Integrated Dentistry I Third Year

1. PICO exercise

2. Clinical Scenario I
10-year-old boy who has an appointment with
you for treatment of caries. After the
completion of the visit the father asked you:
“Doctor, we see a lot of ads about sugar free
chewing gums. Are they good for my child”?

3. Clinical Scenario I
• Structured and focused
PICO
Patient
Intervention
Comparison
Outcome

4. PICO Question
• Structured and focused
– What is the meaning of “sugar-free”?
• Xylitol or sorbitol
– What is the meaning of “good”?
• Lower caries incidence
– What is the patient/population?
• Children (or adults)
– What is the comparison?
• No xylitol, fluoride

5. Clinical Scenario I
PICO question
PICO
Patient
Intervention
Comparison
Outcome
Children
Xylitol
none
Low
Do children with deciduous teeth who consume
chewing
caries
xylitol chewinggum compared to children who
gum,
incidence
don’t, have lower incidence of dental caries?

6. Clinical Scenario II
Concerned about his brownish
teeth, a 35-year-old man asked
you after the completion of a
restorative visit to your clinic:
“Do home tooth whitening kits
work”?

7. What is your PICO?
In adults with tooth discoloration,
would a home tooth whitening kit,
compared to a placebo, improve /
change tooth color?

8. Clinical Scenario III
A company representative came to
your clinic to discuss a new
powered toothbrush. He claims it
is very good for oral hygiene and
that it is superior to a manual
brush.

9. What is your PICO?
For adult patients, will the use of a
powered toothbrush, compared to a
manual toothbrush, result in reduction
in plaque and/or gingivitis?

10. Clinical Scenario IV
• Noura, 40 years old female, is a current
patient of yours who is in today to have the
stitches taken out from where she had a
cancerous lesion removed by the oral
surgeon. She is glad that you caught the lesion
before the cancer progressed to the bone.
However, she is concerned that she may get
more cancerous lesions that are more
progressive and that she may lose jaw bone.
She asks you what is the likelihood of this
happening.

11. Another suggestion for PICO
P
• Oral
cancer
patient
I
• Surgical
removal
of
cancerous
lesion
C
O
• Aggressive
recurrence
of oral
cancer,
overall
survival

12. PICO Question
• “For oral cancer patients, does surgical
removal of cancer lesion affect the risk of
disease recurrence ?”
• Type: prognosis

13. Scenario
• A new patient visits you. He has heart
murmur with regurgitation. He has moderate
periodontitis and has not been seen by a
dentist in many years. In the past, his specific
health condition was pre- medicated with
antibiotic prophylaxis. However, new
evidence reveals that premedication is not
necessary. You want to make sure that his
having periodontal scaling and root planning
will not cause bacterial endocarditis.

14. What do you think of this question?
• For a patient with moderate periodontitis,
will bacterial endocarditis occur after a
periodontal scaling and root planning?

15. PICO
P
I
C
• Cardiac
patient with
moderate
periodontitis
• No
antibiotic
prophy
laxis
• Premedicati
on with
antibiotic
prophylaxis
O
• Lower the
risk of
bacterial
endocarditis
after scaling

16. Types of questions
Type of
Patient or
question problem
“For children
with
posterior
cross bite
in the
primary
dentition…
Intervention
Comparison
Outcome
…will
occlusal
grinding to
remove
premature
contacts,…
…when
compared to
no
intervention,
…
…prevent
posterior
cross bite in
the
permanent
dentition?”

17. Types of questions
Type of
Patient or
question problem
Therapy “For children
with
posterior
cross bite
in the
primary
dentition…
Intervention
Comparison
Outcome
…will
occlusal
grinding to
remove
premature
contacts,…
…when
compared to
no
intervention,
…
…prevent
posterior
cross bite in
the
permanent
dentition?”

18. Types of questions
Type of
Patient or
question problem
“In patients
with
undiagnosed
oral
lesions…
Intervention
Comparison
Outcome
…can a
toluidine
blue
mouth
rinse,…
…when
compared to
an oral
biopsy,…
…effectively
detect oral
cancer and
precancer?”

19. Types of questions
Type of
Patient or
question problem
Diagnosis “In patients
with
undiagnosed
oral
lesions…
Intervention
Comparison
Outcome
…can a
toluidine
blue
mouth
rinse,…
…when
compared to
an oral
biopsy,…
…effectively
detect oral
cancer and
precancer?”

20. Types of questions
Type of Patient or
question problem
“For patients
with
osseointegrated
implants…
Intervention
Comparison
Outcome
…who
smoke,…
…compared
to patients
who do not
smoke,…
…what is the
proportion of
implants lost
at 10 years?”

21. Types of questions
Type of
Patient or
Intervention
question problem
Prognosis “For patients …who
with
smoke,…
osseointegrated
implants…
Comparison
Outcome
…compared
to patients
who do not
smoke,…
…what is the
proportion of
implants lost
at 10 years?”

22. Types of questions
Type of
question
Patient or
problem
“For my
pregnant
dental
assistant…
Intervention
Comparison
Outcome
…exposed
regularly to
the use of
nitrous oxide
for patient
sedation…
… compared
to
unexposed
pregnant
women
to nitrous
oxide
…what is the
risk of harm
to her
unborn
baby?”

23. Types of questions
Type of
Patient or
question problem
Causation “For my
pregnant
dental
assistant…
Intervention
Comparison
Outcome
…exposed
regularly to
the use of
nitrous oxide
for patient
sedation…
… compared
to
unexposed
pregnant
women
to nitrous
oxide
…what is the
risk of harm
to her
unborn
baby?”