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To talk about the one of the projects that we've been working together here during my sabbatical here,

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which is we called it for maybe provisionally the OHA, which is the old Oral Health Foundation.

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So we're working on school days and I slept through school, so this project would have favoured my sales for online.

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Also, student loans, so painful for me.

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Okay. Just briefly, I am also a professor at the Department of Epidemiology at the University of the State of Virginia,

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and I am also a professor at the National School of Public Health.

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So all the consultants. So it just struck me as you know, I come from my background.

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I graduated younger than for a few years of practice, especially for the Vipers.

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Then I migrated to public health and epidemiology, got my first lovin life in 93.

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And I witnessed the birth of the Space Medicine Organ A.V. Club in collaboration.

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I was actually at the University College London and at the London Hospital Medical College at that time.

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Then I thought or thought evidence based data in 1993 and 1997.

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Since 1997, I've been teaching epidemiology and public health to physicians, dentists, nutritionists, basically all.

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Health health care workers. My main interest is on organisation goals and overachievement and I supervise my day to day work.

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I supervise page the calculating.

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So before I start sharing it with you, it is true that we are developing, that we are calling all Hi.

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That stands for Oral Health Answers of this.

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What motivated both to. So what motivated us to create this goal and what motivated those challenges is the practice of evidence based health care.

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So some of the challenges were personal, but they are to cooperate.

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And Cockrum suggested that the relationship between doctors and patients has

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been established as a marriage of two strong desires the desire of the health,

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the desire of the patient to be helped. And the with the advent of the National Health Service here,

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that's novel such as have you had led to decrease ubereats financial barriers to access health services?

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And that's led to a tremendous increase in the number of prescriptions and tests.

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But always the patients wanted doctors to help and the doctor to think of something to do to help patients.

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So that was a marriage of choice.

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It's also important also noted that there was an exaggerated belief in doctors, which probably developed because doctors were able to alleviate pain.

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Because of the general placebo effect. Because that's one part of many decisions.

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All these things are improved over time.

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So whatever you're doing with this process, it looks like something that was.

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And also because of the higher social status of Google.

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But what if he reversed the logic, his logic of providing whatever help you are able to provide and reverse in in that way?

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He suggested that a doctor should always wear.

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Provide treatment if there is an inconsistent policy position that statements are what?

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That's the opposite of what was going on on the before the the movement of evidence based medicine.

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All the challenge challenges to explain to us what you get is named the sick syndrome.

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Well, sick stands for self-defence. Innumeracy and conflict of interest.

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Just self defence. Defensive medicine is when doctors or dentists prescribe excessively for shoot.

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Innumeracy is real. The.

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Get used to. So this will.

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They don't the the meaning of the of the estimates of effectiveness, of accuracy,

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of diagnostic patterns of treatment or otherwise of diagnostic tests.

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And this has been shown to happen mainly because they fail to neglect the base rate of the disease.

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So it puts too much emphasis on the results to be passed without considering the prior probability of the disease.

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And they also don't understand when they hear a 40% reduction, a 30% reduction, what that means and the conflict of interest is,

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well, they refute books like luxury hotels and conferences and all the famous gifts.

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So, for instance, they don't know. They're talking about factors, which is very common.

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And also they are paid a fee for service, which means that the more they do with what they are.

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So this challenging web based practice that we have highlighted.

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Help them to survive if things are left naturally.

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There will be an uncontrolled growth of health care and unsustainable health services.

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And people will to to perpetual patience.

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And this all drive us forth over your health.

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Questions of overdiagnosed Overtreatment.

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So here is a summary of the context that motivated those to create or.

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So doctors desire to help and patients decide to be help exaggerated the doctor's

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health proxy overseeing the work of insurance drivers over the treatment.

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We believe that all her can help overcome this challenge.

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Of course, also looking for someone to that can help to overcome this challenge.

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So to illustrate, you simply demonstrate when we are talking about the diagnosis of administration.

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So we basically painted over that, you know,

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as this conference in Copenhagen thing where we presented a paper to David Stevens myself trying to publish.

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I hope they addressed the issue of overdiagnosis by too much.

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And it was interesting to notice that the audience was surprised because people hear a lot about complains of lots of deaths,

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of lack of access to dentistry. And then we were talking about too much dentistry.

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Especially those who are following the situation in the UK.

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There is a lot of talk about the nature of the stream of fiscal benefits, not wanting to be involved.

