(P < 0.001) most important barrier in implementation ever, the percentage of dentists practising EBD (32.1%)
of EBD compared with private practice dentists. Uni- was rather low among all respondents, in the absence
versity members (36.6%) were more likely to practise of stratification according to country and other demo-
EBD (P < 0.001) compared with solo (48%) and graphic variables (Figure 2), which also seems to be an
group (44%) practising dentists. important finding that needs to be taken into consider-
ation.
The reasons for not adopting EBD in their daily
DISCUSSION
practice might include the following: EBD is still an
Evidence-based medicine is the conscientious, explicit emerging concept and therefore the benefits of EBD in
and judicious use of current best evidence in making providing best practice are not known; poor under-
decisions about the care of individual patients. The standing of evidence-based concepts by clinicians; and
practice of evidence-based medicine means integrating difficulties experienced by dentists in implementing
individual clinical expertise with the best available EBD10,11. The last potential reason was confirmed by
external clinical evidence from systematic research20. 60% of respondents in this study. As identifying
Compared with medicine, evidence-based practice in barriers is an important step towards increasing evi-
dentistry is a relatively new concept that has evolved dence-based practice in dentistry, several studies were
during the past 1520 years and continues to conducted to identify these barriers4,8,9,11,14. In line
evolve13,21. A number of previous studies have evalu- with previous studies, the most frequently noted barri-
ated the level of awareness, and attitudes and practice ers were lack of education on EBD, lack of time and
of dentists of EBD, and described barriers to its imple- lack of clinical guidelines for dental care4,8,9. Other
mentation4,8,2224. These international reports provide frequent barriers reported in the reports were the
evidence that the concept of EBD has different levels ambiguous and conflicting nature of the literature, the
of awareness and adaptation amongst various groups demands of work, financial constraints and poor
of clinicians. However, to the best of the authors availability of evidence4,8,9. Spallek et al.11 identified
knowledge, there are currently very little data on a barriers previously not emphasised in the literature,
target population consisting of several FDI-ERO zone such as fear of criticism by colleagues or lack of confi-
countries, together with the determination of the dence in the research results. They performed a
potential impact of a number of sociodemographic comprehensive survey on barriers to implementing
factors on evidence-based practice. Thus, the findings EBD of early adopters. The survey included analysing
of the present study might be useful for designing barriers under the subtitles of associated with patient,
2015 FDI World Dental Federation 133
Table 3 (a) Percentages of respondents according to each variable and (b) Data based on age, gender, years of practice and kind of practice
134
Country Age range, Gender Years of Kind of practice
(n/%) years (n/%) (n/%) practice (n/%) (n/%)
Yamalik et al.
51
France
Georgia
Portugal
Slovakia
Turkey
Poland
20 30
31 40
41 50
Male
Female
0 10
11 20
21 30
31 over
General practitioner
Specialist
Private
Public
Private and public
Solo
Group practice
University
(a)
Q1
I know what it is 28/41.2 13/46.4 87/31.1 27/33.8 62/31.6 44/30.3 64/33.2 71/33.3 71/34.6 52/28.6 120/30.9 141/34.8 99/32.6 74/34.3 60/34.1 37/40.7 195/31.8 62/36 194/32.8 15/34.1 50/32.5 136/35.8 106/31.3 18/26.9
I practice 21/30.9 9/32.1 118/42.1 18/22.5 40/20.4 50/34.5 63/32.6 79/37.1 59/28.8 55/30.2 131/33.8 123/30.4 106/34.9 70/32.4 51/29 25/27.5 192/31.3 63/36.6 183/30.9 13/29.5 57/37 100/26.3 120/35.4 33/49.2
Dentists should 12/17.6 4/14.3 75/26.8 14/17.5 46/23.5 18/12.4 46/23.8 37/17.4 44/21.5 42/23.1 82/21.1 86/21.2 67/22 43/19.9 37/21 21/23.1 145/23.6 24/14 138/23.3 8/18.2 22/14.3 73/11.3 81/28.9 12/17.9
practice it
No idea 7/10.3 2/7.1 0 21/26.3 48/24.5 33/22.8 20/10.4 26/12.2 31/15.1 33/18.1 55/14.2 55/13.6 32/10.5 29/13.4 28/15.9 20/22 82/13.4 2313.4 77/13 8/18.2 25/16.2 71/23.7 32/9.4 4/6
Total 68 28 280 80 196 145 193 213 205 182 388 405 304 216 176 91 614 172 592 44 154 380 339 67
Q2
UDE 8/14.8 1/3.6 148/100 13/19.4 26/14.1 67/25.5 79/30.2 84/52.5 67/38.1 32/21.5 115/37.2 148/47.4 126/60.3 77/43 47/31.5 12/10.6 222/47.7 40/26.7 193/43.8 7/18.9 63/45 120/36 121/51.3 21/43.8
CDE 33/61.1 16/57.1 0 26/38.8 51/27.7 57/39.6 26/19.1 38/23.8 63/35.8 56/37.6 89/28.8 91/29.2 39/18.7 54/30.2 58/38.9 29/36.3 108/23.2 73/48.7 111/25.2 17/45.9 52/37.1 99/29.7 62/26.3 1735.4
