Cochrane Review Questions The Effectiveness Of School Dental Screening

Cochrane Review Questions The Effectiveness Of School Dental Screening

Readers above a certain age will remember only too well queueing up to ‘open wide’ for an examination by the school dental service.

Using a pop-up lamp and instruments dunked in a disinfectant fluid, a cursory inspection could trigger a letter home informing parents of a cavity or two coupled with a request to see the family’s dentist or, if the family had no dentist, the local community dentist.

But how effective were school dental services?  Cochrane is an international organisation, headquartered in the UK and is ‘not-for-profit’.  It exists for ‘anyone in using high-quality information to make health decisions and consists of clinicians, researchers, patients and health professionals and patients from over 190 countries.

Cochrane has analysed eight studies to ascertain ‘if school dental screening improves oral health of children, and if it does, which screening method works best’.

The key conclusion was that ‘there is not enough evidence to draw conclusions about whether traditional school dental screening can improve dental attendance (can lead to children visiting the dentist more often).

Controversially, the Review states ‘Moreover, it is not clear if improvement in dental attendance leads to better oral health. We still need high-quality studies that measure the impact of screening on oral health over longer periods of time’.

Cochrane’s Review considered oral diseases and especially caries, which affects children across the globe. School dental screening seeks to diagnose paediatric dental caries and signpost parents to get it treated before it progresses. 

The Review’s aim was to discover whether this ‘actually improves children’s oral health defined by the condition of the mouth, throat, teeth and gums.

Cochrane reviewed the topic in 2017, updating its findings in 2019.  The 2022 review considered eight studies covering 21,290 children. Four of the studies covering children aged 4 – 15 were undertaken in the UK, two in India, one in the USA and one in Saudi Arabia.

The eight studies looked at oral health in children who were screened versus children who were not and considered follow up arrangements i.e., education, referrals, advice.

The Review of the studies concluded ‘We do not know whether traditional school dental screening improves dental attendance.

Studies looking at screening based on specific criteria (e.g. targeted at children not registered with a dentist) suggested it might be slightly more effective than no screening for improving attendance at a dentist.’

The review continued ‘a personalised or specific referral letter to parents may improve dental attendance more than a non-specific letter, but we are very unsure about the results.’ Similar uncertainty surrounded the offer of health education and free treatment as a stimulant to improving dental attendance.

Worryingly, a specific referral letter ‘did not encourage more parents to take their children to the dentist when compare to a letter with generic advice to visit a dentist’.

The studies analysed by Cochrane followed up children for three to eleven months after they received screening and the organisation does caution that longer term effects are thus ‘unknown’.

According to NHS Dental Statistics for England 2016-17 NHS dentists saw 6.8 million children in the twelve months up to 30th June. This represented 58.2% of the child population.

For more information about the Cochrane Organisation and its Review click here

https://www.cochrane.org/CD012595/ORAL_school-dental-screening-programmes-improving-oral-health-children

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