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Dental Caries in Children from Birth Through Age 5 Years, Screening and Interventions, 2014

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Recommendations: Prevention of Dental Caries in Children From Birth Through Age 5 Years

  • Dental Caries: Oral Fluoride Supplementation -- Children Age 6 Months to 5 Years
    Grade: B
    Specific Recommendations:

    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. 

    Frequency of Service:

    No studies specifically addressed the dosage and timing of oral fluoride supplementation in children with inadequate water fluoridation. The American Dental Association (ADA) recommendations on the dosage of and age at which to start dietary fluoride supplementation take into account the amount of fluoride in the child's water source. These dosing recommendations are also referenced by the American Academy of Pediatrics (AAP).

    Risk Factor Information:

    All children are at potential risk for dental caries; those whose primary water supply is deficient in fluoride (defined as containing <0.6 ppm F) are at particular risk. While there are no validated multivariate screening tools to determine which children are at higher risk for dental caries, there are a number of individual factors that elevate risk. Higher prevalence and severity of dental caries are found among minority and economically disadvantaged children. Other risk factors for caries in children include frequent sugar exposure, inappropriate bottle feeding, developmental defects of the tooth enamel, dry mouth, and a history of previous caries. Maternal and family factors can also increase children's risk. These factors include poor oral hygiene, low socioeconomic status, recent maternal caries, sibling caries, and frequent snacking. Additional factors associated with dental caries in young children include lack of access to dental care; inadequate preventive measures, such as failure to use fluoride-containing toothpastes; and lack of parental knowledge about oral health.

  • Dental Caries: Fluoride Varnish -- Infants and Children
    Grade: B
    Specific Recommendations:

    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.

    Frequency of Service:

    No study directly assessed the appropriate ages at which to start and stop the application of fluoride varnish. Available trials of fluoride varnish enrolled children ages 3 to 5 years; however, given the mechanism of action of this intervention, benefits are very likely to accrue starting at the time of primary tooth eruption. Limited evidence found no clear effect on caries increment between performing a single fluoride varnish once every 6 months versus once a year or between a single application every 6 months versus multiple applications once a year or every 6 months.

    Risk Factor Information:

    Some organizations have advocated restricting fluoride varnish use to children at “increased risk.” Although several caries risk assessment tools exist, none have been validated in the primary care setting, nor do existing studies demonstrate that these tools, when used by primary care clinicians, can accurately and consistently differentiate between children who will develop dental caries and those who will not. A risk-based approach to fluoride varnish application will miss opportunities to provide an effective dental caries preventive intervention to children who could benefit from it, particularly because currently, in the United States, infants and preschool-aged children are more likely to have regular visits with nondental primary care clinicians than dental care providers.

  • Dental Caries: Screening -- Children From Birth to Age 5 Years
    Grade: I
    Specific Recommendations:

    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.

    Frequency of Service:

    No Frequency of Service information currently available.

    Risk Factor Information:

    All children are at potential risk for dental caries; those whose primary water supply is deficient in fluoride (defined as containing <0.6 ppm F) are at particular risk. While there are no validated multivariate screening tools to determine which children are at higher risk for dental caries, there are a number of individual factors that elevate risk. Higher prevalence and severity of dental caries are found among minority and economically disadvantaged children. Other risk factors for caries in children include frequent sugar exposure, inappropriate bottle feeding, developmental defects of the tooth enamel, dry mouth, and a history of previous caries. Maternal and family factors can also increase children's risk. These factors include poor oral hygiene, low socioeconomic status, recent maternal caries, sibling caries, and frequent snacking. Additional factors associated with dental caries in young children include lack of access to dental care; inadequate preventive measures, such as failure to use fluoride-containing toothpastes; and lack of parental knowledge about oral health.

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