No idea for UDE 3/5.6 0 0 4/6 9/4.9 3/2.1 4/2.9 3/1.9 6/3.4 6/4 11/3.6 8/2.6 5/2.4 7/3.9 3/2 4/5 16/3.4 3/2 15/3.4 2/5.4 2/1.4 11/3.3 4/1.7 3/6.3
No idea for CDE 1/1.9 0 0 5/7.5 16/8.7 0 0 3/1.9 4/2.3 14/9.4 11/3.6 11/3.5 2/0.9 3/1.7 7/4.7 10/12.5 20/4.3 2/1.3 17/3.9 2/5.4 2/1.4 18/5.4 3/1.3 1/2.1
No idea for both 9/16.7 11/39.3 0 19/28.4 82/44.6 17/11.8 27/19.9 32/20 36/20.5 41/27.5 83/26.9 54/17.3 37/17.7 38/21.2 34/22.8 25/31.3 99/21.3 32/21.3 105/23.8 9/24.3 21/15 85/25.5 45/19.1 6/12.5
Total 54 28 148 67 184 144 136 160 176 149 309 312 209 179 149 80 465 150 441 37 140 333 236 48
Q3
UDE 42/52.5 15/45.5 149/100 41/50.6 131/67.2 107/73.8 109/78.4 127/74.7 128/66.3 118/66.7 233/68.9 249/73.2 171/81.8 133/70.4 115/66.1 61/64.9 364/73.5 117/66.1 347/72.3 27/67.5 104/67.1 241/67.7 200/75.2 35/71.4
CDE 36/45 15/45.5 0 27/33.3 18/9.2 38/26.2 20/14.4 29/17.1 46/23.8 39/22 59/17.5 74/21.8 30/13.8 40/21.2 40/23 21/22.3 77/15.6 54/30.5 82/17.1 7/17.5 44/28.4 75/21.1 45/16.9 11/22.4
No idea for UDE 0 0 0 0 13/6.7 0 0 4/2.4 4/2.1 5/2.8 10/3 3/0.9 1/0.5 5/2.6 5/2.9 2/2.1 13/2.6 0 11/2.3 2/5 0 11/3.1 2/0.8 0
No idea for CDE 0 0 0 0 4/2.1 0 0 0 1/0.5 3/1.7 3/0.9 1/0.3 0 0 2/1.2 2/2.1 4/0.8 0 4/0.8 0 0 4/1.1 0 0
No idea for both 2/2.5 3/9.1 0 13/16 29/14.9 0 10/7.2 10/5.9 14/7.3 12/6.8 33/9.8 13/3.8 15/6.9 11/5.8 12/6.9 8/8.5 37/7.5 6/3.4 36/7.5 4/10 7/4.5 25/7 19/7.1 3/6.1
Total 80 33 149 81 195 145 139 170 193 177 338 340 217 189 174 94 495 177 480 40 155 356 266 49
Q4
Yes 42/89.4 28/100 263/100 49/76.6 152/79.2 120/85.7 167/91.8 182/92.9 164/85.9 138/85.7 314/88.7 337/89.6 269/93.1 173/87.8 134/85.4 62/74.7 511/89 138/92 498/90.4 33/86.8 116/84.1 300/85.2 291/92.4 53/93
No 1/2.1 0 0 2/3.1 3/1.6 13/9.3 0 2/1 11/5.8 6/3.7 4/1.1 15/4 0 11/11.3 8/5.1 0 13/2.3 6/4 7/1.3 0 12/8.7 14/4 5/1.6 0
No idea 4/8.5 0 0 13/20.3 37/19.3 7/5 15/8.2 12/6.1 16/8.4 17/10.6 36/10.2 24/6.4 20/6.9 13/6.6 15/9.6 11/13.3 50/8.7 6/4 46/8.3 5/13.2 10/7.2 38/10.8 19/6 4/7
Total 47 28 263 64 192 140 182 196 191 161 354 376 289 197 157 83 574 150 551 38 138 352 315 57
Q5
Dentists 39/29.1 19/32.2 178/98.9 34/30.4 38/20.4 42/26.8 89/51.7 101/49 94/42.3 65/28.9 163/39 185/45.8 150/53.6 98/43.9 70/36.1 30/24.6 274/48.1 74/30 266/46.3 16/30.8 67/34.9 149/36.6 168/50.3 31/41.9
Patients 39/29.1 23/39 2/1.1 38733.9 46/24.7 44/28 36720.9 40/19.4 50/22.5 66/29.3 99/23.7 90/22.3 86/30.6 48/21.5 51/26.3 35/28.7 104/18.2 83/33.6 126/22 10/19.2 53/27.6 97/23.8 73/21.9 18/24.3
Public 19/14.2 8/13.6 0 11/9.8 49/26.3 17/10.8 20/11.6 20/9.7 31/14 33/14.7 61/14.6 43/10.6 29/10.4 29/13 26/13.4 19/15.6 67/11.8 37/15 70/12.2 13/25 20/10.4 55/13.5 34/10.2 12/16.2
Dental profession 32/23.9 8/13.6 0 14/12.5 50/26.9 29718.5 13/7.6 35/17 33/14.9 51/22.7 73/17.5 59/14.6 27/9.6 34/15.2 39/20.1 30/24.6 92/16.1 41/16.6 90/15.7 9/17.3 29/15.1 78/19.1 43/12.9 8/10.8
No idea 2/1.5 1/1.7 0 1/0.9 3/1.6 25/15.9 10/5.8 8/3.9 10/4.5 3/1.3 12/2.9 20/5 13/4.6 11/4.9 6/3.1 1/0.8 22/3.9 10/4 13/2.3 1/1.9 18/9.4 18/4.4 12/3.6 2/2.7
Other 3/2.2 0 0 14/12.5 0 0 4/2.3 2/1 4/1.8 7/3.1 10/2.4 7/1.7 5/1.8 3/1.3 2/1 7/5.7 11/1.9 2/0.8 9/1.6 3/5.8 5/2.6 10/2.5 4/1.2 3/4.1
Total 134 59 180 112 186 157 172 206 222 225 418 404 280 223 194 122 570 247 574 52 192 407 334 74
Q6
Yes 32/68.1 8/29.6 169/54.3 33/54.1 123/65.1 104/72.2 119/63 129/54.9 129/62.9 90/54.5 219/59.3 248/60.9 182/60.5 136/62.4 100/57.8 45/56.3 378/61 89/59.7 344/58.2 23/62.2 98/68.1 223/59.8 202/60.3 14/60.9
No 7/14.9 15/55.6 61/19.6 6/9.8 25/13.2 23/16 29/15.3 42/19.4 29/14.1 37/22.4 64/17.3 72/17.7 55/18.3 32/14.7 31/17.9 19/23.8 97/15.6 39/26.2 103/17.4 10/27 22/15.3 53/14.2 67/20 7/30.4
No idea 8/17 4/14.8 81/26 22/36.1 41/21.7 17/11.8 41/21.7 46/21.2 47/22.9 38/23 86/23.3 87/21.4 64/21.3 50/22.9 42/24.3 16/20 145/23.4 21/14.1 144/24.4 4/10.8 24/16.7 97/26 66/19.7 2/8.7
Total 47 27 311 61 189 144 189 217 205 165 369 407 301 218 173 80 620 149 591 37 144 373 335 23
Q7
Lack of time 19/9.5 9/8.7 54/7.6 27/22.1 55/11.4 51/12.7 62/13 55/10.3 55/10.4 43/9.2 105/10.8 108/10.3 93/12.6 64/11.3 35/7.7 21/9.4 154/10.1 55/11.8 143/9.6 19/17.3 50/12,6 102/11 91/10.5 18/9.6
Lack of financial 17/8.5 6/5.8 49/6.9 9/7.4 34/7.1 41/10.2 44/9.2 39/7.3 47/8.9 26/5.6 86/8.9 70/6.7 65/8.6 43/7.6 31/6.8 14/6.3 120/7.8 35/7.5 110/7.4 8/7.3 38/9.6 74/7.9 68/7.8 11/5.9
incentives
Lack of necessary 25/12.6 21/20.4 107/15 22/18 66/13.7 60/14.9 75/15.7 73/13.6 73/13.7 78/16.7 143/14.8 156/14.9 115/15.2 74/13.1 72/15.8 36/16.1 227/14.8 71/15.2 223/14.9 15/13.6 59/14.9 143/15.3 126/14.5 29/15.5
education on EBD
Lack of necessary 12/6 7/6.8 70/9.8 6/4.9 30/6.2 45/11.2 43/9 46/8.6 39/7.3 40/8.6 78/8.1 91/8.7 66/8.7 49/8.7 35/7.7 16/6.6 135/8.8 33/7.1 127/8.5 6/5.5 36/9.1 85/9.1 70/8.1 12/6.4
publications on
EBD
