USPSTF: Evidence is insufficient to support oral health screening in primary care

Key takeaways:

• The USPSTF said there is not enough evidence to assess the benefit-harm balance of oral health screening and preventive interventions.
• The task force is urgently calling for more research on the subject.

There is not yet enough evidence to adequately assess the benefit-harm balance of oral health screening and preventive interventions for adults and children aged 5 years and older, according to the U.S. Preventive Services Task Force.

The I draft recommendation statement marks the first time the task force has issued recommendations on these topics. John Ruiz, PhD, a task force member, professor of clinical psychology and director of diversity, equity and inclusion at the University of Arizona, told Healio that the task force “urgently calls for more research to be done in order to inform their ability to make” a determination either for or against this kind of screening in primary care settings.

“The task force's evaluations are contingent upon there being evidence to evaluate and, in this case, there was a lack of evidence to make a specific determination,” Ruiz said. “We hope that ... it does become a more urgent call to provide us with that research in order for us to move forward in a more clear way.”

The task force based its recommendation for adults on a review of 16 studies, and its recommendation for children on 23 studies. Some risk factors for developing oral health problems, according to the task force, include lack of flossing and brushing teeth, high sugar diets, tobacco use, developmental defects in teeth and low fluoride exposure.

However, social factors can also affect the risk for oral health conditions. For example, not having dental insurance, low socioeconomic status and living in communities with a shortage of dental professionals can limit access to dental care.

There are also notable racial and ethnic disparities at play due to social drivers of health, according to the task force. Native American/Alaska Native, Asian, Native Hawaiian/Pacific Islander, Black and Hispanic/Latino people are affected by oral health conditions disproportionately.

“It is important for future research to include populations that are most affected by oral health conditions,” Li Li, MD, PhD, MPH, a task force member, said in a press release. “Given the limited evidence, we encourage health care professionals to use their judgment when deciding whether to screen or perform preventive interventions related to oral health for their patients.”

Without treatment, oral health conditions can lead to health problems like irreversible tooth damage, tooth loss and more.

Along with the call for research on screening, the USPSTF called for more research on social factors that contribute to disparities in oral health and addressing oral health in primary care, especially for those who are at a disproportionate risk for oral health conditions.

“Primary care physicians and persons working in those settings can look at this recommendation as, really, a way to say that they should continue to practice as they see fit,” Ruiz said.

In many ways, the draft recommendation does not change the standard of practice, he added.

“They should continue to urge their patients to ... practice good oral health hygiene,” Ruiz said. “However, if somebody is reporting symptoms, they may provide care based on their own best judgment or refer out for additional care.”

The task force’s draft recommendation statements and draft evidence reviews are available for public comments, which can be submitted here until June 20.

References:

• Oral health in adults: screening and preventive interventions draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/oral-health-adults-screening-preventive-interventions. Published May 23, 2023. Accessed May 23, 2023.
• Oral health in adults: screening and preventive interventions draft evidence review. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/oral-health-adults-screening-preventive-interventions. Published May 23, 2023. Accessed May 23, 2023.
• Oral health in children and adolescents ages 5 to 17 years: screening and preventive interventions draft recommendation statement. https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/oral-health-children-adolescents-screening-preventive-interventions. Published May 23, 2023. Accessed May 23, 2023.
• Oral health in children and adolescents ages 5 to 17 years: screening and preventive interventions draft evidence review. https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review23994/oral-health-children-adolescents-screening-preventive-interventions. Published May 23, 2023. Accessed May 23, 2023.
• U.S. Preventive Services Task Force issues draft recommendations on oral health in primary care. https://www.uspreventiveservicestaskforce.org/uspstf/sites/default/files/file/supporting_documents/oral-health-screening-interventions-draft-rec-bulletin.pdf. Published May 23, 2023. Accessed May 23, 2023.