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Evidence-Based Dentistry: ASK- The Clinical Question

BACKGROUND OR FOREGROUND?

STEP ONE 

ASK is your clinical question a background or foreground question ?

Background questions are general knowledge questions and tend to ask who, what, where, when and why. For instance, what causes dental caries?  Typically background questions can be answered with textbooks or clinical guidelines.

Foreground questions are the core of the EBD process.  They require specific knowledge to decide and inform on  a clinical decision as it applies to  a particular patient or population.  


If you are not certain if your question is a background or foreground question consider, “Did I know the answer to this question at the end of the first year of dental school?” If the answer is yes, it is most likely a background question.

Reference:

Evidence-Based Medicine How to Practice and Teach EBM Sackett et al (2000)

SAMPLE CLINICAL QUESTION

Will an occlusal splint reduce temporomandibular joint (TMJ) discomfort for an adult patient with sleep bruxism ?

CONVERT TO SEARCHABLE QUESTION

EBD uses a process called PICO to aid in turning your foreground question into a searchable question.

 

P = Patient or Population

I = Intervention

C = Comparison

 

O = Outcome

 

 

CONVERT TO PICO

Patient / population / problem: Adult with sleep bruxism

Intervention: Occlusal Splints

Comparison: No treatment

Outcome: Reduce pain

QUESTION DOMAIN

Determining the domain or category of a searchable questions is important to deciding what types of information sources may provide the  best answer  to the question.

After converting your question into PICO, determine what domain it is. The most common domains/categories are:

  • Diagnosis

  • Therapy

  • Etiology/Harm

  • Prognosis

 

Most EBD questions fall under Therapy.

 

 Domain Type

Description of Domain

Type of study

Diagnosis

Tests that accurately detect a disease

prospective, blind comparison to a gold standard or cross-sectional

Therapy/Prevention

selecting effective interventions to treat or prevent a disease

 Randomized control trial, cohort, case-control, case series

Etiology/Harm

identifying associations, risk factors and causes of a disease

Randomized control trial, cohort, case-control, cross-sectional

Prognosis

predicting the probable outcome of a disease or treatment

Cohort, case-control, case series

 

 

 

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