Lack of necessary 8/4 7/6.8 40/5.6 5/4.1 26/5.4 26/6.5 29/6.1 27/5 30/5.6 25/5.4 53/5.5 59/5.6 42/5.5 25/4.4 20/4.4 10/7.1 88/5.7 22/4.7 90/6 3/2.7 18/4.5 56/6 45/5.2 8/4.3
websites on EBD
Lack of EB clinical 20/10.1 10/9.7 84/11.7 9/7.4 41/8.5 35/8.7 44/9.2 62/11.6 47/8.9 45/9.7 98/10.1 100/9.6 76/10 57/10.1 41/9 24/10.7 152/9.9 43/9.2 151/10.1 14/12.7 31/7.8 79/8.4 94/10.8 21/11.2
guidelines for
dental care
Lack of EB clinical 14/7.0 8/7.8 31/4.3 3/2.5 26/5.4 32/8 14/2.9 35/6.5 41/7.7 23/4.9 49/5.1 64/6.1 31/4.1 34/6 40/8.8 9/4 88/5.7 25/5.4 80/5.4 3/2.7 29/7.3 61/6.5 43/5 8/4.3
decision support
systems
Limited evidence in 9/4.5 5/4.9 85/11.9 5/4.1 0 22/5.5 48/10 30/5.6 19/3.6 29/6.2 50/5.2 75/7.2 67/8.8 27/4.8 19/4.2 11/4.9 107/7 17/3.6 95/6.4 4/3.6 26/6.5 47/5 67/7.7 11/5.9
the dental field
Lack of awareness 25/12.6 8/7.8 52/7.3 13/10.7 59/12.2 16/4 31/6.5 48/9 49/9.2 44/9.4 89/9.2 83/7.9 54/7.1 51/9 45/9.9 22/9.8 129/8.4 42/9 141/9.4 10/9.1 21/5.3 83/8.9 70/8.1 17/9.1
on EBD
France
Georgia
Portugal
Slovakia
Turkey
Poland
20 30
31 40
41 50
Male
Female
0 10
11 20
21 30
31 over
General practitioner
Specialist
Private
Public
Private and public
Solo
Group practice
University
Lack of continuing 17/8.5 10/9.7 41/5.7 9/7.4 43/8.9 12/3 30/6.3 37/6.9 35/6.6 29/6.2 61/6.3 71/6.8 48/6.3 38/6.7 29/6.4 17/7.6 93/6.1 38/8.2 98/6.6 6/5.5 26/6.5 53/5.6 62/7 17/9.1
education courses
on EBD
EBD being 6/3 2/1.9 45/6.3 6/4.9 34/7.1 9/2.2 22/4.6 23/4.3 28/5.3 28/6 48/5 53/5.1 36/4.7 25/4.4 21/4.6 17/7.6 80/5.2 22/4.7 82/5.5 8/7.3 11/2.8 43/4.6 43/5 14/7.5
perceived as time
consuming
Lack of practical 11/5.5 2/1.9 57/8 5/4.1 29/6 6/1.5 26/5.4 32/6 26/4.9 25/5.4 58/6 52/5 45/5.9 29/5.1 26/5.7 10/4.5 90/5.9 20/4.3 93/6.2 4/3.6 12/3 46/4.9 51/5.9 12/6.4
ways to reach to
best evidence
Limited knowledge 14/7 8/7.8 0 1/0.8 38/7.9 46/11.4 10/2.1 29/5.4 41/7.7 23/5.4 47/4.9 60/5.7 21/2.8 39/6.9 35/7.7 11/4.9 64/4.2 43/9.2 55/3.7 9/8.2 40/10.1 61/6.5 35/4 9/4.8
regarding the
quality of evidence
Others 2/1 0 0/0 2/1.6 1/0.2 1/0.2 0 0 1/0.2 5/1.1 3/0.3 3/0.3 0 1/0.1 3/0.7 2/0.9 5/0.3 0 5/0.3 1/0.9 0 3/0.3 3/0.3 0
Total 199 103 715 122 482 402 478 536 531 466 968 1045 759 566 455 224 1535 466 1493 110 397 936 868 187
Q8
Creating awareness 39/21.9 25/26.3 172/20.6 30/25.4 106/20.6 83/31.7 120/22.2 114/21.1 125/24.7 93/23.2 218/22.9 234/22.5 173/21.1 135/25 92/22.7 48/21.9 357/22.6 95/23.5 335/21.7 24/27.9 90/26 190/22.9 220/23.1 15/20
Developing EB 28/15.7 16/16.8. 153/18.3 21/17.8 106/20.6 41/15.6 96/17.8 107/19.8 86/17 75/18.7 185/19.4 180/17.4 160/19.5 95/17.6 69/17 39/17.8 288/18.2 77/19 289/18.7 15/17.4 57/16.5 142/17.1 187/19.6 12/16
clinical guidelines
Developing EB 31/17.4 16/16.8 141/16.9 9/7.6 90/17.5 21/8 86/15.9 85/15.7 75/14.8 61/15.2 146/15.3 159/15.3 133/16.2 82/15.2 59/14.6 32/14.6 241/15.3 65/16 246/15.9 12/14 46/13.3 121/14.6 150/17.7 13/17.3
clinical decision
support systems
Organising 29/16.3 15/15.8 184/22.1 24/20.3 111/21.6 64/24.4 108/20 122/22.2 107/21.1 89/22.3 197/20.6 230/22.1 169/20.6 114/21.1 93/23 47/21.5 342/21.6 82/20.2 336/21.7 17/19.8 69/19.9 188/23.9 193/20.6 17/22.7
continuing
education courses
on EBD
Negotiating with 26/14.6 14/14.7 95/11.4 11/9.3 41/8 13/5 62/11.5 55/10.2 45/8.9 37/9.2 96/10.1 104/10 89/10.9 50/9.3 35/8.6 24/11 157/9.9 41/10.1 158/10.2 6/7 33/9.5 74/8.9 100/10.5 10/13.3
the authorities for
financial
incentives to foster
implementation of
EBD into practice
Attempts to 23/12.9 9/9.5 83/10 13/11 57/11.1 36/13.7 61/11.3 54/10 60/11.9 45/11.2 100/10.5 119/11.5 87/10.6 55/10.2 52/12.8 26/11.9 175/11.1 44/10.9 166/10.7 9/10.5 44/12.7 101/12.2 95/9.9 7/9.3
overcome the
barriers to
implementation of
EBD into practice
None 2/1.1 0/0.0 6/0.7 0/0.0 2/0.4 1/0.4 0 3/0.6 3/0.6 4/1 5/0.5 6/06 1/0.1 5/0.9 4/1 1/0.5 11/0.7 0 10/0.6 0/ 1/0.3 6/0.7 4/0.4 1/1.3
Other 0 0 0 10/8.5 1/0.2 3/1.1 7/1.3 1/0.2 5/1 1/0.3 7/07 7/0.7 7/0.9 4/0.7 1/0.2 2/1 9/0.6 1/0.2 5/0.3 3/3.5 6/1.7 8/1 3/0.3 0
Total 178 95 834 118 514 262 540 541 506 401 954 1039 819 540 405 219 1580 405 1545 86 346 830 953 75
Q9
Yes 43/91.5 26/92.9 268/91.8 45/71.4 139/72.4 125/90.6 169/89.9 181/87 162/82.2 131/80.4 296/82 346/87.6 264/89.2 181/86.2 129/78.7 65/79.3 511/84.9 131/87.9 490/85.1 30/83.3 119/84.4 290/80.8 296/88.9 52/88.1
No 1/2.1 0 7/2.4 4/6.3 20/10.4 9/6.5 8/4.3 11/5.3 14/7.1 8/4.9 23/6.4 18/4.6 13/4.4 13/6.2 12/7.3 3/3.7 32/5.3 9/6 29/5 1/2.8 11/7.8 25/7 14/4.2 2/3.4
No idea 3/6.4 2/7.1 17/5.8 14/22.2 33/17.2 4/2.9 11/5.9 16/7.7 21/10.7 24/14.7 42/11.6 31/7.8 19/6.4 16/7.6 23/14 14/17.1 59/9.8 9/6 57/9.9 5/13.9 11/7.8 44/12.6 23/6.9 5/8.5
Total 47 28 292 63 192 138 188 208 197 163 361 395 296 210 164 82 602 149 576 36 141 359 333 59
Implementation of EBD into practice
135
Country (%) Age range, years (%) Gender (%) Years of practice (%) Kind of practice (%)
136
Yamalik et al.
