Prevention of Dental Caries in Children From Birth Through Age 5 Years: US

Preventive Services Task Force Recommendation Statement

Virginia A. Moyer
Pediatrics 2014;133;1102; originally published online May 5, 2014;
DOI: 10.1542/peds.2014-0483

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/133/6/1102.full.html

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

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Prevention of Dental Caries in Children From Birth
Through Age 5 Years: US Preventive Services Task Force
Recommendation Statement
AUTHORS: Virginia A. Moyer, MD, MPH, on behalf of the US
abstract Preventive Services Task Force
DESCRIPTION: Update of the 2004 US Preventive Services Task Force KEY WORDS
(USPSTF) recommendation on prevention of dental caries in preschool- dentistry/oral health, preventive medicine
aged children. ABBREVIATIONS
AAPAmerican Academy of Pediatrics
METHODS: The USPSTF reviewed the evidence on prevention of dental ADAAmerican Dental Association
caries by primary care clinicians in children 5 years and younger, fo- NHANESNational Health and Nutrition Examination Survey
cusing on screening for caries, assessment of risk for future caries, USPSTFUS Preventive Services Task Force

and the effectiveness of various interventions that have possible ben- Recommendations made by the US Preventive Services Task
Force are independent of the US government. They should not be
ets in preventing caries. construed as an ofcial position of the Agency for Healthcare
POPULATION: This recommendation applies to children age 5 years Research and Quality or the US Department of Health and
Human Services.
and younger.
The US Preventive Services Task Force (USPSTF) makes
RECOMMENDATION: The USPSTF recommends that primary care clini- recommendations about the effectiveness of specic preventive
cians prescribe oral uoride supplementation starting at age 6 months care services for patients without related signs or symptoms.
for children whose water supply is decient in uoride. (B recommen- It bases its recommendations on the evidence of both the
dation) The USPSTF recommends that primary care clinicians apply benets and harms of the service and an assessment of the
balance. The USPSTF does not consider the costs of providing
uoride varnish to the primary teeth of all infants and children starting a service in this assessment.
at the age of primary tooth eruption. (B recommendation) The USPSTF
The USPSTF recognizes that clinical decisions involve more
concludes that the current evidence is insufcient to assess the bal- considerations than evidence alone. Clinicians should
ance of benets and harms of routine screening examinations for den- understand the evidence but individualize decision making to
tal caries performed by primary care clinicians in children from birth the specic patient or situation. Similarly, the USPSTF notes that
policy and coverage decisions involve considerations in addition
to age 5 years. (I Statement) Pediatrics 2014;133:11021111 to the evidence of clinical benets and harms.
For a list of the USPSTF members, see the Appendix.
www.pediatrics.org/cgi/doi/10.1542/peds.2014-0483
doi:10.1542/peds.2014-0483
Accepted for publication Feb 19, 2014
Address correspondence to USPSTF Coordinator, Agency for
Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD
20850. E-mail: [email protected].
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright 2014 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no nancial relationships relevant to this article to disclose.
FUNDING: The US Preventive Services Task Force is an
independent, voluntary body. The US Congress mandates that
the Agency for Healthcare Research and Quality support the
operations of the US Preventive Services Task Force.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated
they have no potential conicts of interest to disclose.

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 SPECIAL ARTICLE

SUMMARY OF RECOMMENDATIONS balance of benets and harms of rou- RATIONALE

AND EVIDENCE tine screening examinations for dental
Importance
caries performed by primary care
The US Preventive Services Task (USPSTF) Dental caries is the most common
clinicians in children from birth to age
recommendsthatprimarycareclinicians chronic disease in children in the United
5 years. (I Statement)
prescribe oral uoride supplementation States.1 According to the 19992004
starting at age 6 months for children See the Clinical Considerations section
for suggestions for practice regarding National Health and Nutrition Exami-
whose water supply is decient in uo- nation Survey (NHANES), 42% of chil-
the I statement.
ride. (B recommendation) dren ages 2 to 11 years have dental
The target audience for USPSTF rec-
The USPSTF recommends that pri- caries in their primary teeth. After de-
ommendations is primary care clini-
mary care clinicians apply uoride creasing from the early 1970s to the
cians, who provide a wide range of
varnish to the primary teeth of all mid-1990s, the prevalence of dental
health care services to individuals. Al-
infants and children starting at the though dentists can be considered caries in children has been increasing,
age of primary tooth eruption. (B primary care providers of oral health particularly in young children ages 2
recommendation) needs, for the purposes of this rec- to 5 years.2
See the Clinical Considerations section ommendation statement, a primary
for additional information on these care clinician or primary care pro- Recognition of Risk Status
preventive interventions. vider is dened as a nondental health Risk assessment tools generally eval-
The USPSTF concludes that the current care professional (eg, physician, nurse uate risk based on factors such as
evidence is insufcient to assess the practitioner). demographic risk, personal and family

