Summary Importance Tooth decay 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 ages 2 to 5 had dental cavities in their teeth. temporary. The prevalence is higher in Mexican American children (33%) and non-Hispanic black children (28%) than in non-Hispanic white children (18%). Early childhood dental caries is associated with pain, tooth loss, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries. Aim 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 under 5 years of age. Evaluation of the evidence The USPSTF concludes with moderate certainty that there is a moderate net benefit to preventing future dental caries with oral fluoride supplements at recommended doses in children 6 months and 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 cavities with the application of fluoride varnish in all children under 5 years of age. The USPSTF concludes that there is insufficient evidence on routine oral screening for dental caries by primary care physicians in children under 5 years of age and that the balance of benefits and harms of screening cannot be determined. detection. Recommendation The USPSTF recommends that primary care physicians prescribe oral fluoride supplements starting at 6 months for children whose water supply is deficient in fluoride. (Recommendation B) The USPSTF recommends that primary care physicians apply fluoride varnish to the baby teeth of all infants and children starting at the age of baby teeth eruption. (Recommendation B) The USPSTF concludes that current evidence is insufficient to evaluate the balance of benefits and harms of routine screening for dental caries by primary care physicians in children younger than 5 years. |
Importance
Tooth decay is the most common chronic disease in US children.
According to the 2011-2016 National Health and Nutrition Examination Survey, approximately 23% of children ages 2 to 5 had dental cavities in their primary teeth.
The prevalence is higher in Mexican American children (33%) and non-Hispanic black children (28%) than in non-Hispanic white children (18%).
Early childhood dental caries is associated with pain, tooth loss, impaired growth, decreased weight gain, negative effects on quality of life, poor school performance, and future dental caries.
USPSTF assessment of magnitude of net benefit
The US Preventive Services Task Force (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 and older whose water supply It is deficient in fluoride.
The USPSTF concludes with moderate certainty that there is a moderate net benefit of preventing future dental cavities with the application of fluoride varnish in all children under 5 years of age.
The USPSTF concludes that there is insufficient evidence on routine oral screening for dental caries by primary care physicians in children under 5 years of age and that the balance of benefits and harms of screening cannot be determined. detection.
Considerations for practice
Patient population under consideration
This recommendation applies to asymptomatic children under 5 years of age.
Risk evaluation
All children are potentially at risk for tooth decay. There are no validated screening tools to determine which children are at highest risk for dental caries; However, several individual factors increase the risk. A higher prevalence and severity of dental caries is found among low-income populations and certain racial and ethnic populations (e.g., blacks and Mexican Americans).
The risk factors for dental caries in children are multifactorial. Biological risk factors include cariogenic bacteria, developmental defects of tooth enamel, and low saliva flow rates.
Social determinants of health (nonbiological factors) that are associated with an increased risk of cavities include access to dental care, low socioeconomic status, personal and family history of oral health, dietary habits (especially frequent eating of dietary sugars in foods and beverages), fluoride exposure, and oral hygiene practices.
Interventions to prevent dental caries
Oral fluoride supplementation prevents dental caries in patients with water fluoridation deficiency (<0.6 parts fluoride per million parts water [ppm F]). Topical fluoride is applied as a varnish with a small brush in young children (usually available as 5% sodium fluoride [2.26% fluoride]). The use of topical fluoride for cavity prevention is off- label .
Time and dosage
No studies specifically addressed the dose and timing of oral fluoride supplementation in children with inadequate water fluoridation.
No study directly evaluated the appropriate ages to start and stop applying fluoride varnish. However, given the mechanism of action of this intervention, the benefits are likely to accrue from the time of eruption of the primary tooth. In studies, fluoride varnish was most commonly administered as 5% sodium fluoride, every 6 months.
Additional Tools and Resources
There are several related tools and resources that can help clinicians implement this recommendation:
The Community Preventive Services Task Force recommends fluoridation of community water sources to reduce tooth decay. sixteen
The Community Preventive Services Task Force recommends school-based dental sealant delivery programs to prevent cavities.
