International Dental Journal 2015; 65: 127145

SCIENTIFIC RESEARCH REPORT

doi: 10.1111/idj.12160

Implementation of evidence-based dentistry into practice:

analysis of awareness, perceptions and attitudes of dentists
in the World Dental FederationEuropean Regional
Organization zone*
Nermin Yamalik1,2, Secil Karakoca Nemli3, Eunice Carrilho4, Simona Dianiskova5,
Paulo Melo6, Anna Lella7, Joel Trouillet8 and Vladimer Margvelashvili9
1
Department of Periodontology, Faculty of Dentistry, University of Hacettepe, Ankara, Turkey; 2FDI-ERO WG Relations Between Dental
Practitioner and Universities, Bern, Switzerland; 3Department of Prosthodontics, Faculty of Dentistry, University of Gazi, Ankara, Turkey;
4
Faculty of Medicine, University of Coimbra, Coimbra, Portugal; 5Department of Orthodontics, Medical Faculty, Slovak Medical University,
Bratislava, Slovakia; 6Faculty of Dentistry, University of Porto, Porto, Portugal; 7President-elect, FDI-ERO, Polish Chamber of Physicians and
Dentists, Warsaw, Poland; 8Association Dentaire Francaise (ADF), Paris, France; 9Department of Dentistry and Maxillofacial Surgery, Faculty
of Medicine, Tbilisi State University, Tbilisi, Georgia.

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.

Key words: Evidence-based dentistry, attitudes, perceptions, barriers, clinical implementation

evidence-based dentistry (EBD) is currently considered

INTRODUCTION
In dental practice, clinical decision making based on
good-quality evidence is widely accepted to lead to
more effective and efficient treatments1. Thus,
*The project was conducted by the European Regional Organiza-
tion (ERO) Working Group Relationship Between Dental Practi-
tioner and Universities and was presented in the ERO Plenary
Session 2014, New Delhi, India.
2015 FDI World Dental Federation
as the best approach to apply evidence from relevant
research to the care of patients2. The American Dental
Association defines EBD as an approach to oral health
care that requires the judicious integration of system-
atic assessments of clinically relevant scientific
evidence, relating to the patients oral and medical con-
dition and history, with the dentists clinical expertise
and the patients treatment needs and preferences3.
Two main goals of EBD are to find best evidence and
127
Yamalik et al.
to transfer this to everyday practice2. Thereby, resolv-
ing the discrepancies between clinical research and
dental practice might be possible4.
Evidence-based dentistry provides significant advan-
tages to dentists, patients, the dental team and dental
practice1,5. Dentists who make evidence-based clinical
decisions have been shown to be able to continuously
improve their clinical skills and performance. They
can improve the quality and outcomes of the treat-
ment by making decisions based on the best evidence
with regard to treatment outcomes and cost-effective-
ness after considering patient preferences1,4,6,7. The
patients, who know that they will be treated in an evi-
dence-based practice, can feel more confidence and
trust in their dentist1,8. With regard to the dental
team, staff confidence, trust and personal satisfaction
can be increased by implementation of evidence-based
practice. Thus, clinicians can provide interventions
that are scientific, safe, efficient and cost-effective.
Evidence-based practice is a widely accepted term
in medical fields worldwide; in dentistry, however, it
has evolved over the past two decades and is still an
emerging concept4,6,9. Although the concept appears
fundamentally simple and reasonable, dentists have
been slow to translate current science into dental
practice10,11. A number of studies have been
performed to investigate the extent and mode of prac-
titioners adoption of EBD and the described barriers
to its implementation in countries around the
world4,9,12,13.
In several studies conducted among general dental
practitioners, a low level of familiarity with evidence-
based practice was found. Most respondents currently
seek advice from their peer colleagues when faced
with clinical uncertainties. Furthermore, only a small
number of dentists could correctly define EBD and the
various terms used in the field of EBD. The major
barrier reported, by general dentists, to the practising
of EBD was lack of time; however, a desire to find
out more information on EBD was also observed4,12.
In a study conducted by Madhavi et al.14 to evaluate
EBD in orthodontics, it was reported that orthodon-
tists generally had positive attitudes towards evidence-
based practice. However, understanding the concept
was poor, and awareness and understanding were
influenced by age and educational level. Other barri-
ers identified to practising EBD were the publication
of ambiguous literature, lack of clinical guidelines and
practical demands of work.
Other studies were also conducted to evaluate the
levels of awareness and implementation of EBD
among dentists in different countries8,9,12. As an
example, EBD was not a well-known concept among
Malaysian dental practitioners. However, a majority
of the respondents had positive attitudes, interest and
a desire to learn further information about EBD8. In
128
another study conducted among dentists in Kuwait, it
was revealed that the overall awareness of EBD was
low, and clinical decisions appeared to be mostly
based on the clinicians own judgment rather than on
evidence-based sources. A majority of respondents
highlighted the need for education in EBD12. Positive
attitudes towards EBD were also observed among
dental professionals in Sweden9. Although these stud-
ies attempted to assess awareness and implementation
of EBD among different groups of clinicians, to the
best of the authors knowledge, there is limited evi-
dence regarding awareness and perceptions of den-
tists, from different countries within the FDI-ERO
zone, towards EBD.
Therefore, the primary aim of this study was to per-
form a comparative evaluation of the awareness, atti-
tudes and practice of EBD, and perceived barriers to
its use, by dentists in France, Georgia, Poland, Portu-
gal, Slovakia and Turkey. The potential factors affect-
ing the perception, attitudes and practice of dentists
were also analysed.
METHODS
A questionnaire, The Relationship Between Dental
Practitioners and Universities, was developed by the
World Dental Federation-European Regional Organi-
zation (FDI-ERO) Working Group to determine the
perceptions, awareness and attitudes of dentists
regarding EBD and the implementation of EBD in
daily practice. The questionnaire had an introductory
section describing the background of the questionnaire
and its aims (Figure 1).
This introduction was followed by nine closed
questions aiming to analyse implementation of EBD
into daily dental practice. In general, the issues
focused on whether the dentists are familiar with
EBD; if EBD is implemented in daily practice; if it is
taught and, if so, when [e.g. undergraduate dental
education (UDE) or continuing dental education
(CDE)]; if there are obstacles to its effective imple-
mentation in practice; and if there is a perceived role
in the field of EBD for the National Dental Associa-
tions (NDAs), as expressed by the individual dentists
(e.g. organising courses, developing clinical guidelines
and others) (The questionnaire is shown in Figure 1).
The study was conducted in six countries of the FDI-
ERO zone (France, Georgia, Portugal, Slovakia, Tur-
key and Poland), volunteered by their NDAs. The
survey was either placed on the websites of each of
these NDAs or was emailed to the member dentists
by the relevant NDAs. Participants of the survey were
voluntary responders.
The data were entered on a spreadsheet and the fre-
quency distribution of the responses was calculated. For
data analyses, the chi-square test was used (P < 0.05)
2015 FDI World Dental Federation
 Implementation of EBD into practice