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So people are having problems of access. What people don't realise is that there is a lot of overdiagnosed,

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a little bit treatment that may be contributing this under the rules of overtreatment,

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because if you will get two thirds full of treatments that a lot of people don't have time to look out for, what is loss of life.

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That's what we are suggesting is happening. So how exactly this over that was occurred.

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So basically what the diagnosis is,

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when you want to fire conditions that will blow up and the first vehicle into

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patients unnecessarily would classify someone as having a foot of disease.

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This person becomes a patient. And this normally happens by redefining disease and lowering thresholds for disease and risk factors.

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So let me just go to sleep. So I suppose it's Aaron.

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If, like you said, health is from both literally an example of health, which is of the most common dental problem.

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So people use it for dental care when they feel the full of pain.

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When you have the situation in at the stage level five or six famous people, this is all this conflict that requires fame.

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Now. At the time.

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That's that's the wrong time for cavities or dental care as the dentist talked about those at levels five and six.

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The dentist at that time already took the opportunity to also fill this up.

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So these cavities that are much smaller, he is four and at that time they used to fill this cavities, not only putting the tissue around the floor,

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which is too small, it usually would expand the country or create a much larger effect even remotely to avoid future problem.

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And that was the question. If that was a good practice,

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then eventually it became clear that was not the practice and they changed and

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they stopped having to do a surgical procedure in order to do those large.

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So now you have a minimal intervention approach where they try to keep from this feeling to the small lesion, small to medium level.

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It get confused with level two, for instance. And what else?

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Well, happens is that nowadays they're just trying to identify reason where there is no cavity with all white spot lesions.

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So the threshold, a lot has changed.

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And of course, almost everybody had this kind of news.

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But that's the crucial. They didn't penetrate in with the.

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And you can say, well, but if the lesions is identified earlier, that's the problem.

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What we have, which is central to problems work, is that most of the institutions that are defined value, they don't develop.

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And so they are unnecessarily. Well, simply.

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Well, it's no difference in terms of prognosis when you have treatments.

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It's usually is for application professional for the patient and sometimes with the raising issue traditionally.

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So you have interventions, preventive interventions, or you don't have the proposals.

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We don't know what's what's that? So basically what we have now moved from an operating cycle of restoration,

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new restorations in level five and six and three and 4 to 8, repetitive cycle prevention.

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And to do that, dentists suggest, recommends people to use the dentist every six months so they can be.

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Followed and assessed every year twice clean and in order to to avoid a new Newcastle.

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So of course the problem is huge. But in practice, there is a lot of evidence that prevent a visit to the dentist will be beneficial to oral health.

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So the six months we built a check up, which is probably one of the most lively.

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Abandoned Delta Public health measures is also one of the newest evidence based.

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And back more than 40 years now of asylum with this paper the less.

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I bring something simple if you travel because there is this recent progression of.

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Thanks, Wolf. KLEIN The failed license, a small development to a dental practice takes more than two years.

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You should. Why would you need to in six months?

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It's largely similar to periodontal disease.

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And the. Falcon review on the subject of the paper we plan to call to.

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The complication of the interval trial, which was a UK multicenter,

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pragmatic randomised control trial in primary care setting, included only two trials.

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And I'm not going to carry on talking about this now because one of the dental

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fact boxes that I'm going to present to you at the end of the talk about.

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So one school set. Well, there are other initiatives like the dental health, the trip,

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the database as they go through June of at the local practice that were initially

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intended to go to deal with the overwhelming amount of information available.

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So they tried to solve this problem of overload, but they also grew very, very large.

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And so finding answers for sources requires time and expertise.

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And it's challenging to get information from this.

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But. So the overload problem remains unresolved.

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So there was a far more selective repository.

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And here's an example of a search elf looking for a root canal.

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And I found 383 results here.

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So you have to go through all these 383 hits to select what you want.

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So to answer your question. The same search in the evidence based dentistry.

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Now we had 105 hints.

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And these are the jewels of Apple's late dental practice.

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106 point. So.

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So it's really easy to get around and get to answer quickly.

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So all have distinctions. Self control main ways that look divorce is published appraised studies and review.

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So what we do is publish the critically acclaimed work and publish their analysis and the summary of that review.

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The thing with blogs Google Maps, Fortune 500, that's all.

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In all, you look at all the reviews, all the synthesis, and we create one box, one summary of all of this.

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They place all of these benefits. So the use of what is the information is not just one.

