How to apply evidence-based principles in clinical dentistry

Figures & data

Figure 1 Components of evidence-based dentistry.

Notes: Adapted from Masic I, Miokovic M, Muhamedagic B. Evidence based medicine – new approaches and challenges. Acta Inform Med. 2008;16(4):219–225.10 Copyright © 2008 AVICENA. License available at: https://creativecommons.org/licenses/by-nc/3.0/legalcode.

Figure 2 Hierarchy of evidence.

Notes: Adapted from Masic I, Miokovic M, Muhamedagic B. Evidence based medicine – new approaches and challenges. Acta Inform Med. 2008;16(4):219–225.10 Copyright © 2008 AVICENA. License available at: https://creativecommons.org/licenses/by-nc/3.0/legalcode.

Table 1 Formulating PICO question

Question: example question: What is the effect of antibiotic in preventing pain and complications after root canal therapy in patients with diabetes mellitus?	Patient/population	Intervention or exposure	Comparison	Outcome
	Patients with diabetes mellitus	Use of antibiotics after root canal therapy	No antibiotics/placebo after root canal therapy	Reduction in pain and complication
Harm or etiology: Does bottle feeding at night cause caries in children?	Children on bottle feeding	Bottle feeding at night	No bottle feeding at night/water consumption only	Incidence of caries
Diagnosis: Is laser fluorescent technique able to diagnose proximal caries more accurately than bitewing radiographs?	Patients with high caries rate	Laser fluorescent	Bitewing radiographs	Diagnosis of proximal caries
Prognosis: Are patients with apical periodontitis at higher risk of failure of root canal therapy than the patients without apical periodontitis?	Patient with and without apical periodontitis	Root canal therapy	NA	Success and failure of the treatment

Abbreviations: NA, not applicable; PICO, Patient/population (P), Intervention (I), Comparison (C), Outcome (O).

Table 2 Most appropriate study designs according to the type of clinical question

Type of question	Best study design
Diagnosis	Cross-sectional or prospective, blinded comparison to gold standard
Therapy	Randomized controlled trial > cohort study > case–control > case series
Prognosis	Cohort study > case–control > case series
Harm/etiology	Cohort study > case–control > case series

Table 3 Search terms on the base of PICO framework

Clinical question: What is the success rate of direct pulp capping in patients with carious exposure of pulp?
PICO framework	Population		Intervention		Comparison		Outcome
Simple search strategy	Carious pulp exposure	AND	Direct pulp capping	AND	Root canal treatment	AND	Asymptomatic AND no periapical radiolucency
Simple search strategy	Cariously exposed pulp	AND	Pulpotomy	AND	Vital pulp therapy	AND	Survival rate AND success rate
Complex search strategy	Carious pulp exposure OR cariously exposed the pulp	AND	Direct pulp capping OR pulpotomy	AND	Root canal treatment OR vital pulp therapy	AND	Asymptomatic AND no periapical radiolucency OR survival rate AND success rate

Abbreviation: PICO, Patient/population (P), Intervention (I), Comparison (C), Outcome (O).