Priority 1 from the Oral and Dental Health PSP

UNCERTAINTY: What is the best way to prevent tooth decay, and reduce oral health inequalities at a community or population level? (JLA PSP Priority 1)
Overall ranking 1
JLA question ID 0079/1
Explanatory note

Not available for this PSP


Numerous approaches have been evaluated for preventing caries at a community or population level (with only some evaluating reduction in health inequalities). Some of the more frequently evaluated interventions are listed below. None of the interventions are supported by long-term, high quality evidence (supervised mouthrinse programmes, undertaken in a school setting, are supported by moderate level evidence; health inequalities not evaluated)

Water fluoridation: There is low quality evidence that community water fluoridation is effective at reducing caries levels in both deciduous and permanent dentition in children. There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across SES. There is insufficient evidence to determine the effectiveness of water fluoridation for preventing caries in adults. There is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes.

School-based behavioural interventions: insufficient evidence to determine whether behavioural interventions in primary schools leads to a change in behaviours associated with dental caries

School based sealant programmes: moderate evidence of effectiveness in preventing dental
caries and evidence indicating school based sealant programmes increase the number
of children receiving sealants

School based supervised mouthrinse programmes: Moderate quality evidence that regular use of fluoride mouthrinse under supervision results in a large reduction in tooth decay in children's permanent teeth

Supervised toothbrushing programmes: insufficient evidence regarding the effectiveness of supervised toothbrushing on caries incidence in children and adloescants

School screening: Insufficient evidence to determine whether there is a role for traditional school dental screening in improving dental attendance. There is low quality evidence that criteria based screening may improve dental attendance when compared to no screening. There is low quality evidence that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. There is low quality evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.

Distributed toothbrushes/paste: Insufficient evidence (from limited primary evidence) to determine the effectiveness of distributed toothbrushes/toothpastes for the prevention of caries and reduction of inequalities

School based oral health education: There is moderate quality evidence that traditional oral health educational actions are effective in reducing plaque, but not gingivitis. There is no long-term evidence with regard to the prevention of plaque, gingivitis or dental caries in the school environment.

Community wide sealant promotion programmes: insufficient evidence to determine the effectiveness of community-wide sealant promotion programs to increase sealant use and prevent dental caries due to a small number of studies with inconsistent results

For full details of the evidence checked, please see the spreadsheet of data held on the JLA website.

Health Research Classification System category  Oral and gastrointestinal
Extra information provided by this PSP
Original uncertainty examples Original questions focused on all age groups (from peri-natal population through to aging population),different ethnic groups and those with special needs. Interventions listed included school dental screening, school based interventions, community water fluoridation, changes in workforce as well as 'oral health interventions' in general.
Submitted by  1 x patients, carers or members of public, 11 x health professionals, 3 x other
PSP information
PSP unique ID 0079
PSP name Oral and Dental Health
Total number of uncertainties identified by this PSP 38  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 12 December 2018