Task Force Recommends Fluoride for Oral Health in Children

June 1, 2021, 6:06 p.m. News Staff — The U.S. Preventive Services Task Force is accepting comments on a draft recommendation statement and draft evidence review on screening and interventions to prevent dental caries in children younger than 5 years.

Based on a review of the evidence the task force,

recommends that primary care clinicians prescribe oral fluoride supplementation starting at 6 months for children whose water supply is deficient in fluoride (a “B” recommendation),
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 (also a “B” recommendation), and
has concluded that current evidence is insufficient to assess the balance of benefits and harms of performing routine oral screening examinations for dental caries by primary care clinicians in children younger than 5 years (an “I” recommendation).

“Children regularly visit a primary care setting for checkups, which provides an important opportunity for clinicians to play a role in helping reduce and prevent cavities,” task force member Michael Cabana, M.D., M.A., M.P.H., said in a press release.

“Since tooth decay can negatively affect children’s growth and development, these interventions are important to helping maintain children’s health and well-being,” added Martha Kubik, Ph.D., R.N., another member of the task force.

Story Highlights

Also referred to as tooth decay or cavities, dental caries are the most common chronic disease in children and adolescents between 6 and 19 years.

According to the National Institute of Dental and Craniofacial Research, almost 28% of children ages 2 to 5 have had dental caries in their primary teeth, with the prevalence higher in Black and Hispanic children and those living in families with lower income levels.

Update of Existing Recommendation

When finalized, the draft recommendation statement will update and replace the task force’s May 2014 recommendation statement on the topic.

The draft recommendation statement is virtually identical to the 2014 recommendation statement, which also issued B-level recommendations for prescribing oral fluoride supplementation beginning at 6 months for children with fluoride-deficient water supplies and for applying fluoride varnish to the primary teeth of infants and children beginning at the age of primary tooth eruption, and an I-level recommendation on the benefits and harms of routine screening examinations for dental caries. The AAFP supported the 2014 recommendation.

To update the existing recommendation, the task force commissioned an evidence review that focused on screening for dental caries, assessment of risk for future caries and the effectiveness of various interventions that have possible benefits. The task force limited its consideration of caries screening and prevention by primary care clinicians to infants and preschool-aged children based on the observation that in the United States, these clinicians are more likely than dentists to have contact with children younger than 5 years. The review included 33 studies; 19 randomized, controlled trials; four nonrandomized trials; nine observational studies; and one systematic review. Sixteen studies were carried forward from the previous review.

According to the task force, no studies in the evidence review compared clinical outcomes between children younger than 5 years who were screened and not screened for dental caries by primary care clinicians. In addition, no studies reported on the harms of screening.

In terms of interventions, the task force found that dietary fluoride supplementation and fluoride varnish appear to be effective at preventing dental caries outcomes in higher-risk children younger than 5 years. Results from 19 observational studies showed an association between the use of dietary fluoride supplementation and risk of enamel fluorosis in permanent teeth, which is usually mild. In comparison, results from four trials found no differences in risk of fluorosis or any other adverse event between fluoride varnish and placebo or no varnish.

In a section in the evidence review on priority populations, the researchers stated that since children who lack access to a dentist often have multiple encounters with a primary care practitioner, providing oral care in the primary care setting is an important strategy for improving access for vulnerable and underserved populations. The task force also noted that following the publication of the 2014 recommendation, state Medicaid policies to support the application of fluoride varnish for children in primary care was expanded to all states, and that data indicate an association between the implementation of such policies and the increased likelihood of good or excellent teeth for children in this population.

The task force also called for additional research to

confirm the benefits of fluoride varnish among lower-risk children;
determine how the referral of young children for dental care by primary care clinicians affects caries outcomes;
identify effective oral health educational and counseling interventions for parents and caregivers or guardians of young children, and
validate the accuracy and utility of caries risk assessment instruments for use in primary care settings.

Next Steps

The USPSTF will accept comments on the draft recommendation statement and draft evidence review until 11:59 p.m. ET June 7.

All comments will be considered as the task force prepares its final recommendation.