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oral health history, dietary habits, the overall systemic uoride exposure is insufcient, and the balance of ben-
uoride exposure, and oral hygiene level over time. ets and harms of screening cannot be
practices. Information from a clinical No studies specically reported on the determined.
evaluation also has been proposed, risk for uorosis with uoride varnish;
as well as qualitative or quantitative however, compared with other topical CLINICAL CONSIDERATIONS
measure of oral bacterial load. The uoride interventions, systematic ex- Patient Population Under
USPSTF found no studies that evaluated posure to uoride is low after varnish Consideration
the accuracy of risk assessment application.3,4 It is important to con-
instruments for future dental caries in This recommendation applies to chil-
sider a childs overall systemic expo- dren age 5 years and younger.
the primary care setting.
sure to uoride from multiple sources
The USPSTF limited its consideration
(eg, water uoridation, toothpaste, of caries screening and prevention by
Benets of Preventive
Interventions and Early Detection supplements, and/or varnish), but in primary care clinicians to infants and
the United States, enamel uorosis preschool-aged children. The rationale
Preventive Interventions presents as mild cosmetic changes in for this decision was that, at the
The USPSTF found adequate evidence .99% of cases.5 present time, nondental primary care
that oral uoride supplementation, also The USPSTF concludes that there is clinicians are more likely than dentists
known as dietary uoride supplemen- limited evidence about the harms as- to have contact with children ages
tation, in children who have low levels of sociated with uoride varnish or other 5 years and younger in the United
uoride in their water and application preventive interventions for dental States6,7; this situation changes as
of uoride varnish to the primary teeth caries, but that these risks are likely children reach school age and beyond.
of all children can each provide small. In addition, as children grow older,
moderate benet in preventing den- dental professionals use sealants
tal caries. Screening rather than uoride varnish. As such,
The USPSTF found insufcient evidence The USPSTF found no studies addressing the USPSTF limited its review of the
on the benets of provider education of the magnitude of harms of screening evidence of preventive interventions
parents regarding oral hygiene prac- children from birth to age 5 years for for dental caries to this age group.
tices to prevent dental caries in their dental caries or future risk for dental This recommendation should not be
children. caries in the primary care setting. construed to imply that preventive
interventions for dental caries should
Screening USPSTF Assessment cease after 5 years of age.
The USPSTF found no studies address- The USPSTF concludes with moderate
ing the direct effect of routine oral certainty that there is a moderate net Assessment of Risk
screening examinations performed by benet of preventing future dental All children are at potential risk for
primary care clinicians on improved caries with oral uoride supplemen- dental caries; those whose primary
clinical outcomes in children younger tation at recommended doses in chil- water supply is decient in uoride
than 5 years. dren older than 6 months who reside (dened as containing ,0.6 ppm F) are
in communities with inadequate water at particular risk. Although there are
Harms of Preventive Interventions uoride. no validated multivariate screening
and Early Detection
The USPSTF concludes with moderate tools to determine which children are
Preventive Interventions certainty that there is a moderate net at higher risk for dental caries, there
The USPSTF found adequate evidence of benet of preventing future dental are a number of individual factors that
a link between early childhood expo- caries with uoride varnish applica- elevate risk. Higher prevalence and
sure to systemic uoride and enamel tion in all children starting at the age severity of dental caries are found
uorosis, a visible change in the ap- of eruption of primary teeth to age among minority and economically dis-
pearance of the enamel due to altered 5 years. advantaged children. Other risk factors
mineralization. Fluorosis can range The USPSTF concludes that the evi- for caries in children include frequent
from mild (small white spots or dence on performing routine oral sugar exposure, inappropriate bottle
streaks) to severe (discoloration, pit- screening examinations for dental car- feeding, developmental defects of the
ting, or rough enamel), depending on ies in children from birth to age 5 years tooth enamel, dry mouth, and a history

