Module 2 of the Oral Health Tutorial, a production of UT HSC Libraries. This module focuses on evidence-based dental health. View this tutorial to learn how to define evidence-based dental public health, learn effective retrieval strategy, be able to critique the literature and apply it to public health dental practice. This tutorial is copyright Lara Sapp and Julie Gaines.

1. Toolkit for Dental
Health Professionals
Oral Health Information
Tutorial for Dental
Evidence-Based Dental Public Health
Public Health
Professionals
Data Tools and Statistics
Patient Information Purpose: Provides instruction for public health dental
practitioners that focuses on finding and evaluating
information relevant to public health dental practice.
This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human
Services, under Contract No. N01-LM-6-3505 under the Houston Academy of Medicine-Texas Medical Center Library.

2. Evidence-Based Dental
Public Health

3. Objectives
Define evidence-based dental public health
Learn a strategy for effective retrieval of evidence-based
research
Be able to critique and synthesize scientific literature
and apply it to public health dental practice
Identify evidence-based resources on the Web

4. What is Evidence-Based Dental Practice?
“ 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.” - American Dental Association
For additional information about evidence-based dentistry, refer to the
American Dental Association

5. Why Practice Evidence-Based Dentistry?
 Helps filter the immense amount of information that
emerges in the literature
 Effective method of keeping up with the most
current research
 Provides information on how similar cases have been
treated

6. The 5 A’s of Evidence-Based Dentistry
Assess
the patient
Ask clinical
questions
(Use PICO model)
Acquire the
best evidence
Appraise
the evidence
Apply
evidence to patient care

7. PICO Model: The well-built question for evidence–based research
P= Population or problem or patient
What are the characteristics of the patient or population?
What is the condition or disease?
I= Intervention or exposure
What do you want to do with/for the patient or population?
C= Comparison
What is the alternative to the intervention?
O= Outcome
What are the relevant outcomes?
Evidence Based Dentistry for Effective Practice, 2003.

8. Searching the Literature: PubMed
 PubMed is a search engine for MEDLINE created by the U.S. National Library of Medicine
(NLM).
 PubMed is a free, easy-to-use database that is accessible by any computer with Internet
service
 Includes over 17 million citations from MEDLINE and other life science journals for
biomedical articles back to the 1950s.
 Citations are indexed, or coded, with the NLM's controlled vocabulary, called Medical
Subject Headings or MeSH®
 Contains bibliographic citations and author abstracts from more than 5,000 biomedical
journals published in the United States and 80 other countries. PubMed includes links to full
text articles and other related resources. PubMed also includes citations to newer articles
that are not yet fully indexed.
"PubMed Tutorial", this Web-based program will show you how t

9. The PubMed Search
 Medical Subject Headings (MeSH)
The papers in PubMed are indexed by a subject specialist who reads the paper and notes all
the search terms that apply to that paper, cataloguing them as Medical Subject Headings
(MeSH). The terms come from a standardized list of vocabulary and definitions. Click on the
MeSH database link on PubMed's home page: (
http://www.nlm.nih.gov/mesh/meshhome.html), where a quick tutorial will take you step
by step through using the search. MeSH can be more useful than performing a general
search because it allows you to capture the synonyms associated with your topic across
multiple fields. Once you've set up a MeSH search that pulls the papers you are looking for,
save the search and get weekly alerts for any new citations.
 Text words
Include the words the author uses in the title or abstract. “Mouthguard" as a text word
would retrieve articles that use the word “mouthguard" but would not necessarily retrieve
other relevant articles that use the words “mouth protection" or “mouth pieces, protective."
Text words are useful when there is no good match to a subject heading and as an addition
to your MeSH searches. Text words can also help you find citations that have recently been
added to PubMed but are not yet fully indexed.

10. Study Types
 Systematic Reviews- "A type of scientific study that tries to answer a special
question by finding, appraising and summarizing all published, and, if possible,
unpublished work on a topic, according to predetermined criteria."
 Randomized Controlled Trial (RCT)- "An experiment where eligible patients
are randomly allocated into groups to receive (experimental group) or not
receive (control group) one or more interventions that are being compared.“
 Cohort Study- “Makes observations about the association between a
particular exposure or risk factor and the development of a disease or
condition.”
 Case-Control Study- “Involves identifying patients who have had a particular
outcome (cases), and control patients who do not have that outcome, and
then establishing whether there had been a specified exposure or not.”
Evidence-Based Decision Making : A Translational
Guide for Dental Professionals, 2009

11. Hierarchical Levels of Evidence Table
Rank Evidence Level Study Type
1 Systematic review & randomized Review of randomized controlled
controlled trials trials,
Experimental + control,
Randomization
2 Cohort Studies Experimental + control, no
randomization
3 Case-Control Studies Experimental + control,
retrospective
4 Case Reports Experimental only, prospective
5 Narrative review, editorial
N/A Epidemiology, Animal studies, In
vitro studies

12. Hierarchical Levels of Evidence
A well done study assigned a Level 1 rank is
considered the most rigorous and least
susceptible to bias, while a study ranked Level
5 is considered the least rigorous and is more
susceptible to bias.

13. Try to find a systematic
review to answer your
question. If one is not
available, you can choose
other types of studies
lower on the hierarchical
pyramid of evidence.