Tips for practice regarding the declaration
When deciding whether to screen children for dental cavities from birth to 5 years of age, doctors should consider the following.
Potential avoidable burden
Tooth decay is a common chronic disease that can cause pain and decrease quality of life.
According to the National Health and Nutrition Examination Survey, the prevalence of dental caries increased from 24% to 28% between 1988-1994 and 1999-2004; the prevalence was approximately 23% between 2011 and 2016.
17% of children living below the poverty line had untreated cavities between 2011 and 2014. Dental concerns cause the loss of more than 50 million school hours each year.3
Possible damage
Primary care dental cavity screenings for children from birth to age 5 are non-invasive and are not likely to cause serious harm.
Current practice
A 2009 study showed that only about half of pediatricians reported examining the teeth of more than half of their patients ages 0 to 3, and few (4%) reported applying fluoride varnish regularly.
Update to previous USPSTF recommendation
This is an update to the 2014 USPSTF recommendation statement, in which the USPSTF similarly recommended that primary care physicians prescribe oral fluoride supplements beginning at 6 months for children whose water supply is poor. in fluoride (recommendation B) and that primary care physicians apply fluoride as a varnish to the primary teeth of all infants and children starting at the age of eruption of primary teeth (recommendation B).
The USPSTF did not find sufficient evidence to evaluate the balance of benefits and harms of routine dental caries screening by primary care physicians in children younger than 5 years (statement I).
Harms of preventive interventions
Severe fluorosis ( e.g., demonstrated by discoloration and pitted or roughened tooth enamel surfaces) is rare, with a prevalence of less than 2%.
Nineteen observational studies showed an association between systemic fluoride ingestion in early childhood and enamel fluorosis of permanent teeth. Four trials (n = 4141) found no difference in the risk of fluorosis or any other adverse event between fluoride varnish and placebo or no varnish.
How does evidence fit with biological knowledge?
Systemic fluoride is incorporated into tooth structures during their formation.
If fluoride is ingested repeatedly during tooth development, it is deposited on the entire surface of the tooth and provides protection against cavities.
Topical fluoride treatments, such as varnishes, help protect teeth that are already present. In this method, fluoride is incorporated into the surface layer of the teeth, making them more resistant to cavities. Systemic fluoride also provides some measure of topical effects, as it is found in saliva and bathes the teeth.
Therefore, providing both systemic and topical fluoride to children during tooth development fits with the biological understanding of the protective actions of fluoride against dental caries.
All children with erupted teeth can potentially benefit from periodic application of fluoride varnish, regardless of the fluoride levels in their water. Although the evidence supporting fluoride varnish comes from higher-risk populations, provision of fluoride varnish to all children is reasonable because the prevalence of risk factors is high in the US population.
Recommendations from other institutions
The American Academy of Pediatrics (AAP) recommends that pediatricians perform oral health risk assessments on all children at every well-child visit starting at 6 months.
The AAP also recommends application of fluoride varnish according to the AAP/Bright Futures Periodicity Schedule (applied at least once every 6 months for all children and every 3 months for children at high risk for cavities) and supplements. dietary fluoride for all children who do not have an adequate supply of fluoride in their primary drinking water. The AAP recommends a first visit to the dentist before one year of age.
The American Dental Association recommends that children be seen by a dentist within 6 months of the first tooth erupting and no later than 12 months of age. It also recommends a 2.26% fluoride varnish for children under 6 years old who are at risk of developing tooth decay.
The Centers for Disease Control and Prevention recommends that fluoride supplements be best prescribed to children at high risk for dental cavities whose drinking water lacks adequate fluoridation.
The American Academy of Pediatric Dentistry states that dietary fluoride supplements should be considered for children at risk for cavities who drink fluoride-deficient water (<0.6 ppm F). It also states that children at increased risk for cavities should receive professional fluoride treatment (for example, 5% sodium fluoride varnish or 1.23% acidulated phosphate fluoride) every 6 months.
