Abstract：
Dental caries is common in children and adolescents aged 5 to 17 years and potentially amenable to primary care screening and prevention.
To systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.
MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.
Diagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.
One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.
Dental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.
Three systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, -0.73 [95% CI, -1.30 to -0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.
Administration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.
To systematically review the evidence on primary care screening and prevention of dental caries in children and adolescents aged 5 to 17 years to inform the US Preventive Services Task Force.
MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.
Diagnostic accuracy of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions and systematic reviews of such studies; cohort studies on primary care oral health screening and preventive intervention harms.
One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Random-effects meta-analysis was performed for fluoride supplements and xylitol; for other preventive interventions, pooled estimates were used from good-quality systematic reviews.
Dental caries, morbidity, functional status, quality of life, harms; diagnostic test accuracy.
Three systematic reviews (total 20 684 participants) and 19 randomized clinical trials, 3 nonrandomized trials, and 1 observational study (total 15 026 participants) were included. No study compared screening vs no screening. When administered by dental professionals or in school settings, fluoride supplements compared with placebo or no intervention were associated with decreased change from baseline in the number of decayed, missing, or filled permanent teeth (DMFT index) or decayed or filled permanent teeth (DFT index) (mean difference, -0.73 [95% CI, -1.30 to -0.19]) at 1.5 to 3 years (6 trials; n = 1395). Fluoride gels were associated with a DMFT- or DFT-prevented fraction of 0.18 (95% CI, 0.09-0.27) at outcomes closest to 3 years (4 trials; n = 1525), fluoride varnish was associated with a DMFT- or DFT-prevented fraction of 0.44 (95% CI, 0.11-0.76) at 1 to 4.5 years (5 trials; n = 3902), and resin-based sealants were associated with decreased risk of carious first molars (odds ratio, 0.21 [95% CI, 0.16-0.28]) at 48 to 54 months (4 trials; n = 440). No trial evaluated primary care counseling or dental referral. Evidence on screening accuracy, silver diamine fluoride, xylitol, and harms was very limited, although serious harms were not reported.
Administration of fluoride supplements, fluoride gels, varnish, and sealants in dental or school settings improved caries outcomes. Research is needed on the effectiveness of oral health preventive interventions in primary care settings and to determine the benefits and harms of screening.
摘要：
龋齿常见于5至17岁的儿童和青少年，可能适合初级保健筛查和预防。
系统审查5至17岁儿童和青少年的初级保健筛查和预防龋齿的证据，以告知美国预防服务工作组。
MEDLINE,Cochrane中央控制试验登记册,和Cochrane系统评价数据库（至2022年10月3日）；监测至2023年7月21日。
初级保健筛查工具和口腔检查的诊断准确性；筛查和预防性干预的随机和非随机试验以及此类研究的系统评价；初级保健口腔健康筛查和预防性干预危害的队列研究。
一名调查员提取了数据；第二个检查了准确性。两名研究者独立评估研究质量。对氟化物补充剂和木糖醇进行了随机效应荟萃分析；对于其他预防性干预措施，汇总估计值来自高质量的系统综述.
龋齿,发病率，功能状态，生活质量,危害；诊断测试准确性。
3项系统评价（共20684名参与者）和19项随机临床试验，3项非随机试验，纳入1项观察性研究(共15,026名参与者).没有研究比较筛选与不筛选。由牙科专业人员或学校环境管理时，与安慰剂或无干预相比，氟补充剂与衰变数量相对于基线的减少相关，失踪,或填充恒牙(DMFT指数)或腐烂或填充恒牙(DFT指数)(平均差，-0.73[95%CI，-1.30至-0.19]）在1.5至3年（6项试验；n=1395）。在最接近3年的结果（4项试验；n=1525），氟化物凝胶与0.18的DMFT或DFT预防分数相关（95％CI，0.09-0.27），氟化物清漆在1至4.5年（5项试验；n=3902）时与0.44的DMFT或DFT阻止分数相关（95％CI，0.11-0.76），和树脂基密封剂与龋齿第一磨牙的风险降低相关(比值比，在48至54个月时为0.21[95%CI，0.16-0.28]）（4项试验；n=440）。没有试验评估初级保健咨询或牙科转诊。筛查准确性的证据，二氟化银,木糖醇,危害非常有限，尽管没有严重的危害报告。
服用氟化物补充剂，氟化物凝胶,清漆,和密封剂在牙科或学校设置改善龋齿的结果。需要研究初级保健机构中口腔健康预防干预措施的有效性，并确定筛查的益处和危害。
系统审查5至17岁儿童和青少年的初级保健筛查和预防龋齿的证据，以告知美国预防服务工作组。
MEDLINE,Cochrane中央控制试验登记册,和Cochrane系统评价数据库（至2022年10月3日）；监测至2023年7月21日。
初级保健筛查工具和口腔检查的诊断准确性；筛查和预防性干预的随机和非随机试验以及此类研究的系统评价；初级保健口腔健康筛查和预防性干预危害的队列研究。
一名调查员提取了数据；第二个检查了准确性。两名研究者独立评估研究质量。对氟化物补充剂和木糖醇进行了随机效应荟萃分析；对于其他预防性干预措施，汇总估计值来自高质量的系统综述.
龋齿,发病率，功能状态，生活质量,危害；诊断测试准确性。
3项系统评价（共20684名参与者）和19项随机临床试验，3项非随机试验，纳入1项观察性研究(共15,026名参与者).没有研究比较筛选与不筛选。由牙科专业人员或学校环境管理时，与安慰剂或无干预相比，氟补充剂与衰变数量相对于基线的减少相关，失踪,或填充恒牙(DMFT指数)或腐烂或填充恒牙(DFT指数)(平均差，-0.73[95%CI，-1.30至-0.19]）在1.5至3年（6项试验；n=1395）。在最接近3年的结果（4项试验；n=1525），氟化物凝胶与0.18的DMFT或DFT预防分数相关（95％CI，0.09-0.27），氟化物清漆在1至4.5年（5项试验；n=3902）时与0.44的DMFT或DFT阻止分数相关（95％CI，0.11-0.76），和树脂基密封剂与龋齿第一磨牙的风险降低相关(比值比，在48至54个月时为0.21[95%CI，0.16-0.28]）（4项试验；n=440）。没有试验评估初级保健咨询或牙科转诊。筛查准确性的证据，二氟化银,木糖醇,危害非常有限，尽管没有严重的危害报告。
服用氟化物补充剂，氟化物凝胶,清漆,和密封剂在牙科或学校设置改善龋齿的结果。需要研究初级保健机构中口腔健康预防干预措施的有效性，并确定筛查的益处和危害。