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 SPECIAL ARTICLE

of previous caries. Maternal and family to all children is reasonable, as the Potential Preventable Burden
factors also can increase childrens prevalence of risk factors is high in the Dental caries is the most common
risk. These factors include poor oral US population, the number needed to chronic disease in children in the United
hygiene, low socioeconomic status, treat is low, and the harms of the in- States. It is 4 times more common than
recent maternal caries, sibling caries, tervention are small to none. childhood asthma and 7 times more
and frequent snacking. Additional fac- The USPSTF did not review the evi- common than hay fever. According to
tors associated with dental caries in dence on the effectiveness of tooth the NHANES, the prevalence of dental
young children include lack of access brushing, but regular tooth brushing caries has risen from 24% to 28% be-
to dental care; inadequate preventive with uoride toothpaste by children tween 19881994 and 19992004.2 Ap-
measures, such as failure to use is very important in preventing dental proximately 20% of surveyed children
uoride-containing toothpastes; and caries.10 with caries had not received treatment.
lack of parental knowledge about Symptomatic dental caries in children
oral health.8,9 Timing and Dosage of Preventive are associated with pain, loss of teeth,
Some organizations have advocated Interventions impaired growth, and decreased weight
restricting uoride varnish use to No studies specically addressed the gain, and can affect appearance, self-
children at increased risk. Although dosage and timing of oral uoride esteem, speech, and school perfor-
several caries risk assessment tools supplementation in children with in- mance. Dental-related concerns lead to
exist, none have been validated in the adequate water uoridation. The the loss of more than 54 million school
primary care setting, nor do existing American Dental Association (ADA) rec- hours each year.16
studies demonstrate that these tools, ommendations on the dosage of and
when used by primary care clini- age at which to start dietary uoride Potential Harms
cians, can accurately and consis- supplementation take into account the No studies examined the harms of
tently differentiate between children amount of uoride in the childs water performing primary care screening
who will develop dental caries and source.11 These dosing recommendations examinations for dental caries in
those who will not.8,9 A risk-based also are referenced by the American children from birth to age 5 years.8,9
approach to uoride varnish appli- Academy of Pediatrics (AAP).12 However, given the noninvasive nature
cation will miss opportunities to No study directly assessed the appro- of an oral examination, these harms
provide an effective dental caries priate ages at which to start and stop are expected to be minimal.
preventive intervention to children the application of uoride varnish.
who could benet from it, particu- Current Practice
Available trials of uoride varnish en-
larly because currently, in the United rolled children ages 3 to 5 years; In one study, only about half of pedia-
States, infants and preschool-aged however, given the mechanism of action tricians reported examining the teeth
children are more likely to have reg- of this intervention, benets are very of half of their patients ages 0 to 3
ular visits with nondental primary likely to accrue starting at the time years.17
care clinicians than dental care pro- of primary tooth eruption. Limited evi-
viders.6,7 dence found no clear effect on caries Other Approaches to Prevention
increment between performing a single In April 2013, the Community Preventive
Interventions to Prevent Dental uoride varnish once every 6 months Services Task Force recommended uo-
Caries versus once a year13 or between a sin- ridation of community water sources
As noted previously, oral uoride sup- gle application every 6 months versus based on strong evidence of effective-
plementation prevents dental caries in multiple applications once a year or ness in reducing dental caries.18 It
patients with inadequate water uori- every 6 months.14,15 also recommends school-based dental
dation. sealant delivery programs to prevent
All children with erupted teeth can Suggestions for Practice Regarding caries.
potentially benet from the periodic the I Statement Xylitol may have promise as an addi-
application of uoride varnish, re- In deciding whether to routinely per- tional method to reduce the risk for
gardless of the levels of uoride in their form screening examinations for dental dental caries. Xylitol is classied by the
water. Although the evidence to support caries in children from birth to age US Food and Drug Administration as
varnish is drawn from higher-risk 5 years, clinicians should consider the a dietary supplement and is found in
populations, the provision of varnish following factors. over-the-counter consumer products,

