Fluoride Use in Caries Prevention in the Primary Care Setting

http://pediatrics.aappublications.org/content/early/2014/08/19/peds.2014-1699.full.pdf

Fluoride Use in Caries Prevention in the Primary Care Setting. Melinda B. Clark, Rebecca L. Slayton and SECTION ON ORAL HEALTH. Pediatrics; originally published online August 25, 2014; DOI: 10.1542/peds.2014-1699

[Comentario en una revista de noticias médicas online]
Pediatricians should prescribe fluoride as soon as their patients' teeth emerge, the American Academy of Pediatrics (AAP) says in new guidelines.
Pediatricians should prescribe fluoride as soon as their patients' teeth emerge, the American Academy of Pediatrics (AAP) says in new guidelines.
Published online August 25 in Pediatrics, the clinical report lays out specific recommendations for children at each stage of development.
Although the AAP endorsed the guidelines on fluoride use from the Centers for Disease Control and Prevention in 2001, it is only now incorporating them into its own publications.
Fluoride has both risks and benefits for children, and pediatricians must be aware of these to promote their patients' oral health, write report authors Melinda B. Clark, MD, and Rebecca L. Slayton, DDS, PhD.
Although largely preventable, dental caries remains the most common chronic childhood disease in the United States. Research long ago established the effectiveness of fluoride in stopping the progression of the disease.
Fluoride use does carry some risks. The best established risks are fluorosis, subsurface hypomineralization, and porosity between developing enamel rods. Fluorosis has been increasing the last 2 decades, as sources of fluoride have become more prevalent, and it now affects about 41% of US adolescents, the authors report.
In mild cases, fluorosis takes the form of clinically insignificant striations and opaque areas. Moderate to severe cases, which are rare in the United States, can cause pitting, brittle incisor edges, and weakened grove anatomy in permanent 6-year molars. However, the risk for fluorosis development largely passes by age 8 years.
Fluoride also can also be toxic when consumed in very large quantities. The authors estimate the toxic dose of elemental fluoride at 5 to 10 mg/kg body weight. For this reason, they recommend limiting the quantity prescribed at 1 time to no more than a 4-month supply and providing supervision for fluoride use by small children.

Dental interventions to prevent caries in children. A national clinical guideline

http://www.sign.ac.uk/pdf/SIGN138.pdf

Scottish Intercollegiate Guidelines Network (SIGN). Dental interventions to prevent caries in children. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2014 Mar. 45 p. Acceso a texto completo Major Recommendations Note from the Scottish Intercollegiate Guidelines Network (SIGN) and National Guideline Clearinghouse (NGC): In addition to these evidence-based recommendations, the guideline development group also identifies points of best clinical practice in the full-text guideline document. The grades of recommendations (A-D) and levels of evidence (1++, 1+, 1-, 2++, 2+, 2-, 3, 4) are defined at the end of the "Major Recommendations" field. Predicting Caries Risk Carries Risk Assessment C - The following factors should be considered when assessing caries risk: Clinical evidence of previous disease Dietary habits, especially frequency of sugary food and drink consumption Social history, especially socioeconomic status Use of fluoride Plaque control Saliva Medical history D - Specialist child healthcare professionals should consider carrying out a caries risk assessment of children in their first year as part of the child's overall health assessment. D - Children whose families live in a deprived area should be considered as at increased risk of early childhood caries when developing preventive programmes. Delivery of Dental Brief Interventions in the Practice Setting Effectiveness of Dental Brief Interventions B - Oral health promotion interventions should facilitate daily toothbrushing with fluoride toothpaste. Format of Dental Brief Interventions B - Oral health promotion interventions should be based on recognised health behaviour theory and models such as motivational interviewing. Social Determinants of Oral Health C - As part of the patient assessment, a social history should be taken which will contribute to dental brief interventions being specific to individuals and tailored to their particular needs and circumstances. Toothbrushing with Fluoride Toothpaste Concentration of Fluoride Toothpaste A - Following risk assessment, children and young people up to the age of 18 years who are at standard risk of developing dental caries should be advised to use toothpastes in the range 1,000 to 1,500 parts per million fluoride (ppmF). A - Following risk assessment, children aged from 10 to 16 years who are at increased risk of developing dental caries should be advised to use toothpastes at a concentration of 2,800 ppmF. Frequency and Duration of Brushing Frequency of Toothbrushing A - Toothbrushing with fluoride toothpaste should take place at least twice daily. Supervised Toothbrushing A - Supervision of toothbrushing with fluoride toothpaste is recommended as an effective caries prevention measure. Toothbrushing Practice A - Children should be encouraged to spit out excess toothpaste and not rinse with water after brushing. Topical Anticaries Interventions Topical Fluoride Varnish A - Fluoride varnish should be applied at least twice yearly in all children. Sealants Use of Sealants A - Resin-based fissure sealants should be applied to the permanent molars of all children as early after eruption as possible.

