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Prevention of Dental Caries in Children Younger Than 5 Years Old
Evidence Syntheses, No. 104
Investigators: Roger Chou, MD, Amy Cantor, MD, MHS, Bernadette Zakher, MBBS, Jennifer Priest Mitchell, BA, and Miranda Pappas, MA.
Author Information and AffiliationsStructured Abstract
Background:
A 2004 U.S. Preventive Services Task Force (USPSTF) review recommended that primary care clinicians prescribe oral fluoride supplementation to preschool children over the age of 6 months whose primary water source is deficient in fluoride but found insufficient evidence to recommend for or against risk assessment of preschool children by primary care clinicians for the prevention of dental caries.
Purpose:
To systematically update the 2004 USPSTF review on prevention of dental caries in children younger than age 5 years by medical primary care clinicians.
Methods:
We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the 1st quarter of 2013) and Ovid MEDLINE® (1999 through March 8, 2013) and manually reviewed reference lists.
Results:
No randomized trial or observational study compared clinical outcomes between children younger than age 5 years screened and not screened by primary care clinicians for dental caries. One good-quality cohort study found primary care pediatrician examination following 2 hours of training associated with a sensitivity of 0.76 for identifying a child with one or more cavities and 0.63 for identifying children age <36 months in need of a dental referral compared with a pediatric dentist evaluation. No study evaluated the accuracy of risk-assessment tools applied by primary care clinicians to identify children younger than age 5 years at increased risk for future dental caries. We identified no new trials on the effects of oral fluoride supplementation in children younger than 5 years on dental caries outcomes. Three randomized trials published since the prior USPSTF review were consistent with three previous trials in finding fluoride varnish more effective than no fluoride varnish in reducing caries incidence in higher risk children younger than age 5 years (percent reduction in caries increment, 18 to 59%), although in all trials fluoride varnish was applied by dental personnel. Three trials reported no clear effects of xylitol versus no xylitol on caries incidence in children younger than 5 years. Five new observational studies in an updated systematic review were consistent with previous findings of an association between early childhood exposure to systemic fluoride and enamel fluorosis. Other than diarrhea, reported in two trials of xylitol, harms were poorly reported in trials of caries prevention interventions. Evidence on the effectiveness of educational or counseling interventions and the effectiveness of primary care referral to a dentist remains sparse or unavailable
Limitations:
Only English-language articles were included. Due to limited evidence from randomized trials, we included nonrandomized trials. Studies conducted in resource-poor settings may be of limited applicability to screening in the United States.
Conclusions:
Evidence previously reviewed by the USPSTF found oral fluoride supplementation effective at reducing caries incidence in children younger than age 5 years but associated with risk of enamel fluorosis. New evidence supports the effectiveness of professionally applied fluoride varnish at preventing caries in higher risk children younger than age 5 years. Research is needed to understand the accuracy of primary care oral health examination and caries risk assessment, primary care referral to dental care, and effective parental and caregiver/guardian educational and counseling interventions.
Contents
- 1. Introduction
- Purpose and Previous U.S. Preventive Services Task Force Recommendation
- Condition Definitions
- Prevalence and Burden of Disease
- Etiology and Natural History
- Risk Factors and Indicators
- Rationale for Screening and Screening Strategies
- Interventions and Treatment
- Current Clinical Practice
- Recommendations of Other Groups
- 2. Methods
- 3. Results
- Key Question 1 How Effective Is Oral Screening (Including Risk Assessment) by the Primary Care Clinician in Preventing Dental Caries in Children Younger Than Age 5 Years?
- Key Question 2a How Accurate Is Screening by the Primary Care Clinician in Identifying Children Younger Than Age 5 Years Who Have Cavitated or Noncavitated Caries Lesions?
- Key Question 2b How Accurate Is Screening by the Primary Care Clinician in Identifying Children Younger Than Age 5 Years Who Are at Increased Risk for Future Dental Caries?
- Key Question 3 What Are the Harms of Oral Health Screening by the Primary Care Clinician?
- Key Question 4 How Effective Is Parental or Caregiver Oral Health Education by the Primary Care Clinician in Preventing Dental Caries in Children Younger Than Age 5 Years?
- Key Question 5 How Effective Is Referral by a Primary Care Clinician to a Dentist in Preventing Dental Caries in Children Younger Than Age 5 Years?
- Key Question 6 How Effective Is Preventive Treatment (Dietary Fluoride Supplementation, Topical Fluoride Application, or Xylitol) in Preventing Dental Caries in Children Younger Than Age 5 Years?
- Key Question 7 What Are the Harms of Specific Oral Health Interventions for Prevention of Dental Caries in Children Younger Than Age 5 Years (Parental or Caregiver Oral Health Education, Referral to a Dentist, and Preventive Treatments)?
- Contextual Question. What Percentage of Children Younger Than Age 5 Years in the United States Have Access to Dental Care, and What Factors Are Associated With Access to Dental Care in This Population?
- 4. Discussion
- References
- Appendix A Detailed Methods
- Appendix B Evidence Tables and Quality Tables
Acknowledgments: The authors acknowledge Andrew Hamilton, MLS, MS, for assistance with literature searches and Amanda Brunton, BS, for assistance with preparing this report; both are based at Oregon Health and Science University. We also thank AHRQ Officers Aileen Buckler, MD, MPH, and Tess Miller, DrPH, and U.S. Preventive Services Task Force leads Virginia Moyer, MD, MPH, Linda Baumann, PhD, RN, Glenn Flores, MD, David Grossman, MD, MPH, and Adelita Cantu, RN, PhD, for their contributions to this report.
Prepared for: Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services1, Contract No. HHSA-290-2007-10057-I, Task Order No. 13. Prepared by: Pacific Northwest Evidence-based Practice Center2
Suggested citation:
Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M. Prevention of Dental Caries in Children Younger Than 5 Years Old: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 104. AHRQ Publication No. 12-05170-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014.
This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. HHSA-290-2007-10057-1, Task Order Number 13). The findings and conclusions in this document are those of the authors, who are responsible for its contents, and do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment.
This report may be used, in whole or in part, as the basis for development of clinical practice guidelines and other quality enhancement tools, or as a basis for reimbursement and coverage policies. AHRQ or U.S. Department of Health and Human Services endorsement of such derivative products may not be stated or implied.
None of the investigators has any affiliations or financial involvement that conflicts with the material presented in this report.
- 1
540 Gaither Road, Rockville, MD 20850; www
.ahrq.gov - 2
Oregon Health & Science University, Mail Code: BICC, 3181 SW Sam Jackson Park Road, Portland, OR 97239
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