51
31
France
Georgia
Portugal
Slovakia
Turkey
Poland
20 30
31 40
41 50
Male
Female
0 10
11 20
21 30
General practitioner
Specialist
Private
Public
Private and public
Solo
Group practice
University
TOTAL
(b)
Q1
I know what it is 10.7 5 33.3 10.3 23.8 16.9 28.4 27.5 27.5 20.2 46 54 38.4 28.7 23.3 9.6 75.9 24.1 74.9 5.8 19.3 52.3 40.8 6.9 261
I practice 8.2 3.5 46.1 7 15.6 19.5 24.6 30.9 23 21.5 51.6 48.4 42.1 27.8 20.2 10 75.3 24.7 72.3 5.1 22.5 39.4 47.3 13 256
Dentists should practice it 7.1 2.4 44.4 8.3 27.2 10.7 27.2 21.9 26 24.9 48.8 51.2 39.9 25.6 22 12.5 85.8 14.2 82.1 4.8 13.1 43.4 48.2 7.2 169
No idea 6.3 1.8 0 18.9 43.2 29.7 18.2 23.6 28.2 30 50 50 29.4 36.6 25.6 18.3 78.1 21.9 70 7.3 22.7 65.7 29.6 3.7 111
Q2
UDE 3 0.4 56.3 4.9 9.9 25.5 30.2 32.1 25.6 12.3 43.7 56.3 48.1 29.4 18 4.5 84.7 15.3 73.4 2.7 24 45.8 46.2 8 263
CDE 18 8.7 0 14.2 27.9 31.1 14.2 20.8 34.4 30.6 49.4 50.6 21.6 30 32.2 16.1 59.7 40.3 61.7 9.4 28.9 55.3 34.7 9.5 183
No idea for UDE 15.8 0 0 21.1 47.4 15.8 21.1 15.8 31.6 31.6 57.9 42.1 4.4 7.9 4.2 17.4 84.2 15.8 78.9 10.5 10.5 57.9 21.1 15.8 19
No idea for CDE 4.5 0 0 22.7 72.7 0 0 14.3 19 66.7 50 50 29.1 13.6 31.8 45.4 90.9 9.1 81 9.5 9.5 81.8 13.6 4.5 22
No idea for both 6.5 8 0 13.8 59.4 12.3 19.9 23.5 26.5 30.2 60.6 39.4 27.6 28.4 25.3 18.7 75.6 24.4 77.8 6.7 15.6 62.5 33.1 4.4 138
Q3
UDE 8.7 3.1 30.7 8.5 27 22.1 22.6 26.3 26.6 20.5 48.3 51.7 35.6 27.7 24 12.7 75.7 24.3 72.6 5.6 21.8 50.3 41.7 7.3 485
CDE 26.9 11.2 0 20.1 13.4 28.4 14.9 21.6 34.3 29.1 44.4 55.6 22.9 30.6 30.5 16 58.8 41.2 61.7 5.3 33.1 56.8 34.1 8.4 134
No idea for UDE 0 0 0 0 100 0 0 30.8 30.8 38.5 76.9 23.1 7.7 38.5 38.5 15.4 100 0 84.6 15.4 0 84.6 15.4 0 13
No idea for CDE 0 0 0 0 100 0 0 0 25 75 075 25 0 0 50 50 100 0 100 0 0 100 0 0 4
No idea for both 4.3 6.4 0 27.7 61.7 0 21.7 21.7 30.4 26.1 71.7 28.3 22.6 23.9 26.1 17.4 86 14 76.6 8.5 14.9 53.2 40.4 6.4 47
Q4
Yes 6.4 4.3 40.2 7.5 23.2 18.3 25.7 28 25.2 21.2 48.2 51.8 41.5 26.7 20.7 11.1 78.7 21.3 77 5.1 17.9 46.3 44.9 8.1 654
No 5.3 0 0 10.5 15.8 68.4 0 10.5 57.9 31.6 21.1 78.9 0 57.9 42.1 0 68.4 31.6 36.8 0 63.2 73.7 26.3 0 19
No idea 6.6 0 0 21.3 60.7 11.5 25 20 26.7 28.3 60 40 33.9 22.1 25.4 18.7 89.3 10.7 75.4 8.2 16.4 62.3 31.1 6.6 61
Q5
Dentists 11.1 5.4 50.9 9.7 10.9 12 25.5 28.9 26.9 18.6 46.8 53.2 43.1 28.1 20.1 8.6 78.7 21.3 76.2 4.6 19.2 42.7 48.1 8.9 350
Patients 20.3 12 1 19.8 24 22.9 18.8 20.8 26 34.3 52.4 47.6 29.5 25.3 27.1 18.4 55.6 44.4 66.7 5.3 28 50.8 38.2 9.4 192
Public 18.3 7.7 0 10.6 47.1 16.3 19.2 19.2 29.8 31.8 58.7 41.3 28.2 28.2 25.2 18.5 64.4 35.6 68 12.6 19.4 53.9 33.3 11.8 104
Dental profession 24.1 6 0 10.5 37.6 21.8 9.8 26.5 25 38.6 55.3 44.7 20.7 26.2 30 23.1 96.2 30.8 70.3 7 22.7 11 33 6.2 133
No idea 6.3 3.1 0 3.1 9.4 78.1 32.3 25.8 32.3 38.6 37.5 62.5 41.9 35.5 19.4 3.2 68.8 31.3 40.6 3.1 56.3 56.3 37.5 6.3 32
Other 17.6 0 0 82.4 0 0 23.5 11.8 23.5 21.2 58.8 41.2 29.4 17.6 11.8 41.1 84.6 15.4 52.9 17.6 29.4 58.8 23.5 17.6 17
Q6
Yes 6.8 1.7 36 7 26.2 22.2 25.5 27.6 27.6 19.2 46.9 53.1 39.3 29.4 21.6 9.7 80.9 19.1 74 4.9 21.1 48 43.4 8.2 469
No 5.1 10.9 44.5 4.4 18.2 16.8 21.2 30.7 21.2 27 47.1 52.9 40.1 23.3 22.6 13.9 71.3 28.7 76.3 7.4 6.3 39.2 49.6 10.4 137
No idea 4.6 2.3 46.8 12.7 23.7 9.8 23.8 26.7 27.3 22.1 49.7 50.3 37.2 29.1 24.4 12.3 87.3 12.7 83.7 2.4 14 56.4 38.4 5.3 171
Q7
Lack of time 8.8 4.2 25.1 12.6 25.6 23.7 28.8 25.6 25.6 20 49.3 50.7 43.7 20.1 16.4 9.8 73.7 26.3 67.5 9 23.6 47.9 42.7 8.4 215
Lack of financial incentives 10.9 3.8 31.4 5.8 21.8 26.3 28.2 25 30.1 16.7 55.1 44.9 22.5 28.1 21.2 9.2 77.4 22.6 70.5 5.1 24.4 48.1 44.1 7.1 156
Lack of necessary education on EBD 8.3 7 35.5 7.3 21.9 19.9 25.1 24.4 24.4 26.1 47.8 52.2 38.7 24.9 24.2 12.1 76.2 23.8 75.1 5.1 19.9 47.7 42 9.6 301
Lack of necessary publications on EBD 7.1 4.1 41.2 3.5 17.6 26.5 25.6 27.4 23.2 23.8 46.2 53.8 39.8 29.6 21 9.6 80.4 19.6 75.1 3.6 21.3 50.6 41.6 7.2 170
Lack of necessary websites on EBD 7.1 6.3 35.7 4.5 23.2 23.2 26.1 24.3 27 22.5 47.3 52.7 37.8 31.5 18 12.6 80 20 98.1 2.7 16.2 51 40.9 7.2 114
Lack of EB clinical guidelines for dental 10.1 5 42.2 4.5 20.6 17.6 22.2 31.3 23.7 22.8 49.5 50.5 38.4 28.8 20.7 12.1 77.9 22.1 77 7.1 15.8 40.3 48 10.8 199
care
Lack of EB clinical decision support 12.3 7 27.2 2.6 22.8 28.1 12.4 31 36.3 20.3 43.4 56.6 27.2 12.3 35.1 7.9 77.9 22.1 71.4 2.7 25.9 53.9 38 7.1 113
systems
Limited evidence in the dental field 7.1 4 67.5 4 0 17.5 38.1 23.8 15.1 23 40 60 54 21.8 15.4 8.9 86.3 13.7 76 3.2 20.8 37.6 53.6 8.8 125
Lack of awareness on EBD 14.5 4.6 30.1 7.5 34.1 9.2 18 27.9 28.5 25.6 51.7 48.3 31.4 29.6 26.2 12.8 75.4 24.6 82 5.8 12.2 48.3 40.7 9.9 172
Lack of continuing education courses on 12.9 7.6 31.1 6.8 32.6 9.1 22.9 28.2 26.7 22.2 46.2 53.8 37.5 28.8 22 12.8 71 29 75.4 4.6 20 40.2 46.9 12.8 132
EBD
EBD being perceived as time consuming 5.9 2 44.1 5.9 33.3 8.8 21.8 22.8 27.7 27.8 47.5 52.5 35.3 24.5 23.5 16.6 78.4 21.6 81.2 7.9 10.9 42.6 42.5 13.8 101
Lack of practical ways to reach to best 10 1.8 51.8 4.5 26.4 5.5 23.9 29.4 23.9 23 52.7 47.3 40.9 26.2 23.6 9.1 81.8 18.2 85.3 3.7 11 41.8 46.3 11 110
evidence
Limited knowledge regarding the quality 13.1 7.5 0 0.9 35.5 43 9.4 27.4 38.7 24.5 43.9 56.1 19.8 36.8 33.1 10.3 59.8 40.2 52.9 8.7 38.5 57.5 33.1 8.5 106
of evidence
Others 33.3 0 0 33.3 16.7 16.7 0 0 16.7 83.3 50 50 0 16.7 50 33.4 100 0 83.3 16.7 0 50 50 0 6
Q8
Creating awareness 8.6 5.5 37.8 6.6 23.3 18.2 26.5 25.2 27.7 20.5 48.2 51.8 38.6 30.1 20.5 10.7 79 21 74.6 5.3 20 42.2 48.8 8.6 450
Developing EB clinical guidelines 7.7 4.4 41.9 5.8 29 11.2 26.4 29.4 23.6 20.6 50.7 49.3 44 26.1 19 10.8 78.9 21.1 80.1 4.2 15.8 39.1 51.5 8.8 363
Developing EB clinical decision support 10.1 5.2 45.8 2.9 29.2 6.8 28 27.7 24.4 19.9 47.9 52.1 43.5 26.8 19.3 10.5 78.8 21.2 80.9 3.9 15.1 39.2 49 11 308
systems
Organising continuing education courses 6.8 3.5 43.1 5.6 26 15 25.4 28.6 25.1 20.9 46.1 53.9 39.9 27 22 11.1 80.7 19.3 79.6 4 16.4 44.3 45.5 9.7 424
on EBD
Negotiating with the authorities for 13 7 47.5 5.5 20.5 6.5 31.2 27.6 22.6 18.6 48 52 44.9 25.2 17.7 12.1 79.3 20.7 80.2 3 16.8 37.1 50.2 6.5 199
financial incentives to foster
implementation of EBD into practice
Attempts to overcome the barriers to 10.4 4.1 37.6 5.9 25.8 16.3 27.7 24.5 27.3 20.5 45.7 54.3 39.5 20 23.6 11.9 79.9 20.1 75.8 4.1 20.1 45.7 43 5 221
implementation of EBD into practice
11
14
41
72
641
TOTAL
10.9
coming barriers. In the present study, basic barriers
University
9.1
8.1
4.8
0
were identified by a large number of dentists. By
36.4
21.4
46.1
34.2
Group practice
revealing barriers, the practice of EBD, which aimed
32
to provide continuous improvements in patient care
54.5
57.1
45.3
61.1
Solo
61
based on new research developments, might be
enhanced25. Taken together, all of these studies reveal
Kind of practice (%)
42.9
18.6
26.8
15.1
Private and public
9.1
that, despite the positive attitude of dentists towards
EBD, there are an array of barriers in place when it
21.4
Public
4.7
2.4
6.8
0 comes to implementation of EBD in practice.
