Year: 2021
Type: article
Abstract: Dental caries is one of the most prevalent chronic noncommunicable diseases among children in the US and the world 1 and one of the most common unmet health care needs of underserved children. 2 This costly and burdensome disease can result in severe pain, failure to thrive, and poor school performance, which have consequences for a child's short-and long-term future.Dental caries can start in early childhood and progress throughout the life course, despite being preventable.Many of the behaviors that cause dental caries are established early in life, which makes early childhood a critical period to establish effective healthy practices and start preventive interventions.To address these challenges, primary care clinicians have been called on to assess the oral health of their patients; provide anticipatory guidance and counseling about oral hygiene, fluoride exposures, and diet; assist with referrals; and apply fluoride varnish.In an updated Recommendation Statement in this issue of JAMA, 3 the US Preventive Services Task Force (USPSTF), supported by an updated evidence review, 4,5 issues recommendations similar to those in its 2014 Recommendation Statement on screening and interventions to prevent dental caries in children younger than 5 years, 6 including the application of fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption (B recommendation).3 Fluoride varnish is one of the simplest, safest, and most effective professionally delivered strategies available to prevent caries, 7 and its use is considered part of care in pediatric primary care.Yet interprofessional efforts to curb the prevalence and severity of this persistent childhood disease have not been successful at decreasing disparities and inequities in dental caries prevalence and access to care experienced by minority, poor, and underserved children in the US.In fact, despite previous recommendations, existing policies, and reimbursement, fluoride varnish use in medical settings for all young children has remained underutilized or utilized in a subjective manner.8 Furthermore, current evidence suggests that application of fluoride varnish in a clinic setting is more likely to be cost-effective in populations with high caries risk, which indicates a need to target groups with higher risk.9 Therefore, actions must be taken so that these USPSTF recommendations can be implemented more effectively than in the past, with strategies to reduce the persistent large disparities and inequities in caries rates and access to care.The USPSTF recommendations highlight the higher prevalence and severity of dental caries among low-income and certain racial and ethnic (eg, Black and Mexican American) populations.3 Specifically, dental caries "prevalence is higher in Mexican American children (33%) and non-Hispanic Black children (28%) than in non-Hispanic White children (18%)." 3 For these USPSTF recommendations to decrease-rather than widen-disparities in child dental caries, innovation in how to implement and tailor preventive dental care is needed at both the individual and population levels, resulting in an equitable delivery of preventive strategies by primary care clinicians.Lessons on equitable access to preventive child health services and the health care system have been gained through the response to the COVID-19 pandemic.The primary unmet child health care need during the COVID-19 pandemic was not medical care but dental care.10 Dental offices closed and school-based dental prevention programs were suspended, with many school-based dental programs not re-engaging until recently in many parts of the country.11,12 During this time of greater need for oral health promotion during the COVID-19 pandemic-when families have experienced numerous challenges accessing dental services from dentists and school-based programs-the + Related article at jama.
Source: JAMA Health Forum
Language: English
Subfield: Periodontics
Field: Dentistry
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,000
OpenAlex ID: W4200540912