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Another difference that all this other sources, they grow each time more because they encompass more and more things and still.

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And important part was looking for less is more. So we restrict our fat boxes.

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So the most commonly dealt with. We'll give you just the bill for three vote, but that's not a lot.

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But as far as we know, the first Fox box was a drugs Fox box, which was developed by Schwartz and Wallace 3013.

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And the other one more recent boxes from the housing support boxes and developed like you get in here in your house were inspired by this little one.

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So here's the deal. Just to show you what it was possible.

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The Drug FAQ talks about a drug to treat Alzheimer's disease.

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And you have to. So we want coming.

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You have the evidence about this drug and the benefits.

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They divide the thought, the box lines, and the red line starts the benefits and then the harms.

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The both. They will be both. Then you see basically they say they show here they just showed these two trials that they selected.

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They give the up and they have one column for the treatment room column for the placebo.

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So one outcome is three and five scale of coils that at all time will give you a lot of scale.

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So that's welcome. And they give the results separately for one.

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So it's not one single people.

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And he has a small summary, but he's also one of the following smoke from the outcome.

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So they interpret very deeply what result means, and they give me the source of information with a reference that requires approval.

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So if you think about this drug on the back of this drug benefits and heart, and here is another quote from the original sample of this war was about.

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In which the test of the they wanted to be effective mammography screening and they I have

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the first column but also hope that no screening and the second fold don't have a screening.

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So have all civil incidents of the the outcome both separate.

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And also you have benefits involved and a small very about.

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So this is the fact that these expire lands.

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So it's all has to go. So basically what we want is a concise start on all sides.

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Summaries of the best available evidence format that promotes clear thinking.

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So I think if I can summarise in this purpose, we hope to identify and communicate the truth that has been hidden behind an excess of information.

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That's what we'll. Got to make a point about more studies in there.

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Unfortunately, there are surf outcomes of more than a third for patients.

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So what that means is that it comes with a lot of patients and also lack prognostic when.

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So for me, the principle of hope that less is more or had select studies that assessed tangible outcomes.

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So the company prioritised a lot of things like SlutWalk Youth A.

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17, the dancing witches will stage Ragu with over 3.5 losers of active oral function and wellbeing, including chewing ability viewing of.

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Alam importantly, avoids key tangible outcomes like wide squat lesions or gingivitis,

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which is just the redness of the girl or small bleeding that is questionable.

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Important for oral health. Now we also have of interest the general use the vehicle.

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So we expect that we will.

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Several dentists administered the treatment being tested and launched from a highly specialised

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clinic where you only have one or two very skilful dentists by the nature of what we do.

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We also favour, of course, of all the studies that the syncopations opening in day to day vertical.

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So what's the structure of. So each day out of the block, Fox blocks these three names of information.

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So the work is comprehensive but takes longer to consult because it's very expensive school.

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It has everything down, all the things, everything. You create that first books, all thinking, process, smoothing.

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On the other hand, the last three is superficial.

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Lightweight provides a quick and musical solution.

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It was also immediately mentioned, which includes some good things, like, for instance, the precision of the estimates and the deep assault.

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But it's more convinced than you want the basement, which is very easy to.

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So depending on the interest of the user, you find that what is that specific moment?

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They can choose to consult one or another. Quick and superficial information or marketing.

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Okay, so how do we find out what I'm going to show you?

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Well, the template that we put a fat portfolio of the most detailed layer of the.

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That simply functions as a guide to us authors of the.

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When we act, we are creating a specific force in order.

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So I want to show you just a little more or less some of the postings.

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And then I'm going to go to the examples, because I think if you look at the examples, you will just know how.

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In any case. So the creator did not have to write down all these questions.

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So what's the question? The main source of information, main outcomes that are going to be reported in that box and etc.

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I'd like to just talk a little bit about the question so we have to write down.

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So since the beginning, the treatment, specify the treatment, specify the outcomes.

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The population should be left open as well as any company of interest.

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But what? And it is at this stage that maybe we have to reframe the question.

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We have to live with thinking of oppression. What may be the results of the question?

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For example, the dental check up the fact books.

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We had to reframe the question to consider interactive because we were interested initially to check up with multiple.

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But there is no study of check ups and check with the medical school because that is never agreed.

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So I'll look for patients to to check Check-up.

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The maximum we managed to get was given the interval time between check-ups ups.

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We found evidence of studies, basically one study that compared a six month check up with a 24 month check.

