Tooth Decay in Kids

Tooth decay prevention in small children may call for fluoride in primary care visits

/ Author:  / Reviewed by: Robert Carlson, M.D

(RxWiki News) Primary care physicians act as the first line of defense for public health concerns. Some believe fluoride treatments for children may become part of regular visit to the doctor’s office.

The US Preventive Services Task Force is in the process of updating their recommendation for the prevention of tooth decay in small children. This new recommendation involves the possibility of using a fluoride varnish on small children in primary care offices.

However, this process does come with known side effects.

"Talk to your pediatrician about dental care."

The US Preventive Services Task Force (USPSTF), chaired by Virginia Moyer, MD, MPH, has released a draft on recommendations for dental care for infants and small children. This draft was designed to update the 2004 USPSTF recommendation for preventing tooth decay in small children.

The draft is available for the public to read and comment on until June 17, 2013.

“Tooth decay is the most common chronic disease in American children, but only about one out of four children under 6 years old visit a dentist,” said Dr. Moyer.

“Fortunately, evidence shows that primary care clinicians can play an important role in helping to reduce tooth decay, substantially improving children’s health,” Dr. Moyer continued.

The research that was used to shape this recommended update was led by Roger Chou, MD, from Oregon Health & Science University in Portland.

In 2004, the USPSTF recommendation stated that primary care clinicians should prescribe fluoride supplements to children aged 6 months to 5 years of age if they lived in a region that did not have fluoride in the water supply.

The 2004 recommendation did not find enough evidence for or against the screening for potential tooth decay by primary care clinicians.

For this update, the researchers looked through medical databases for studies published between 1999 and 2013 for evidence on preventing tooth decay in small children.

They found very little new published evidence on this topic. The researchers concluded that the use of oral fluoride was still appropriate for preventing tooth decay in small children. 

However, enamel fluorosis was a possible side effect of fluoride treatments. Enamel fluorosis causes white streaks or even brown stains on tooth enamel. It happens when teeth are over exposed to fluoride during development.

The researchers did find evidence that a fluoride varnish could help reduce tooth decay in small children. According to the USPSTF, fluoride varnish is a treatment that could be applied by a primary care clinician during an office visit.

The USPSTF did not find evidence to support a recommendation for or against primary care clinicians screening for tooth decay in small children.

“The draft Recommendation Statement endorses dietary fluoride supplementation and topical fluoride as effective measures for preventing tooth decay. Although the value of fluoride is hardly a revelation, recognition of childhood tooth decay as an increasingly pervasive issue is welcome, as is the acknowledgement of the need for improved prevention," Mark Bornfeld, DDS, told dailyRx.

"However, the USPSTF does not explain their rationale for suggesting that tasking the primary care medical provider with preventive dental responsibility would be preferable to improving the accessibility of more conventional dental care." 

"Especially given their penchant for prioritizing cost effectiveness, it is curious that the USPSTF would opt to re-invent the wheel. A better strategy would have been to advocate for reducing the barriers that prevent children from receiving timely dental service,” said Dr. Bornfeld, who was not involved with the study. 

Annual check-ups can range between $0 and $200 depending upon location and insurance coverage. 

This recommendation was issued on the US Preventive Services Task Force website.

The USPSTF is a department within the Agency for Healthcare Research and Quality, which is part of the US Department of Health and Human Services.

Reviewed by: 
Review Date: 
May 20, 2013
Last Updated:
April 16, 2014