The role of NDAs in improvement of the implementa-
90.9
35.7
76.7
70.7
78.1
Private
13.2
Specialist
10
22
0
86.8
100
General practitioner
90
78
10.2
19.5
31
9.1
7.3
36.4
20.1
29.3
21 30
and continuing education courses improve dentists
7.1
32
28.3
31.7
22.2
59.3
43.9
42.5
Female
Gender (%)
46.1
56.1
57.5
Male
50
51
7.1
40
25.2
34.1
29.2
41 50
30
31 40
7.1
CDE, continuing dental education; EB, evidence-based; EBD, evidence-based dentistry; UDE, undergraduate dental education.
30
20 30
50
0
19.3
Poland
9.1
5.5
22
21.5
48.8
45.2
Turkey
7.1
19.2
Slovakia
the potential to overcome some of the reported barriers
Country (%)
9.8
0
41.5
17.1
23.3
4
0
France
6.7
2.1
4.1
Yes
No
138
France/ France/ France/ France/ France/ Georgia/ Georgia/ Georgia/ Georgia/ Portugal/ Portugal/ Portugal/ Slovakia/ Slovakia/ Turkey/
Georgia Portugal Slovakia Turkey Poland Portugal Slovakia Turkey Poland Slovakia Turkey Poland Turkey Poland Poland
Q1
Yamalik et al.
I know what it is 0.691 0.0001* 0.287 0.002* 0.004* 0.022* 0.882 0.115 0.151 0.006* 0.199 0.195 0.086 0.132 0.891
I practice 0.628 0.415 0.233 0.002* 0.554 1 0.888 0.178 0.983 0.483 0.0001* 0.837 0.124 0.366 0.001*
Dentists 0.519 0.913 1 1 0.107 0.523 0.576 0.488 0.761 1 0.845 0.021* 1 0.123 0.021*
should practice it
No idea 0.483 0.0001* 0.028* 0.189 0.219 0.005* 0.019* 0.093 0.104 0.0001* 0.0001* 0.113 0.155 0.174 0.963
Q2
UDE 0.151 0.0001* 0.658 0.738 0.0001* 0.0001* 0.056 0.217 0.0001* 0.002* 0.0001* 0.395 0.171 0.001* 0.0001*
CDE 0.754 0.0001* 0.014* 0.0001* 0.005* 0.0001* 0.216 0.001* 0.124 0.0001* 0.0001* 0.0001* 0.018* 0.858 0.003*
No idea for UDE 0.548 0.002* 1 0.711 0.189 n.a. 0.311 0.604 1 0.001* 0.0001* 0.024* 0.511 0.204 0.373
No idea for CDE 1 0.129 0.222 0.208 0.264 n.a. 0.318 0.229 n.a. 0.0001* 0.0001* n.a. 1 0.002* 0.0001*
No idea for both 0.058 0.0001* 0.183 0.005* 0.434 0.0001* 0.508 1 0.001* 0.0001* 0.0001* 0.0001* 0.216 0.003* 0.0001*
Q3
UDE 0.021* 0.0001* 0.076 0.021* 0.414 0.338 0.474 0.469 0.055 0.001* 0.0001* 0.0001* 0.958 0.207 0.028*
CDE 0.252 0.0001* 0.007* 0.0001* 0.0001* 0.0001* 0.435 0.0001* 0.008* 0.0001* 0.0001* 0.0001* 0.0001* 0.032* 0.0001*
No idea for UDE n.a. n.a. n.a. 0.078 n.a. n.a. n.a. 0.374 n.a. n.a. 0.0001* n.a. 0.087 n.a. 0.006*
No idea for CDE n.a. n.a. n.a. 0.587 n.a. n.a. n.a. 1 n.a. n.a. 0.019* n.a. 0.576 n.a. 0.148
No idea for both 0.337 0.016* 0.019* 0.078 0.117 0.0001* 0.374 0.777 0.001* 0.0001* 0.0001* n.a. 0.293 0.0001* 0.0001*
Q4
Yes n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
No
No idea
Q5
Dentists 0.675 0.002* 0.026* 0.0001* 0.0001* 0.117 0.277 0.0001* 0.0001* 0.707 0.0001* 0.0001* 0.0001* 0.001* 0.017*
Patients 0.653 0.0001* 0.115 0.0001* 0.0001* 0.0001* 0.336 0.0001* 0.0001* 0.0001* 0.0001* 0.0001* 0.0001* 0.0001* 0.077
Public 0.638 0.0001* 0.031* 0.081 0.0001* 0.0001* 0.336 0.718 0.035* 0.0001* 0.0001* 0.0001* 0.376 0.396 0.005*
Dental profession 0.011* 0.0001* 0.0001* 0.0001* 0.0001* 0.0001* 0.669 0.762 0.447 0.0001* 0.0001* 0.0001* 0.865 0.902 0.383
No idea 1 0.016* 0.586 0.261 0.031* 0.074 0.518 0.397 0.082 0.154 0.051 0.0001* 1 0.003* 0.0001*
Other 0.548 0.002* 0.031* 0.008* 0.018* n.a. 0.005* n.a. n.a. 0.0001* n.a. n.a. 0.0001* n.a. 0.0001*
Q6
Yes n.a. 0.331 n.a. 0.913 n.a. 0.0001* n.a. n.a. n.a. 0.056 0.084 0.0001* 0.081 n.a. 0.0001*
No n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
No idea n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a. n.a.
