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Evidence-based Decision Making

What is Evidence-based Decision Making?

Mosby's Dental Dictionary defines evidence-based decision making as: a type of informal decision-making that combines clinical expertise, patient concerns, and evidence gathered from scientific literature to arrive at a diagnosis and treatment recommendation.

Or more graphically:

Evidence-based Decision Making

There are five elements to the approach: 

  1. Question — Develop a clear question based on the patient's clinical problem. (PICO)
  2. Find — Find the latest evidence through efficient searching for information (articles, guidelines,  systematic reviews, etc.)
  3. Appraise — Critically appraise the evidence to assess its value (critical thinking)
  4. Act — Act on the evidence you find, if appropriate and relevant to the clinical situation to provide treatment for the patients (i.e. add your expertise and the patient's concerns to the evidence)
  5. Evaluation — Evaluate each aspect of your performance in this process (double-check that you did each process thoroughly and properly)

Find The Evidence

Choose the highest level of evidence. Start at the top of the pyramid and work your way down. Does Cochrane's have a systematic review? If not, is there another systematic review out there? If not, are there randomized controlled trial articles? If not, is there a case study? The top four tiers are secondary evidence -- information has been appraised and filtered. The fifth tier (Control Studies) indicates primary evidence. These are not filtered so try for peer reviewed articles.

Hierarchy of Evidence

EBD pyramid Hierarchy of Evidence

If you can't find a systematic review then which of the controlled studies should you look at? Randomized controlled trials or Cohort controlled trials? Use the list below to choose.

If your question type is:

Then find:
Randomized controlled trial (double-blind preferable)

Selected Websites

Evidence-based Dentistry

ADA Center for Evidence-Based Dentistry 

Centre for Evidence-based Dentistry

EBD Tutorial
Introduction to Evidence-Based Dentistry


How to Read a Scientific Journal
A short and fun guide to making sense of scholarly articles.

The Little Handbook of Statistical Practice                
Explanations of what statistical information is really telling you

Dental Anatomy 

Looking for Research Articles?

Start with these Electronic Resources/Databases

  • CINAHL with Full Text
    Many full-text articles. Focus is on patients so use CINAHL when you need to find information on how people and dentistry interact. For example, dental hygienist occupational stress or nutrition and dental caries. CINAHL will give you fewer dental hygiene related articles than Medline, but more full-text.
  • Medline (EBSCOhost)
    No full-text on its own – but there are lots of links to other database articles. Medline focuses on biomedical research. Use when you need to find research information on interactions, effects, diagnoses, behaviors, etc. For example, the effect of fluoride or prevalence of caries in a certain group.
    • PubMed uses the same data that Medline does but is free to anyone. The searching interface may not be as easy as EBSCOhost’s but if you learn how to use PubMed, you can get the same results. The link above will allow you to be told if Oregon Tech Library has the article in one of its databases. PubMed links to open access articles so there is some full-text.
  • Cochrane Library
    Cochrane Library is primarily used for its database of systematic reviews. Use this when looking for evidence-based information. It also has many clinical trial articles, technology assessments, and economic evaluations.
  • SMART (Imagebase)
    When you need an illustration for your report, try here. Academic Search Premier also has an image search.

For other medical and allied health databases, go to: www.oit.edu/libraries/find/articles/subject/healthmed

Specific Journal Articles on Evidence-based Decision Making

Develop The Question


P – Patient or Problem How would you describe the patient or problem to a colleague? What are the most important characteristics?
I – Intervention or Exposure What do you want to do for the patient?
C – Comparison or Control What is the main alternative to compare to? (Another treatment, placebo, surgery? - this can be optional)
O – Outcome What do you want to accomplish, improve, or affect? Needs to be measurable.

Types of clinical questions

Therapy (RCT) Determining the effect of different treatments on improving patient function or avoiding adverse events
Harm (RCT/Cohort) Ascertaining the effects of potentially harmful agents (including therapies) on patient function, morbidity, and mortality
Diagnosis (Compare to Gold Standard) Establishing the power of an intervention to differentiate between those with and without a target condition or disease
Prognosis (Cohort) Estimating the future course of a patient’s disease

PICO Worksheet and Search Strategy

Iris Godwin

Iris Godwin, Technical Services Librarian


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Last Updated September 2010