USPSTF backs primary care dental screening

Brush up on oral-health screening
Brush up on oral-health screening

HealthDay News -- The U.S. Preventive Services Task Force (USPSTF) is recommending that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months and apply fluoride varnish to primary teeth for children aged 5 years and younger.

"Evidence shows that both fluoride varnish and oral fluoride supplements can help prevent tooth decay in young children," Task Force member Glenn Flores, MD, said in a statement. "These interventions are more vital than ever because, after decades of decline, the rate of tooth decay in children is rising, particularly in those 2 to 5 years old. Preventing this disease is critical to children's well-being." 

Prevalence of dental caries in this population has increased from 24% to 28% between 1988 and 2004, NHANES data indicate, and approximately 20% of surveyed children with caries had not received treatment. 

The guidance is the first update since 2004 and is considered a Grade B recommendation, as there is insufficient evidence to weigh the benefits and harms of primary care screening for dental caries.

"The USPSTF found no studies addressing the direct effect of oral screening by primary care clinicians on improved clinical outcomes in children younger than age 5 years. However, early detection allows for early referral to a dentist for treatment of caries and precaries (noncavitated caries) lesions," the Task Force wrote in it's draft Recommendation Statement.

Children with dental caries may experience pain, loss of teeth, impaired growth and decreased weight gain.

Despite the availability of an American Academy of Pediatrics primary care oral health risk assessment tool for use starting at the 6-month visit, only about half of primary care clinicians report examining teeth in patients aged 0 to 3 years. Yet, just two to four hours of training is sufficient to teach clinicians how to appropriately identify children with dental caries and those that require dental referral, according to the researchers.

Based on the available literature, for children whose water supply is deficient of fluoride, it is recommended that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months. From the age of primary tooth eruption, fluoride varnish should be applied to the primary teeth of infants and children (Grade B recommendation).

"Further studies investigating the effectiveness of xylitol and other potential treatments for preventing dental caries would also be useful to expand the range of preventive interventions. All studies should also evaluate possible harms," the Task Force wrote.

The draft Recommendation Statement is available for public comment until June 17, 2013.

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