Dental caries in children remains a significant public health problem worldwide so early identification and management is important. School dental screening was endorsed by WHO in 2003 and this typically involves a brief visual examination of the mouth and notification of the child’s parent or guardian with the main aim of identifying those with oral health problems and ensuring follow up. While the effectiveness of screening is dependant on follow up programmes the format varies from country to country. 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. This decision was confirmed in 2012 and is currently under routine review.
The aim of this Cochrane review was to assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.
Searches were conducted in the Cochrane Oral Health’s Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, the US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform databases with no restrictions on date or language. Cluster or parallel randomised controlled trials (RCTs) evaluating school dental screening compared with no intervention or another type of screening were considered. Standard Cochrane methodological process were followed.
- 7 studies (5 cluster RCTs) involving 20,192 children aged 4-15 yrs of age were included.
- Follow-up ranged from 3-8 months.
- 4 studies were carried out in the UK, 2 in India one in the USA.
- 2 trials were considered to be at low risk of bias, 3 at unclear risk and 2 at high risk.
- 4 RCTS compared traditional screening versus no screening, meta-analysis was inconclusive because of substantial inconsistency so no conclusions were drawn.
- 2 RCTs compared criteria-based screening versus no screening with pooled data suggesting a possible benefit RR = 1.07(95%CI; 0.99 to 1.16) [Low certainty evidence]. No evidence of difference was seen for criteria-based screening versus traditional screening. RR = 1.01 (95%CI; 0.94 to 1.08) [very low-certainty evidence].
- One trial compared a specific (personalised) referral letter to a non-specific one with the results favouring the specific letter; RR = 1.39 (95%CI; 1.09 to 1.77) for attending general dentist services and RR =1.90 (95%CI; 1.18 to 3.06) for attending specialist orthodontist services (low-certainty evidence).
- Low certainty evidence from 1 trial examining screening supplemented with motivation to screening alone found dental attendance more likely after screening supplemented with motivation RR = 3.08 (95%CI; 2.57 to 3.71) [low-certainty evidence].
The authors concluded: –
The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).
We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the ’common-sense model of self-regulation’ was better than a standard referral letter.
We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.
This update of an earlier Cochrane review (Dental Elf – 12th Jan 2018) and now includes data from 7 trials compared with 6 in the earlier review. However, the additional data has not changed the conclusions. The reviews highlight that the main outcome of almost all of the included studies was dental attendance and although this is desirable it does not mean that any necessary treatment is carried out or assess improved oral health. The included studies assess the outcomes at 3-9 months with the reviewers suggesting that future research should look at longer term outcomes and cost-benefit. The reviewers also recommend that any future trials should follow CONSORT Guidelines and be conducted in middle- and low-income countries to provide locally relevant evidence.
As noted earlier the UK National Screening Committee is currently undertaking a routine review of its current recommendation on School dental screening which is expected to be completed by the end of 2019.
Arora A, Khattri S, Ismail NM, Kumbargere Nagraj S, Eachempati P. School dental screening programmes for oral health. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD012595. DOI: 10.1002/14651858.CD012595.pub3.
UK National Screening Committee – Dental Disease
Dental Elf – 12th Jan 2018