Informe SESPAS

Promoción de la salud y prevención en tiempos de crisis: el rol del sector sanitario. Informe SESPAS 2014

Este artículo revisa la evolución de los estilos de vida e identifica algunas prioridades y líneas de mejora en prevención y promoción de la salud en el momento actual de crisis económica. Se utilizan diversas fuentes, incluida una encuesta a 30 expertos/as en salud pública y atención primaria. Entre 2006 y 2012 no se detectan grandes cambios en estilos de vida, salvo un descenso en el consumo habitual de alcohol. Desciende ligeramente el consumo de drogas ilegales, pero aumenta el de psicofármacos. La mayoría de los/las expertos/as considera que debe mejorarse la toma de decisiones sobre cribados poblacionales y vacunas, incluyendo el análisis del coste de oportunidad, y mayor transparencia e independencia de los/las profesionales implicados/as. La prevención está contribuyendo a la medicalización de la vida, pero hay opiniones divididas sobre la necesidad de algunas actividades preventivas. Las prioridades en prevención están en el ámbito de la salud mental y de la infección por el virus de la inmunodeficiencia humana en grupos vulnerables. La mayoría de los/las expertos/as considera que las intervenciones de promoción de la salud tienen potencial para mitigar los efectos de la crisis, y que son grupos prioritarios la infancia, las personas desempleadas y otros grupos vulnerables. Son intervenciones prioritarias las actividades comunitarias en colaboración con ayuntamientos y otros sectores, la abogacía y la promoción de la salud mental. Se considera deseable un mayor uso de la legislación y de los medios de comunicación como herramientas de promoción. Es importante clarificar el rol del sector sanitario en las actividades intersectoriales, y reconocer las limitaciones, puesto que los determinantes sociales de salud dependen de otros sectores. Se advierte asimismo del riesgo derivado de los recortes y de las políticas que inciden negativamente en las condiciones de vida.

European report on preventing child maltreatment 2013

Child maltreatment is a leading cause of health inequality, with the socioeconomically disadvantaged more at risk, perpetuating social injustice. Though it is a priority in most countries of the WHO European Region, few devote adequate resources and attention to its prevention.

This report outlines the high burden of child maltreatment, its causes and consequences and the cost−effectiveness of prevention programmes. It makes compelling arguments for increased investment in prevention and, by offering policy-makers a preventive approach based on strong evidence and shared experience, it will help them respond to increased demands from the public to tackle child maltreatment.

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Primary care interventions to prevent tobacco use in children and adolescents: U.S. Preventive Services Task Force recommendation statement.


The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. (B recommendation)

Description: Update of the 2003 U.S. Preventive Services Task Force (USPSTF) recommendation on primary care interventions to prevent tobacco use in children and adolescents.

