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Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task
, Karina W Davidson1, Michael J Barry2
1Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York.
Insights
Preventing early childhood dental caries is crucial. The US Preventive Services Task Force recommends fluoride supplementation for children with low fluoride water and fluoride varnish for all children under five.
Area of Science:
- Pediatric Dentistry
- Preventive Healthcare
- Public Health
Background:
- Dental caries is the most common chronic disease in US children.
- Prevalence is disproportionately higher among Mexican American and non-Hispanic Black children.
- Early childhood caries is linked to adverse health, developmental, and academic outcomes.
Purpose of the Study:
- To update recommendations on preventing dental caries in children under five.
- Systematic review commissioned by the US Preventive Services Task Force (USPSTF).
Main Methods:
- Systematic review of screening and interventions for dental caries prevention.
- Focused on asymptomatic children younger than 5 years.
Main Results:
- Moderate net benefit of oral fluoride supplementation for children 6+ months in low-fluoride areas.
- Moderate net benefit of fluoride varnish for all children under five.
- Insufficient evidence on routine oral screening by primary care clinicians.
Conclusions:
- Recommend oral fluoride supplementation for eligible children starting at 6 months.
- Recommend fluoride varnish application for all infants and children upon primary tooth eruption.
- Evidence is insufficient to recommend routine oral screening by primary care clinicians.
Importance:
Dental caries is the most common chronic disease in children in the US. According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children aged 2 to 5 years had dental caries in their primary teeth. Prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%). Dental caries in early childhood is associated with pain, loss of teeth, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries.
Objective:
To update its 2014 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on screening and interventions to prevent dental caries in children younger than 5 years.
Population:
Asymptomatic children younger than 5 years.
Evidence Assessment:
The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with oral fluoride supplementation at recommended doses in children 6 months or older whose water supply is deficient in fluoride. The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental caries with fluoride varnish application in all children younger than 5 years. The USPSTF concludes that the evidence is insufficient on performing routine oral screening examinations for dental caries by primary care clinicians in children younger than 5 years and that the balance of benefits and harms of screening cannot be determined.
Recommendation:
The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children younger than 5 years. (I statement).
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