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such as wipes or gum. A single small, to acquire the materials required to pro- caregivers about optimum health prac-
fair-quality trial of xylitol wipes use vide varnish, as well as state-by-state in- tices for oral hygiene at home.
in children ages 6 to 35 months formation on billing codes and any
found a 91% relative reduction in training requirements (available at http:// DISCUSSION
decayed, missing, or lled surface www2.aap.org/oralhealth/PracticeTools.
Burden of Disease
increment19; however, 4 other stud- html). The National Interprofessional
ies showed no clear effect of xylitol Initiative on Oral Health, a consortium Dental caries is the most common
on caries risk in children younger of funders and health professionals, chronic disease in children in the United
than 5 years.2023 As such, there is focuses on educating and training pri- States, and is increasing in prevalence
currently not enough evidence to mary care clinicians on oral health among young children.1 According to
formally recommend its routine use prevention (additional information is the NHANES, the prevalence of tooth
in caries prevention. available at http://www.niioh.org). decay in primary teeth in children ages
2 to 5 years increased from approxi-
OTHER CONSIDERATIONS Cost mately 24% to 28% between 19881994
State Medicaid reimbursement for and 19992004.2 Approximately 20% of
Implementation
uoride varnish application, when of- surveyed children with caries had not
Many primary care providers already fered, ranges from $9 to $53 per ap- received treatment of the condition.
prescribe oral uoride supplementation plication when applied by licensed In addition, the NHANES found that
to patients with low levels of uoride providers who have had appropriate among children ages 2 to 11 years, 54%
in their water; however, application of training, including physicians, physi- of children in households living below
uoride varnish is not currently com- cian assistants, nurse practitioners, the federal poverty threshold had pri-
monly performed in many primary registered nurses, and licensed prac- mary dental caries, as well as one-third
care ofces (estimated at about 4% of tical nurses (varying by state).26 of children in households living 200%
practices in 2009).17 The techniques for above the poverty threshold. Fifty-ve
application are simple and easy to Research Needs and Gaps percent of Mexican American children
learn, and uoride varnish does not have dental caries compared with 43%
Studies are needed to assess and val-
require specialized equipment or per- of African American children and 39%
idate multivariate risk assessment
sonnel and can be applied quickly. of white children. Mexican American
tools that can accurately identify high-
However, providers and other qualied children also are more likely to have
risk populations most likely to benet
staff may require some training before untreated dental caries (33%) than
from caries preventive interventions,
offering this procedure.24,25 Dentists
such as uoride varnish. African American (28%) and white (20%)
and physicians can apply varnish in children.2
all states. In some states, physician Further research also would be helpful
assistants, nurse practitioners, nurses, to conrm the benets of uoride Early childhood caries can cause pain,
varnish among lower-risk and younger loss of teeth, caries later in life, im-
and medical assistants can do so also.
children. paired growth/weight gain, missed
Efforts are under way to address con- school days, and negative effects on
cerns surrounding resources, in- Racial and ethnic minority children, as
quality of life. Caries in early childhood
frastructure, training, and payment well as children living in low socioeco-
are associated with failure to thrive
mechanisms for the provision of uo- nomic conditions, are at signicantly in-
and can affect speech, appearance,
ride varnish in the nondental primary creased risk for caries compared with
and school performance. They are
care setting. For example, the AAP white children and children who live
also associated with an increased risk
Section on Oral Health has partnered in adequate to high socioeconomic con-
for caries in additional primary or
with the Health Resources and Services ditions. Future studies on risk assess-
permanent teeth. More than 51 million
Administrations Maternal and Child mentandpreventiveinterventionsshould
hours of school are missed each
Health Bureau and the ADA Foundation enroll sufcient numbers of racial and
year because of childhood dental
to educate and advocate for primary ethnic minority children to understand
concerns.16
pediatric care professionals to apply the benets and harms of interventions
uoride varnish. They have created in these specic populations.
a Web site with a number of helpful More research also is needed to esti- Scope of Review
tools and resources to assist nondental mate the effectiveness of interventions To update the 2004 recommendation,
primary care providers, including how by clinicians to educate parents and the USPSTF commissioned a systematic