Q7
Lack of time 0.883 0.0001* 0.669 0.196 0.994 0.032* 0.499 0.671 0.927 0.0001* 0.001* 0.0001* 0.023* 0.417 0.074
Lack of financial 0.422 0.001* 0.031* 0.013* 0.673 0.268 0.376 0.591 0.607 1 0.449 0.0001* 0.821 0.041* 0.007*
incentives
Lack of 0.037* 0.017* 0.192 0.038* 0.501 0.0001* 0.001* 0.0001* 0.002* 0.627 0.771 0.018* 0.791 0.339 0.058
necessary
education
on EBD
Lack of necessary 1 0.727 0.077 0.187 0.364 0.686 0.058 0.165 0.681 0.068 0.098 0.007* 0.413 0.001* 0.0001*
publications
on EBD
Lack of necessary 0.453 0.544 0.322 0.738 0.839 0.065 0.041* 0.083 0.543 0.534 0.805 0.069 0.426 0.092 0.201
websites on EBD
Lack of EB clinical 1 0.038* 0.005* 0.007* 0.073 0.242 0.037* 0.089 0.297 0.117 0.243 0.948 0.412 0.144 0.308
guidelines for
dental care
Lack of EB 1 0.0001* 0.002* 0.017* 0.604 0.004* 0.003* 0.039* 0.615 0.391 0.218 0.0001* 0.126 0.004* 0.024*
clinical
decision
support systems
139
Yamalik et al.
CDE, continuing dental education; EB, evidence-based; EBD, evidence-based dentistry; UDE, undergraduate dental education. n.a, statistical comparison was not applicable because of the
Turkey/
Poland
0.011*
0.607
0.309
to 42%. Although most of the dentists (77100%)
n.a.
1
reported that they believe EBD is beneficial, EBD
practice was still limited. This might be attributed to
Slovakia/
Poland
0.001*
0.138
0.594
the lack of EBD training during UDE in all countries,
n.a.
except Portugal. Nowadays, academic dental institu-
1
tions seek to provide curricular content and learning
Slovakia/
0.0001*
Turkey
0.341
n.a.
set for evidence-based practice. However, emphasis
1 on EBD is relatively new, and thus educating under-
Portugal/
0.0001*
0.024*
0.767
0.679
n.a.
time. Marshall et al.13 investigated the perceptions of
members of a dental faculty regarding EBD and
reported their positive attitudes and efforts in
Portugal/
Turkey
0.328
0.716
0.373
n.a.
0.0001*
0.682
0.597
n.a.
education.
Evaluation of perceived barriers according to coun-
Georgia/
0.567
0.001*
n.a.
0.029*
0.003*
n.a.
n.a.
0.431
n.a.
1
0.015*
0.171
0.567
0.027*
0.178
0.0001*
France/
0.011*
0.002*
0.199
0.001*
0.003*
n.a.
0.539
n.a.
n.a.
implementation
the barriers to
No idea
Yes
and NDAs28.
140 2015 FDI World Dental Federation
Implementation of EBD into practice
Densts who gave response "Yes" to the queson Densts who gave response of " I pracce" to the
"Do you believe that generally EBD is benecial" queson "About evidence based denstry"
France
France 8.2%
6.4% Poland Georgia
Georga 19.5%
Poland 4.3% 3.5%
18.3%
Turkey
15.6%
Turkey Portugal
23.2% 40.2% Portugal
Slovakia 46.1%
7%
Slovakia
7.5%
(a) (b)
Figure 3. (a) Frequency distribution of a total of 654 dentists who gave the response yes to the question Do you believe that generally EBD is bene-
cial?, according to country. (b) Frequency distribution of a total of 256 dentists who gave the response I practice to the question About evidence based
dentistry, according to country.
Trends in awareness, perceptions and behaviour quality of evidence. However, the skewed distribution
regarding EBD, with respect to age of participant and of the general practitioners and specialists, in which
year of graduation from dental school, were quite general practitioners comprised the majority (81.6%)
prominent in the present study. Age of participant and of respondents, should be considered when interpret-
years of practice did not have a significant effect on ing these findings.
dentists regarding their awareness and practice of EDB. University members were more likely to practice
However, an important finding was that EBD was EBD; however, their frequency in this study was quite
taught to younger dentists in UDE and they believed low (7.6%) compared with solo practising (48%) and
that education in UDE is the correct approach, whereas group practising (44%) dentists. Their high awareness
older dentists were educated in EBD through CDE. of, and effort to teach, EBD has previously been
These findings support those reported in previous stud- reported13. This study also uncovered interesting and
ies9,29 indicating that EBD has evolved over the past unaddressed considerations regarding the effect of the
two decades and that its inclusion in the curricula of type of practice on EBD. Awareness of the concept of
academic dental institutions is relatively recent. A EBD and believing its benefits was significantly low
recent study of Straub-Morarend et al.9 indicated that among solo practising dentists. This may indicate the
as the year of dental school graduation became more advantages of team work and a multidisciplinary
recent, the percentage of students understanding EBD approach. Dentists working in public health-care ser-
increased. They found that recent graduates were more vices reported lack of time as a significant and the
likely to report insufficient time as a primary barrier to most important barrier to the implementation of EBD
practising EBD, which is in agreement with our results; compared with private practice dentists. This reveals
however, the results were not statistically significant. that the high demand by patients of public health-care
Considering all age groups, lack of education on EBD services may preclude dentists from performing EBD
was the primary barrier, which was significantly higher practice. However, this finding should not be overesti-
for older dentists. mated as 77.5% of the respondents worked in private,
The responses obtained for general practitioners 4.7% worked in public and 17.8% worked in both
showed notable differences compared with those private and public practices.
obtained for specialists. Specialists were significantly This questionnaire survey was anonymous and
more likely to report that they know, practice and therefore the respondents could be comfortable com-
find EBD beneficial, as indicated in previous municating their true thoughts. However, the study
research9. Following the trend of the dentists with included a number of limitations. One was the diffi-
more years in practice, specialists also reported that culty in achieving good feedback from most of the
they had received education on EBD during CDE Web questionnaires. The data were self-reported and
rather than during UDE. This may be related to the this is not the most accurate method of gathering the
advanced training they received in evidence-based perceptions of health-care professionals29. However, it
practice. Furthermore, all scientific activities per- would have been difficult to gather information from
formed during the postgraduate education period may such a large number of people from different coun-
make dentists familiar with critical thinking and EBD tries using a method other than a self-reported survey.
practice9,13. Regarding the barriers, specialists had a Another possible problem was that, even though the
significant emphasis on quality of science and reported surveys were anonymous, in order to create a good
that limited knowledge was available regarding the impression, the respondents may not report their
2015 FDI World Dental Federation 141
Table 5 Data regarding the impact of age, gender, years of practice and kind of practice on the responses
142
Age, years Gender Years of Kind of
(n/%) (n/%) practice (n/%) practice (n/%)
2030 3140 4150 51 P Male Female P 010 1120 2130 31over P General Specialist P Private Public Private P Solo Group University P
practitioner and practice member
public
Yamalik et al.
