In light of a recent study published in the Journal of the American Medical Association Pediatrics, the American Academy of Pediatric Dentistry (AAPD) and the American Dental Association (ADA) have reaffirmed their strong support for early dental visits to prevent childhood tooth decay.
The study examined Medicaid-covered children in Alabama, US, comparing cavity-related treatment among children who were provided preventive dental services by a dentist, primary care provider and those receiving none at all.
While the authors “observed little evidence of the benefits” of preventive care, the results must be scrutinized carefully. The authors noted the study’s limitations, including the lack of information about oral health behaviors.
“As the authors state, this study design did not allow for evaluation of factors such as a genetic predisposition, previous disease and environmental considerations such as diet, frequency of brushing and flossing, the use of fluoride toothpaste and drinking fluoridated water, all of which are crucial in reducing the risk of cavities,” said Dr Mia L. Geisinger, associate professor, Department of Periodontology, University of Alabama at Birmingham and member of the ADA’s Council on Scientific Affairs.
“Furthermore, there is no evaluation to determine if untreated cavities are present in those individuals who did not seek dental care for restorative treatment, so the data are incomplete. Because of this study’s limitations, we cannot make any definitive conclusions from the data provided and further research is necessary. This study highlights the need to invest in oral health research to address the epidemic levels of tooth decay in some populations of children.”
The study design relied on a review of Medicaid data, which have inherent limitations as the data come from hundreds of providers in many community and clinical settings with varied training and experience. Approaches to management of early childhood cavities vary greatly depending on the provider.
Little is known about the state of oral health of the children seen by dentists at the time of the first visit and it is unclear if the children studied were referred to a dentist because they showed signs of cavities or if they already had tooth decay upon their first visit.
“Studies of this nature are important in advancing our knowledge about early childhood cavities and their prevention and treatment, but these findings are not definitive, and further study is critical, in view of other findings supportive of early care and the epidemic nature of early childhood cavities,” said Dr Paul Casamassimo, director of the AAPD’s Pediatric Oral Health Research & Policy Center. “Given Medicaid populations’ well-documented high levels of untreated dental decay, it is to be expected that many referrals for a dental visit will result in restorative care. The study also lacks any comparison with the oral health status of those children not receiving preventive dental care.
“A comprehensive approach to preventing the onset of early childhood cavities by early dental visits which assess risk and establish preventive interventions within a dental home provides the best chance of keeping children cavity-free. The AAPD is committed to the study of least-invasive approaches to prevention and management of early childhood cavities including engagement of the primary care medical community, use of fluoride varnish and sliver diamine fluoride, and early establishment of the dental home.”
Both the AAPD and ADA recommend that children visit a dentist at least once before the age of one. Various recent studies support the benefit of an early visit to the dentist in both public and privately covered populations.
This study highlights the importance of reducing the risk of cavities among underserved children, and additional research should be conducted to determine best practices for preventive services.