Figure 1. Questionnaire: (a) page 1 and (b) page 2.

using the SPSS Statistics for Windows Version 19.0
(IBM Corp., Armonk, NY, USA).
For analysis of cumulative data from the six coun-
tries, the percentage of responses to each question-
naire item was calculated. To compare awareness,
perceptions, practice and perceived barriers of dentists
from different countries towards EBD, pairwise com-
parisons of countries were performed using the chi-
square test (P < 0.05).
The potential factors, including age, gender, years of
practice and type of practice, affecting the perception,
attitudes and practice of dentists were also analysed
using the chi-square test (P < 0.05). From the question-
naire, age of the respondents was obtained and cate-
gorised as 2030, 3140, 4150 and 51 for which enabled us to evaluate further the potential
comparison of age groups. Similarly, years of practice
was categorised as 010, 1120, 2130 and 31.
In the questionnaire, kind of practice was evalu-
ated under three categories, as follows: (i) General
practice, or Specialist in dentistry; (ii) Private or pub-
lic or Public and private; and (iii) Solo practice, or
Solo practice in a medical clinic, or Group practice (in
a dental clinic with other dentists), or Group practice
(in a medical clinic with other dentists), or University
faculty member (private university), or University fac-
ulty member (public university). In the third category,
to obtain an adequate sample size for statistical analy-
sis, the subcategories were combined into Solo prac-
tice, Group practice or University faculty member,

2015 FDI World Dental Federation 129

Yamalik et al.

(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

4. Do you believe that generally evidence-based dentistry is beneficial?

a) Yes b) No c) No idea

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)

6. Do you believe that dentists experience difficulties in implementing evidence-based dentistry

into practice?
a) Yes b) No c) No idea

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.

