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Systematic review and meta-analysis of randomised controlled trials on the effectiveness of school-based dental screening versus no screening on improving oral health in children

A selection of abstracts of clinically relevant papers from other journals. The abstracts on this page have been chosen and edited by John R. Radford.

Abstract

No effect of school-based dental screening programmes on caries or dental attendance.

Main

Joury E, Bernabe E et alJ Dent 2017;58: 1–10

Hauled out of class, lined-up along draughty corridors, then only to be scolded because Mum had forgotten to sign the consent form; but many worthy organisations such as the World Health Organisation have recommended the screening of caries in children. In the UK, school dental inspection had been a statutory requirement for more than one hundred years. But then over 10 years ago, the UK National Screening Committee stated that there was no evidence for the effectiveness of school-based dental screening. The decision to continue with these or otherwise was one for local authorities. The aim of this systematic review was to assess the effectiveness of school-based dental screening compared with no screening in those aged 3–18 years old.

This rigorous systematic review followed the PRISMA guideline and was registered with PROSPERO. Three sets of independent reviewers interrogated the usual data bases together with other sources. Appendix A in the paper gives the search keywords and MeSH terms and filters for each of the databases. It is interesting to note how each of the databases, although starting with the same MeSH ('mass screening') built their searches. Five cluster RCTs were identified. A cluster RCT is when groups of subjects, as opposed to individual subjects, are randomised. A meta-analysis was carried out on 28,442 children, included in the cluster RCTs. Cochrane's criteria of risk of bias assessment were used which revealed an 'unclear or high risk of bias'. Only one RCT measured the prevalence and mean number of teeth with caries but all five reported on dental attendance.

When comparing those who attended dental screening programmes and those who did not: 1) there was no difference in attendance, 2) there was no difference in the prevalence of caries in both deciduous and permanent teeth, and 3) there were no difference in the 'prevalence of sepsis, presence of gross plaque or calculus, and trauma to the permanent incisor teeth'.

But then qualitative studies have shown that parents, teachers and school nurses value dental screening. Nevertheless, dental screening may more effectively meet its purpose if subsequent treatment appointments were arranged after school and dental practices were located close to the school.

The findings of this study are of relevance to high income countries but it should be stressed not necessarily generalisable to middle-low and low-income countries. In these countries, school-based dental screening may be a key oral health priority as such programmes may 'tackle the growing burden of dental caries in their child population.'

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Systematic review and meta-analysis of randomised controlled trials on the effectiveness of school-based dental screening versus no screening on improving oral health in children. Br Dent J 222, 675 (2017). https://doi.org/10.1038/sj.bdj.2017.403

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