Cochrane · intervention · CD012595
School dental screening programmes for oral health
Arora, A, Kumbargere Nagraj, S, Khattri, S, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.
Questions
21
current version
GRADE rated
12
No studies
7
Included studies
8
as reported
No studies 7 · 33.3%Ungraded 2 · 9.5%Very low 11 · 52.4%Low 1 · 4.8%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adolescents aged 3 to 19 years attending a school in any country. Participants can have deciduous permanent or mixed dentition. Inclusion independent of dental disease or dental caries level at the start of the study current dental treatment dentist attendance levels and nationality | 21290 children aged 4-15 years from eight RCTs (four UK, two India, one USA, one Saudi Arabia) |
| Intervention | School dental screening versus placebo or no screening; School dental screening A versus B (where A and B refer to different types of screening) | Traditional screening (n=4); Criteria-based screening (n=2); Specific referral letter (n=1); Traditional screening with motivation (n=1); CSM referral letter (n=1); CSM referral letter plus dental information guide (n=1); Referral to a specific dental treatment facility (n=1) |
| Comparison | Placebo/No screening/Different types of screening | No screening (n=4); Non-specific referral letter (n=1); Traditional screening alone (n=1); Standard referral letter (n=1); CSM referral letter (n=1); Generic advice letter to see a dentist (n=1) |
| Outcomes | Dental attendance; Proportion of children with treated and untreated caries; Proportion of children with other treated and untreated oral health needs; Caries measured by any validated index; Gingivitis measured by any validated index; Developmental defects of enamel measured by any validated index; Malocclusion or orthodontic treatment needs measured by any validated index; Trauma to teeth measured by any validated index; Cost-effectiveness; Adverse events | Dental attendance (n=7); Proportion of children with treated/untreated caries (receipt of dental care) (n=1); Prevalence of dental caries per child (n=1); Trauma to permanent incisor teeth (n=1); Number of caries in primary teeth (dt index) (n=1); Number of caries in permanent teeth (DT index) (n=1) |
| Study designs | Randomised controlled trials where randomisation occurs at the level of the group (clustered by school or class or both) or individual children. Exclude quasi-randomised trials and cross-over trials | Eight RCTs (six cluster-randomised) |
| Timing | Short-term effects (minimum follow-up of three months up to two years); Long-term effects (follow-up of more than two years) | Short-term effects only (follow-up 3 to 11 months) |
Search date: 2021-10. Databases: Cochrane Oral Health's Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE Ovid; Embase Ovid; ClinicalTrials.gov; World Health Organization International Clinical Trials Registry Platform
Questions and results
Show all 4 versionsTraditional screening (referral card given if the inspecting dentist judges the child needs to see a dentist) vs No screening
Population: School children (aged 4 to 15 years), primary and secondary schools in the UK and India
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children with treated/untreated caries | Proportion of children with treated/untreated caries: Not reported (Summary of findings 1). | 0 studies | No studies |
Trauma to permanent incisor teeth | Milsom 2006 reported the prevalence of trauma to the permanent incisor teeth as a dichotomous outcome (reduction from baseline yes/no); we were unable to include this data in a meta-analysis. | 1 study | Ungraded |
Proportion of children with other untreated oral health needs | Proportion of children with other treated/untreated oral health need: Not reported (Summary of findings 1). | 0 studies | No studies |
Malocclusion or orthodontic treatment needs measured by any validated index | No studies measured malocclusion or orthodontic treatment needs (by any validated index). | 0 studies | No studies |
Dental attendance 3 to 4 months | Data not pooled; 6281 participants (4 RCTs); Very low. There was substantial heterogeneity, in part due to study design (3 cluster-RCTs and 1 individually randomised trial). We are unable to draw conclusions about this… | 4 studies · 6281 participants | Very low Downgraded: risk of bias, inconsistency |
Developmental defects of enamel measured by any validated index | No studies measured developmental defects of enamel (by any validated index). | 0 studies | No studies |
Gingivitis measured by any validated index | No studies measured gingivitis (by any validated index). | 0 studies | No studies |
Adverse events | Adverse events: Not reported (Summary of findings 1). | 0 studies | No studies |
Prevalence of dental caries per child | Milsom 2006 measured prevalence of dental caries as mean number of teeth with active caries in primary teeth (dt) and permanent teeth (DT); post-intervention changes from baseline were not significant, and the authors… | 1 study · 16684 participants | Ungraded |
Cost effectiveness | As none of the studies reported cost-effectiveness, we could not assess the cost-benefit aspect of school dental screening. | 0 studies | No studies |
Criteria-based screening (dentist refers using pre-established criteria) vs No screening
Population: School children, primary and secondary schools in the UK
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental attendance 3 to 4 months | RR 1.07 [0.99, 1.16] 331 per 1000 vs 355 per 1000 | 2 studies · 4980 participants | Low Downgraded: imprecision |
Criteria-based screening (dentist refers using pre-established criteria) vs Traditional screening
Population: School children, primary and secondary schools in the UK
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental attendance 3 to 4 months | RR 1.01 [0.94, 1.08] 335 per 1000 vs 338 per 1000 | 2 studies · 5316 participants | Very low Downgraded: imprecision, inconsistency |
Criteria-based screening with specific (personalised) referral letter vs Criteria-based screening with non-specific referral letter
Population: School children, secondary school in the UK (aged 11 to 13 years)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental attendance at orthodontist mean 8 months | RR 1.90 [1.18, 3.06] 194 per 1000 vs 368 per 1000 | 1 study · 201 participants | Very low Downgraded: risk of bias, imprecision |
Dental attendance at general dentist mean 8 months | RR 1.39 [1.09, 1.77] 490 per 1000 vs 687 per 1000 | 1 study · 201 participants | Very low Downgraded: risk of bias, imprecision |
Traditional screening with motivation (oral health education and offer of free treatment) vs Traditional screening alone
Population: School children, primary and secondary schools in India
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental attendance mean 3 months | RR 3.08 [2.57, 3.71] 100 per 1000 vs 308 per 1000 | 1 study · 2486 participants | Very low Downgraded: risk of bias, imprecision |
Referral letter based on the common-sense model (CSM) of self-regulation plus dental information guide (DIG) vs Standard referral letter
Population: School children, primary schools in the USA
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months | OR 1.26 [0.82, 1.93] 382 per 1000 vs 438 per 1000 | 1 study · 395 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Referral letter based on the common-sense model (CSM) of self-regulation vs Standard referral letter
Population: School children, primary schools in the USA
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months | OR 0.97 [0.62, 1.51] 382 per 1000 vs 375 per 1000 | 1 study · 388 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Referral letter based on the common-sense model (CSM) plus dental information guide (DIG) vs Referral letter based on the common-sense model (CSM) alone
Population: School children, primary schools in the USA
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months | OR 1.30 [0.85, 1.99] 376 per 1000 vs 439 per 1000 | 1 study · 411 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Referral to a specific dental treatment facility vs Generic advice letter to see a dentist
Population: School children, primary school in Saudi Arabia
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Dental attendance (number of dental visits) median 11 months | RR 0.91 [0.34, 2.47] 43 per 1000 vs 39 per 1000 | 1 study · 362 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Number of caries in primary teeth (dt index) median 11 months | MD -0.20 [-0.72, 0.32] | 1 study · 362 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Number of caries in permanent teeth (DT index) median 11 months | MD 0.30 [-0.03, 0.63] | 1 study · 362 participants | Very low Downgraded: risk of bias, imprecision, indirectness |