Draft Research Plan

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

September 19, 2019

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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Proposed 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 younger than age 5 years may experience during a clinician 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 or increased risk for dental caries. Children at either risk level may experience interventions, which are not addressed in this analytic framework. The outcomes of interest for children at either risk level are decreased dental caries and associated complications.

Proposed Analytic Framework: Interventions for Dental Caries in Children Younger Than Age 5 Years

This figure is an analytic framework that depicts the events that children younger than age 5 years may experience during a clinician visit. The figure shows that children may undergo a risk factor assessment, which may cause adverse effects. This will lead to them being identified at either average risk or increased risk for dental caries. Children at either risk level may experience the following interventions: parental or caregiver/guardian oral health education; referral to a dentist; or preventive interventions, which may cause adverse effects. The outcomes of interest for children at either risk level are decreased dental caries and associated complications.

 

  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 dentist 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 dentist, 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 Proposed 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 Placebo or no treatment 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		 Cost effectiveness
Study Designs 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; case-control studies; 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