Table 2 Cumulative data for all participants

Q1- About evidence-based dentistry (EBD)? Q7- If yes, what are the barriers to implementation
of EBD into practice?*
Total 797 Total 2023
I know what it is 261 32.8 Lack of time 215 10.6
I practice 256 32.1 Lack of financial incentives 156 7.7
Dentists should practice it 169 21.2 Lack of necessary education on EBD 301 14.9
No idea 111 13.9 Lack of necessary publications on EBD 170 8.4
Q2- Has EBD been taught to you in Lack of necessary websites on EBD 112 5.5
Total 625 Lack of EB clinical guidelines for dental care 199 9.8
UDE 262 41.9 Lack of EB clinical decision support systems 114 5.6
CDE 183 29.3 Limited evidence available in the dental field 126 6.2
NI for UDE 19 3 Lack of awareness on EBD 173 8.5
NI for CDE 22 3.5 Lack of continuing education courses on EBD 132 6.5
NI for both 138 22.1 EBD being perceived as time consuming 102 5
Q3- Do you believe that EBD Lack of practical ways to reach to best evidence 110 5.4
should be taught in
Total 683 Limited knowledge regarding the quality of evidence 107 5.3
(appraisal of evidence)
UDE 485 71 Others 6 0.3
CDE 134 19.6 Q8- What is the role of National Dental Associations
in improvement of the implementation of EBD in
practice?*
NI for UDE 13 1.9 Total 2001
NI for CDE 4 0.6 Creating awareness 455 22.7
NI for both 47 6.9 Developing EB clinical guidelines 365 18.2
Q4- Do you believe that generally Developing EB clinical decision support systems 308 15.4
EBD is beneficial
Total 734 Organising continuing education courses on EBD 427 21.3
Yes 654 89.1 Negotiating with the authorities for financial incentives 200 10
to foster implementation of EBD into practice
No 19 2.6 Attempts to overcome the barriers to implementation 221 11
of EBD into practice
No idea 61 8.3 Others 11 0.5
Q5- If yes, who benefits from EBD and None 14 0.7
its implementation to dental practice
Total 828 Q9- Do you believe that dental faculties and National
Dental Associations can collaborate for implementation
of EBD into practice
Dentists 350 42.3 Total 760
Patients 192 23.2 Yes 646 85
Public 104 12.6 No 41 5.4
Dental Profession 133 16.1 No idea 73 9.6
No idea 32 3.9
Other 17 2.1
Q6- Do you believe that dentists experience
difficulties in implementing EBD
Total 779
Yes 469 60.2
No 137 17.6
No idea 173 22.2

*Multiple choice questions.

CDE, continuous dental education; EB, evidence-based; NI, no idea; UDE, undergraduate dental education.

gal and Poland believed that dental faculties and
NDAs can collaborate for implementation of EBD
into practice, and 70% of dentists from Slovakia
and Turkey agreed with this response (Table 3a).
Data regarding the potential impact of variables on
perceptions and attitudes towards EBD
Data analyses with regard to the variables age and
year of graduation from dental school revealed
similar findings between countries regarding having
knowledge about EBD (Table 5). The statistical
results of these two variables indicate that EBD was
132
taught to younger dentists in UDE, whereas EBD was
taught to older dentists in CDE, and a higher propor-
tion of young dentists practised EBD compared with
older dentists (Figure 4). Younger dentists more fre-
quently believed that generally EBD is beneficial
compared with older dentists, and this finding was
statistically significant (P < 0.05) (Table 5). Lack of
time was listed as a barrier more often among young
dentists. The lack of financial incentives seemed to
be less important for dentists with more years in
practice compared with those with fewer years in
practice (Figure 5). Gender did not have significant
effect on the respondents awareness perceptions and
2015 FDI World Dental Federation

