Oral disease, in particular caries is the commonest disease in children worldwide and a major public health problem. Oral diseases impose considerable financial, social and personal burdens so prevention early detection and treatment are important. Schools dental screening is considered to help make children and parents aware of dental problems early and was endorsed by the World Health Organisation in 2003.
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. A position that was endorsed following a review in 2014. However, School dental screening continues in many countries often as part of school health services although processes and objectives vary from country to country.
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. There were no restrictions on language or date of publication.
Randomised controlled trials (RCTs) evaluating school dental screening compared with no intervention or with one type of screening compared with another were considered. Standard Cochrane methodological approaches were used for data abstraction, quality assessment and analysis.
- 6 studies involving a total of 19,498 children aged 4-15 yrs were included.
- 6 studies were cluster RCTs.
- 2 studies were considered to be at low risk of bias, 3 at unclear risk and one at high risk.
- Four trials evaluated traditional screening versus no screening. Due to inconsistencies no conclusions could be drawn.
- Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence).
- There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).
- In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).
- One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).
- None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening. None of the trials reported cost-effectiveness and adverse events.
The authors concluded: –
The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was 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 was 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 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) improves dental attendance in comparison to screening alone.
We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.
Even before the UK National Screenings committee’s 2006 decision regarding school dental screening for dental health its value in improving oral health of children was being questioned. Although it continues to have the confidence of politicians, health care planners and policymakers in many countries. This Cochrane review found some evidence that ‘screening as a dual process of clinical examination and informing parents of their child’s oral health status might bring enhanced clinical effects if the process of information were strengthened with specific or personalised referrals or periodic reminders.’ But only very-low to low quality evidence quality evidence regarding the role of school dental screening for increasing dental attendance.
These finding are in agreement with a similar systematic review by Joury et al (Dental Elf – 19th Dec 2016) includes four of the 5 studies included in this review. The fifth study, included by Joury was excluded from the current review because of the short 3 months follow up period. As the authors note the included studies measured dental attendance as an outcome rather than oral health and none of the studies reported on long-term effects. A majority of the included studies were performed in the UK so along with a recommendation for further high quality research there is a recommendation for research in middle and low-income countries.
Arora A, Khattri S, Ismail NM, Kumbargere Nagraj S, Prashanti E. School dental screening programmes for oral health. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD012595. DOI: 10.1002/14651858.CD012595.pub2.
Dental Elf – 19th Dec 2016
Milsom KM, Tickle M, Blinkhorn AS. Is school dental screening a political or a scientific intervention? J Dent Res. 2008 Oct;87(10):896-9. PubMed PMID: 18809742.