Q1
I know what it is 33.2 33.3 34.6 36.9 0.931 30.9 34.8 0.655 30.7 31.5 32.4 28.7 0.935 31.8 36 0.004* 32.8 34.1 32.5 0.421 35.9 35.4 31.5 0.271
I practice 32.6 37.1 28.8 37.5 0.436 33.8 30.4 0.088 32.8 29.8 27.6 28.7 0.626 31.3 36.6 0.002* 30.9 29.5 37 0.052 26 27.7 36.6 0.0001*
Dentists should 23.8 17.4 21.5 25.5 0.175 21.1 21.2 0.624 20.7 18.3 20 24.1 0.701 23.6 14 0.116 23.3 18.2 14.3 0.197 18.4 23.1 23.1 0.385
practice it
No idea 10.4 12.2 15.1 18.5 0.058 14.2 13.6 0.516 9.9 12.3 15.1 23 0.011* 13.4 13.4 0.388 13 18.2 16.2 0.111 19.7 13.8 8.8 0.0001*
Q2
UDE 30.2 52.5 38.1 18 0.0001* 37.2 47.4 0.182 39 32.8 25.4 13.8 0.0001* 47.7 26.7 0.116 43.8 18.9 45 0.002* 33.4 55 48.7 0.639
CDE 19.1 23.8 35.8 31.5 0.0001* 28.8 29.2 0.481 12.1 23 31.4 33.3 0.0001* 23.2 48.7 0.0001* 25.2 45.9 37.1 0.0001* 30 27.9 28.3 0.015*
No idea for UDE 2.9 1.9 3.4 3.4 n.a. 3.6 2.6 0.472 1.5 3 1.6 4.6 n.a. 3.4 2 1 3.4 5.4 1.4 n.a. 3.4 2.3 1.6 0.631
No idea for CDE 0 1.9 2.3 7.9 0.0001* 3.6 3.5 0.954 0.6 1.3 3.8 11.5 n.a. 4.3 1.3 0.401 3.9 5.4 1.4 n.a. 5.9 2.3 1 0.006*
No idea for both 19.9 20 20.5 23 0.036* 26.9 17.3 0.001* 11.5 16.2 18.4 28.7 0.001* 21.3 21.3 0.068 23.8 24.3 15 0.407 27.2 14 20.4 0.001*
Q3
UDE 78.4 74.7 66.3 57.7 0.046* 68.9 73.2 0.411 52.9 56.6 62.2 70.1 0.018* 73.5 66.1 0.0001* 72.3 67.5 67.1 0.0001* 66.7 74 73.3 0.311
CDE 14.4 17.1 23.8 21.9 0.001* 17.5 21.8 0.487 9.3 17 21.6 24.1 0.0001* 15.6 30.5 0 61.7 17.5 28.4 0.0001* 20.9 22 19.5 0.044*
No idea for UDE 0 2.4 2.1 2.8 n.a. 3 0.9 0.059 0.3 2.1 2.7 2.3 n.a. 2.6 0 0.142 2.3 5 0 3.3 2 0 0.028*
No idea for CDE 0 0 0.5 1.7 n.a. 0.9 0.3 0.348 0 0 1.1 2.3 n.a. 0.8 0 1 0.8 0 0 1.3 0 0
No idea for both 7.2 5.9 7.3 6.7 0.651 9.8 3.8 0.001* 4.6 4.7 6.5 9.2 7.5 3.4 0.571 7.5 10 4.5 0.409 7.8 2 7.2 0.765
Q4
Yes 91.8 92.9 85.9 87.5 0.005* 88.7 89.6 0.004* 83.3 73.6 72.4 82.8 0.0001* 89 92 0.0001* 90.4 86.8 84.1 n.a. 84.8 87.1 92.4 0.041*
No 0 1 5.8 3.4 1.1 4 0.0 4.7 4.3 0 2.3 4 1.3 0 8.7 2.8 9.7 1.2
No idea 8.2 6.1 8.4 9.6 10.2 6.4 6.2 5.5 8.1 12.6 8.7 4 8.3 13.2 7.2 12.4 3.2 6.4
Q5
Dentists 51.7 49 42.3 36.5 0.467 39 45.8 0.891 46.4 41.7 37.8 34.5 0.114 48.1 30 0.068 46.3 30.8 34.9 0.681 33.8 52.5 48.6 0.023*
Patients 20.9 19.4 22.5 37.1 0.0001* 23.7 22.3 0.101 17.3 20.4 27.6 40.2 0.0001* 18.2 33.6 0.0001* 22 19.2 27.6 0.0001* 25.4 14.8 22.9 0068
Public 11.6 9.7 14 18.5 0.011* 14.6 10.6 0.012* 9 12.3 14.1 21.8 0.011* 11.8 15 0.0001* 12.2 25 10.4 0.0001* 13.6 13.1 10.6 0.025*
Dental profession 7.6 17 14.9 28.7 0.0001* 17.5 14.6 0.041* 8.4 14.5 21.1 34.5 0.0001* 16.1 16.6 0.0001* 15.7 17.3 15.1 0.094 20.5 11.5 13.4 0.012*
No idea 5.8 3.9 4.5 1.7 0.341 2.9 5 0.352 4 4.7 3.2 1.1 0.493 3.9 4 0.092 2.3 1.9 9.4 0.0001* 4 6.6 3.2 0.647
Other 2.3 1 1.8 3.9 n.a. 2.4 1.7 0.465 1.5 1.3 1.1 8 n.a. 1.9 0.8 1 1.6 5.8 2.6 n.a. 2.6 1.6 1.4 0.123
Q6
Yes 63 54.9 62.9 50.6 0.718 59.3 60.9 0.743 56.3 57.9 54.1 51.7 0.891 61 59.7 0.0001* 58.2 62.2 68.1 0.017* 60.4 56.9 59.6 0.028*
No 15.3 19.4 14.1 20.8 17.3 17.7 17 13.6 16.8 21.8 15.6 26.2 17.4 27 15.3 14.6 12.3 19.5
No idea 21.7 21.2 22.9 21.3 23.3 21.4 19.8 21.3 22.7 18.4 23.4 14.1 24.4 10.8 16.7 25 30.8 21
Q7
Lack of time 13 10.3 10.4 11.2 0.325 10.8 10.3 0.461 28.8 27.2 18.9 24.1 0.091 10.1 11.8 0.001* 9.6 17.3 12.6 0.0001* 10.9 11 10.6 0.608
Lack of financial 9.2 7.3 8.9 5.7 0.193 8.9 6.7 0.026* 20.1 18.3 16.8 16.1 0.734 7.8 7.5 0.134 7.4 7.3 9.6 0.053 7.7 9 7.7 1
incentives
Lack of necessary 15.7 13.6 13.7 20.3 0.042* 14.8 14.9 0.761 35.6 31.5 38.9 41.4 0.276 14.8 15.2 0.002* 14.9 13.6 14.9 0.464 15.2 15.5 14 0.122
education on EBD
Lack of necessary 9 8.6 7.3 10.4 0.637 8.1 8.7 0.778 20.4 20.9 18.9 18.4 0.936 8.8 7.1 0.636 8.5 5.5 9.1 0.337 9.3 7.7 8 0.779
publications
on EBD
Lack of necessary 6.1 5 5.6 6.5 0.817 5.5 5.6 0.964 13 14.9 10.8 16.1 0.551 5.7 4.7 0.735 6 2.7 4.5 0.475 6.4 3.9 5.3 0.785
websites on EBD
Lack of EB clinical 9.2 11.6 8.9 11.6 0.488 10.1 9.6 0.444 23.5 24.3 22.2 27.6 0.802 9.9 9.2 0.131 10.1 12.7 7.8 0.146 8.5 8.4 10.8 0.011*
guidelines for
dental care
Lack of EB clinical 2.9 6.5 7.7 5.9 0.005* 5.1 6.1 0.389 9.6 14.5 21.6 10.3 0.002* 5.7 5.4 0.269 5.4 2.7 7.3 0.041* 6.5 6.5 5.2 0.376
decision support
systems
Limited evidence 10 5.6 3.6 7.5 0.0001* 5.2 7.2 0.084 20.7 11.5 10.3 12.6 0.003 7 3.6 0.183 6.4 3.6 6.5 0.479 4.2 9 7.3 0.035*
in the dental field
Lack of awareness 6.5 9 9.2 11.4 0.128 9.2 7.9 0.173 16.7 21.7 24.3 25.3 0.119 8.4 9 0.019* 9.4 9.1 5.3 0.083 9.2 7.1 8.5 0.183
on EBD
Lack of continuing 6.3 6.9 6.6 7.6 0.981 6.3 6.8 0.819 14.9 16.2 15.7 19.5 0.767 6.1 8.2 0.001* 6.6 5.5 6.5 0.781 5.5 6.5 6.8 0.023*
education
courses on EBD
EBD being 4.6 4.3 5.3 7.3 0.289 5 5.1 0.931 11.1 10.6 13 19.5 0.151 5.2 4.7 0.452 5.5 7.3 2.8 0.054 4.4 5.8 5 0.018*
perceived
as time
consuming
Lack of 5.4 6 4.9 6.4 0.901 6 5 0.206 13.9 12.3 14.1 11.5 0.888 5.9 4.3 1 6.2 3.6 3 0.102 4.6 6.5 6.4 0.149
practical ways
to reach to
best evidence
2030 3140 4150 51 P Male Female P 010 1120 2130 31over P General Specialist P Private Public Private P Solo Group University P
practitioner and practice member
public
Limited 2.1 5.4 7.7 6.8 0.0001* 4.9 5.7 0.478 6.5 16.6 18.9 12.6 0.0001* 4.2 9.2 0.0001* 3.7 8.2 10.1 0.0001* 7.2 3.2 4.1 0.052
knowledge
regarding
the quality
of evidence
Others 0 0 0.2 1.3 n.a. 0.3 0.3 1 0 0.4 1.6 2.3 n.a. 0.3 0 0.591 0.3 0.9 0 n.a. 0.4 0 0.4 n.a
Q8
Creating 22.2 21.1 24.7 28.7 0.128 22.9 22.5 0.486 53.6 57.4 49.7 55.2 0.465 22.6 23.5 0.032* 21.7 27.9 26 0.101 23.2 21.6 23.9 0.001*
awareness
Developing EB 17.8 19.8 17 23.1 0.288 19.4 17.4 0.069 49.5 40.4 37.3 44.8 0.035 18.2 19 0.073 18.7 17.4 16.5 0.294 16 22.3 19.3 0.0001*
clinical guidelines
Developing 15.9 15.7 14.8 18.8 0.251 15.3 15.3 0.743 41.2 34.9 31.9 36.8 0.176 15.3 16 0.103 15.9 14 13.3 0.194 13.9 17.6 16 0.0001*
EB clinical
decision support
systems
Organising 20 22.2 21.1 27.4 0.745 20.6 22.1 0.559 52.3 48.5 50.3 54 0.761 21.6 20.2 0.469 21.7 19.8 19.9 0.303 23.9 16.9 19.8 0.011*
continuing
education courses
on EBD
Negotiating with 11.5 10.2 8.9 11.4 0.057 10.1 10 0.775 27.6 21.3 18.9 27.6 0.092 9.9 10.1 0.332 7 9.5 0.383 8.7 10.1 10.9 0.0001*
the authorities
for financial
