Pacific Northwest Evidence-based Practice Center, the Department of Medical Informatics and Clinical Epidemiology; Oregon Health & Science University, Portland.
Division of General Internal Medicine; Oregon Health & Science University, Portland.
JAMA. 2023 Nov 14;330(18):1780-1790. doi: 10.1001/jama.2023.20685.
Dental caries and periodontal disease are common adult oral health conditions and potentially amenable to primary care screening and prevention.
To systematically review the evidence on primary care screening and prevention of dental caries and periodontal disease in adults to inform the US Preventive Services Task Force.
MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (to October 3, 2022); surveillance through July 21, 2023.
Diagnostic accuracy studies of primary care screening instruments and oral examination; randomized and nonrandomized trials of screening and preventive interventions; cohort studies on primary care oral health screening and preventive intervention harms.
One investigator abstracted data; a second checked accuracy. Two investigators independently rated study quality. Diagnostic accuracy data were pooled using a bivariate mixed-effects binary regression model.
Dental caries, periodontal disease, morbidity, quality of life, harms; and diagnostic test accuracy.
Five randomized clinical trials, 5 nonrandomized trials, and 6 observational studies (total 3300 participants) were included. One poor-quality trial (n = 477) found no difference between oral health screening during pregnancy vs no screening in caries, periodontal disease, or birth outcomes. One study (n = 86) found oral health examination by 2 primary care clinicians associated with low sensitivity (0.42 and 0.56) and high specificity (0.84 and 0.87) for periodontal disease and with variable sensitivity (0.33 and 0.83) and high specificity (0.80 and 0.93) for dental caries. Four studies (n = 965) found screening questionnaires associated with a pooled sensitivity of 0.72 (95% CI, 0.57-0.83) and specificity of 0.74 (95% CI, 0.66-0.82) for periodontal disease. For preventive interventions no study evaluated primary care counseling or dental referral, and evidence from 2 poor-quality trials (n = 178) of sealants, and 1 fair-quality and 4 poor-quality trials (n = 971) of topical fluorides, was insufficient. Three fair-quality trials (n = 590) of persons with mean age 72 to 80 years found silver diamine fluoride solution associated with fewer new root caries lesions or fillings vs placebo (mean reduction, -0.33 to -1.3) and decreased likelihood of new root caries lesion (2 trials; adjusted odds ratio, 0.4 [95% CI, 0.3-0.7]). No trial evaluated primary care-administered preventive interventions.
Screening questionnaires were associated with moderate diagnostic accuracy for periodontal disease. Research is needed to determine benefits and harms of oral health primary care screening and preventive interventions.
龋齿和牙周病是常见的成人口腔健康状况，可能适合初级保健筛查和预防。
系统回顾成人龋齿和牙周病的初级保健筛查和预防的证据，为美国预防服务工作组提供信息。
MEDLINE、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库（截至 2022 年 10 月 3 日）；2023 年 7 月 21 日进行监测。
初级保健筛查工具和口腔检查的诊断准确性研究；筛查和预防干预的随机和非随机试验；初级保健口腔健康筛查和预防干预危害的队列研究。
一名调查员提取数据；第二名调查员检查准确性。两名调查员独立评估研究质量。使用双变量混合效应二项回归模型对诊断准确性数据进行汇总。
龋齿、牙周病、发病率、生活质量、危害；以及诊断测试准确性。
纳入了 5 项随机临床试验、5 项非随机试验和 6 项观察性研究（共 3300 名参与者）。一项质量较差的试验（n=477）发现，在妊娠期间进行口腔健康筛查与不筛查相比，在龋齿、牙周病或分娩结局方面没有差异。一项研究（n=86）发现，由 2 名初级保健临床医生进行口腔健康检查与牙周病的低敏感性（0.42 和 0.56）和高特异性（0.84 和 0.87）相关，与龋齿的可变敏感性（0.33 和 0.83）和高特异性（0.80 和 0.93）相关。四项研究（n=965）发现，筛查问卷对牙周病的敏感性为 0.72（95%置信区间，0.57-0.83），特异性为 0.74（95%置信区间，0.66-0.82）。对于预防干预措施，没有研究评估初级保健咨询或牙科转诊，2 项质量较差的试验（n=178）的窝沟封闭剂和 1 项质量良好和 4 项质量较差的试验（n=971）的局部氟化物的证据不足。三项质量良好的试验（n=590）对平均年龄为 72 至 80 岁的人群进行了研究，发现与安慰剂相比，银胺氟化物溶液与较少的新根龋或填充物相关（平均减少量为-0.33 至-1.3），并且新根龋病变的可能性降低（2 项试验；调整后的优势比，0.4 [95%置信区间，0.3-0.7]）。没有试验评估初级保健管理的预防干预措施。
筛查问卷与牙周病的中等诊断准确性相关。需要研究口腔初级保健筛查和预防干预的益处和危害。
