USPSTF: Importance of Preventing Dental Caries in Young Children Interview with:

Michael Cabana, M.D., M.A., M.P.H  professor of pediatrics at the Albert Einstein College of Medicine. He is also physician-in-chief at the Children's Hospital at Montefiore and the chair of the Department of Pediatrics at the Albert Einstein College of Medicine  U.S. Preventive Services Task Force

Dr. Cabana

Michael Cabana, M.D., M.A., M.P.H
Professor of Pediatrics
Albert Einstein College of Medicine.
Physician-in-chief , Children’s Hospital at Montefiore
Chair of the Department of Pediatrics
Albert Einstein College of Medicine
Member, U.S. Preventive Services Task Force What is the background for this study and recommendation statement? 

Response: Dental caries, also known as cavities or tooth decay, is the most common chronic disease in children in the United States and can develop in any child whose teeth have come in. Many young children under five years old do not visit a dentist, so the Task Force reviewed the latest evidence on how primary care clinicians can help prevent tooth decay in young children.

The Task Force’s research led to two important findings: all young children whose teeth have come in should have fluoride varnish applied by their clinician, and all children six months and older whose water supply doesn’t contain enough fluoride should receive fluoride supplements. Both approaches can help prevent cavities in kids.

The Task Force also determined that there is not enough evidence to recommend for or against screening for tooth decay in the primary care setting for children under five. This is consistent with the Task Force’s 2014 recommendation on dental caries. Is it appropriate for non-dental professionals to apply fluoride treatments to infant teeth?

Response: This recommendation is not meant to replace the important work of dentists. We know many children under five years old do not see dentists but do regularly see their primary care clinicians to receive vaccines, for regular checkups, and when they are sick. Applying topical fluoride varnish and prescribing oral fluoride supplementation when appropriate are both preventive services that primary care clinicians can easily provide in their offices. This recommendation gives primary care clinicians the opportunity to play a role in helping reduce and prevent tooth decay for those who may not otherwise receive this important care. What should readers take away from your report?

Response: Readers should understand that tooth decay is common, particularly in children ages two to five years old. If left untreated, decay and cavities can lead to pain and loss of the affected teeth, while also negatively affecting children’s speech, appearance and growth. This recommendation can help prevent those negative consequences in kids. The evidence clearly shows that applying fluoride varnish and fluoride supplementation in children younger than five years old is both safe and effective. What recommendations do you have for future research as a result of this work?

Response: The Task Force is calling for more research in several important areas. First, more research is needed to understand the benefits and harms of regular screening for cavities by primary care clinicians. There is not enough evidence on the accuracy of certain risk-assessment tools that clinicians might use in this screening.

The Task Force is also asking for further research on the effectiveness of clinicians’ efforts to educate parents and caregivers on the best practices to keep children’s teeth healthy at home. Trials with more racial and ethnic representation – such as appropriately including Hispanic/Latino and Black children – would help the Task Force to better understand the benefits and harms of oral interventions in these specific groups. Is there anything else you would like to add?

Response: Any child whose teeth have come in is at risk for tooth decay, but Hispanic/Latino and Black children and children in low-income households are at higher risk than other children. Tooth decay is also more likely to go untreated in these communities due to a lack of access to dental care. Primary care visits can play an important role in improving oral health in these communities. Other factors that put children at higher risk for tooth decay include frequent sugar consumption, low fluoride levels in water, previous tooth decay, poor oral hygiene, and developmental defects of tooth enamel.


US Preventive Services Task Force, Davidson KW, Barry MJ, Mangione CM, Cabana M, Caughey AB, Davis EM, Donahue KE, Doubeni CA, Kubik M, Li L, Ogedegbe G, Pbert L, Silverstein M, Stevermer J, Tseng CW, Wong JB. Screening and Interventions to Prevent Dental Caries in Children Younger Than 5 Years: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Dec 7;326(21):2172-2178. doi: 10.1001/jama.2021.20007. PMID: 34874412. 

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Dec 10, 2021 @ 6:10 pm 

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