Dental Hygiene - EBP: Ask a Clinical Question

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Glossary (CEBM)

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The Well-Built Clinical Question

ASSESS the Patient	1. Start with the patient: a clinical problem/question arises from the care of the patient
ASK the Question	2. Construct a well-built question derived from the case

EBM always begins and ends with the patient. To begin this process, consider the following clinical scenario:

A 48 year old salesman presents to your office for his recare appointment. He is scheduled for a 4 month recare appointment but due to his busy work schedule he is two months late. While talking with him you learn that he is diabetic type II. He frequently uses breath mints. He is away from home approximately 3-4 days a week. He eats out often. He knows his smile and breath are important for his job. He admits with his busy schedule that he doesn’t always brush twice a day. His periodontal chart reveals that he has generalized 4mm pockets with moderate bleeding. His fasting blood glucose level is <160.

You know there is a relationship between periodontal disease and diabetes. You would like to share with him the evidence supporting this relationship.

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The next step in this process is to take the identified problem and construct a question that is relevant to the case and is phrased in such a way as to facilitate finding an answer.

Anatomy of a good clinical question: PICO

PICO is a mnemonic that helps one remember the key components of a well focused question. The question needs to identify the key problem of the patient, what treatment you are considering for the patient, what alternative treatment is being considered (if any) and what is the outcome you want to avoid or promote.

P = Patient or problem

How would you describe a group of patients similar to yours? What are the most important characteristics of the patient? This may include the primary problem, disease, or co-existing conditions. Sometimes the sex, age or race of a patient might be relevant to the diagnosis or treatment of a disease.

I = Intervention, prognostic factor, or exposure

Which main intervention, prognostic factor, or exposure are you considering? What do you want to do for the patient? Prescribe a drug? Order a test? Order surgery? What factor may influence the prognosis of the patient? Age? Co-existing problems? Has the patient been exposed to something? Asbestos? Cigarette smoke?

C = Comparison

What is the main alternative to compare with the intervention? Are you trying to decide between two drugs, a drug and no medication or placebo, or two diagnostic tests? Your clinical question does not always need a specific comparison.

O = Outcomes

What can you hope to accomplish, measure, improve or affect? What are you trying to do for the patient? Relieve or eliminate the symptoms? Reduce the number of adverse events? Improve function or test scores?

The structure of the PICO might look like this:

Patient / Problem	diabetic, busy life style, periodontal disease
Intervention	reduce recare interval, nutritional counseling and Oral hygiene instruction
Comparison, if any	standard of care
Outcome	Reduction in periodontal disease, stabilized diabetes

For our patient, the clinical question might be:

Is controlling diabetes going to improve his periodontal condition or vice versa?

Two additional elements of the well-built clinical question are the type of question and the type of study. This information can be helpful in focusing the question and determining the most appropriate type of evidence or study.

Revised July 2010 / Adapted February 2011