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News / September 29, 2009

Guideline aims to reduce tooth decay

by Guy Hiscott

Tooth decay is the single most common chronic disease in Irish children, reports a Health Research Board funded initiative, based at University College Cork (UCC).

In addition, more than half of five-year olds living in areas with non-fluoridated water, and one in three living in fluoridated areas, have one or more teeth that are decayed, filled or have been extracted because of decay. Further, half of all 12-year olds and three-quarters of all 15-year olds have experienced decay in their permanent teeth.

The research has produced comprehensive, evidence-based guidelines to reduce tooth decay in Irish children. Key recommendations include an increased emphasis on early identification of children who are at high risk of developing decay, and strategies to prevent decay for high-risk individuals, as well as for the population at large. 

Carmel Parnell, one of the researchers and a senior dental surgeon in the HSE, said: ‘We systematically reviewed the best international research on prevention of tooth decay in children, and examined relevant guidelines developed in other countries.

‘This evidence was then considered by our multidisciplinary Guideline Development Group, in the context of the Irish health service and the limited existing public dental services. Historically, the public dental service has tried to maximise its available resources by focusing on school-aged children and prevention of decay in permanent teeth, but we know we are seeing children too late to effectively prevent decay.

‘With all of the research evidence pointing towards early identification and preventive measures, particularly at a very young age, we realised that we need involve public health nurses, practice nurses, GPs and other primary care workers, all of whom have regular contact with young children, in identifying pre-school children at high risk of decay, and channeling them into the dental services.

‘In the context of our current health care system, this seemed the most practical way to develop needs-based access to dental services for high caries risk preschool children.’

As part of the research work, the team consulted with key stakeholders to agree the recommendations contained in this guideline. These include:
• An oral assessment should be incorporated into each child’s developmental visit from the age of eight months and recorded in the child’s health record
• Referral pathways should be developed to ensure pre-school children, who are at high risk from tooth decay, can be referred from primary, secondary and social care services into dental services
• Children should be offered a dental assessment during their first year in primary school
• A formal caries risk assessment should be done for children attending the dental clinic for dental assessment or emergency care, using the newly developed Caries Risk Assessment Checklist
• The Caries Risk Assessment Checklist should be integrated into the electronic patient record.

‘These guidelines were drawn up in consultation with groups such as the public health nurses because we recognised that participation of front line primary care staff is a necessary and cost effective way of identifying at-risk preschool children, and getting them into care quickly,’ commented Professor Helen Whelton of UCC, who led the project guideline team.

Prof. Whelton continued: ‘We wanted the guidelines to be practical, to use the existing healthcare services and to take a patient-centred approach. This guideline offers an efficient framework for early identification and effective treatment of children who need dental services. We are confident that it will receive the support it needs to translate these evidence-based recommendations into practice, which will improve the oral health of children in Ireland.’

Commenting on the new guidelines, Enda Connolly, Chief Executive of the Health Research Board, said, ‘If health research is going to have a real impact on public health and patient care, it must be grounded in evidence. It also needs to be translated from a good idea into a change in practice or policy for maximum effect. This project is a perfect illustration of how this can be achieved in an Irish setting. It also highlights how investments in research can lead to more efficient practices and delivery of health services.’

Strategies to prevent dental caries in children and adolescents can be downloaded in full at