By JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA
December 20, 2023
The US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of preventive services to improve the health of the public. The recommendations that are made are based on scientific evidence, typically systematic reviews, that focus on the benefits and harms of specific services or procedures. The USPSTF acknowledges that clinical decisions are based on other factors in addition to evidence as patient situations may involve multiple considerations.
In terms of screening and prevention interventions for oral health in adults, the USPSTF evaluated clinical health outcomes focused on the presence and severity of dental caries, presence and severity of periodontal disease, tooth loss, morbidity, quality of life, functional status, and harms of screening and treatment related to these conditions. The patient population under consideration was represented by asymptomatic adults aged 18 years or older.
The review involved clinical assessments and standardized risk prediction tools used by primary care providers to identify adults who have existing oral health conditions or might benefit from interventions to prevent disease due to increased risk. Interventions reviewed included counseling, health education, decreasing the frequency of sugar intake, use of fluoride, sealants, silver diamine fluoride, and xylitol.
The USPSTF found insufficient evidence to recommend for or against screening or preventive interventions for oral health conditions in the primary care setting for adults. The Task Force suggests primary care clinicians use their clinical expertise to decide whether to perform these services. Further, in deciding to perform screening or interventions, primary care providers should consider the potential preventable burden, potential harms, and current practice. Of note, the USPSTF indicated that screening and standardized risk assessments are noninvasive and seem unlikely to cause serious harm, but evidence is lacking. Health education and counseling are also noninvasive.
Given that there is limited evidence to support recommendations for screening and preventive interventions for oral health in adults by primary care providers, the USPSTF is calling for additional research to fill critical evidence gaps to make actionable preventive service recommendations. For each evidence gap, the Task Force notes that research must focus on screening and interventions that can be performed in nondental primary care settings. As well, this research must be inclusive of populations with a high prevalence of oral health conditions including Asian, Black, Hispanic/Latino, Native American/Alaska Native and Hawaiian Native/Pacific Islander persons with social determinants that contribute to disparities in oral health.
In a companion paper, the USPSTF made similar recommendations related to screening and preventive interventions for oral health in children and adolescents aged 5 to 17 years reporting that the current evidence is insufficient to assess the balance of benefits and harms of routine screening and preventive interventions performed by primary care providers in asymptomatic children and adolescents aged 5 to 17 years. Oral health conditions included dental caries which remains one of the most common chronic conditions of childhood negatively affecting eating, speaking, learning, and quality of life. Inequities in the affordability and accessibility of oral health care and disadvantages related to social determinants of health are significant.
The Task Force identified that further research is needed to assess the effectiveness and harms of oral health screening strategies and preventive interventions in primary care settings for this population. Preventive interventions should include fluoride gel and varnish, sealants, silver diamine fluoride, and xylitol. Oral health education and behavioral counseling interventions performed by primary care clinicians in relation to oral health outcomes should be evaluated.
Access the full paper pertaining to adults here.
Access the full paper related to children and adolescents here.
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This article summarizes the research white papers “Screening and Preventive Interventions for Oral Health in Adults” and “Screening and Preventive Interventions for Oral Health in Children and Adolescents Aged 5 to 17 Years” as published online by the US Preventive Services Task Force, September 2023. (https://jamanetwork.com/journals/jama/fullarticle/2811427 and https://jamanetwork.com/journals/jama/fullarticle/2811706)
JoAnn Gurenlian, RDH, MS, PhD, AAFAAOM, FADHA, is the ADHA Director of Education, Research and Advocacy, professor emerita in the Department of Dental Hygiene at ISU, and former president of the American Dental Hygienists’ Association 1990-1991.
