The U.S. Preventive Services Task Force (USPSTF) grades its recommendations (A, B, C, D, or I) and the quality of the overall evidence for a service (good, fair, poor). The definitions of these grades can be found at the end of the "Major Recommendations" field.
The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride. B recommendation.
The USPSTF found fair evidence that, in preschool children with low fluoride exposure, prescription of oral fluoride supplements by primary care clinicians leads to reduced dental caries. The USPSTF concluded that the benefits of caries prevention using oral fluoride supplementation outweigh the potential harms of dental fluorosis, which in the United States are primarily observed as a mild cosmetic discoloration of the teeth.
The USPSTF concludes that the evidence is insufficient to recommend for or against routine risk assessment of preschool children by primary care clinicians for the prevention of dental disease. I recommendation.
The USPSTF found no validated risk-assessment tools or algorithms for assessing dental disease risk by primary care clinicians and little evidence that primary care clinicians are able to systematically assess risk for dental disease among preschool-aged children. The USPSTF further found little evidence that either counseling of parents or referring high-risk children to dental care providers results in fewer caries or reduced dental disease. Thus, the USPSTF concluded there is insufficient evidence to determine the balance between the benefits and harms of routine risk assessment to prevent dental disease among preschool children.
Clinical Considerations
- Dental disease is prevalent among young children, particularly those from lower socioeconomic populations; however, few preschool-aged children ever visit a dentist. Primary care clinicians are often the first and only health professionals whom children visit. Therefore, they are in a unique position to address dental disease in these children.
- Fluoride varnishes, professionally applied topical fluorides approved to
prevent dental caries in young children, are adjuncts to oral supplementation. Their advantages over other topical fluoride agents (mouth-rinse and gel) include ease of use, patient acceptance, and reduced potential for toxicity.
- Dental fluorosis (rather than skeletal fluorosis) is the most common harm
of either oral fluoride or fluoride toothpaste use in children younger than 2
years in the United States. Dental fluorosis is typically very mild and only
of aesthetic importance. The recommended dosage of fluoride supplementation
was reduced by the American Dental Association in 1994, which is likely to
decrease the prevalence and severity of dental fluorosis. The current dosage
recommendations are based on the fluoride level of the local community's water
supply and are available online at www.ada.org. The primary care clinician's
knowledge of the fluoride level of his or her patients' primary water supply
ensures appropriate fluoride supplementation and minimizes risk for fluorosis.
Definitions:
Strength of Recommendations
The Task Force grades its recommendations according to one of 5
classifications (A, B, C, D, I) reflecting the strength of evidence and
magnitude of net benefit (benefits minus harms):
A
The USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.
B
The USPSTF recommends that clinicians provide [the service] to eligible patients. The USPSTF found at least fair evidence that [the service] improves important health outcomes and concludes that benefits outweigh harms.
C
The USPSTF makes no recommendation for or against routine provision of [the service]. The USPSTF found at least fair evidence that [the service] can improve health outcomes but concludes that the balance of benefits and harms is too close to justify a general recommendation.
D
The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.
I
The USPSTF concludes that the evidence is insufficient to recommend for or against routinely providing [the service]. Evidence that [the service] is effective is lacking, of poor quality, or conflicting and the balance of benefits and harms cannot be determined.
Strength of Evidence
The USPSTF grades the quality of the overall evidence for a service on a
3-point scale (good, fair, poor):
Good
Evidence includes consistent results from well-designed, well-conducted
studies in representative populations that directly assess effects on health
outcomes.
Fair
Evidence is sufficient to determine effects on health outcomes, but the
strength of the evidence is limited by the number, quality, or consistency of
the individual studies, generalizability to routine practice, or indirect nature
of the evidence on health outcomes.
Poor
Evidence is insufficient to assess the effects on health outcomes because of
limited number or power of studies, important flaws in their design or conduct,
gaps in the chain of evidence, or lack of information on important health
outcomes.
