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Evidence-Based Dentistry

P.I.C.O. Model

Asking a well-built question and paying attention to the "five A's of the evidence cycle, Assess, Ask, Acquire, Appraise and Apply are keys to Evidence Based Practice in clinic.

Before searching for EBM materials it is helpful to frame your question using the P.I.C.O. method. 

  • Patient, Population, or Problem
  • Intervention, Prognostic factor, or Exposure
  • Comparison or Intervention (if appropriate)
  • Outcome

You should also ask what type of question are you asking - diagnosis, etiology, therapy, prevention, or harm?

Five Step Process

Five Important Steps for Evidence Based Practice:

Step 1: Formulating a well-built question (PICO)

Step 2: Identifying articles and other evidence-based resources that answer the question

Step 3: Critically appraising the evidence to assess its validity

Step 4: Applying the evidence

Step 5: Re-evaluating the application of evidence and areas for improvement

Sample question

Among adults with tooth discoloration wishing to whiten their teeth, which is a more effective treatment, a compound containing hydrogen peroxide or one containing carbamide peroxide?

The Evidence

Evidence - Based Medicine is the integration of best research evidence with clinical expertise and patient values. (Sackett DL, Straus SE, Richardson WS, et. al. Evidence - based medicine: how to practice and teach EBM. 2nded. Edinburg: Churchill Livingstone, 2000)

ADA definition of Evidence-based dentistry (EBD): an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.


Evidence Based Dentistry

Levels of Evidence

Quality of Evidence ranges from A (High) - several high-quality studies with consistent results - to D (very low) - expert opinion, no direct research evidence, or one or more studies with very severe limitation (Essential Evidence Plus. (2009). Levels of Evidence. Malden, MA: John Wiley).



  • Evidence Based Dentistry Tutorial 
    A tutorial from the Information Services Department of the Library of the Health Sciences-Chicago, University of Illinois at Chicago. It is designed to support both curriculum-based EBP instruction and the ongoing education of practicing professionals. 
  • JAMAEvidence  
    Fundamental tools for understanding and applying the medical literature and making clinical diagnoses.