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So we came because of that. That's a different question, wasn't it?

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But that's the best we could get. Also, we were interested in outcomes such as truth, loss to faith.

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If you go to the next six months, you will have lost some of these outcomes.

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They didn't. So we have to accept.

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Only then can cavity also scale of oral functioning like wellbeing and gingivitis.

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Just as we are. Back in the early 1990, I was planning to do a trial of multiple up.

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That was after one year.

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From our calculations, sample size. I needed nearly 40 general practice equipment at the end of one year.

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I bought less than seven, but people were not willing to follow.

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The goal was not feasible. And that was the only life in my life.

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Have you tried each new trial that they would launch?

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They are looking to try 24 months off. Six months into that, the benefits would be closer.

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It was three months and eight months.

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And well, the thing is to be allocated to 24 months, only 30% of the participants, because the date is only with all of you for four months.

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Those who they believed were at most developing care and don't want things.

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But don't ask me to give you all the gift that patient will never be subjected to.

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So only 30%, 70% of the patients in this trial.

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People ought to be able to get. So basically we have that's the best weapon.

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That's the real life. Then not for fact books that have people that don't exist.

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So there is also the practical layer, while both about clinical considerations of showing your gets up is easier instead of breathing here.

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Also the perspective to putting the visual aspect of this to perspective.

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It is truly remarkable that we will have this while I was showing one example.

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A source of information about their main character. So we have to write down everything that was done or just find the source of information before

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selecting the reference for the systematic review of the primary studies that were selected.

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Study a number of participants, details about intervention, length of follow up.

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All of it is reported. Then there is a search strategy and strategy in four steps.

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So we have to stay the date of the search, find the most recent systematic review.

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And if you look at this database here, if no appropriate review is the most relevant, credible primary studies.

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Then you look at the two or three citations of systematic reviews and citations.

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The most recent review. Finally, finally among the press.

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And if you don't find or if you find the an all the more results of systematic review and the third step that is the step one.

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Now Table of contents of Summary of evidence as a single core samples to represent the present efficacy.

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So we always look at all the cons for each group.

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We have the for Muslims outcomes. So let's use it.

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So long. So now, with the treatment. All without.

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Without. So sometimes these incidents are reported involving numbers, sometimes in percentages.

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The absolute numbers. But when we report that some bourbons, we keep the the denominator constant.

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So we hope everything's fine.

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We want to change of.

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We will say so in pale versus five.

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It makes a really.

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And I should mention that David and I and other colleagues of vaping are review to find out the best format of whole patient.

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So depending on the results of these. We may change the presentation of results in.

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Okay. Well, to the event in the examples.

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So we have now I showed you the box in draft form, so I won't pay attention to the layout of what we want for you.

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So if we manage to get funding, we have people, professionals to work on the layout.

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Which are very important.

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So one example that I will give you is the benefit of local check-up for health Audience The success rate of root canal treatment.

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So there's a full profit doubles because of some interesting examples of how be.

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So one of them has to update up to date.

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Systematic review, which is the dental Check-up example.

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And then all the ones. You don't affect the box on root canal treatment in Philadelphia since 2010.

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After that, many private citizens will come as consumers.

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All of this glamorous third party. And also the question about the different treatment.

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So if you want to check all kinds of technological treatments,

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we have to also take all the questions from our fashion forward cohorts or other experimental activities.

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We have indirect data, indirect evidence from the dental check-up.

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We have direct evidence that walking on the canal treatment.

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So. Is this true?

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Examples. I like the fact that in real life.

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Scenarios. We never have a perfect scenario.

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So health professionals and patients frequently find themselves making decisions based on less than perfect evidence.

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We believe this will help them think new challenging scenarios.

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So the political order is six months to 24 months.

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You have the. Which is the most superficial, quick, so patient we have.

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If you ever leave the nose with for what the comparison is about, it's adults aged 18 years or older, followed by four years.

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You look like one of.

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So we each each line here is more logical.

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She might not want the benefits of the five year cost in the postcard and you have the six month info on.

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And we have a number of them and this is what we.

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And so you don't see any indication of seizure of people, really.

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You clear? For instance, if you look at the 31 patients we've had,

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the presence of 50 with the formation of all three procedure was the result of the

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patient say that there was no statistically significant difference in the benefits.

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So even without that engineer you.

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That's five conferences ago. And in the case of when you travel with the.

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Well. If you look at the.

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Moving it to the intermediate layer to.

