Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Chou, Roger; Bougatsos, Christina; Griffin, Jessica; Selph, Shelley S.; Ahmed, Azrah; Fu, Rongwei; Nix, Chad; Schwarz, Eli

doi:10.1001/jama.2023.20435

Cited by 4 publications

(1 citation statement)

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“…The disparate burden of dental caries among young children has prompted recommendations for primary care clinicians to provide preventive oral care for children 5 years and younger, including referral to a dentist . A 2023 systematic review by the US Preventive Services Task Force concluded that there is insufficient evidence for oral health (OH) screening, counseling, referrals, and preventive interventions performed by primary care clinicians in reducing dental caries. The few retrospective cohort studies that have examined the effectiveness of nondental clinicians delivering preventive OH services to young children enrolled in Medicaid have also been inconclusive …”

Section: Introductionmentioning

confidence: 99%

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Nelson,

Albert,

Selvaraj

et al. 2024

JAMA Netw Open

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ImportanceUntreated tooth decay is disproportionately present among low-income young children. While American Academy of Pediatrics (AAP) guidelines require pediatric clinicians to implement oral health care, the effectiveness of these oral health interventions has been inconclusive.ObjectiveTo test the effectiveness of multilevel interventions in increasing dental attendance and reducing untreated decay among young children attending well-child visits (WCVs).Design, Setting, and ParticipantsThe Pediatric Providers Against Cavities in Children’s Teeth study is a cluster randomized clinical trial that was conducted at 18 pediatric primary care practices in northeast Ohio. The trial data were collected between November 2017 and July 2022, with data analyses conducted from August 2022 to March 2023. Eligible participants included Medicaid-enrolled preschoolers aged 3 to 6 years attending WCVs at participating practices who were enrolled at baseline (WCV 1) and followed-up for 2 consecutive examinations (WCV 2 and WCV 3).InterventionsClinicians in the intervention group received both the practice-level (electronic medical record changes to document oral health) and clinician-level (common-sense model of self-regulation theory–based oral health education and skills training) interventions. Control group clinicians received AAP-based standard oral health education alone.Main Outcomes and MeasuresDental attendance was determined through clinical dental examinations conducted by hygienists utilizing International Caries Detection and Assessment System criteria and also from Medicaid claims data. Untreated decay was determined through clinical examinations. A generalized estimating equations (GEE) approach was used for both clinical examinations and Medicaid claims data.ResultsEighteen practices were randomized to either intervention or control. Participants included 63 clinicians (mean [SD] age, 47.0 [11.3] years; 48 female [76.2%] and 15 male [23.8%]; 28 in the intervention group [44.4%]; 35 in the control group [55.6%]) and 1023 parent-child dyads (mean [SD] child age, 56.1 [14.0] months; 555 male children [54.4%] and 466 female children [45.6%]; 517 in the intervention group [50.5%]; 506 in the control group [49.5%]). Dental attendance from clinical examinations was significantly higher in the intervention group (170 children [52.0%]) vs control group (150 children [43.1%]) with a difference of 8.9% (95% CI, 1.4% to 16.4%; P = .02). The GEE model using clinical examinations showed a significant increase in dental attendance in the intervention group vs control group (adjusted odds ratio, 1.34; 95% CI, 1.07 to 1.69). From Medicaid claims, the control group had significantly higher dental attendance than the intervention group at 2 years (332 children [79.6%] vs 330 children [73.7%]; P = .04) but not at 3 years. A clinically but not statistically significant reduction in mean number of untreated decay was found in the intervention group compared with controls (B = −0.27; 95% CI, −0.56 to 0.02).Conclusions and RelevanceIn this cluster randomized clinical trial, children in the intervention group had better dental outcomes as was evidenced by increased dental attendance and lower untreated decay. These findings suggest that intervention group clinicians comprehensively integrated oral health services into WCVs.Trial RegistrationClinicalTrials.gov Identifier: NCT03385629

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Section: Introductionmentioning

confidence: 99%

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Nelson,

Albert,

Selvaraj

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Barry,

Nicholson,

Silverstein

et al. 2023

JAMA

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ImportanceOral health is fundamental to health and well-being across the lifespan. Oral health conditions affect the daily lives of school-age children and adolescents, leading to loss of more than 51 million school hours every year. Untreated oral health conditions in children can lead to serious infections and affect growth, development, and quality of life.ObjectiveThe US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in children and adolescents aged 5 to 17 years.PopulationAsymptomatic children and adolescents aged 5 to 17 years.Evidence AssessmentThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries) performed by primary care clinicians in asymptomatic children and adolescents aged 5 to 17 years.RecommendationsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries, in children and adolescents aged 5 to 17 years. (I statement)

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Screening and Preventive Interventions for Oral Health in Adults

Barry,

Nicholson,

Silverstein

et al. 2023

JAMA

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ImportanceOral health is fundamental to health and well-being across the life span. Dental caries (cavities) and periodontal disease (gum disease) are common and often untreated oral health conditions that affect eating, speaking, learning, smiling, and employment potential. Untreated oral health conditions can lead to tooth loss, irreversible tooth damage, and other serious adverse health outcomes.ObjectiveThe US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate screening and preventive interventions for oral health conditions in adults.PopulationAsymptomatic adults 18 years or older.Evidence AssessmentThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions for oral health conditions (eg, dental caries or periodontal disease) performed by primary care clinicians in asymptomatic adults.RecommendationsThe USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of preventive interventions performed by primary care clinicians for oral health conditions, including dental caries or periodontal-related disease, in adults. (I statement)

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Screening, Referral, Behavioral Counseling, and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Cited by 4 publications

References 93 publications

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Multilevel Interventions and Dental Attendance in Pediatric Primary Care

Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years

Screening and Preventive Interventions for Oral Health in Adults

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