School-based screening for dental disease

This study further establishes the association between childhood adversity and bipolar disorder, but more work is needed to provide us with clinically useful evidence.

Many countries undertake school-based dental screening programmes and these have been endorsed by the World Health Organisation who state “Screening of teeth and mouth enables early detection, and timely interventions towards oral diseases and conditions, leading to substantial cost savings. It plays an important role in the planning and provision of school oral health services as well as health services”. However, in 2006 the UK National Screening committee noted that there was no evidence to support the effectiveness of school-based dental screening in increasing dental attendance rates or reducing caries levels for children, particularly those from low socioeconomic position.  This position was endorsed following a review in 2014.

The aim of this review was to evaluate the effectiveness of school-based dental screening versus no screening on improving oral health in children aged 3–18 years

Methods    

Searches were conducted in the Medline, Embase, Cochrane Library, Web of Science, Clinical Trials.gov and WHO International Clinical Trials Registry Platform databases with no restrictions. Randomised controlled trials (RCTs) of school-based dental screening versus no screening for oral health, conducted on children aged 3–18 years, of both sexes, from different socio- demographic backgrounds, attending schools were considered. The primary outcomes were prevalence and mean number of teeth with caries, incidence of dental attendance and harms of screening.

3 sets of reviewers independently screened the titles and abstracts and two reviewers independently abstracted data. Quality was assessed using Cochrane’s risk of bias tool. Narrative and quantitative syntheses of included studies’ findings were performed

Results

  • 5 cluster RCT studies were included
  • 3 studies were conducted in the UK, 2 in India.
  • The screening intervention and approach to non-screened group varied across the studies.
  • Follow up ranged from 2- 4 months.
  • 4 studies only measured the outcome, incidence of dental attendance.
  • For an intracluster correlation coefficient of 0.030, there was no statistically significant difference in dental attendance between children who received dental screening and those who did not receive dental screening RR = 1.11 (95%CI; 0.97 to 1.27).
  • The overall quality of the evidence using GRADE was considered to be very low quality.

Conclusions

The authors concluded

There is currently no evidence to support or refute the clinical benefits or harms of dental screening. Routine dental screening does not have an effect on dental attendance of school children, but there is a lot of uncertainty in this finding because of the quality of evidence. Given the potential benefits and costs of screening, there is a need to conduct an RCT with low risk of bias, adequate sample size, and follow-up to identify differences in clinical outcomes. Such an RCT should include intensive follow-up as one of the arms. A cost-effectiveness analysis should accompany this RCT, so that one can determine whether dental screening provides value for money.

Comments

Sadly, dental caries a preventable disease remains the most prevalent disease worldwide. It is the 10th most prevalent condition in children and in the UK is the single commonest reason for children to undergo a general anaesthetic.  So detecting treating and preventing caries in children is an import goal.

This well conducted review included 5 RCTs that suggest that there is no statistically significant difference in dental attendance between children who received dental screening and those who did not receive dental screening. However, the overall quality of the evidence is of very low quality.  The discussion in the review highlights that the concept of schools screening is valued by parents and teachers but the need for most robust follow up procedures was noted. While identifying children with caries and facilitating treatment is a primary objective, school screening also provide valuable planning and monitoring data. In some areas school screening programmes have ceased in line with the UK National Screening Committee recommendation while this may release dental resources they need to be redirected to dental preventive interventions as levels of dental disease in children remain too high.  This review finds that because the available evidence is not good enough to support or refute the clinical benefits or harms more high quality research is needed.

Links

Primary paper

Joury E, Bernabe E, Sabbah W, Nakhleh K, Gurusamy K. Systematic review and meta-analysis of randomised controlled trials on the effectiveness of school-based dental screening versus no screening on improving oral health in children. J Dent. 2016 Nov 22. pii: S0300-5712(16)30240-8. doi:10.1016/j.jdent.2016.11.008. [Epub ahead of print] Review. PubMed PMID: 27884719.

 Other references

 NHS Screening Committee – Dental Screening in Children

The intracluster correlation coefficient (ICC)

 

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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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