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

Oral Health Other oral health4 versionsAMSTAR 2: not assessed

Full textEvery question was extracted from the full review (methods and results), not only its Summary of Findings table.

Questions

current version

GRADE rated

No studies

Included studies

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

Current version only

Traditional 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

CD012595.PUB4 (current) · 10 questions

Outcome	Effect	Evidence	Status / GRADE
Proportion of children with treated/untreated caries same question in other reviews	Proportion of children with treated/untreated caries: Not reported (Summary of findings 1).	0 studies	No studies
Trauma to permanent incisor teeth same question in other reviews	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 same question in other reviews	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 same question in other reviews	No studies measured malocclusion or orthodontic treatment needs (by any validated index).	0 studies	No studies
Dental attendance 3 to 4 months same question in other reviews	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 same question in other reviews	No studies measured developmental defects of enamel (by any validated index).	0 studies	No studies
Gingivitis measured by any validated index same question in other reviews	No studies measured gingivitis (by any validated index).	0 studies	No studies
Adverse events same question in other reviews	Adverse events: Not reported (Summary of findings 1).	0 studies	No studies
Prevalence of dental caries per child same question in other reviews	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 same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental attendance 3 to 4 months same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental attendance 3 to 4 months same question in other reviews	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)

CD012595.PUB4 (current) · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Dental attendance at orthodontist mean 8 months same question in other reviews	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 same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental attendance mean 3 months same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months same question in other reviews	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

CD012595.PUB4 (current) · 1 question

Outcome	Effect	Evidence	Status / GRADE
Proportion of children with treated/untreated caries (receipt of dental care) mean 8 months same question in other reviews	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

CD012595.PUB4 (current) · 3 questions

Outcome	Effect	Evidence	Status / GRADE
Dental attendance (number of dental visits) median 11 months same question in other reviews	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 same question in other reviews	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 same question in other reviews	MD 0.30 [-0.03, 0.63]	1 study · 362 participants	Very low Downgraded: risk of bias, imprecision, indirectness

Traditional 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

CD012595.PUB3 · 9 questions

Outcome	Effect	Evidence	Status / GRADE
Presence of gross plaque or calculus	Presence of gross plaque or calculus was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Trauma to permanent incisor teeth	Trauma to the permanent incisor teeth was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Prevalence of dental caries per child	A four-arm cluster-RCT with 16,684 participants (Milsom 2006) described prevalence of dental caries per child as its primary outcome; measured as mean number of teeth with active caries in primary (dt) and permanent…	1 study · 16684 participants	Ungraded
Proportion of children with other untreated oral health needs	None of the included trials tested this outcome.	0 studies	No studies
Adverse events	None of the trials reported any adverse events or harms of screening activity.	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 individual-level RCT). Due to the inconsistency, we downgraded the evidence…	4 studies · 6281 participants	Very low Downgraded: risk of bias, inconsistency
Cost effectiveness	None of the trials reported cost effectiveness of school dental screening programmes.	0 studies	No studies
Prevalence of sepsis	Prevalence of sepsis was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Proportion of children with treated/untreated caries	Not measured for traditional screening versus no screening; the only trial reporting treated/untreated caries (Nelson 2019) evaluated referral-letter comparisons.	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

CD012595.PUB3 · 1 question

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

CD012595.PUB3 · 1 question

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)

CD012595.PUB3 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
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	Low Downgraded: risk of bias
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	Low Downgraded: risk of bias

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

CD012595.PUB3 · 1 question

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	Low Downgraded: risk of bias

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

CD012595.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental care received (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

CD012595.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental care received (receipt of dental care) mean 8 months	OR 0.97 [0.62, 1.50] 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

CD012595.PUB3 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental care received (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

Traditional 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

CD012595.PUB2 · 9 questions

Outcome	Effect	Evidence	Status / GRADE
Proportion of children with other untreated oral health needs	None of the included trials tested this outcome.	0 studies	No studies
Proportion of children with untreated caries	None of the included trials tested this outcome.	0 studies	No studies
Presence of gross plaque or calculus	Presence of gross plaque or calculus was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Trauma to permanent incisor teeth	Trauma to the permanent incisor teeth was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Prevalence of sepsis	Prevalence of sepsis was a secondary outcome of Milsom 2006, measured as dichotomous data; the trial demonstrated no significant difference across the four arms.	1 study	Ungraded
Cost effectiveness	None of the trials reported cost effectiveness of school dental screening programmes.	0 studies	No studies
Adverse events	None of the trials reported any adverse events or harms of screening activity.	0 studies	No studies
Prevalence of dental caries per child	A four-arm cluster-RCT with 16,684 participants (Milsom 2006) described prevalence of dental caries per child as its primary outcome; measured as mean number of teeth with active caries in primary (dt) and permanent…	1 study · 16684 participants	Ungraded
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 individual-level RCT). Due to the inconsistency, we downgraded the evidence…	4 studies · 6281 participants	Very low Downgraded: risk of bias, inconsistency

Criteria-based screening (dentist refers using pre-established criteria) vs No screening

Population: School children, primary and secondary schools in the UK

CD012595.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental attendance 3 to 4 months	RR 1.07 [0.99, 1.16] 2.3 [-0.3, 5] % more	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

CD012595.PUB2 · 1 question

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)

CD012595.PUB2 · 2 questions

Outcome	Effect	Evidence	Status / GRADE
Dental attendance at orthodontist mean 8 months	RR 1.90 [1.18, 3.06] 17.4 [3.5, 39.9] % more	1 study · 201 participants	Low Downgraded: risk of bias
Dental attendance at general dentist mean 8 months	RR 1.39 [1.09, 1.77] 19.1 [4.4, 37.7] % more	1 study · 201 participants	Low Downgraded: risk of bias

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

CD012595.PUB2 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Dental attendance mean 3 months	RR 3.08 [2.57, 3.71] 20.9 [15.7, 27.2] % more	1 study · 2486 participants	Low Downgraded: risk of bias

School dental screening vs Placebo or no screening

Population: Children and adolescents aged 3 to 19 years attending a school in any country; deciduous, permanent, or mixed dentition

CD012595 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Protocol (planned comparison; no trials included). Planned outcomes: proportion of children with untreated caries; proportion with other untreated oral health need; dental attendance; caries by any validated index;…	0 studies	No studies

School dental screening (type A) vs A different type of school dental screening (type B)

Population: Children and adolescents aged 3 to 19 years attending a school in any country; deciduous, permanent, or mixed dentition

CD012595 · 1 question

Outcome	Effect	Evidence	Status / GRADE
Outcome NR	Protocol (planned head-to-head comparison of two different screening types; no trials included). Same planned primary and secondary outcome set as the screening-versus-no-screening comparison.	0 studies	No studies