USPSTF Reaffirms Advice on Preventing Cavities in Preschoolers

By Reuters Staff

December 08, 2021

NEW YORK (Reuters Health) - The U.S. Preventive Services Task Force (USPSTF) continues to recommend that pediatricians and other primary-care doctors apply fluoride varnish to infants' primary teeth soon after they erupt.

This grade-B recommendation is consistent with the 2014 recommendation from the task force.

The task force also continues to recommend that primary-care doctors prescribe oral fluoride supplements starting at age six months for children who have not had fluoride added to their drinking water. This grade B recommendation is also in line with the earlier recommendation.

Dental caries is the most common chronic disease in children in the U.S., the task force says.

According to National Health and Nutrition Examination Survey (NHANES) data, about 23% of children aged two to five years have dental caries in their primary teeth, which can cause pain, loss of teeth, impaired growth, decreased weight gain, and harm quality of life.

The task force also says there continues to be insufficient evidence to recommend that primary-care doctors routinely examine the mouths of their preschool-aged patients for dental caries.

The updated recommendations are published in JAMA.

"Although the recommendations are largely unchanged from the prior USPSTF Recommendation Statement, the evidence behind these recommendations is stronger, particularly for caries prevention with early application of fluoride varnish," note the authors of a linked editorial.

The American Academy of Pediatrics, American Academy of Pediatric Dentistry, and the American Dental Association currently recommend a visit to the dentist by age one year, Dr. Melinda Clark with Albany Medical Center in New York and Dr. Patricia Braun with Denver Health in Colorado point out.

Yet very few children will have seen a dentist by their first birthday, despite an estimated 10% already having cavities. On the other hand, most children have at least one visit with a healthcare professional by age one year.

"Therefore, primary care clinicians are well-positioned to deliver preventive oral health services, which are proven to reduce caries in young children," the editorial writers say. However, "few primary care clinicians nationwide report providing basic oral health services."

"By adhering to the USPSTF recommended preventive oral health services and enacting evidence-based solutions, primary care clinicians could ensure the delivery of more effective whole-person care; help ameliorate oral health inequities that may be related to socioeconomic status, race and ethnicity, and insurance status; and potentially assist the dental profession in meeting the overwhelming demand for preventive dental care and improving oral health for children," they conclude.

SOURCE:,, and JAMA, online December 7, 2021.