Integrated Dentistry I Third Year

1. “ASK”
PICO Question

2. Objectives
•
•
•
•
Background and foreground questions
PICO components
PICO question
PICO question types

3. Background and foreground questions
 For a patient complaining of drug induced
xerostomia, some background questions can be:
• What causes xerostomia?
• How are xerostomia patients managed?
• What are saliva substitutes?
• What are saliva stimulants?
 Answers can come from text books, colleagues or
seniors

4. Background and foreground questions
• For a patient complaining of drug induced
xerostomia, a foreground question may
compare one type of saliva substitute to
another, one type of saliva stimulant to
another, a stimulant to a substitute. It
depends on the evidence
• Look for answers in current articles, primary
or secondary

5. Background and foreground questions
Background questions
• General knowledge,
broad
• Ask who, what, when,
where, how or why
• Narrow the broad
scope
• Identify resources to
provide details to a
broad question
Foreground questions
• Specific
• Identify P, I, C, O
• Structured to find
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precise answer & -#345
phrased to facilitate
computerized search
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• Identify valid evidence
to answer a specific
question

6. Foreground question
• Generated directly by the patient or the care
considered for the patient
• Can emerge from an observed problem, a
topic of interest, to explore a new material or
procedure, to clarify differences, or compare
cost- effectiveness

7. PICO
Needs and problems
clinical question
Adequate information, without too many
details
Purposes
• Focuses on what is important for the patient
• Facilitates subsequent search
• Identifies the problem and outcomes,
therefore type of evidence
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8. P: Patient problem/ population
To describe the patient:
• Describe a population with a problem similar
to the patient
• Describe the patient to a colleague
• Describe characteristics of patient:
 Primary problem
 Chief complaint
 Age, race, gender,….

9. I: Intervention
• What you plan to do for the patient
• It is the main consideration for that patient

10. C: Comparison
-,+*
• It is the alternative to the Intervention
• Only one alternative should be considered
• It is the only optional component of the PICO
question

11. O: Outcome
• The result of what you plan to accomplish or
improve
• It should be measureable, e.g., relieving the
symptoms, maintaining function, improving
esthetics
• Specific outcomes yield better search results
• AVOID: more effective…

12. PICO Question
• Combines PICO components into a question
that can be investigated and answered

13. PICO Question
• In a patient with P, will I, as compared with C,
O?
• Do not forget to list additional terms or
phrases like synonyms or alternative terms

14. PICO Questions’ Types
Depending on the I:
• Therapy/ prevention
• Diagnosis
• Harm/ etiology/ causation
• Prognosis
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15. Example: clinical scenario
• A 35years-old female presents with a chief
complaint of bleeding gums. She found out that
she is pregnant last week. She is taking prenatal
vitamins and sucks on crystallized ginger which
she says relieves nausea associated with morning
sickness. She has had sporadic dental care in the
past.
• Oral exam revealed calculus deposits, 4-6 mm
pockets, bleeding on gentle probing— all signs
consistent with a diagnosis of moderate
periodontitis.
• Patient read an online article which said gum
disease may cause miscarriage and she is
concerned since she lost her first baby two years
ago at the beginning of the second trimester.

16. PICO components
•
•
•
•
•
•
•
•
P
Pregnant female
I
Periodontitis
C
No periodontitis
O
Poor pregnancy outcomes

17. PICO question
• In a patient with P, will I, as compared with C,
O?
• In a pregnant patient, will periodontitis
compared to no periodontitis, increase the
risk of miscarriage (poor pregnancy
outcome)?

18. PICO question type
Therapy/ prevention
Prognosis
Diagnosis
Harm/ causation/ etiology