Not So Fast on Dental Screenings in Primary Care, USPSTF Says

Routine screening by primary care clinicians for signs of tooth decay and gum disease may not identify patients most at risk of developing these conditions, according to a statement from the U.S. Preventive Services Task Force (USPSTF). Journal of the American Medical Association November 7th.

Making recommendations to improve oral health may also not attract the patients who need the information most, the group said in a statement.

This task force is not recommending that primary care providers cease all oral health screening of adults or that they never discuss ways to improve oral health. But the current evidence for the most effective oral health screening or enhancement strategies in primary care settings received an “I” level, or “uncertain.” The highest ratings a screening test can receive are an “A” or a “B”, which indicates there is strong evidence for screening, a “C” which indicates few clinicians can provide screening, and a “D” which indicates screening is available. The possibility of checking is very high.

The USPSTF states that primary care clinicians should immediately refer any patient with significant dental caries or gum disease to a dentist. But what clinicians should do in patients with no obvious oral health problems remains controversial.

“‘I’m a note on where the evidence is right now, and then a call for more research to see if we can get clearer information next time,” said John Ruiz, Ph.D., professor of clinical psychology at the University of Arizona, Tucson. A professor at the branch campus, he is a member of the working group.

More than 90% of U.S. adults may have dental cavities, and 26% of those adults have untreated cavities, which can lead to severe infection or tooth loss. Additionally, 42% of adults suffer from some type of gum disease. More than two-thirds of Americans age 65 or older have gum disease, which is the leading cause of tooth loss in this group. People who are low-income, have no health insurance, or belong to marginalized racial or ethnic groups are at greater risk for the harms of tooth decay and gum disease.

“Oral health is important to overall health,” Ruiz said, and any new research on oral health screening and enhancement efforts should be demographically representative of adults affected by these conditions.

In an accompanying editorial, oral health researchers from the National Institutes of Health and the University of California, San Francisco, echo the call for representative research and encourage closer collaboration between primary care providers and dentists to improve oral health. healthy.

Oral health screening and referral from primary care clinicians can help ensure that individuals receive the interventions needed for dental treatment to benefit oral and potentially overall health,” the authors write. “Similarly, findings during a dental visit Medical challenges and oral mucosal manifestations of chronic health conditions should lead to medical referral for prompt evaluation and treatment.”

lack of data

The USPSTF defines oral health screening for patients over 18 years of age with no obvious signs of cavities or gum disease as the examination of the patient's mouth during a physical examination. Additionally, clinicians can use predictive models to identify patients who are at greater risk for these problems.

Strategies to improve oral health include encouraging patients to reduce their intake of refined sugars, flossing and brushing effectively to reduce bacteria, and using fluoride gels, fluoride varnishes, or other types of sealants to make cavities more difficult to form.

A review of the literature found limited analysis of primary care clinicians performing these tasks. Perhaps not surprisingly, more such studies exist for dentists, leaving an open field for specialized research into what primary care clinicians should do to optimize their patients' oral health.

“In the absence of clear guidance, clinicians should continue to use their best judgment,” Ruiz said.

An interviewed dentist Medscape Medical News Screening can be as simple as a doctor asking a patient how often they brush their teeth and giving the patient a toothbrush during the visit.

“It all comes down to, is the person brushing their teeth?” said Dr. Jennifer Hartshorn, who specializes in community and preventive dentistry at the University of Iowa in Iowa City.

“In any case, check their mouth, ask them how often they brush their teeth, and urge them to find a dental office if possible,” Hartshorne said, especially for patients who smoke or suffer from conditions such as dry mouth, which can increase Risk of dryness.

Ruiz and Hartshorn reported no relevant financial relationships.

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