14. Evidence-Based Tools
The Centre for Evidence-Based Medicine, provides useful information and
downloads for critical appraisal of medical evidence:
Example critical appraisal sheets- Step-by-step guidelines for critical appraisal
Calculators- Designed to calculate statistical data related to evidence-based
dentistry
CATmaker- Download a wizard that guides you through a critical appraisal, then
calculates appropriate evidence-based medicine values
Explanations & Examples- Learn how to apply statistical applications and terms
to evidence-based dentistry
To access the detailed critical appraisal section from the Centre for Evidence-Based Medicine:
www.cebm.net/critical_appraisal.asp

15. Guide to Reading Research Articles
The University of Southern California Health Science Center developed this four question guide to help
researchers critically analyze content in articles:
What is the purpose of the study? Does the purpose of the study relate to an important problem?
How was the purpose investigated? Was the question studied in a credible and rigorous manner?
What are the findings and conclusions? Do the findings and conclusions relate the data to the purpose?
 Are the findings of this study applicable to my practice?

16. Further Study: Overviews of Evidence-Based Practice
 Evidentista
 Academic Center for Evidence-Based Practice, UTHSCSA Sc
 Agency for Healthcare Research and Quality (AHRQ)
 Centre for Evidence Based Medicine

17. Sample Clinical Question
Are school-based fluoride varnish programs effective
in preventing dental caries?
P= Children
I= School-based fluoride varnish programs
C= Implied
O= Reduce incidence of approximal caries

18. MeSH Search Terms
In the sample clinical question, the “key concepts” or
PICO parts must be identified with their MeSH terms:
Key Concept MeSH Term
P Children All Child 0-18 years
(limit)
I School-based programs School health services
Fluoride varnish Topical fluoride
C Implied Implied
O Reduced incidence of Dental caries
dental caries

19. Practice Case Study #1
Sam is a 49-year old man with moderate
periodontitis, who was recently diagnosed with type
2 diabetes mellitus. Sam’s glycosylated hemoglobin
is 12%, which places him in the category of poorly
controlled diabetes. Sam is worried that his diabetes
will increase his chance of losing his teeth. He wants
to know the impact diabetes now has on his oral
health.
Write down an answerable question, then put it in the
PICO format.
Evidence-Based Decision Making : A Translational
Guide for Dental Professionals, 2009

20. Clinical Question: Case Study #1
What impact will Type 2 diabetes mellitus have
on the oral health, specifically tooth loss, of a 49-
year old man with moderate periodontitis?
P= 49-year old man with moderate periodontitis?
I= Type 2 diabetes mellitus
C= Implied
O= Tooth Loss

21. Case Study #1: MeSH Search Terms
In the practice case study, the “key concepts” or PICO
parts must be identified with their MeSH terms:
Key Concept MeSH Term
P 49-year old man with Middle Aged: 45-64 years
moderate periodontitis (limit)
Periodontitis
I Type 2 Diabetes Mellitus Diabetes Mellitus, Type 2
C Implied Implied
O Tooth Loss Tooth Loss

22. Practice Case Study #2
A partnership between your community dental clinic
and the dental school is establishing an oral cancer
screening program as part of an outreach initiative.
To justify the new program, you must find research
that supports the objective to increase patients’
chance of early oral cancer detection.
Write down an answerable question, then put it in
the PICO format.

23. Clinical Question: Case Study #2
Do community oral cancer screening programs increase
a patient’s chance of early oral cancer detection?
P= Adults
I= Community oral cancer screenings
C= No screenings
O= Increase a patient’s chance of early oral cancer
detection

24. Case Study #2: MeSH Search Terms
In the practice case study, the “key concepts” or PICO parts
must be identified with their MeSH terms:
Key Concept MeSH Term
P Adult Adult: 19-44 years
(limit)
I Community Community Health Services
Cancer Screening Early Detection of Cancer
C Implied Implied
O Early Detection Already Stated
Oral Cancer Mouth Neoplasms

25. Databases
 American Dental Association’s Directory of Systematic Reviews
Links to systematic review abstracts available on PubMed
 The Cochrane Database of Systematic Reviews
Full-text of systematic reviews prepared by the Cochrane
Collaboration
 Cochrane Central Register of Controlled Trials (CENTRAL)
Contains over 300,000 bibliographic references to controlled
trials that have been identified by the distinguished
contributors to the Cochrane Collaboration

26. Databases (cont.)
 DARE( Database of Abstracts of Reviews of Effects)
Contains 15,000 abstracts of systematic reviews that focus
on the effects of interventions used in health and social
care.
 PubMed/MEDLINE
Principal biomedical database that contains bibliographic
citations and author abstracts from over 4,900 medical
journals (250 journals are specific to the field of Dentistry)
 PubMed Clinical Queries
Provides specialized PubMed searches for clinicians

27. Examples of Evidence-Based Journals
 Evidence-Based Dentistry
Publishes quarterly, some FREE, full-text available
online. Publishes articles on the latest developments in
oral health.
 Journal of Evidence-Based Dental Practice
FREE Table of Contents and Abstracts available online.
Publishes original articles and review articles about
clinical procedures and their outcomes.

28. Additional Tutorials on Evidence-Based Practice
 UNC-Chapel Hill Evidence-Based Dentistry Tutorial
 Boston University, Alumni Medical Library
 University of Illinois at Chicago

29. References
Clarkson, Jan, Harrison, Jayne E., Ismail, Amid I., Needleman, Ian &
Worthington, Helen. (2003). Evidence Based Dentistry for Effective Practice.
New York, New York: Martin Dunitz, an imprint of the Taylor & Francis
Group.
Forrest, Jane L, Miller, Syrene A., Overman, Pamela R. & Newman, Michael G.
( 2009). Evidence-Based Decision Making: A Translational Guide for Dental
Professionals. Philadelphia, PA: Lippencott Williams & Wilkins, a Wolters
Kluwer business.