Fluoride, Sealants Win Against Youth Tooth Decay, Comprehensive Study Informs U.S. Health Policy

In a recent systematic review published in the journal JAMA Network, The researchers synthesized the available literature on interventions to prevent oral health problems, particularly dental caries, in young people aged five to 17. They identified three systematic reviews, 22 clinical trials and one observational study including more than 35,700 participants. Their results found that fluoride gels and supplements, varnishes, and sealants helped improve caries outcomes and overall oral health. Although intended to inform the U.S. Preventive Services Task Force, these findings provide valuable details for schools and dental practitioners caring for children and adolescents in this age group.

Study: Screening, referral, behavioral counseling and preventive interventions for oral health in children and adolescents aged 5 to 17 yearss. Image credit: Sergii Kuchugurnyi/Shutterstock

Oral health problems in children

Children and adolescents are very susceptible to oral health problems, leading to decreased well-being and a pain-related aversion to solid foods. Tooth decay is the most common of these dental conditions, caused by cariogenic bacteria adhering to the teeth that metabolize sugars to produce acid. Over time, the acid demineralizes tooth structure, causing cavities, pain and oral disability.

Oral health services for school-aged children exhibit disparities related to location, race/ethnicity, parental education, and socioeconomic status. Providing oral health interventions, such as dental screening and preventive education in schools and colleges, could fill this gap, thereby improving children’s quality of life.

The present study was conducted to equip the United States Preventive Services Task Force (USPTF) with information and recommendations that could be used to develop and implement dental interventions in children and adolescents. It accompanies a companion report providing information and guidance on interventions for adults, both of which address oral health disparities and long-term outcomes of poor dental care.

About the study

The present study aimed first to identify cohorts requiring oral health interventions (screening and assessment of risk factors), and then to evaluate necessary interventions for those identified as having dental problems. To systematically review the available literature on these topics, key questions (KQs) were formulated, encompassing the effectiveness and accuracy of oral screening, the risks or harms of the screening process, and the positive and potential harms of interventions.

To answer these questions, the researchers used a systematic review framework in which they brought together relevant literature from three medical databases (MEDLINE, the Cochrane Database of Systematic Reviews, and the Cochrane Controlled Trials Register). They supplemented the identified publications with relevant references derived from publication citations. Inclusion criteria included all dental screening studies performed in primary care settings without requiring the intervention of a dental specialist. Preventative interventions such as behavioral counseling, clinical referrals, and preventative medications/treatments that did not require medical approval or administration training were also included.

Outcomes were measured in terms of number of decayed, missing or filled permanent teeth (DMFT index) or surface areas (DMFS). For young children who have retained one or more baby teeth, modified measures called decayed or filled teeth (DFT) or surface area (DFS) indices have been used. Following predefined USPSTF criteria, the quality of identified publications was checked and rated as “good,” “fair,” or “poor.”

Statistical analysis included a meta-analysis of oral health interventions from publications rated as high quality and a random effects profile likelihood model investigation for lower quality publications.

Study results

Three systematic reviews comprising 54 trials from 53 publications (20,648 participants) and 23 individual articles (15,026 participants) met the inclusion criteria and were included in this study. A distinct lack of literature on oral health screening was revealed, with one of 76 publications included addressing the topic. In contrast, several publications have studied the outcomes of dental interventions in dental schools and settings.

The screening study found that trained nurses could visually identify dental caries with high sensitivity and specificity. Parents and guardians were found to have moderate sensitivity and high specificity when given a checklist-style questionnaire, suggesting that dental consultations are not necessary for preliminary assessments of children’s dental health and adolescents.

Meta-analysis of the intervention found that fluoride supplements led to small decreases in DMFT/DMT, particularly in areas experiencing unfluoridated water, low socioeconomic status, or high burden of cavities. Fluoride gels, varnishes and sealants administered by dentists have led to significant improvement in caries outcomes, with sealants producing the best results. Two studies testing the effects of xylitol failed to establish the benefits of this intervention.

The effectiveness of delivering unsupervised interventions in primary care centers and at home could not be verified due to insufficient publication data. Preventive interventions yielded confusing results for some variables (fluoride levels in water, oral health education, dental behaviors) or lacked sufficient data for analyses.

Interventions were associated with low to moderate harm in some studies. However, this damage was mainly cosmetic (blackening of teeth subjected to SDF preventive treatment), and no serious injuries were reported in any of the 76 studies evaluated.

Conclusions

The present study reviews previous literature on dental interventions for caries and other oral health problems in children and adolescents aged 5 to 17 years. This systematic review and meta-analyses found that visiting a dental professional for a preliminary diagnosis of caries in most settings is unnecessary and can be easily performed by parents, guardians, nurses, and professionals. of health.

Although data on most hypotheses studied were insufficient to obtain conclusive results, interventions involving fluoride supplements (particularly in socioeconomically disadvantaged areas), fluoride gels, varnishes, and sealants were all associated with better oral health and reduced risk of cavities in children and adolescents.