Uncertain evidence on the value of school dental screening programmes

Boy having teeth examinedOral diseases, especially dental caries, affect children worldwide. If unchecked, oral health can deteriorate progressively and adversely impact children’s general well-being. It also has a financial bearing at family and community levels. School dental screening is a public health measure where the oral examination of children is carried out in the school setting, and then parents are informed about the oral condition and treatment needs of their child. The screening aims to identify oral health concerns at an early stage, and prompt parents to seek treatment where required.

What was the research?

A systematic review to examine whether school dental screening improves the oral health of children; and if it does, which is the best screening method. The review was first published in December 2017, and we last conducted a search for evidence on 4 March 2019.

Who conducted the research?

The research was conducted by a team led by Ankita Arora of Melaka-Manipal Medical College, Malaysia, on behalf of Cochrane Oral Health. Shivi Khattri, Noorliza Mastura Ismail, Sumanth Kumbargere Nagraj and Eachempati Prashanti were also on the team.

What evidence was included in the review?

We included 7 randomised controlled trials, including 20,192 children. Four studies were conducted in the UK, two were based in India and one in the USA. The children in these studies were 4 to 15 years old. Studies compared children who were screened in school to children who did not undergo screening in terms of their oral health and visits to the dentist. Studies also compared one type of screening to another (for example, variations in clinical examination or referral process).

What did the evidence say?

There is insufficient evidence to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. School dental screening programmes with personalised referral letters or additional motivation elements probably have the ability to improve dental attendance over the short term (follow-up of three months up to two years). Screening based on specific criteria may possibly be better than no screening. However, it is not clear if improvement in dental attendance leads to the better oral health of children. We still need high-quality studies that measure the impact of screening on oral health carried out over longer periods of time.

How good was the evidence?

We are uncertain whether traditional school dental screening improves dental attendance as we assessed the certainty of the evidence as low or very low.

What are the implications for dentists and the general public?

In this systematic review, we found very low certainty to low-certainty evidence, which is insufficient to draw conclusions about the role of school dental screening for improvement in dental attendance. There is an absence of evidence to comment on the efficacy of school dental screening to improve oral health.

What should researchers look at in the future?

All of the trials except one measured only dental attendance as the primary outcome. Even though dental attendance post-screening is a desirable outcome, it does not guarantee further follow-up to completion of treatment and is not a measure of improved oral health.

We recommend standardisation of definitions of school dental screening programmes so that future research can be based on it. We encountered different terminology for various screening and referral procedures, for example, ‘criteria-based’ screening, and screening with ‘specific’ referral letters. We cannot comment on the universal application of these terms and it makes drawing comparisons difficult. We also recommend standardising various forms of screening processes.

More clinical trials on this topic are needed. We recommend the conduct and reporting of clinical trials be improved by following the CONSORT group guidelines.


Arora A, Khattri S, Ismail NM, Kumbargere Nagraj S, Prashanti E. School dental screening programmes for oral health. Cochrane Database of Systematic Reviews 2019, Issue 8. Art. No.: CD012595. DOI: 10.1002/14651858.CD012595.pub3.

This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base. It was originally published on 1st May 2018, and updated on 8 August 2019.

2 thoughts on “Uncertain evidence on the value of school dental screening programmes

  1. We all know what a public healthcare issue this is and how important preventive dental education is for our children. The American Dental Association needs to allow the dental hygienist profession to intervene as public healthcare officials to educate our preschool and elementary children across our nation.

  2. Pingback: School dental screening - National Elf Service

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