"Do you believe that generally EBD is benecial"
No idea
8.3%
No
2.6%
Yes
89.1%
(a)
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
obtained from general practitioners were significantly
different compared with those obtained from special-
ists in the aspects awareness (P = 0.002), practice
(P = 0.004) and find EBD beneficial (P < 0.001).
Specialists also reported that they had received educa-
tion on EBD during CDE (40.3%) rather than UDE
(15.3%) (Table 5). Dentists working in public health-
care services reported lack of time as the significantly
(P < 0.001) most important barrier in implementation
of EBD compared with private practice dentists. Uni-
versity members (36.6%) were more likely to practise
EBD (P < 0.001) compared with solo (48%) and
group (44%) practising dentists.
DISCUSSION
Evidence-based medicine is the conscientious, explicit
and judicious use of current best evidence in making
decisions about the care of individual patients. The
practice of evidence-based medicine means integrating
individual clinical expertise with the best available
external clinical evidence from systematic research20.
Compared with medicine, evidence-based practice in
dentistry is a relatively new concept that has evolved
during the past 1520 years and continues to
evolve13,21. A number of previous studies have evalu-
ated the level of awareness, and attitudes and practice
of dentists of EBD, and described barriers to its imple-
mentation4,8,2224. These international reports provide
evidence that the concept of EBD has different levels
of awareness and adaptation amongst various groups
of clinicians. However, to the best of the authors
knowledge, there are currently very little data on a
target population consisting of several FDI-ERO zone
countries, together with the determination of the
potential impact of a number of sociodemographic
factors on evidence-based practice. Thus, the findings
of the present study might be useful for designing
2015 FDI World Dental Federation
Implementation of EBD into practice
"About evidence based denstry"
No idea
13.9% I know
what it is
32.8%
Densts should
pracce it
21.2%
I pracce
32.1%
(b)
effective national/regional/global strategies for imple-
menting EBD into practice.
It was encouraging to note that when dentists were
asked about EBD, most respondents reported familiar-
ity and positive attitudes. Furthermore, 89.1% believed
that EBD is beneficial. This finding, which is inconsis-
tent with previous studies4,8,9, is important because it
might reflect the high demands of modern-day dentists
for best practice and clinical decision making. How-
ever, the percentage of dentists practising EBD (32.1%)
was rather low among all respondents, in the absence
of stratification according to country and other demo-
graphic variables (Figure 2), which also seems to be an
important finding that needs to be taken into consider-
ation.
The reasons for not adopting EBD in their daily
practice might include the following: EBD is still an
emerging concept and therefore the benefits of EBD in
providing best practice are not known; poor under-
standing of evidence-based concepts by clinicians; and
difficulties experienced by dentists in implementing
EBD10,11. The last potential reason was confirmed by
60% of respondents in this study. As identifying
barriers is an important step towards increasing evi-
dence-based practice in dentistry, several studies were
conducted to identify these barriers4,8,9,11,14. In line
with previous studies, the most frequently noted barri-
ers were lack of education on EBD, lack of time and
lack of clinical guidelines for dental care4,8,9. Other
frequent barriers reported in the reports were the
ambiguous and conflicting nature of the literature, the
demands of work, financial constraints and poor
availability of evidence4,8,9. Spallek et al.11 identified
barriers previously not emphasised in the literature,
such as fear of criticism by colleagues or lack of confi-
dence in the research results. They performed a
comprehensive survey on barriers to implementing
EBD of early adopters. The survey included analysing
barriers under the subtitles of associated with patient,
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

2015 FDI World Dental Federation

 Table 3 continued
Country Age range, Gender Years of Kind of practice
(n/%) years (n/%) (n/%) practice (n/%) (n/%)

2015 FDI World Dental Federation

 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

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

2015 FDI World Dental Federation

 Implementation of EBD into practice

with health-care provider and with health-care organi-

11
14

41
72
641
TOTAL

sation, rating the barriers and their opinions for over-

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

tion of EBD has also been evaluated in this survey,

which previously had not been emphasised in the litera-
20.4

13.2
Specialist
10

22
0

ture. The most frequent expectations of clinicians from

NDAs included creating awareness, organising contin-
79.6

86.8
100

General practitioner
90

78

uing education courses and developing evidence-based

clinical guidelines. However, it should be emphasised
14.3

10.2

19.5

 31
9.1

7.3

that whilst well-developed evidence-based guidelines

Years of practice (%)

36.4

20.1
29.3

21 30
and continuing education courses improve dentists
7.1

32

knowledge and overcome some barriers, they do not

45.5
28.6

28.3
31.7
22.2

improve dentists clinical decision-making skills, which

11 20

themselves may inadvertently create other bar-

41.3
31.7
26.4

riers11,13,26,27. Therefore, drawing attention to finding

0 10
9.1
50

best evidence and transferring this into everyday prac-

54.5

59.3
43.9
42.5

Female
Gender (%)

tice seems more important. Furthermore, producing

50

guidelines is a precise procedure, and organisations

54.4

46.1
56.1
57.5

Male
50

should develop dissemination strategies for timely deliv-

ery of information, reduce the complexity of recom-
20.3
19.5
33.3

 51
7.1
40

mendations for clinicians and produce useable chairside

Age range, years (%)

