Q&A: Oral health screening in children
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Key takeaways:
- There is a lack of evidence to recommend for or against oral health screening in primary care.
- There is also a lack of evidence to recommend for or against preventive oral health interventions.
Earlier this year, the U.S. Preventive Services Task Force said there is a lack of evidence to adequately assess the benefit-harm balance of primary care clinicians performing oral health screenings or preventive oral health interventions.
This conclusion was reinforced recently in a statement by the USPSTF that was published in JAMA.
We spoke with John M. Ruiz, PhD, professor of clinical psychology at the University of Arizona and member of the USPSTF, about the statement and what more is needed to make a recommendation.
Healio: Besides cavities and tooth decay, what other oral health issues would primary care physicians potentially screen children for?
Ruiz: There were two recommendation statements that came out, one for children and adolescents aged 5 to 17 years and the second for adults. The recommendation statements are about oral health screening and interventions in a primary care setting. When making the recommendation for children aged 5 years and older, the USPSTF focused on cavities. Unfortunately, there is limited evidence on preventive services in the primary care setting for both populations.
Healio: You found there was insufficient evidence to assess whether the benefits of routine screening would outweigh the risks. What kind of evidence is missing?
Ruiz: An “I statement” indicates that evidence is insufficient to make a recommendation for or against a preventive service, and is a call for more research. What we really need in order to make an evaluation is evidence that speaks to the accuracy of the screening technique — and specifically, the accuracy of that screening technique in the context of a primary care setting. There’s a lot of evidence that’s out there about how to conduct oral health assessments, but doing it specifically in a primary care setting is where the evidence was lacking. We’re also calling for researchers to focus future efforts on people who are more likely to experience oral health conditions and on social factors that contribute to disparities in oral health.
Healio: Were there some studies that demonstrated it had benefits?
Ruiz: There was a little bit of evidence, but the evidence wasn’t enough to really make a determination for or against screening. In other words, the available evidence is not enough to where you can reliably say that either screening or preventive interventions are recommended services.
Now, there are a couple of things that are important to note about what we are looking for, such as asking if there are outcome benefits to getting screened and identifying potential things like cavities. You also want to make sure that there are no potential harms. Even though the screening is noninvasive and unlikely to cause harm, that doesn’t mean that people would necessarily benefit from screening. Fundamentally, we weren’t able to appropriately evaluate the relative benefits and harms due to the lack of evidence, so that led to the I statements.
There are also two other things to think about. First of all, this recommendation is specifically for people without symptoms. If a person has symptoms or sees something of concern, they should immediately go to their physician or their dental care specialist and have that looked at. If a physician has a patient who comes in and is symptomatic, they should, of course, either address that issue or make an appropriate referral. But for people who are without symptoms, the physician should continue to use their best judgment on whether or not they should offer screening or preventive interventions related to oral health conditions. There are some populations — including individuals who are Hispanic, Latino, Black or American Indian — who have higher rates of oral health challenges, and physicians should keep that in mind during their regular examinations.
References:
Barry MJ, et al. JAMA. 2023;doi:10.1001/jama.2023.21408.
Nicholson W, et al. JAMA. 2023;doi:10.1001/jama.2023.20879.
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