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 SPECIAL ARTICLE

review of the evidence on prevention of supplementation ranged from 32% to Potential Harms of Preventive
dental caries by primary care clinicians 72% for decayed, missing, and lled Interventions
in children 5 years and younger. The teeth and from 38% to 81% for decayed, The USPSTF considered a recently up-
review focused on screening for caries, missing, and lled tooth surfaces ver- dated systematic review on enamel uo-
assessment of risk for future caries, sus placebo (vitamin drops) or no rosis that includes 5 new studies that
and the effectiveness of various inter- supplementation.8,9 were not available for the 2004 recom-
ventions that have possible benets in mendation.35 These observational stud-
preventing caries. Fluoride Varnish ies consistently found an association
Three recent good- and fair-quality between early childhood exposure to
Risk Assessment trials assessed professionally applied systemic uoride and enamel uorosis.
No studies assessed the effective- topical uoride varnish in children 5 The evidence is limited in that measures
ness of the use of formal risk as- years and younger. The trials com- of early childhood uoride exposure
sessment tools by primary care pared uoride varnish applied every were based on parental recall.8,9 Risk
clinicians in identifying children at 6 months with no uoride varnish. estimates ranged from an odds ratio of
highest risk for dental caries. Al- One was conducted in rural Canadian 10.8 (95% condence interval 1.962.0)
though there are tools available from Native populations without water for exposure during the rst 2 years
several professional organizations uoridation and another was con- of life to a slight increase in risk (odds
for use in the primary care setting, no ducted in an Australian aboriginal ratio, 1.11.7, depending on compari-
studies evaluated their performance community with water uoridation son).35 Fluorosis can range from mild
or use. levels of ,0.6 ppm F for nearly 90% of (small white spots or streaks) to severe
participants.33,34 The third trial en- (discoloration, pitting, or brown stain-
Effectiveness of Preventive rolled primarily Latino and Chinese ing), depending on the overall systemic
Interventions underserved children in an urban US uoride exposure level over time. In the
Fluoride Supplementation community with adequate water uo- United States, the prevalence of severe
ridation.13 All 3 trials found that uo- enamel uorosis is estimated at ,1%.5
Six older studies2732 assessed the ef-
ride varnish was associated with a No studies reported the risk for uo-
fectiveness of oral uoride supple-
mentation; the USPSTF found no new decreased risk for dental caries after rosis with uoride varnish application;
studies since its previous 2004 review. 2 years. Absolute mean reductions in however, the degree of systemic uo-
Although the studies had some meth- the number of affected tooth surfaces ride exposure after varnish application
odological limitations, such as lack of ranged from 1.0 to 2.4.8,9 is low.3,4
adjustment for potential confounders, Three fair-quality studies evaluated
the effect of frequency of uoride Potential Harms of Screening
inadequate blinding, or unreported
attrition, and were fairly heteroge- varnish application on caries out- No studies compared harms in chil-
neous, they support the conclusion comes.1315 Two found that multiple dren who were receiving routine oral
that oral uoride supplementation uoride varnish applications within screening examinations versus those
leads to decreased dental caries in a 2-week period were associated with not screened for dental caries by pri-
children 5 years and younger who have no statistically signicant differences mary care providers.8,9
inadequate uoridation in their water. in caries incidence versus a 6-month
application schedule.14,15 One trial Estimate of Magnitude of Net
The single randomized trial (n = 140;
Benet
uoridation level ,0.1 ppm F) found found no statistically signicant dif-
that 0.25-mg uoride drops or chews ference in caries rates for once- versus The USPSTF concludes with moderate
were associated with decreased risk twice-yearly varnish application.13 The certainty that there is a moderate net
for caries versus no uoride supple- optimum frequency of uoride varnish benet to prescribing oral uoride
mentation in Taiwanese children age application is not known. supplementation at recommended doses
2 years at enrollment.31 Relative re- starting at age 6 months to children
ductions ranged from 52% to 72% for Effectiveness of Screening with inadequate uoride in their water.
decayed, missing, and lled teeth and No studies examined the effectiveness There is also moderate net benet to
from 51% to 81% for decayed, missing, of routine oral screening examinations applying uoride varnish to the primary
and lled tooth surfaces. Across all 6 performed by primary care clinicians in teeth of all infants and children starting
trials, relative reductions with uoride preventing dental caries.8,9 at the age of primary tooth eruption.