tools with easy-to-understand evidence-based recom-

35.7

25.2
34.1
29.2

41 50
30

mendations. The results of this survey also revealed that

dentists have positive attitudes towards the collabora-
28.1
26.8
22.2

31 40
7.1

CDE, continuing dental education; EB, evidence-based; EBD, evidence-based dentistry; UDE, undergraduate dental education.
30

tion of dental facilities and NDAs for implementation

of EBD into practice, which has not been mentioned in
26.3
19.5
15.3

20 30
50
0

the literature. In one study, conducted by Marshall

et al.13, dental faculty members confirmed the impor-
21.4

19.3

Poland
9.1

5.5
22

tance of teaching students EBD. The EBD content of the

facilities curriculum is unknown. It is likely that the
18.2

21.5
48.8
45.2

Turkey
7.1

collaboration of NDAs and dental faculties may have

71.4

19.2

Slovakia
the potential to overcome some of the reported barriers
Country (%)

9.8
0

and improve evidence-based practice.

54.5

41.5
17.1
23.3

Knowledge on EBD might be associated with cul-

Portugal
0

tural shifts or curricular variations9. Therefore, one

Georgia
objective of this study was to perform a comparative
2.7
0
0

4
0

evaluation of the perceptions of dentists from six FDI-

18.2

France
6.7
2.1
4.1

ERO zone countries: France, Georgia, Portugal, Slova-

0

kia, Turkey and Poland. As such a diverse response

from FDI-ERO zone countries regarding EBD percep-
Table 3 continued

tions and attitudes of dentists has not previously been

obtained, the findings of the present study might pro-
vide valuable information on the dentists in these
countries. The literature reveals that EBD is presumed
to be well accepted and practised in European
No idea

countries8; however, this survey presents conflicting

Other
None

Yes
No

results. For example, the percentage of respondents

Q9

2015 FDI World Dental Federation 137

 Table 4 Statistical data regarding comparative analysis of the six countries

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

2015 FDI World Dental Federation

 Table 4 continued
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

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

2015 FDI World Dental Federation

Limited evidence 1 0.361 0.202 0.0001* 0.888 0.601 0.166 0.0001* 0.776 0.006* 0.0001* 0.027* 0.001* 0.216 0.0001*
in the dental field
Lack of 0.146 0.0001* 0.003* 0.011* 0.0001* 0.062 0.549 1 0.031* 0.349 0.0001* 0.338 0.273 0.116 0.0001*
awareness
on EBD
Lack of 0.981 0.0001* 0.031* 0.094 0.0001* 0.002* 0.037* 0.118 0.0001* 0.736 0.004* 0.344 0.328 0.302 0.003*
continuing
education
courses
on EBD
EBD being 0.706 0.977 0.941 0.527 0.229 0.555 1 0.271 0.693 0.577 0.251 0.047* 0.245 0.399 0.007*
perceived
as time consuming
Lack of 0.125 0.488 0.072 0.276 0.001* 0.281 1 0.549 0.617 0.123 0.461 0.0001* 0.285 0.318 0.005*
practical ways
to reach to
best evidence
Limited knowledge 1 0.0001* 0.0001* 0.223 0.639 0.0001* 0.0001* 0.293 0.915 0.154 0.0001* 0.0001* 0.002* 0.0001* 0.003*
regarding
the quality
of evidence
(appraisal
of evidence)
Others 0.539 0.016* 1 0.102 0.171 n.a. 1 1 1 0.023* 0.373 0.292 0.138 0.223 1
Q8
Creating 0.218 0.001* 0.004* 0.003* 0.036* 0.0001* 0.0001* 0.0001* 0.003* 0.771 0.671 0.089 0.591 0.166 0.226
awareness
Developing EB 0.962 0.209 0.036* 0.686 0.002* 0.229 0.051 0.662 0.006* 0.147 0.096 0.002* 0.012* 0.619 0.0001*
clinical guidelines
Developing 1 0.012* 0.0001* 0.047* 0.0001* 0.117 0.0001* 0.228 0.0001* 0.0001* 0.484 0.0001* 0.0001* 1 0.0001*
EB clinical
decision
support systems
Organising 1 0.747 0.076 0.851 0.201 1 0.228 1 0.478 0.031* 0.848 0.099 0.029* 0.371 0.097
continuing
education
courses on EBD
Implementation of EBD into practice

139
 Yamalik et al.

who gave the response I practice ranged from 20%

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

opportunities for students to develop an essential skill

0.802

0.341

n.a.
set for evidence-based practice. However, emphasis
1 on EBD is relatively new, and thus educating under-
Portugal/

0.0001*

graduate and graduate dentists on EBD may take

Poland

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

designing and expanding the EBD content in their

0.051

0.328

0.716
0.373

n.a.

curriculum. CDE is also an important resource for

learning EBD11. In France and Georgia, most dentists
Portugal/
Slovakia

0.0001*

learned EBD from CDE, rather than from their dental

0.134

0.682

0.597

n.a.

education.
Evaluation of perceived barriers according to coun-
Georgia/

try revealed that lack of education and lack of

0.0001*
Poland

0.567

awareness on EBD were the most frequent difficulties.

n.a.

