In recent years, the impressive development of technologies in health care has been accompanied by an increase in the demand for services due to patient and provider expectations and subsequently by rising costs (Jonsson E & Banta D, 1999; OECD Health Data, 2006). Oral Health systems have developed at different speeds and with contrary degrees of complexity involving improvement in Oral health delivery across the Nation. Since the demand for Oral healthcare outweighs the resources available to provide it, create imbalance and simultaneous pressure on Central and State governments to allocate resources appropriately, has been a prominent factor, desirable in the development of Oral health technology assessment in India. Delivering Oral health services involves making decisions, on what interventions should be open, the way the Oral health system should be organized and how the interventions should be provided in order to achieve an optimal Oral health gain with available resources, while at the same time, respecting people’s prospects. Decision-makers thus need information about the available options and their potential cost in resource allocation. In the light of more careful appraisal, it is now clear that interventions once thought to be beneficial have turned out to be of no help or at worst, unsafe to the Patients and counterfeiting to the Oral health delivering system. This recognition has led to the emergence of a concept known as “Evidence-Based Dentistry”, which argues that the information used by policymakers should be based on meticulous research. This policy concisely introduced the concept of “Health technology assessment”, which has been described as “the speciality of assistance to health policymaking” (Jonsson & Banta 1999).

1. ORAL HEALTH TECHNOLOGY ASSESSMENT: PERSPECTIVES IN ORAL HEALTH CARE
POLICIES AND DECISION MAKING.
Author: Dr. Shoeb Ahmed Ilyas BDS, MPH, EMSRHS, M.Phil. (HHSM), MHRM,
MS (PSY), MS (BIOTECH), PGDMLE, F.H..TA.
Health Care Quality Management Consultant
Ruby Med Plus, Telangana State, India.
Introduction
In recent years, the impressive development of technologies in health care has been accompanied
by an increase in the demand for services due to patient and provider expectations and
subsequently by rising costs (Jonsson E & Banta D, 1999; OECD Health Data, 2006). Oral Health
systems have developed at different speeds and with contrary degrees of complexity involving
improvement in Oral health delivery across the Nation.
Since the demand for Oral healthcare outweighs the resources available to provide it, create
imbalance and simultaneous pressure on Central and State governments to allocate resources
appropriately, has been a prominent factor, desirable in the development of Oral health technology
assessment in India.
Delivering Oral health services involves making decisions, on what interventions should
be open, the way the Oral health system should be organized and how the interventions should be
provided in order to achieve an optimal Oral health gain with available resources, while at the same
time, respecting people’s prospects. Decision-makers thus need information about the available
options and their potential cost in resource allocation. In the light of more careful appraisal, it is
now clear that interventions once thought to be beneficial have turned out to be of no help or at
worst, unsafe to the Patients and counterfeiting to the Oral health delivering system. This
recognition has led to the emergence of a concept known as “Evidence-Based Dentistry”, which
argues that the information used by policymakers should be based on meticulous research. This
policy concisely introduced the concept of “Health technology assessment”, which has been
described as “the speciality of assistance to health policymaking” (Jonsson & Banta 1999).

2. Health Technology Assessment International (HTAi) defines Health Technology Assessment as
“research-based, practice-oriented assessments of relevant available knowledge on the direct and
intended consequences of technologies, as well as the indirect and unintended consequences”
(HTAi)
The scope of Oral Health Technology Assessment
Oral Health Technology Assessment is a multidisciplinary activity, which methodically
evaluates the effects of a technology on Oral health, on the availability and distribution of
resources, on other aspects of Oral health system performance such as equity, responsiveness,
interventions applied to the system, that is, policies on organizing and financing the Oral health
system and achievement of its ultimate goal i.e. Oral health gain.
Basis of Health Technology Assessment
Health Technology Assessment has been compared to a bridge between the world of research
and the world of decision-making (Battista, 1996). This bridge is anticipated to allow the transfer of
knowledge produced in scientific Dental research to the decision-making Process. In order to
achieve this, Oral Health Technology Assessment is committed to the work of collecting and
analysing evidence from Dental research in a systematic and reproducible way and to make it
accessible and usable for decision-making purposes, in fastidious by means of assessment
reports.
Health Technology Assessment shares these principles with evidence based medicine
(EBM) and clinical practice guidelines (CPG) and together with them, builds a body of best practice
initiatives (Perleth et al. 2001). Health Technology Assessment literacy encompasses the wide
range of knowledge-uptake, skills and competencies required to seek out, comprehend, evaluate
and use HTA information to make informed decisions. (Lavis JN et al, 2003 & Zarcadoolas C et al,
2005)
Classic Vs Modern Oral Health Technology Assessment
Classic Oral Health Technology Assessment has focussed on a financial analysis of the costs
of the technology and on the benefits to the patient, to reflect quality of Oral Health, to assess