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The USPSTF found inadequate evidence the application of uoride varnish into In 2004, the USPSTF concluded that
on the effectiveness of routine caries 2 parts to increase clarity surrounding the evidence was insufcient to rec-
screening examinations performed the relevant populations for each in- ommend for or against routine risk
by primary care providers to improve tervention. The USPSTF expanded its assessment by primary care clinicians
outcomes in children 5 years and rationale for why it recommends uo- of children 5 years and younger for the
younger. The USPSTF also found in- ride varnish for all infants and children prevention of dental disease (I state-
adequate evidence regarding the po- once their primary teeth have erupted, ment). The current recommendation
tential harms. rather than only those deemed to be at concludes that there is not enough
Therefore, the USPSTF concludes that high risk, and why it believes that the evidence to recommend for or against
the evidence on the benets and harms available evidence was sufcient to routine oral screening examinations
of routine caries screening examina- make this recommendation for non- for dental caries performed by pri-
tions performed by primary care dental primary care providers. The mary care clinicians in children 5 years
providers in children 5 years and USPSTF added language concerning and younger.
younger is lacking, and the balance potential implementation issues for
of benets and harms cannot be de- the use of uoride varnish by primary RECOMMENDATIONS OF OTHERS
termined. care professionals. The USPSTF also
The AAP has issued 2 policy statements
claried the denitions of primary
related to dental care in children. The
How Does Evidence Fit With Biologic care provider, dental practitioner,
rst, issued in 2003 and reafrmed
Understanding? and inadequate water uoridation.
in 2009, encourages providers to in-
Systemic uoride becomes incorporated Finally, the USPSTF included an expla-
corporate oral healthrelated services
into tooth structures during their for- nation of the target age range for this
into their practices. Specically, the
mation. If uoride is ingested repeatedly recommendation and provided addi-
AAP recommends an oral health as-
during tooth development, it is de- tional details on enamel uorosis.
sessment for all children by age 6
posited throughout the tooth surface months and a rst dental visit by age
and provides protection against car- UPDATE OF PREVIOUS 1 year.38 The second statement sup-
ies. Topical uoride treatments, such RECOMMENDATION ports oral uoride supplementation
as varnishes, help protect teeth that This is an update of the 2004 USPSTF and application of uoride varnish in
are already present. In this method, recommendation statement, in which children at risk for dental caries.39
uoride is incorporated into the sur- the USPSTF recommended that primary The ADA recommends that children be
face layer of the teeth, making them care clinicians prescribe oral uoride seen by a dentist within 6 months of
more resistant to decay. Systemic supplementation to children 6 months eruption of the rst tooth and no later
uoride also provides some measure and older whose primary water source than age 12 months. It also recom-
of topical effects, as it is found in the is decient in uoride (B recommenda- mends the application of uoride var-
saliva and bathes the teeth. Thus, tion). This recommendation was based nish every 6 months in preschool-aged
providing both systemic and topical on fair evidence that prescription of children who are at moderate risk
uoride to children during tooth de- oral uoride supplements by primary for dental caries and every 3 to 6
velopment ts with the biologic un- care clinicians to young children with months in children who are at high
derstanding of uorides protective low uoride exposure is associated risk.40 It recommends daily dietary
actions against dental decay.36,37 with reduced risk for dental caries uoride supplements for children
that outweighs the potential harms from birth to age 16 years who are at
Response to Public Comments of enamel uorosis, which primarily high risk for developing dental caries
A draft version of this recommendation manifests in the United States as mild and whose primary source of drinking
statement was posted for public com- cosmetic discoloration of the teeth. water is decient in uoride; high-risk
ment on the USPSTF Web site from The current statement similarly recom- status can be determined by using
May 21 to June 20, 2013. All comments mends oral uoride supplementation, risk assessment tools developed by 1
received were reviewed during the but expands to include the recommen- of several professional health organ-
creation of the nal recommendation dation that primary care providers apply izations. Dietary uoride supplemen-
statement. Based on public feedback, uoride varnish to the primary teeth of tation is not recommended when
the USPSTF separated its recommen- all children 5 years and younger starting water uoridation levels are .0.6
dation on uoride supplementation and at tooth eruption. ppm F.11

