Final Research Plan

Prevention of Dental Caries in Children Younger Than 5 Years: Screening and Interventions

January 02, 2020

Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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The final Research Plan is used to guide a systematic review of the evidence by researchers at an Evidence-based Practice Center. The resulting Evidence Review will form the basis of the USPSTF Recommendation Statement on this topic.

The draft Research Plan was available for comment from September 19 to October 16, 2019.

Analytic Framework: Screening for Dental Caries in Children Younger Than Age 5 Years*

This figure is an analytic framework that depicts the events that children ages 0 to less than 5 years may experience during a clinician office visit. The figure shows that children may undergo an oral screening and risk factor assessment, which may cause adverse effects. This leads them to being identified at either average risk for dental caries or at increased risk for dental caries. Children at either risk level may experience interventions. It is noted that interventions are provided to children found to have caries on screening, which is not addressed in this analytic framework. The outcomes of interest for children at either risk level are decreased dental caries and associated complications.

*The numbers in the analytic framework correspond to the Key Question numbers below.
†Interventions are provided to children found to have caries on screening.

Analytic Framework: Interventions to Prevent Dental Caries in Children Younger Than Age 5* Years

This figure is an analytic framework that depicts the events that children ages 0 to less than 5 years may experience during a clinician office visit. The figure shows that children may undergo a risk factor assessment. This will lead to them being identified at either average risk for dental caries or at increased risk for dental caries. Children at either risk level may experience the following interventions, which it is noted are provided to children without caries: parental or caregiver/guardian oral health education; referral to a dental health care provider; or preventive interventions, any of which may cause adverse effects. The outcomes of interest for children at either risk level are decreased dental caries and associated complications.

 

 

*The numbers in the analytic framework correspond to the Key Question numbers below.
†Interventions are provided to children without caries.

  1. How effective is oral screening (including risk assessment) performed by a primary care clinician in preventing dental caries in children younger than age 5 years?
  2. How accurate is screening performed by a primary care clinician in identifying children younger than age 5 years who:
    1. Have cavitated or noncavitated caries lesions?
    2. Are at increased risk for future dental caries?
  3. What are the harms of oral health screening performed by a primary care clinician in children younger than age 5 years?

  1.  How accurate is screening performed by a primary care clinician in identifying children younger than age 5 years who are at increased risk of future dental caries*?
  2. How effective is parental or caregiver/guardian oral health education provided by a primary care clinician in preventing dental caries in children younger than age 5 years?
  3. How effective is referral by a primary care clinician to a dental health care provider in preventing dental caries in children younger than age 5 years?
  4. How effective are preventive interventions (dietary fluoride supplementation, topical fluoride application, silver diamine fluoride, or xylitol) in preventing dental caries in children younger than age 5 years?
  5. What are the harms of specific oral health interventions to prevent dental caries in children younger than age 5 years (parental or caregiver/guardian oral health education, referral to a dental health care provider, and preventive interventions)?

*This is the same question as Key Question 2b for screening

The Contextual Question will not be systematically reviewed and is not shown in the Analytic Framework.

  1. How effective is silver diamine fluoride in preventing dental caries in children age 5 years or older?

The Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the Key Questions (KQs).

Category Included Excluded
Populations Asymptomatic children younger than age 5 years Animal studies, adults, children older than preschool age (≥5 years), and children who are symptomatic for dental caries
Interventions KQs 1–3 (screening) and KQ 1 (preventive interventions): Oral screening and risk factor assessment performed by a primary care clinician

KQs 2, 3, 5 (preventive interventions): Parent/caregiver/guardian oral health education and/or referral to dentist

KQs 4, 5 (preventive interventions): Preventive interventions: oral fluoride supplementation, topical fluoride application, silver diamine fluoride, or xylitol (including xylitol given to the child or mother)		 KQs 1–3 (screening) and KQ 1 (preventive interventions): Community- or school-based screening interventions

KQs 2, 3 (preventive interventions): Education or referral not performed in primary care settings; education or referral for existing caries

KQs 4, 5 (preventive interventions): Interventions not available for preschool children or not available in the United States; treatment for existing caries
Comparisons No intervention or placebo Active treatment
Outcomes KQs 1, 3 (screening) and KQs 2–5 (preventive interventions): Dental caries, morbidity, quality of life, and function

KQ 2 (screening) and KQ 1 (preventive interventions): Diagnostic accuracy and measures of risk prediction

KQ 3 (screening) and KQ 5 (preventive interventions): Dental fluorosis, tooth staining, emotional stress, acute toxicity, and other associated complications

 Cost effectiveness
Setting Applicable to U.S. primary care practice Schools; dental clinics providing interventions not available in primary care settings
Study Design KQ 1 (screening) and KQs 2–4 (preventive interventions): Randomized, controlled trials; nonrandomized, controlled clinical trials; and cohort studies

KQ 2 (screening) and KQ 1 (preventive interventions): Studies of diagnostic accuracy or risk prediction

KQ 3 (screening) and KQ 5 (preventive interventions): Randomized, controlled trials; nonrandomized, controlled clinical trials; cohort studies; or case-control studies (if data from randomized trials are lacking); and systematic reviews		 KQs 1, 2 (screening) and KQs 1–4 (preventive interventions): Case-control studies; uncontrolled intervention studies

All KQs: Opinions, editorials, or case reports
Study Quality Good or fair quality Poor quality

The draft Research Plan was posted for public comment on the USPSTF website from September 19 to October 16, 2019. In response, the USPSTF made the following revisions: added a footnote to both Analytic Frameworks to clarify that in the screening framework, interventions are provided to children found to have caries on screening, and in the prevention analytic framework, interventions are provided to children without caries; changed “dentist” to “dental health care provider”; and revised the exclusion criteria to indicate that dental clinics providing interventions not available in primary care clinics are excluded from the review (interventions that can be provided in primary care practices will be included even if they are administered in other settings). Also, the USPSTF determined it will abstract information regarding the skill level or training of primary care clinicians participating in studies of screening and preventive interventions, and evaluate the effects of skill level/training on effectiveness (data permitting).