Oral 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 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.
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 6 randomised controlled trials, including 19,498 participants. Four studies were conducted in the UK and two were based in India. 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 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 very low.
What are the implications for dentists and the general public?
For a long time, school dental screening has held a confident and important place in public health practice as it seems of obvious value. However, 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?
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 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.
School dental screening programmes for oral health. Cochrane Database of Systematic Reviews 2017, Issue 12. Art. No.: CD012595. DOI: 10.1002/14651858.CD012595.pub2., , , , .
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.