Methods: The USPSTF reviewed the evidence on the effectiveness of primary care interventions on the rates of initiation or cessation of tobacco use in children and adolescents and on health outcomes, such as respiratory health, dental and oral health, and adult smoking. The USPSTF also reviewed the evidence on the potential harms of these interventions.

Population: This recommendation applies to school-aged children and adolescents. The USPSTF has issued a separate recommendation statement on tobacco use counseling in adults and pregnant women.

Recommendation: The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents.

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The U.S. Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without related signs or symptoms.

It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.

The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms.

Validity and reliability of a structured interview for early detection and risk assessment of parenting and developmental problems in young children: a cross-sectional study.

van Stel HF, Staal II, Hermanns JM, Schrijvers AJ.

BMC Pediatr. 2012 Jun 14;12:71. doi: 10.1186/1471-2431-12-71.

Abstract

BACKGROUND:

Preventive child health care is well suited for the early detection of parenting and developmental problems. However, as far as the younger age group is concerned, there are no validated early detection instruments which cover both the child and its environment. Therefore, we have developed a broad-scope structured interview which assesses parents' concerns and their need for support, using both the parental perspective and the experience of the child health care nurse: the Structured Problem Analysis of Raising Kids (SPARK). This study reports the psychometric characteristics of the SPARK.

METHOD:

A cross-sectional study of 2012 18-month-old children, living in Zeeland, a province of the Netherlands. Inter-rater reliability was assessed in 67 children. Convergent validity was assessed by comparing SPARK-domains with domains in self-report questionnaires on child development and parenting stress. Discriminative validity was assessed by comparing different outcomes of the SPARK between groups with different levels of socio-economic status and by performing an extreme-groups comparison. The user experience of both parents and nurses was assessed with the aid of an online survey.

RESULTS:

The response rate was 92.1% for the SPARK. Self-report questionnaires were returned in the case of 66.9% of the remaining 1721 children. There was selective non-reporting: 33.1% of the questionnaires were not returned, covering 65.2% of the children with a high-risk label according to the SPARK (p < 0.001). Inter-rater reliability was good to excellent with intraclass correlations between 0.85 and 1.0 for physical topics; between 0.61 and 0.8 for social-emotional topics and 0.92 for the overall risk assessment. Convergent validity was unexpectedly low (all correlations ≤0.3) although the pattern was as expected. Discriminative validity was good. Users were satisfied with the SPARK and identified some topics for improvement.

CONCLUSION:

The SPARK discriminates between children with a high, increased and low risk of parenting and developmental problems. It does so in a reliable way, but more research is needed on aspects of validity and in other populations.

PMID:

 

22697218

 

[PubMed - indexed for MEDLINE] 

PMCID:

 

PMC3465192

 

Free PMC Article

USPSTF Perspective on Evidence-Based Preventive Recommendations for Children

Published online July 2, 2012 Pediatrics Vol. 130 No. 2 August 1, 2012
pp. e399 -e407
(doi: 10.1542/peds.2011-2087)

The development and use of evidence-based recommendations for preventive care by primary care providers caring for children is an ongoing challenge.
This issue is further complicated by the fact that a higher proportion of recommendations by the US Preventive Services Task Force (USPSTF) for pediatric preventive services in comparison with adult services have insufficient evidence to recommend for or against the service. One important root cause for this problem is the relative lack of high quality screening and counseling studies in pediatric primary care settings. The paucity of studies limits the development of additional evidence-based guidelines to enhance best practices for pediatric and adolescent conditions. In this article, we describe the following: (1) evidence-based primary care preventive services as a strategy for addressing important pediatric morbidities, (2) the process of making evidence-based screening recommendations by the USPSTF, (3) the current library of USPSTF recommendations for children and adolescents, and (4) factors influencing the use of USPSTF recommendations and other evidence-based guidelines by clinicians. Strategies to accelerate the implementation of evidence-based services and areas of need for future research to fill key gaps in evidence-based recommendations and guidelines are highlighted.