Am Fam Physician. 2024;109(3):261-262
Related USPSTF Clinical Summary Table: Screening and Preventive Interventions for Oral Health in Adults
Author disclosure: No relevant financial relationships.
Case Study
A 27-year-old man presents with his six-year-old daughter for an annual wellness visit. He reports that his daughter is doing well, but he lost his job in the past year. This resulted in a loss of dental insurance for their family, and neither he nor his daughter has been seen for dental examinations in the past 12 months.
He reports that the family is relying on church and community food banks, and their diet has recently consisted of more fast food and snack foods than usual. He and his daughter report having no symptoms of oral health disease.
Case Study Questions
1. As the primary care physician performing the general wellness examinations, which one of the following routine screening interventions would be most appropriate for this visit, according to the U.S. Preventive Services Task Force (USPSTF) recommendations?
A. Screen for dental caries only in the six-year-old.
B. Screen for dental caries only in the 27-year-old.
C. Screen for dental caries and periodontal disease in both patients.
D. Screen for dental caries and periodontal disease in the 27-year-old; screen only for dental caries in the six-year old.
E. Use clinical judgment to decide whether to screen either the parent or child for oral health conditions.
2. The USPSTF recommendations focus on which of the following?
A. Dental caries in children and adolescents five to 17 years of age.
B. Dental caries in adults.
C. Periodontal disease in adults.
D. Dental caries in children five years and younger.
3. Which one of the following may be a risk factor for oral health conditions in adults, according to the USPSTF recommendations?
A. Tobacco use.
B. Adequate fluoride exposure.
C. Having one or two alcoholic drinks per week.
D. Younger age.
E. Brushing twice a day.
Answers
1. The correct answer is E. The USPSTF concluded that there is inadequate evidence to assess the balance of benefits and harms of screening for oral health conditions (e.g., dental caries, periodontal disease) performed by primary care clinicians in asymptomatic adults and in asymptomatic children and adolescents five to 17 years of age.1,2 The USPSTF carefully considers evidence of benefits and harms, makes recommendations when supported by sufficient evidence, and makes recommendations on primary care–relevant services. Based on the evidence, the USPSTF cannot recommend for or against oral health screening or preventive interventions for children, adolescents, or adults in the primary care setting.3,4 The USPSTF is calling for more research to address oral health in nondental primary care settings, particularly in people who are more likely to experience oral health conditions, and on social factors that contribute to disparities in oral health. In the absence of evidence, health care professionals should use their judgment when deciding whether to screen or perform preventive interventions related to oral health for patients five years and older. It is important to note that these recommendations are for people without any signs or symptoms.1,2
2. The correct answers are A, B, and C. These recommendations focus on dental caries in children and adolescents five to 17 years of age. Dental caries are the most common oral health condition in this population and most potentially amenable to primary care interventions.1 Additionally, the recommendations focus on dental caries and periodontal disease as the most common oral health conditions and those most potentially amenable to primary care interventions in adults 18 years and older.2 The USPSTF has a separate recommendation for children five years and younger. The USPSTF recommends oral fluoride supplements starting at six months of age for children younger than five years with water sources deficient in fluoride and administration of varnish to the primary teeth of all children younger than five years after tooth eruption.5
3. The correct answer is A. Frequent intake of sugar, inadequate oral hygiene, tobacco use, suboptimal fluoride exposure, unhealthy alcohol use, and methamphetamine use increase the risk of oral health conditions. According to 2009 to 2016 National Health and Nutrition Examination Survey data, in adults 30 years and older, smokers have a higher rate of periodontal disease (62%) compared with the overall population (42%). Older adults are more likely to have medical conditions or use medications causing xerostomia (dry mouth) that contribute to oral health conditions.2
The views expressed in this work are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the U.S. Department of Defense, Emory University, Mayo Clinic, or the U.S. government.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statements and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/oral-health-children-adolescents-screening- preventive-interventions and https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/oral-health-adults-screening-preventive-interventions.
