Arora Ankita, Khattri Shivi, Ismail Noorliza Mastura, Kumbargere Nagraj Sumanth, Prashanti Eachempati
Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Melaka-Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Melaka, Malaysia, 751501.
Cochrane Database Syst Rev. 2017 Dec 21;12(12):CD012595. doi: 10.1002/14651858.CD012595.pub2.
School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status.
To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services.
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 15 March 2017), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 15 March 2017), MEDLINE Ovid (1946 to 15 March 2017), and Embase Ovid (15 September 2016 to 15 March 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.
We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another.
We used standard methodological procedures expected by Cochrane.
We included six trials (four were cluster-RCTs) with 19,498 children who were 4 to 15 years of age. Four trials were conducted in the UK and two were based in India. We assessed two trials to be at low risk of bias, one trial to be at high risk of bias and three trials to be at unclear risk of bias.None of the six trials reported the proportion of children with untreated caries or other oral diseases.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found it to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported cost-effectiveness and adverse events.
AUTHORS' CONCLUSIONS: The trials included in this review evaluated short-term effects of screening, assessing follow-up periods of three to eight months. We found very low certainty evidence that was insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening there was no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) improves dental attendance in comparison to screening alone.We did not find any trials addressing cost-effectiveness and adverse effects of school dental screening.
学校口腔检查是指在学校环境中对儿童口腔进行目视检查，随后让家长了解其孩子当前的口腔健康状况和治疗需求。学校检查旨在比症状性疾病出现更早阶段识别儿童，从而促进对儿童的预防性和治疗性口腔保健。本综述评估学校口腔检查在改善口腔健康状况方面的有效性。
评估学校口腔检查项目对整体口腔健康状况和牙科服务使用情况的有效性。
Cochrane口腔健康信息专家检索了以下数据库：Cochrane口腔健康试验注册库（截至2017年3月15日）、Cochrane对照试验中心注册库（CENTRAL，Cochrane研究注册库，截至2017年3月15日）、MEDLINE Ovid（1946年至2017年3月15日）以及Embase Ovid（2016年9月15日至2017年3月15日）。检索了美国国立卫生研究院试验注册库（ClinicalTrials.gov）和世界卫生组织国际临床试验注册平台以查找正在进行的试验。检索电子数据库时对语言或出版状态未设限制；然而，由于Cochrane集中搜索项目旨在识别所有临床试验并将其添加到CENTRAL，因此对Embase的检索限于过去六个月。
我们纳入了评估学校口腔检查与无干预相比或一种检查类型与另一种检查类型相比的随机对照试验（RCTs）（整群或平行）。
我们采用了Cochrane期望的标准方法程序。
我们纳入了六项试验（四项为整群RCTs），涉及19498名4至15岁儿童。四项试验在英国进行，两项试验基于印度。我们评估两项试验偏倚风险低，一项试验偏倚风险高，三项试验偏倚风险不明。六项试验均未报告未经治疗的龋齿或其他口腔疾病儿童比例。四项试验评估了传统检查与无检查的比较。我们对“就诊牙科”这一结果进行了荟萃分析，结果不确定且异质性高。发现异质性部分归因于研究设计（三项整群RCTs和一项个体水平RCT）。由于不一致性，我们将证据降级为“非常低确定性”，无法就此比较得出结论。两项整群RCTs（均为四臂试验）评估了基于标准的检查与无检查的比较，合并效应估计值RR为1.07（95%CI 0.99至1.16），表明检查可能有益（低确定性证据）。将基于标准的检查与传统检查比较时，没有证据表明存在差异（RR 1.01，95%CI 0.94至1.08）（非常低确定性证据）。在一项试验中，将特定（个性化）转诊信与非特定转诊信进行了比较。结果支持特定转诊信，普通牙医服务就诊的效应估计值RR为1.39（95%CI 1.09至1.77），专科正畸医生服务就诊的效应估计值RR为1.90（95%CI 1.18至3.06）（低确定性证据）。一项试验比较了补充激励措施的检查与单独检查。补充激励措施的检查后就诊牙科的可能性更大，效应估计值RR为3.08（95%CI 从2.57至3.71）（低确定性证据）。没有试验进行长期随访以确定学校口腔检查的持久效果。没有试验报告成本效益和不良事件。
本综述纳入的试验评估了检查的短期效果，随访期为三至八个月。我们发现非常低确定性的证据，不足以让我们得出关于传统学校口腔检查在改善就诊牙科方面是否有作用的结论。对于基于标准的检查，我们发现低确定性证据表明与无检查相比可能改善就诊牙科。然而，与传统检查相比，没有证据表明就诊牙科存在差异（非常低确定性证据）。我们发现低确定性证据可得出结论，与非特定转诊信相比，个性化或特定转诊信可改善就诊牙科。我们还发现低确定性证据表明，与单独检查相比，补充激励措施（口腔健康教育和提供免费治疗）的检查可改善就诊牙科。我们未发现任何试验涉及学校口腔检查的成本效益和不良影响。
