Final Research Plan
Oral Health in Children and Adolescents Aged 5 to 17 Years: Screening and Preventive Interventions
June 17, 2021
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.
- How effective is screening for oral health performed by a primary care clinician in preventing negative oral health outcomes?
- How accurate is screening for oral health performed by a primary care clinician in identifying children and adolescents who:
- Have oral health issues?
- Are at increased risk of future oral health issues?
- What are the harms of screening for oral health performed by a primary care clinician?
- How accurate is screening for oral health performed by a primary care clinician in identifying children and adolescents who are at increased risk of future oral health issues?*
- How effective is oral health behavioral counseling provided by a primary care clinician in preventing oral health issues?
- How effective is referral by a primary care clinician to a dental health care provider in preventing oral health issues?
- How effective are preventive interventions in preventing oral health issues?
- What are the harms of specific interventions (behavioral counseling, referral, and preventive interventions) to prevent oral health issues?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What is the association between presence or severity of dental caries of deciduous or permanent teeth and pain, quality of life, function, and tooth loss/edentulism? What is the association between presence or burden of dental caries of deciduous teeth and subsequent presence or severity of dental caries of permanent teeth?
- What factors (e.g., race/ethnicity, age, socioeconomic status, cultural factors, educational attainment, or health literacy) are associated with oral health care disparities in children, adolescents, and adults?
- What is the effectiveness of primary care interventions to reduce oral health care disparities in children, adolescents, and adults?
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.
This review will address screening, risk assessment, and preventive interventions for oral health in children (starting at age 5 years) through older adults. Younger children (younger than age 5 years) are addressed in a separate USPSTF recommendation. This review will focus on the oral health conditions of dental caries and periodontitis. Screening for oral cancer in adults is addressed in a separate USPSTF recommendation. Separate Analytic Frameworks address children and adolescents ages 5 to 17 years and adults. In addition, for each of these populations, separate Analytic Frameworks address screening for oral health conditions and prevention of oral health conditions, to more clearly distinguish treatment of children and adolescents with existing dental caries identified by screening (screening Analytic Framework) from treatment of children without dental caries to prevent the development of future caries (intervention Analytic Framework). Populations of interest include groups defined by age (for children, those with deciduous teeth vs. permanent dentition; for adults, age <65 vs. ≥65 years), sex, socioeconomic status, race/ethnicity, educational attainment, and health literacy. Dental X-rays are not addressed because they are not typically obtained in primary care settings or ordered by primary care clinicians.
|Populations||Asymptomatic children (starting at age 5 years) through older adults, including pregnant persons
Populations of interest include groups defined by: age (children, those with deciduous teeth vs. permanent dentition; adults, <65 vs. ≥65 years), sex, socioeconomic status, race/ethnicity, educational attainment, and health literacy
|Children younger than age 5 years (this population is addressed in a separate USPSTF recommendation)|
|Treatment for existing oral health issues|
|Comparisons||No intervention or placebo||Active treatment|
|Outcomes||Dental caries (incidence and severity)
Periodontal disease in adults (incidence and severity)
Quality of life
Harms of screening and treatment (e.g., dental fluorosis, tooth staining, bone effects, and neurological effects)
|Setting||Primary care or applicable to U.S. primary care practice (e.g., screening or preventive interventions do not require specialized dental training or equipment and are feasible for implementation in primary care); includes teledentistry approaches based in primary care settings||Dental clinics providing interventions not available in primary care settings|
|Study Design||Screening: Trials and cohort studies
Preventive interventions: Trials; large cohort studies for selected harms (e.g., dental fluorosis, harms related to radiation exposure)Risk assessment: Studies of diagnostic accuracy or risk prediction
|Case-control studies or uncontrolled studies|
|Study Quality||Good or fair quality||Poor quality|
Abbreviations: U.S. = United States; USPSTF = U.S. Preventive Services Task Force.
The draft Research Plan was posted on the USPSTF website for public comment from March 18, 2021, to April 14, 2021. In response, the USPSTF revised the inclusion criteria to clarify that screening is performed by a primary care provider and that preventive interventions are administered by a primary care provider or are feasible to be administered by a primary care provider. The USPSTF made no other changes.