3. safety, effectiveness, and cost-effectiveness profiles of a new Dental technology and decision
support for regulators, manufacturers, investors and patients.
Modern Oral Health Technology Assessment is based on evidence from clinical studies
performed with the new Dental technology, evidence from early bench and animal testing, early
clinical experience and from previous generations of the Dental technology.
Oral Health Technology Assessment process
The perspective in which Oral Health Technology Assessment research is carried out
determines the methods used and the extent and comprehensiveness of the assessment. The
extent and level of details of Oral Health Technology Assessment vary considerably depending
upon who commisioned a study and why? The decision-maker raises a policy question or
institutions undertaking Oral Health Technology Assessment often proactively identify areas where
information is likely to be needed in the future, perhaps through a process of perspective scanning.
In order to give an evidence-based solution to the problems outlined in the policy question, the
Dental researchers undertaking the assessment will need to specify the policy question in terms of
safety, efficacy, effectiveness, psychological, social, ethical, organizational, professional and
economic aspects.
Formulating Dental research questions is a crucial part of the assessment, since it rearranges
the original decision-making problem, the policy question into questions that can be answered by
evaluating scientific evidence. Once the Dental research questions have been posed, the task of
the Oral Health Technology Assessment researchers is to retrieve, analyse and synthesize the
available evidence, preparing it in a way that is useful for decision-makers (it must respond to their
information needs). The researchers will try to identify and collect the best available evidence that
will allow them to give valid answers to the questions. Then researchers will summarize this
evidence in a way that corresponds to the original policy question. In some cases it is appropriate
to give recommendations for policy-making or to outline the policy options that result from the
assessment. Hence, the evidence-based approach relies mainly on research, that is, on
systematically collected and rigorously analysed data following a pre-established plan. Evidence is
the result of a search for practical, useful knowledge (Banta 2003).
Hierarchy of research designs for evidence-based Dentistry
(Based mainly on internal validity)

4. Randomized controlled trial, Cohort Studies, Case-control studies, Case series, Single case
reports, ideas, opinions, animal research, in-vitro (”test-tube”) research and increasing validity.
The extent to which the information provided by a study has clinical or policy relevance been
defined as the “non-methodological quality” of the evidence (Lohr & Carey, 1999)
The group of studies selected as the best available to answer the questions is called the “body of
evidence”. A body of evidence is characterized by a combination of the factors that is, the hierarchy
of research design, the directness of the evidence and the quality of execution. Other factors such
as the number of studies, the size of the effect and the homogeneity/ consistency of results across
the group of studies are also relevant when judging the strength of the evidence.
In Oral Health Technology Assessment, for each of the aspects of the assessment, the
standard and relevance of available evidence need to be assessed. The fundamental rationale is at
all times the same: are the research findings valid? Are they relevant to the assessment questions?
How strong is the body of evidence? Non-epidemiological research such as empirical, social or
political science may be mostly appropriate to obtain evidence on aspects such as preferences,
conformity barriers to implementation, etc., which influence the intervention in question, and thus
need to be taken into consideration when formulating recommendations on an intervention in a
particular context.
Disinvestment from ineffective Oral healthcare practices
Disinvestment relates to the processes (partially or completely) withdrawing Oral health
resources from existing oral healthcare practices, procedures, technologies, or pharmaceuticals
that are deemed to deliver little or no health gain for their cost, and thus do not represent efficient
health resource allocation. Debatably the goal of reducing use of less effective or inappropriately
applied technologies or practices has been central to evidence-based Dentistry. Systematic policy
approaches to disinvestment program requires an explicit focus on the potential for cost-savings
coupled with improved quality of Oral care and may improve efficiency as well as equity, quality,
safety of care and perhaps even sustainability. Financial and collaborative Support is needed for
research advancement in the methodological underpinnings associated with Oral health technology
assessment and for disinvestments specifically.

5. Early Assessment of Oral Health Technology
The process of innovation in Dental devices is significant to the improvements in patient care, but it
is costly and uncertain. Design and management decisions have to be made by Dental device
firms and their investors before the clinical performance of the device is actually known.
To support investment and design decisions of technology at an early stage (Eddy, 1996)
illustrated a method in the medical field for the analyst and he focussed on the following points-
 Identify performance and outcome measures most relevant for later evidence-based
assessment.
 Evaluate the possible spectrum of expected performance of the technology.
 Identify the main drivers of product performance and of related critical outcome measures,
and
 Identify the optimal strategy for continuation and improvement of the device project given
the firm’s risk attitude.
Applications of Health Technology Assessment
Health Technology Assessment can serve as a bridge between the sources of knowledge and the
levels of decision, offering decision makers the best synthesis of scientific evidence and the added
value of the analysis of related economic, social, ethical, and legal issues (Battista RN & Hodge
MJ, 1999).
Useful, relevant, and evidence-based information provided through HTA on a timely basis will
allow decision makers to have enough elements to decide on the future use of new technology and
to promote the rational use of healthcare services (Jonsson E & Banta D, 1999).
The knowledge thus generated can contribute to health care management at the three levels of
decision-making: Macro (health policies), Meso (institutional rules), and Micro (clinical
management) (Battista RN et al, 1999).
Conclusion
The results of Oral Health technology assessment are used with varying levels of impact on
decision-making, Dental interventions, and even of Oral health care reform, since the latter can be
considered as an intervention in the Oral health system to plan capacities to shape the profit
catalogue or to restructure service provisions. To fulfill this task properly, evidence from different
research traditions may be considered in an assessment.

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