archived

Final Research Plan

Dental Caries in Children from Birth Through Age 5 Years: Screening

December 15, 2012

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 Report forms the basis of the USPSTF Recommendation Statement on this topic.

The draft Research Plan was available for comment from July 10 until August 7, 2012 at 5:00 p.m., ET.

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Select Text Description below for details.

Text Description

This figure depicts the key questions. This figure illustrates the events that children ages 0 to 5 years may experience during a clinician visit. The figure shows that children may undergo oral screening and risk factor assessment. This could cause them to have adverse effects. This will lead to them being placed into one of two categories: average risk for dental caries, or increased risk for dental caries. Children at average risk for dental caries may experience one of two interventions: parental or caregiver/guardian oral health education or referral to a dentist. These interventions may cause adverse effects. Children at increased risk for dental caries may experience one of three interventions: parental or caregiver/guardian oral health education; referral to a dentist; or preventive treatments. These interventions may cause adverse effects. The outcomes of interest for both children at average and increased risk of dental caries are decreased dental caries and associated complications.

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  1. How effective is oral health screening and risk assessment by the primary care clinician* in preventing dental caries and complications among children from birth to age 5 years?
  2. How accurate is oral health screening by the primary care clinician in identifying children from birth to age 5 years who:
    1. Have dental caries and/or pre-caries lesions?
    2. Are at increased risk for future dental caries?
  3. What are the harms of oral health screening?
  4. How effective is parental or caregiver/guardian oral health education by the primary care clinician for prevention of dental caries in children at average or increased risk?
  5. How effective is referral by a primary care clinician to a dentist in preventing dental caries in children at average or increased risk?
  6. How effective are preventive interventions (oral fluoride supplementation, topical fluoride application, and xylitol) in preventing dental caries in children at increased risk?
  7. What are the harms of oral health interventions (parental or caregiver/guardian oral health education, referral to a dentist, and preventive treatments)?

*Primary care clinician is defined as a nondental primary care clinician.

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  1. What percentage of young children in the United States have access to dental care,* and what factors are associated with access to dental care in this population?

*Access to dental care is defined as the ability of a child to receive dental care services, based on availability of dental care providers and/or ability to pay for those services.

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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 report. Criteria are overarching as well as specific to each of the key questions (KQs).

  Inclusion
Population Asymptomatic children ages 0 to 5 years.
Setting Settings and populations of children applicable to U.S. primary care practice.
Screening (KQs 1–3) Oral screening and/or risk assessment provided or prescribed by primary care clinicians.
Treatment or Management Interventions (KQs 4–7) Interventions to reduce dental caries, including parental or caregiver/guardian oral health education (such as dental hygiene behavior and decrease in refined sugar intake), referral to a dentist, and preventive treatments (such as fluoride treatment, oral fluoride supplementation, topical fluoride application, or xylitol).
Comparisons KQs 1–3: Risk assessment and oral screening versus none
KQs 4–7: Treatment/intervention versus no treatment/intervention, placebo, or other treatment/intervention
Outcomes Dental caries and associated complications.
Harms Include, but may not be limited to: dental fluorosis, emotional stress, and acute toxicity.
Study Designs KQs on benefits include randomized, controlled trials, cohort studies, and systematic reviews. KQs on harms include randomized, controlled trials, cohort studies, and case-control studies. KQ on diagnostic accuracy includes studies that compare accuracy of primary care clinician examination in identifying caries or precaries lesions with reference standard. KQ on risk prediction includes studies that evaluate the predictive utility of risk-prediction instruments in primary care settings.
Language English only
Data Sources OVID MEDLINE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Cochrane Methodology Register, Health Technology Assessment, National Health Sciences Economic Evaluation Database, and Database of Abstracts of Reviews of Effects, secondary referencing.
Search Dates MEDLINE: 2001 to May 2012
Cochrane: 2001 to May 2012
Health Technology Assessment, National Health Sciences Economic Evaluation Database, and Database of Abstracts of Reviews of Effects: 3rd Quarter 2012
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