Priority 20 from the Oral and Dental Health PSP

UNCERTAINTY: What is the best way to prevent tooth decay in individuals (of all ages)? (JLA PSP Priority 20)
Overall ranking 20
JLA question ID 0079/20
Explanatory note

Not available for this PSP
Evidence

A wide range of interventions have been evaluated for the prevention of caries (including sealants, varnishes, scale and polish, tooth mousse (CPP-ACP),probiotics, slow-release fluoride devices, fluoride supplements, dietary advice, oral hygiene advice, xylitol)

Sealants: There is moderate quality evidence that resin‐based sealants applied on occlusal surfaces of permanent molars are effective for preventing caries in children and adolescents (at 24 months). There is insufficient evidence to judge the effectiveness of glass ionomer sealant or the relative effectiveness of different types of sealants.

Fluoride varnish: There is moderate quality evidence that fluoride varnish reduces decayed, missing or filled tooth surfaces in both primary and permanent dentition. The evidence regarding the frequency of the application is less clear.

Scale and polish: High quality evidence that for adults without severe periodontitis who regularly access routine dental care, there is little or no difference in gingivitis and probing depths over two to three years between routinely provided scale and polish and no scheduled scale and polish.

Tooth mousse: weak evidence of a short-term remineralization effect of CPP-ACP; insufficient evidence regarding long-terms effects

Probiotics: Insufficient evidence regarding the role of probiotics for preventing caries

Slow-release fluoride devices: There is insufficient evidence to determine the caries-inhibiting effect of slow-release fluoride glass beads.

Fluoride supplements: There is weak evidence that fluoride supplements are associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth; There is weak and inconsistent evidence that the use of fluoride supplements prevents dental caries in primary teeth.

Dietary advice: Insufficient evidence regarding the effectiveness of one-to-one dieatary advice in the dental setting, for the prevention of caries

Oral Hygiene advice: Insufficient high quality evidence to recommend any specific one-to-one oral hygiene advice method as being effective in improving oral health or being more effective than any other method.

Xylitol: insufficient evidence to determine whether xylitol‐containing products (other than fluoride containing toothpastes) can prevent caries in infants, older children, or adults.

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 aspects of the prevention of tooth decay, encompassing a broad range of interventions (including fluoride varnishes, sealants, OHI, reduction in sugar consumption), settings (including primary care settings, educational settings, supermarkets, care homes), healthcare providers, and age groups.  For example, what effect has the discontinuation of school dental checks had on the incidence of dental caries in school age children? What is the best form and setting(s) for a complex intervention to prevent caries in children?   Should free toothbrushes & toothpaste be offered at a dental appointment?  How can we prevent dental disease in the aging population?
Submitted by  6 x patients, carers or members of public, 17 x health professionals, 2 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