title: Preventing dental caries in children <5 years: systematic review updating USPSTF recommendation.
abstract: OBJECTIVE
  Screening and preventive interventions by primary care providers could improve outcomes related to early childhood caries. The objective of this study was to update the 2004 US Preventive Services Task Force systematic review on prevention of caries in children younger than 5 years of age.
  
  
  METHODS
  Searching Medline and the Cochrane Library (through March 2013) and reference lists, we included trials and controlled observational studies on the effectiveness and harms of screening and treatments. One author extracted study characteristics and results, which were checked for accuracy by a second author. Two authors independently assessed study quality.
  
  
  RESULTS
  No study evaluated effects of screening by primary care providers on clinical outcomes. One good-quality cohort study found pediatrician examination associated with a sensitivity of 0.76 for identifying a child with cavities. No new trials evaluated oral fluoride supplementation. Three new randomized trials were consistent with previous studies in finding fluoride varnish more effective than no varnish (reduction in caries increment 18% to 59%). Three trials of xylitol were inconclusive regarding effects on caries. New observational studies were consistent with previous evidence showing an association between early childhood fluoride use and enamel fluorosis. Evidence on the accuracy of risk prediction instruments in primary care settings is not available.
  
  
  CONCLUSIONS
  There is no direct evidence that screening by primary care clinicians reduces early childhood caries. Evidence previously reviewed by the US Preventive Services Task Force found oral fluoride supplementation effective at reducing caries incidence, and new evidence supports the effectiveness of fluoride varnish in higher-risk children.
authors.affiliation: Pacific Northwest Evidence-Based Practice Center, Oregon Health & Science University, Portland, Oregon 97239, USA. chour@ohsu.edu
authors.forename: Roger
authors.initials: R
authors.lastname: Chou
authors.forename: Amy
authors.initials: A
authors.lastname: Cantor
authors.forename: Bernadette
authors.initials: B
authors.lastname: Zakher
authors.forename: Jennifer Priest
authors.initials: JP
authors.lastname: Mitchell
authors.forename: Miranda
authors.initials: M
authors.lastname: Pappas
mesh_terms: D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003731:Dental Caries / Q000453:epidemiology / Q000517:prevention & control*; D003733:Dental Caries Susceptibility; D005260:Female; D005459:Fluorides / Q000008:administration & dosage; D006267:Health Education, Dental; D006801:Humans; D007223:Infant; D008297:Male; D008403:Mass Screening; D010290:Parents / Q000193:education; D011320:Primary Health Care; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States; D014993:Xylitol / Q000008:administration & dosage
chemical_list: D005459:Fluorides; D014993:Xylitol
keywords: Dental caries; children; counseling; education; fluoride; fluorosis; prevention; screening; treatment; xylitol