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 SPECIAL ARTICLE

The Centers for Disease Control and limit the use of high-concentration states that children at increased risk for
Prevention recommends that clinicians uoride products, such as varnish and caries should receive a professional
counsel parents about appropriate use gel, to high-risk individuals.37 uoride treatment (eg, 5% sodium uo-
of uoridated toothpastes, especially in The American Academy of Pediatric Den- ride varnish or 1.23% acidulated phos-
children 2 years and younger; prescribe tistry states that uoride dietary supple- phate uoride) every 6 months.41
uoride supplements to children at high ments should be considered for children The American Academy of Family
risk for dental caries whose drinking at risk for caries who drink uoride- Physicians is updating its recom-
water lacks adequate uoridation; and decient (,0.6 ppm) water. It also mendations on the subject.

REFERENCES
1. National Center for Health Statistics. 10. Marinho VC, Higgins JP, Sheiham A, Logan Fluoridation. Atlanta, GA: Community Pre-
Healthy People 2010 Final Review. Hyatts- S. Fluoride toothpastes for preventing ventive Services Task Force; 2013. Available
ville, MD: National Center for Health Sta- dental caries in children and adolescents. at: www.thecommunityguide.org/oral/uo-
tistics; 2012. Available at: www.cdc.gov/ Cochrane Database Syst Rev. 2003;(1): ridation.html. Accessed January 28, 2014
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 SPECIAL ARTICLE

APPENDIX (Mount Sinai School of Medicine, New MS (Veterans Affairs Palo Alto Health
York, and James J. Peters Veterans Care System, Palo Alto, and Stanford
Affairs Medical Center, Bronx, NY); University, Stanford, CA); William R.
US PREVENTIVE SERVICES TASK
Linda Ciofu Baumann, PhD, RN (Uni- Phillips, MD, MPH (University of
FORCE
versity of Wisconsin, Madison, WI); Washington, Seattle, WA); and Michael
Members of the USPSTF at the time this Susan J. Curry, PhD (University of Iowa P. Pignone, MD, MPH (University of
recommendation was nalized* are College of Public Health, Iowa City, IA); North Carolina, Chapel Hill, NC).
Virginia A. Moyer, MD, MPH, Chair Mark Ebell, MD, MS (University of Former USPSTF members Adelita
(American Board of Pediatrics, Chapel Georgia, Athens, GA); Francisco A.R. Gonzales Cantu, RN, PhD, David C.
Hill, NC); Michael L. LeFevre, MD, MSPH, Garca, MD, MPH (Pima County Depart- Grossman, MD, MPH, and Glenn
Co-Vice Chair (University of Missouri ment of Health, Tucson, AZ); Jessica Flores, MD, also contributed to the
School of Medicine, Columbia, MO); Herzstein, MD, MPH (Air Products, development of this recommenda-
Albert L. Siu, MD, MSPH, Co-Vice Chair Allentown, PA); Douglas K. Owens, MD, tion.

*
For a list of current Task Force members, go to www.
uspreventiveservicestaskforce.org/members.htm.

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Prevention of Dental Caries in Children From Birth Through Age 5 Years: US
Preventive Services Task Force Recommendation Statement
Virginia A. Moyer
Pediatrics 2014;133;1102; originally published online May 5, 2014;
DOI: 10.1542/peds.2014-0483
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/133/6/1102.full.
html
References This article cites 32 articles, 9 of which can be accessed free
at:
http://pediatrics.aappublications.org/content/133/6/1102.full.
html#ref-list-1
Post-Publication One P3R has been posted to this article:
Peer Reviews (P3Rs) http://pediatrics.aappublications.org/cgi/eletters/133/6/1102

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