Prevention and management of dental decay in the pre-school child

Abstract

Scope and purposeThe guideline addresses effective strategies for preventing and managing dental decay in the preschool child. The nature of dental decay, its diagnosis and its epidemiology are reviewed. Methods for prevention and management of the disease at an individual and population level are reviewed and identification of children at increased risk of developing dental disease is discussed.MethodologyThe guideline was synthesised following the SIGN methodology (see www.sign.ac.uk/guidelines/fulltext/50/index.html). Searches were devised in collaboration with members of the guideline-development group. Searches for guidelines used Embase and Medline for the period 1996–2003 and a range of websites. Searches for systematic reviews, meta-analyses, randomised controlled trials (RCT) and observational studies were carried out with the Cochrane library, Embase and Medline (1990–2003, with a final update in June 2004). The definitions of the types of evidence and the grading of recommendations used in this guideline originate from the US Agency for Health Care Policy and Research1 and are set out in Tables 1 and 2.Review and updatingThe guideline was published in November 2005 and will be considered for updating in 3 years.Clinical recommendationsFor summary, see Table 3 below.Research recommendationsDuring the identification and critical appraisal of evidence for this guideline, it became apparent that there is limited evidence from high-quality, rigorous and methodologically sound research, and that the evidence currently available is often poor and incomplete. The guideline development group recommended that research should be carried out evaluating the benefits, and potential risks of fluorosis, of a community-based water fluoridation scheme in the current environment in Scotland, determining the relationship between oral health and health inequalities, exploring how dental services should be provided in areas of deprivation to minimise inequalities, evaluating community-based prevention programmes, including the involvement of health visitors, ascertaining the most effective combination of preventive, or preventive and restorative, interventions for different caries-risk groups, with different levels of deprivation, in different settings, examining the relationship between age and caries experience in the preschool child, describing the caries experience of preschool children with special needs, completing RCT to investigate the apparent caries-reducing effect of sugar-substituted sweets, investigating the effect of breast- and bottle-feeding on the development of early childhood caries in studies that control for other dietary factors, identifying effective interventions to improve the diet at weaning and preschool age, examining the effectiveness of structured nursery toothbrushing programmes, determining the optimum age at which to commence brushing children's teeth, exploring the effect of one-to-one dental health education on health outcomes, evaluating the effectiveness of dental health education programmes promoting the use of fluoride outside a structured programme, examining the effects of maternal use of xylitol in preventing caries in young children, identifying specific barriers to the implementation of oral health strategies, and how to overcome them, assessing the effectiveness of preventive advice delivered by the dental team in the dental practice environment, determining the effectiveness of fluoride and chlorhexidine varnishes, and fissure sealing in the primary dentition, conducting RCT in primary care to investigate the relative efficacy of conventional restorative management of carious primary teeth including the role of general anaesthetic compared with alternative techniques, and with a prevention-only approach, establishing the effect of remuneration on quality of dental care and availability of dental practitioners.