However, dentists from Slovakia reported lack of

1
1

time as the most frequent barrier in implementation

Georgia/
Turkey

0.001*

of EBD, in line with previous studies4,8,9. In contrast

0.752

n.a.

to the literature, lack of time was of low statistical

1
1

significance for dentists from Portugal compared with

Georgia/
Slovakia

0.029*
0.003*

dentists from other countries. In the present study,

0.338

n.a.

n.a.

lack of necessary education on EBD was the main dif-

ficulty. Besides these common difficulties, financial
Georgia/
Portugal

constrains were reported by dentists from Malaysia

0.018*

0.431

and the UK4,8, poor availability of evidence was em-

n.a.

n.a.
1

phasised by dentists from Sweden9 and lack of Internet

connection in the workplace was reported in Kuwait12.
0.0001*
France/
Poland

0.015*

0.171
0.567

These results may lead to the conclusion that differ-

n.a.

ences in sociocultural habits, the national economy,

workplace conditions and health-care systems may
0.0001*
France/
Turkey

0.027*

0.178

influence dentists implementation of EBD.

n.a.

A novel aspect of EBD, the role of NDAs in

1

improvement of the implementation of evidence-based

Slovakia

0.0001*
France/

0.011*

0.002*
0.199

practice, was analysed in the present study. The

n.a.

results of the survey revealed that creating awareness

*Difference is statistically significant (P < 0.05).

was the most frequent expectation of dentists from

Portugal
France/

0.001*

0.003*

the six countries included in this study; developing

0.275
n.a.

n.a.

clinical guidelines and organising continuing educa-

tion courses were also reported. This might be inter-
Georgia
France/

preted as the expectation, by dentists, of support and

0.416

0.539
n.a.

n.a.

solutions from NDAs for the most frequently per-

1

ceived barriers, such as lack of education and lack

Attempts to overcome
of EBD into practice

of EBD into practice

Table 4 continued

Negotiating with the

of awareness. Whilst modern-day NDAs and institu-

financial incentives

tions make efforts to emphasise the importance of

implementation

implementation

low response rate.

