The Guide to Community Preventive Services strongly recommends community water fluoridation and school-based sealant programs to prevent tooth decay
A report released today by the Centers for Disease Control and Prevention (CDC) issued a strong recommendation for two community-based interventions to prevent tooth decay — community water fluoridation and school dental sealant programs. Some programs provide pit and fissure sealants to children in a school setting, and others also involve private dental practices or public dental clinics.
Promoting Oral Health: Interventions for Preventing Dental Caries, Oral and Pharyngeal Cancers, and Sports-related Craniofacial Injuries, A Report on the Recommendations of the Task Force on Community Preventive Services (www.cdc.gov/mmwr) summarizes the recommendations of the independent, non-Federal Task Force based on systematic reviews of the scientific evidence of effectiveness for selected community interventions to prevent and control tooth decay, oral (mouth) and pharyngeal (throat) cancers, and sports-related injuries to the head, mouth, and face. These conditions are common, sometimes life-threatening, costly, and potentially preventable by currently used strategies. For example, more than 90 percent of people 18 years and older have had tooth decay.
"This new report combines the best available studies of community water fluoridation and school sealant programs to inform a broad public health audience that show that these interventions are among the most effective means we have for preventing tooth decay," said Dr. William R. Maas, director of CDC's oral health program. "These strategies are particularly useful for reaching entire communities, but especially groups at high risk for decay, and they are essential to achieving the national objectives put forth by Healthy People. Communities should use these findings to support their local planning processes; if local goals and resources permit, use of these interventions should be initiated or increased."
Community water fluoridation is the adjustment of the natural fluoride level in a community's water system to the optimal level for preventing tooth decay, about 1 part per million. Dental sealants are plastic materials applied to the pits and fissures of teeth to prevent tooth decay. School-based programs provide pit and fissure dental sealants to children in a school setting. School-linked programs also involve private dental practices or public dental clinics.
In their review of the evidence, the Task Force found that:
Tooth decay typically decreased by 30 percent to 50 percent after starting or continuing community water fluoridation.
In examining the effectiveness of school-based or school-linked dental sealant programs, there was typically a 60 percent decrease in tooth decay on the chewing surfaces of posterior teeth after sealant application. School-based and linked programs in the U.S. generally target vulnerable populations less likely to receive private dental care such as children eligible for free and reduced lunch programs.
The Task Force also evaluated other community approaches that sought to increase use of dental sealants, to increase early detection of oral cancers and improve health status and reduce mortality from oral cancers, and finally, to encourage the use of helmets, facemasks, and mouthguards in contact sports. However, for these three interventions, the Task Force was unable to make a recommendation either for or against these approaches because of a lack of qualifying studies on which to base a recommendation. This finding indicates the need for more research on effectiveness for these interventions. In the meantime, potential users are encouraged to judge the usefulness of these interventions based on other criteria.
The Task Force review was developed as part of The Guide to Community Preventive Services (Community Guide) which provides recommendations on population-based interventions to promote health and to prevent disease, injury, disability, and premature death, appropriate for use by communities and healthcare systems. More information about the Community Guide (including links to a variety of resources) is available at http://www.thecommunityguide.org . Further information about the Task Force's review on oral health can be found at http://www.thecommunityguide.org/Guide/oralhealth_f1.html
Full findings of the Oral Health Chapter will be published in the American Journal of Preventive Medicine in 2002.