USPSTF: More evidence needed to develop oral health exams in primary care

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Good oral health is important to overall health, but more research is needed to find the best ways to integrate tooth and gum examinations for adults and children in primary care.

On Nov. 7, 2023, the U.S. Preventive Services Task Force (USPSTF) published its Final Recommendation Statements on screening and preventive interventions for adults and children.

USPSTF concluded that “current evidence is insufficient to assess the balance of benefits and harms of routine screening performed by primary care clinicians for oral health conditions,” including dental caries in children and adults, and periodontal-related disease in adults.

“The Task Force needs more evidence on whether and how primary care professionals can promote good oral health in school-aged children, adolescents, and adults,” Task Force member John Ruiz, PhD, said in a news release. “Healthy teeth and gums are an important part of overall health, so it is essential that research focuses on oral health screening and preventive interventions in the primary care setting.”

Cavities and gum disease are the most common and potentially most amenable to primary care interventions, according to the Task Force. Dental caries is the most common condition in adults worldwide, and in the United States, more than 90% of adults have them. An estimated 26% are untreated, which can lead to serious infection and tooth loss.

USPSTF wants more research on the issue, especially for patients more likely to experience oral health issues and who may deal with social factors that create disparities in oral health. Dental problems are disproportionately worse for people living in rural and underserved areas, in poverty, without insurance coverage, who are homeless, or who are Asian, Black, Hispanic/Latino, or Native American/Alaska Natives.

“In the absence of evidence, primary care clinicians should use their clinical expertise to decide whether to perform these services,” the final recommendation said.

Lack of data should not discourage primary care physicians and other clinicians from considering oral health during medical examinations, said an editorial discussing the recommendation in JAMA.

“Data demonstrate that good oral health is associated with improved systemic outcomes in many conditions including diabetes, HIV, pregnancy, respiratory tract infections, and certain cardiovascular conditions,” said the editorial, “A Call for More Oral Health Research in Primary Care,” by Michael S. Reddy, DMD, DMSc, Rena N. D’Souza, DDS, MS, PhD, and Jennifer Webster-Cyriaque, DDS, PhD. Teamwork becomes a key way to help patients, they said.

“To keep patient health at the forefront, medical primary care must partner with dentistry,” they said. “Without a coordinated effort, highly preventable oral health disparities and poorer overall health outcomes will persist.”

USPSTF has a separate recommendation for children aged 5 years or younger for oral fluoride supplements, starting at age 6 months, for children whose water supply is deficient in fluoride. There is a recommendation to apply varnish to the primary teeth of children younger than 5 years old, and USPSTF recommends fluoride in community water sources to fight cavities.

USPSTF has published its recommendations and supporting materials for adults and children.