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.