authorities for

the barriers to

EBD, efficient strategies to implement EBD should be

applied, and the number of continuing educational
to foster

No idea

courses may be increased. This might be a way to

Other
None

Yes

increase the collaboration between dental faculties

No
Q9

and NDAs28.
140 2015 FDI World Dental Federation

Densts who gave response "Yes" to the queson
"Do you believe that generally EBD is benecial"
France
6.4%
Georga
Poland 4.3%
18.3%
Turkey Portugal
23.2% 40.2%
Slovakia
7.5%
(a)
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
regarding EBD, with respect to age of participant and
year of graduation from dental school, were quite
prominent in the present study. Age of participant and
years of practice did not have a significant effect on
dentists regarding their awareness and practice of EDB.
However, an important finding was that EBD was
taught to younger dentists in UDE and they believed
that education in UDE is the correct approach, whereas
older dentists were educated in EBD through CDE.
These findings support those reported in previous stud-
ies9,29 indicating that EBD has evolved over the past
two decades and that its inclusion in the curricula of
academic dental institutions is relatively recent. A
recent study of Straub-Morarend et al.9 indicated that
as the year of dental school graduation became more
recent, the percentage of students understanding EBD
increased. They found that recent graduates were more
likely to report insufficient time as a primary barrier to
practising EBD, which is in agreement with our results;
however, the results were not statistically significant.
Considering all age groups, lack of education on EBD
was the primary barrier, which was significantly higher
for older dentists.
The responses obtained for general practitioners
showed notable differences compared with those
obtained for specialists. Specialists were significantly
more likely to report that they know, practice and
find EBD beneficial, as indicated in previous
research9. Following the trend of the dentists with
more years in practice, specialists also reported that
they had received education on EBD during CDE
rather than during UDE. This may be related to the
advanced training they received in evidence-based
practice. Furthermore, all scientific activities per-
formed during the postgraduate education period may
make dentists familiar with critical thinking and EBD
practice9,13. Regarding the barriers, specialists had a
significant emphasis on quality of science and reported
that limited knowledge was available regarding the
2015 FDI World Dental Federation
Implementation of EBD into practice
Densts who gave response of " I pracce" to the
queson "About evidence based denstry"
France
8.2%
Poland Georgia
19.5%
3.5%
Turkey
15.6%
Portugal
Slovakia 46.1%
7%
(b)
quality of evidence. However, the skewed distribution
of the general practitioners and specialists, in which
general practitioners comprised the majority (81.6%)
of respondents, should be considered when interpret-
ing these findings.
University members were more likely to practice
EBD; however, their frequency in this study was quite
low (7.6%) compared with solo practising (48%) and
group practising (44%) dentists. Their high awareness
of, and effort to teach, EBD has previously been
reported13. This study also uncovered interesting and
unaddressed considerations regarding the effect of the
type of practice on EBD. Awareness of the concept of
EBD and believing its benefits was significantly low
among solo practising dentists. This may indicate the
advantages of team work and a multidisciplinary
approach. Dentists working in public health-care ser-
vices reported lack of time as a significant and the
most important barrier to the implementation of EBD
compared with private practice dentists. This reveals
that the high demand by patients of public health-care
services may preclude dentists from performing EBD
practice. However, this finding should not be overesti-
mated as 77.5% of the respondents worked in private,
4.7% worked in public and 17.8% worked in both
private and public practices.
This questionnaire survey was anonymous and
therefore the respondents could be comfortable com-
municating their true thoughts. However, the study
included a number of limitations. One was the diffi-
culty in achieving good feedback from most of the
Web questionnaires. The data were self-reported and
this is not the most accurate method of gathering the
perceptions of health-care professionals29. However, it
would have been difficult to gather information from
such a large number of people from different coun-
tries using a method other than a self-reported survey.
Another possible problem was that, even though the
surveys were anonymous, in order to create a good
impression, the respondents may not report their
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

