Prevention of Dental Caries in Children From Birth Through Age 5 Years: US Preventive Services Task Force Recommendation Statement

1. Virginia A. Moyer, MD, MPH 
2. on behalf of the US Preventive Services Task Force
3. 1. DESCRIPTION: Update of the 2004 US Preventive Services Task Force (USPSTF) recommendation on prevention of dental caries in preschool-aged children.
      METHODS: The USPSTF reviewed the evidence on prevention of dental caries by primary care clinicians in children 5 years and younger, focusing on screening for caries, assessment of risk for future caries, and the effectiveness of various interventions that have possible benefits in preventing caries.
      POPULATION: This recommendation applies to children age 5 years and younger.
      RECOMMENDATION: The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose water supply is deficient in fluoride. (B recommendation) The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. (B recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening examinations for dental caries performed by primary care clinicians in children from birth to age 5 years. (I Statement)

Preventing Dental Caries in Children under 5 Years: Systematic Review Updating USPSTF Recommendation.

Pediatrics. 2013 Aug;132(2):332-50. doi: 10.1542/peds.2013-1469. Epub 2013 Jul15.Chou R, Cantor A, Zakher B, Mitchell JP, Pappas M.

BACKGROUND AND OBJECTIVE: Screening and preventive interventions by primary care 
providers could improve outcomes related to early childhood caries. The objective
of this study was to update the 2004 US Preventive Services Task Force systematic
review on prevention of caries in children younger than 5 years of age.
METHODS: Searching Medline and the Cochrane Library (through March 2013) and
reference lists, we included trials and controlled observational studies on the
effectiveness and harms of screening and treatments. One author extracted study
characteristics and results, which were checked for accuracy by a second author. 
Two authors independently assessed study quality.
RESULTS: No study evaluated effects of screening by primary care providers on
clinical outcomes. One good-quality cohort study found pediatrician examination
associated with a sensitivity of 0.76 for identifying a child with cavities. No
new trials evaluated oral fluoride supplementation. Three new randomized trials
were consistent with previous studies in finding fluoride varnish more effective 
than no varnish (reduction in caries increment 18% to 59%). Three trials of
xylitol were inconclusive regarding effects on caries. New observational studies 
were consistent with previous evidence showing an association between early
childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk
prediction instruments in primary care settings is not available.
CONCLUSIONS: There is no direct evidence that screening by primary care

clinicians reduces early childhood caries. Evidence previously reviewed by the US
Preventive Services Task Force found oral fluoride supplementation effective at
reducing caries incidence, and new evidence supports the effectiveness of
fluoride varnish in higher-risk children.