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Uh, what do you see here that you're not feeling of three other sources of information for your life?

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FOLKENFLIK So here we have the source of information, which is this fact.

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But and you help me think about.

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But that's true. And then you have to move on.

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We could move to the things Player one, which is the most detailed.

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The world is setting the table here that we did not see the letter to is the

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interpretation of each outcome result in relation to the estimate and precision.

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For example, if you look at the percentage of patients with cavities, we write, the interpretation of all the interpretations was new,

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and the imprecision of these estimates indicates that there is no evidence that there was a difference between six and 24 month intervals.

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So that's what this one word interpretation for you ultimately on each one of them, these labels.

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And then you have all things being equal sort consideration.

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So let's play what the advantages and disadvantages of a potential.

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Well, we've see what's the information that is lacking.

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Explain everything in this. Books.

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And then the perspective for the vision of the population.

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So I just think it's interesting.

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And so to read what we said to the perspective of the interview,

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it is not possible to know whether I will benefit from the six month or the 24 month interval between the two check ups.

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If I am over 18 years of age and my dentist will see this, that I am more high risk of developing cancer periodontitis.

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Visiting the dentist for a check-up That is,

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even when I feel that there is nothing wrong with my teeth and gums once every six months or once every two years,

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you probably have the same effect on my old son.

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So we need to look.

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And although the text for those who are interested in football once we st was the aspect of the population.

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We give all good sources of informations here, all the publications consulted.

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The result of the scaffold will be followed in each step.

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How we calculated the person closely when they were.

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It was it's not properly really not available until it's been outlawed.

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And finally, the example of Scott. The question was how many patients complete root canal treatment but extract the gift within five or ten.

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On the telephone. There is no information about the procedure.

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Just say the. Data fall within 5 minutes.

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Thousands of patients with strolling barefoot folk will have this exciting five year plan.

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Nearly 20%, 70%. So that's all possible.

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But then in the second layer, we have.

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What we think of our view of public health is not only will the position of possession and have discussions of income,

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which is what we would develop with the sausage population, plenty, because we both want to do well as all this public studies.

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We had to look at. And if you go to the label once we have the same information on the table that we're having, these two would be the same tables.

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And then. We have all the clinical considerations.

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For instance. Well, let me to you the clinical considerations for this five.

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The extraction of the tooth is a definite and effective way of treating root canal infection or toothache.

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And the dog treatment is an alternative intervention that is performed to eradicate or prevent infection in the root canal,

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toothache and the extraction of tooth.

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Therefore it is of interest for the and for some patients to know the effectiveness of the novel as its function for.

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Sometimes there's a lot of people's initiative but must be discontinued and the tooth extracted within one year due to,

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for example, perforation of the technology and location instrument structure.

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Don't, you know, crack and people die. The reasons for starting but not successfully copying can be good growth,

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lagging on that selection of cases and technical or biological difficulties related the tooth and the dentist.

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And here comes the important information. This fox box does not include and the daunting treatment that started.

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But the have not been this have not been sorry but had to be discontinued.

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It provides information, all of the devoted treatment that was completed.

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There is a lot of box. That provides information about the equipment that was started so that when it was open, so they'll be usable.

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Here is the data.

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If you completed successfully the treatment that 15% and then treatment signalling both the frequency of the stop voice and the final treatment.

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And there is the possibility that it's not important.

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And there's another factor for that to show that 30% of the stuff a one of the most significant.

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So that's what's going on. Another perspective too.

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Individual the perspective to the population. And we'll see what the source of information was.

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The it is the search strategy. So when it came to the relevance to this, among those citations of the review, of course,

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was 2005, you identified all those studies have got to think about these things,

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which are the population to a nationwide population study in South Korea, a nationwide population study, the United States.

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So there was a couple of things. Other nationwide studies we do.

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So there are so many studies that help us.

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Straight out to all of you. I'm doing fine.

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So we felt like verify that there is a need for systematic review of the there was a protocol.

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But what I noticed with you and with all of Drupal, also of developing protocol.

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So the point is for the board. And so we had to do all this together.

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We cannot ignore this just because there is room for systematic review.

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So we have had some of. To gather all this data together.

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Let me explain here the calculations that we do that.

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How we calculated the imprecision precision of the estimates.

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That's all we talked about.

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And with all this explanation, how we managed to get through this.

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And no information should succeed.

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Okay open that to by now all of.

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Waiting for the order to be available. So.