Fluoride and sealants win against youth tooth decay, powerful review informs US health policy

In a recent systematic review published in the journal JAMA Network, The researchers synthesized the available literature on interventions aimed at preventing oral health problems, particularly dental caries, in young people aged between five and 17 years. They identified three systematic reviews, 22 clinical trials and one observational study involving more than 35,700 participants. Their findings revealed that fluoride gels and supplements, varnishes and sealants helped improve tooth decay outcomes and overall oral health. Although aimed at informing the US Preventive Services Task Force, these findings provide valuable insight for schools and dentists who care 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 yearssmall. Image credit: Sergii Kuchugurnyi / Shutterstock

Oral health problems in children

Children and adolescents are highly susceptible to oral health problems, resulting in reduced well-being and pain-related aversion to solid food. Dental caries is the most common of these dental diseases, caused by cariogenic bacteria that attach to the teeth and metabolize sugars to produce acid. The acid, over time, desalinates the tooth structure, causing tooth decay, pain and oral disability.

Oral health services for school-age children show 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 bridge this gap, thereby improving the quality of life of children.

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 related report that provides information and guidance on adult interventions that address oral health inequalities and the long-term health effects of poor dental care.

About the study

The present study aimed first to identify cohorts requiring oral health interventions (screening and risk factor assessment) and then to assess the interventions required by those identified as having dental concerns. To systematically review the available literature on these topics, key questions (KQs) were formulated, including the effectiveness and accuracy of oral screening, the risks or disadvantages of the screening process, and the benefits and potential harms of the interventions.

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

Results were measured in terms of the number of permanent teeth damaged, missing or filled (DMFT index) or surfaces (DMFS). For young children who retained one or more primary teeth, modified measurements called decayed or filled tooth (DFT) or tooth surface (DFS) indices were used. Following pre-defined USPSTF criteria, identified publications were quality-checked and rated as ‘good’, ‘fair’ or ‘poor’.

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

Study findings

Three systematic reviews including 54 trials from 53 publications (20,648 participants) and 23 single papers (15,026 participants) met the inclusion criteria and were included in this study. A severe lack of literature on oral health screening was revealed, with one in 76 including publications addressing the topic. In contrast, multiple publications have investigated the outcomes of dental interventions in school and dental settings.

The screening study revealed that trained nurses could visually detect dental caries with high sensitivity and specificity. Parents and guardians were found to have moderate sensitivity and high specificity when provided with a checklist-type questionnaire, suggesting that dental visits are not necessary for preliminary assessments of dental health in children and adolescents.

The meta-analysis of the intervention found that fluoride supplementation resulted in small reductions in DMFT/DMT, especially in areas experiencing non-fluoridated water, low socioeconomic status, or heavy caries burden. Dentist-administered fluoride gels, varnish, and sealants resulted in significantly improved caries results, with sealants producing the best results. Two studies that tested the effects of xylitol were unable to determine the benefits of this intervention.

Unsupervised intervention management in primary care centers and homes could not be verified for efficacy due to insufficient published data. Preventive interventions showed confounding effects for some variables (water fluoridation levels, oral health education, dental behaviors) or had insufficient data for analyses.

Interventions were associated with low to moderate harm in some studies. However, this damage was mainly cosmetic (darkening of SDF prophylactically treated teeth) and no serious injury was reported in any of the 76 studies reviewed.

conclusions

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

While data for most cases under investigation were insufficient for definitive results, interventions involving fluoride supplements (especially in socioeconomically disadvantaged areas), fluoride gels, varnishes, and sealants were associated with improved oral health and reduced caries risk in children and adolescents.