Bhaskar Vaishnavi, McGraw Kathleen A, Divaris Kimon
Department of Health Policy and Management, Gillings School of Global Public Health, Chapel Hill, NC, USA.
Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Clin Cosmet Investig Dent. 2014 Mar 20;6:21-7. doi: 10.2147/CCIDE.S41499. eCollection 2014.
Dental caries, the most common childhood chronic disease, disproportionately affects vulnerable parts of the population and confers substantial impacts to children, families, and health systems. Because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation secondary to disease development, early preventive dental visits (EPDVs) are widely advocated by professional and academic stakeholders. The aim of this comprehensive review was to critically review and summarize available evidence regarding the effectiveness of EPDVs in improving children's oral health outcomes.
A systematic literature search of the PubMed and Embase electronic databases was undertaken to identify peer-reviewed publications investigating the effectiveness of EPDVs on oral health outcomes, including clinical, behavioral, and cost end points up to October 30, 2013. Outcomes of the identified studies were abstracted and summarized independently by two investigators.
Four manuscripts met the inclusion criteria and were included in the review. All studies were conducted in the US and employed a retrospective cohort study design using public insurance-claims data, whereas one study matched claims files with kindergarten state dental surveillance data. That study found no benefit of EPDVs in future clinically determined dental caries levels in kindergarten. The other three studies found mixed support for an association of EPDVs with subsequent more preventive and fewer nonpreventive visits and lower nonpreventive service-related expenditures. Selection bias and a problem-driven dental care-seeking pattern were frequently articulated themes in the reviewed studies.
The currently available evidence base supporting the effectiveness of EPDVs and the year 1 first dental visit recommendation is weak, and more research is warranted. The benefits of EPDVs before the age of 3 years are evident among children at high risk or with existing dental disease. However, EPDVs may be associated with reduced restorative dental care visits and related expenditures during the first years of life.
龋齿是儿童最常见的慢性疾病，对弱势群体的影响尤为严重，给儿童、家庭和卫生系统带来了巨大影响。由于促进口腔健康和预防疾病的努力从根本上优于疾病发生后的牙齿修复，专业和学术利益相关者广泛倡导早期预防性牙科就诊（EPDV）。本综述的目的是批判性地回顾和总结关于EPDV在改善儿童口腔健康结果方面有效性的现有证据。
对PubMed和Embase电子数据库进行系统文献检索，以识别截至2013年10月30日研究EPDV对口腔健康结果有效性的同行评审出版物，包括临床、行为和成本终点。两名研究人员独立提取和总结了所识别研究的结果。
四篇手稿符合纳入标准并被纳入综述。所有研究均在美国进行，采用回顾性队列研究设计，使用公共保险理赔数据，其中一项研究将理赔档案与幼儿园州牙科监测数据进行了匹配。该研究发现EPDV对未来幼儿园临床确定的龋齿水平没有益处。其他三项研究对EPDV与随后更多预防性就诊、更少非预防性就诊以及更低的非预防性服务相关支出之间的关联支持不一。选择偏倚和问题驱动的牙科就诊模式是综述研究中经常提到的主题。
目前支持EPDV有效性和1岁首次牙科就诊建议的证据基础薄弱，需要更多研究。在高危或患有现有牙科疾病的儿童中，3岁前进行EPDV的益处是明显的。然而，EPDV可能与生命最初几年修复性牙科就诊和相关支出的减少有关。
