Physicians' roles in preventing dental caries in preschool children: a summary of the evidence for the U.S. Preventive Services Task Force.
BACKGROUND
Almost 20% of children aged 2 to 5 years have untreated dental caries. Physician interventions to prevent and manage dental caries in preschool children could help address this common problem.


OBJECTIVE
To review the evidence for effectiveness of five possible physician interventions- (1) screening and risk assessment, (2) referral, (3) provision of dietary supplemental fluoride, (4) application of fluoride varnish, and (5) counseling-for the prevention of dental caries for the U.S. Preventive Services Task Force.


METHODS
Articles from 1966 to 2001 addressing the effectiveness of primary care clinicians' interventions to prevent or manage dental caries were identified in MEDLINE. The evidence for effectiveness of supplemental fluorides, fluoride varnish, and counseling for caries prevention performed by dental personnel was also examined through existing and new systematic reviews.


RESULTS
For most key questions related to the five interventions, the evidence for primary care clinician effectiveness was rated as poor owing to the scarcity of studies. Ten surveys of physicians' knowledge and behavior about fluoride supplementation provided fair evidence, suggesting that supplementation decisions were often made without consideration of other fluoride exposures. Reviews of the dental literature identified fair evidence supporting the effectiveness of both fluoride supplements and varnish, although information describing effectiveness and adverse outcomes of supplementation with the most recent dosage schedule is not available.


CONCLUSIONS
Evidence for the effectiveness of traditionally recommended primary care clinician interventions (screening, referral, counseling) to prevent dental caries in preschool children is lacking. There is fair evidence for the effectiveness of two fluoride-based interventions (fluoride supplementation and varnish) applicable in primary care practice. However, there is also fair evidence indicating that physicians' consideration of fluoride exposure is incomplete, thus increasing the risk for fluorosis among those prescribed supplements.
Bader
James D
JD
Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA. jim_bader@unc.edu
Rozier
R Gary
RG
Lohr
Kathleen N
KN
Frame
Paul S
PS
D002675:Child, Preschool; D003376:Counseling; D003731:Dental Caries / Q000517:prevention & control*; D005459:Fluorides / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D008403:Mass Screening; D010819:Physician's Role; D011322:Primary Prevention; D012017:Referral and Consultation; D018570:Risk Assessment; D014481:United States
D005459:Fluorides