incentives
to foster
implementation
of EBD into
practice
Attempts to 11.3 10 11.9 13.9 0.397 10.5 11.5 0.614 296.9 23.4 28.1 29.9 0.584 11.1 10.9 0.446 10.7 10.5 12.7 0.555 12.5 10.8 9.3 0.077
overcome
the barriers to
implementation
of EBD into
practice
None 0 0.6 0.6 1.2 n.a. 0.5 0.6 1 0.3 2.1 2.2 1.1 n.a. 0.7 0 0.231 0.6 0 0.3 n.a. 0.9 0 0.5 n.a
Other 1.3 0.2 1 0.2 n.a. 0.7 0.7 1 2.217 0.5 2.3 n.a. 0.6 0.699 0.3 3.5 1.7 n.a. 1 0.7 0.3 0.073
Q9
Yes 89.9 87 82.2 75 0.114 82 87.6 0.115 56.3 57.9 54.1 51.7 0.891 84.9 87.9 0.003* 85.1 83.3 84.4 n.a. 78.6 91.7 88.8 0.061
No 4.3 5.3 7.1 6.3 6.4 4.6 17. 13.6 16.8 21.8 5.3 6 5 2.8 7.8 7.4 5 3.7
No idea 5.9 7.7 10.7 18.7 11.6 7.8 19.8 21.3 22.7 18.4 9.8 6 9.9 13.9 7.8 14 3.3 7.5
CDE, continuing dental education; EB, evidence-based; EBD, evidence-based dentistry; UDE, undergraduate dental education. n.a, statistical comparison was not applicable because of the low response rate.
*Difference is statistically significant (P < 0.05).
Implementation of EBD into practice
143
Yamalik et al.
Densts who has received EBD educaon in Densts who gave response of "I pracce" to
"undergraduate dental educaon" by years of the queson "About evidence based denstry"
pracce by years of pracce
31over 31over
4.5% 10%
2130
18% 2130
20.2% 010
42.1%
010
48.1%
1120
1120 27.8%
29.4%
(a) (b)
Figure 4. (a) Frequency distribution of dentists who received evidence-based denstistry (EBD) education in undergraduate dental education, according
to years of practice. (b) Frequency distribution of dentists who responded I practice to the question About evidence based dentistry,
according to years of practice.
25
2030
3140
20
4150
Frequency (%)
51over
15
10
0
Lack of me
Others
Limited knowledge regarding the quality of
Lack of connuing educaon courses on EBD
evidence
Figure 5. Frequency of reported barriers to the implementation of evidence-based dentistry (EBD) into practice.
actual and true perceptions14. Setting a more detailed Evidence-based practice is a relatively new concept
questionnaire, including items measuring the level of in dentistry. Awareness, attitudes and knowledge of
knowledge and practice, may partially overcome this dentists from different countries varied towards EBD,
problem. In previous studies, technical terms com- which might be attributed to socio-economic, cultural
monly used in evidence-based practice were consid- and curricular variations. Respondents expressed
ered and the source of information was asked for awareness and positive attitudes towards EBD; how-
when faced with clinical uncertainties4,8. Further ever, the frequency of practising EBD was low. Except
research is warranted, especially to identify knowledge for Portugal, there is a lack of EBD training during
levels and solutions to increase the use of the relevant UDE in all countries, and young dentists, in
literature in scientific practice. particular, believed that they were receiving such edu-
Despite these limitations, the present study is likely cation, during their undergraduate training, from the
to provide significant data based on the perceptions dental faculty. Dental specialists generally had a
and attitudes of European dentists regarding EBD and higher level of awareness regarding EBD compared
implementation of EBD into daily practice. It is with general practitioners. Lack of education on EBD,
possible that these data may be a helpful tool for deci- lack of time and lack of clinical guidelines for dental
sion-makers, educators and members of organised care were the major barriers identified in this study.
dentistry who plan to further improvements the imple- Respondents desired to enhance their knowledge and
mentation of EBD into daily practice. use of EBD in everyday practice. They expect educa-
144 2015 FDI World Dental Federation
Implementation of EBD into practice
tional programmes to be organised by NDAs and sup- 14. Madhavji A, Araujo EA, Kim KB et al. Attitudes, awareness,
and barriers toward evidence-based practice in orthodontics.
ported by dental faculties. Am J Orthod Dentofacial Orthop 2011 140: 309316.
Previous studies reveal the expressed need, for an
15. Bauer J, Spackmart S, Chiappelli F et al. Evidence-based den-
improved collaboration between the NDAs and the tistry: a clinicians perspective. J Calif Dent Assoc 2006 34:
dental faculties28,30. It is likely that EBD, and its 511517.
effective implementation into practice, may be an 16. Gillette J, Matthews JD, Frantsve-Hawley J et al. The benefits
appropriate area in which NDAs and dental faculties of evidence-based dentistry for the private dental office. Dent
Clin North Am 2009 53: 3345.
may consider for working together.
17. Crawford JM, Briggs CL, Engeland CG. Publication bias and
its implications for evidence-based clinical decision making.
J Dent Educ 2010 74: 593600.
Acknowledgements
18. Ismail AI, Bader JD. Evidence-based dentistry in clinical prac-
The authors would like to thank to the six National tice. J Am Dent Assoc 2004 135: 7883.
Dental Associations (French Dental Association, 19. Chiappelli F, Prolo P, Newman M et al. Evidence-based prac-
tice in dentistry: benefit or hindrance. J Dent Res 2003 82: 67.
Georgian Dental Association, Polish Dental Chamber,
20. Sackett DL, Rosenberg WMC, Muir Gray JA et al. Evidence
Portuguese Dental Association, Slovakian Dental based medicine: what it is and what it isnt. BMJ 1996 312:
Chamber, Turkish Dental Association) for kindly par- 7172.
ticipating this survey. The authors also would like to 21. Gillette J. Answering clinical questions using the principles of
thank all the members of WG. evidence-based dentistry. J Evid Based Dent Pract 2009 9: 18.
22. Hannes K, Norre D, Goedhuys J et al. Obstacles to implement-
ing evidence-based dentistry: a focus group-based study. J Dent
Conict of interest Educ 2008 72: 736744.
23. Nieri M, Mauro S. Continuing professional development of
The authors declare no conflict of interest. dental practitioners in Prato, Italy. J Dent Educ 2008 72: 616
625.
24. Rabe P, Holmen A, Sj ogren P. Attitudes, awareness, and per-
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