2015 FDI World Dental Federation

 Table 5 continued
Age, years Gender Years of Kind of

2015 FDI World Dental Federation

(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

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

Lack of necessary educaon on EBD

Lack of necessary publicaons on EBD

Lack of EB clinical decision support systems

Lack of nancial incenves

Lack of necessary web sites on EBD

Lack of EB clinical guidelines for dental care

Limited evidence available in the dental eld

Lack of awareness on EBD

EBD being perceived as me consuming

Lack of praccal ways to reach to best evidence

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

tional programmes to be organised by NDAs and sup-
ported by dental faculties.
Previous studies reveal the expressed need, for an
improved collaboration between the NDAs and the
dental faculties28,30. It is likely that EBD, and its
effective implementation into practice, may be an
appropriate area in which NDAs and dental faculties
may consider for working together.
Acknowledgements
The authors would like to thank to the six National
Dental Associations (French Dental Association,
Georgian Dental Association, Polish Dental Chamber,
Portuguese Dental Association, Slovakian Dental
Chamber, Turkish Dental Association) for kindly par-
ticipating this survey. The authors also would like to
thank all the members of WG.
Conict of interest
The authors declare no conflict of interest.
REFERENCES
1. Richards D, Lawrence A. Evidence based dentistry. Br Dent
J 1995 79: 270273.
2. Kishore M, Panat SR, Aggarwal As et al. Evidence based dental
care: integrating clinical expertise with systematic research.
J Clin Diagn Res 2014 8: 259262.
3. ADA policy statement on evidence-based dentistry. Available
from: http://ebd.ada.org/en/about/. Accessed 24 January 2015.
4. Iqbal A, Glenny AM. General dental practitioners knowledge
of and attitudes towards evidence based practice. Br Dent
J 2002 23: 587591; discussion 583.
5. Merijohn GK, Bader JD, Frantsve-Hawley J et al. Clinical deci-
sion support chairside tools for evidence-based dental practice.
J Evid Based Dent Pract 2008 8: 119132.
6. Sutherland SE. Evidence-based dentistry: part I. Getting started.
J Can Dent Assoc 2001 67: 204206.
7. Bader J, Ismail A, Clarkson J. Evidence-based dentistry and the
dental research community. J Dent Res 1999 78: 14801483.
8. Yusof ZY, Han LJ, San PP et al. Evidence-based practice
among a group of Malaysian dental practitioners. J Dent Educ
2008 72: 13331342.
9. Straub-Morarend CL, Marshall TA, Holmes DC et al. Toward
defining dentists evidence-based practice: influence of decade of
dental school graduation and scope of practice on implementa-
tion and perceived obstacles. J Dent Educ 2013 77: 137145.
10. Kao RT. The challenges of transferring evidence-based dentistry
into practice. J Evid Based Dent Pract 2006 6: 125128.
11. Spallek H, Song M, Polk DE et al. Barriers to implementing
evidence-based clinical guidelines: a survey of early adopters.
J Evid Based Dent Pract 2010 10: 195206.
12. McColl A, Smith H, White P et al. General practitioners per-
ceptions of the route to evidence based medicine: a question-
naire survey. BMJ 1998 31: 361365.
13. Marshall TA, Straub-Morarend CL, Qian F et al. Perceptions
and practices of dental school faculty regarding evidence-based
dentistry. J Dent Educ 2013 77: 146151.
2015 FDI World Dental Federation
Implementation of EBD into practice
14. Madhavji A, Araujo EA, Kim KB et al. Attitudes, awareness,
and barriers toward evidence-based practice in orthodontics.
Am J Orthod Dentofacial Orthop 2011 140: 309316.
15. Bauer J, Spackmart S, Chiappelli F et al. Evidence-based den-
tistry: a clinicians perspective. J Calif Dent Assoc 2006 34:
511517.
16. Gillette J, Matthews JD, Frantsve-Hawley J et al. The benefits
of evidence-based dentistry for the private dental office. Dent
Clin North Am 2009 53: 3345.
17. Crawford JM, Briggs CL, Engeland CG. Publication bias and
its implications for evidence-based clinical decision making.
J Dent Educ 2010 74: 593600.
18. Ismail AI, Bader JD. Evidence-based dentistry in clinical prac-
tice. J Am Dent Assoc 2004 135: 7883.
19. Chiappelli F, Prolo P, Newman M et al. Evidence-based prac-
tice in dentistry: benefit or hindrance. J Dent Res 2003 82: 67.
20. Sackett DL, Rosenberg WMC, Muir Gray JA et al. Evidence
based medicine: what it is and what it isnt. BMJ 1996 312:
7172.
21. Gillette J. Answering clinical questions using the principles of
evidence-based dentistry. J Evid Based Dent Pract 2009 9: 18.
22. Hannes K, Norr
e D, Goedhuys J et al. Obstacles to implement-
ing evidence-based dentistry: a focus group-based study. J Dent
Educ 2008 72: 736744.
23. Nieri M, Mauro S. Continuing professional development of
dental practitioners in Prato, Italy. J Dent Educ 2008 72: 616
625.
24. Rabe P, Holm
en A, Sj ogren P. Attitudes, awareness, and per-
ceptions on evidence-based dentistry and scientific publications
among dental professionals in the county of Halland, Sweden: a
questionnaire survey. Swed Dent J 2007 31: 113120.
25. Rinchuse D, Kandasamy S, Ackerman M. Deconstructing evi-
dencein orthodontics: making sense of systematic reviews, ran-
domized clinical trials, and meta-analyses. World J Orthod
2008 9: 167176.
26. van der Sanden WJ, Mettes DG, Plasschaert AJ et al. Effective-
ness of clinical practice guideline implementation on lower third
molar management in improving clinical decision-making: a ran-
domized controlled trial. Eur J Oral Sci 2005 113: 349354.
27. Grol R. Successes and failures in the implementation of evi-
dence based guidelines for clinical practice. Med Care 2001 39
(Suppl. 2): II46II54.
28. Yamalik N, Mersel A, Margvelashvili V et al. Analysis of the
extent and efficiency of the partnership and collaboration
between the dental faculties and National Dental Associations
within the FDIERO zone: a dental faculties perspective. Int
Dent J 2013 63: 266272.
29. Iacopino AM. The influence of new science on dental educa-
tion: current concepts, trends, and models for the future. J Dent
Educ 2007 71: 450462.
30. Yamalik N, Mersel A, Cavalle E et al. Collaboration between
dental faculties and National Dental Associations (NDAs) within
the World Dental Federation-European Regional Organization
zone: an NDAs perspective. Int Dent J 2011 61: 307313.
Correspondence to:
Nermin Yamalik,
Department of Periodontology,
Faculty of Dentistry,
University of Hacettepe,
Sihhiye, Ankara 06100,
Turkey.
Email: nyamalik@tdb.org.tr
145