Scolaris Content Display Scolaris Content Display

Cochrane Database of Systematic Reviews

Programas de cribado odontológico en escuelas para la salud bucodental

Esta versión no es la más reciente

ver la versión actual 27 julio 2022

Información

DOI:
https://doi.org/10.1002/14651858.CD012595.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 21 diciembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Salud oral

Copyright:
  1. Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

Cifras del artículo

Altmetric:

Citado por:

Citado 0 veces por enlace Crossref Cited-by

Contraer

Autores

  • Ankita Arora

    Correspondencia a: Department of Pedodontics and Preventive Dentistry, Faculty of Dentistry, Melaka‐Manipal Medical College, Melaka, Malaysia

    [email protected]

  • Shivi Khattri

    Department of Periodontics, Subharti Dental College and Hospital, Meerut, India

  • Noorliza Mastura Ismail

    Department of Community Dentistry, Faculty of Dentistry, Melaka‐Manipal Medical College, Melaka, Malaysia

  • Sumanth Kumbargere Nagraj

    Department of Oral Medicine and Oral Radiology, Faculty of Dentistry, Melaka‐Manipal Medical College, Melaka, Malaysia

  • Eachempati Prashanti

    Department of Prosthodontics, Faculty of Dentistry, Melaka‐Manipal Medical College, Melaka, Malaysia

Contributions of authors

Ankita Arora: drafting the protocol, screening trials, data extraction, assessment of risk of bias and entering data into RevMan 5, selection of trials, drafting the final review and updating the review.
Shivi Khattri: undertaking searches, selecting trials, data extraction and entering data into RevMan 5, drafting the final review and updating the review.
Noorliza Mastura Ismail: screening articles, selecting trials, drafting the final review and updating the review.
Sumanth Kumbargere Nagraj: selecting the trials, data analysis, assessment of risk of bias, drafting the final review and updating the review.
Eachempati Prashanti: drafting the protocol, drafting the final review, updating the review and acting as arbiter.

Sources of support

Internal sources

  • Melaka Manipal Medical College, Manipal University, Melaka Campus, Malaysia.

    Library support and providing training in Cochrane Systematic Reviews

  • Cochrane South Asia Centre, CMC, Vellore, India.

    Methodological and statistical support was provided in this Cochrane systematic review.

External sources

  • National Institute for Health Research (NIHR), UK.

    This review was supported by the NIHR, via Cochrane Infrastructure funding to Cochrane Oral Health. The views and opinions expressed herein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, the NIHR, the NHS or the Department of Health.

  • Cochrane Oral Health Global Alliance, Other.

    The production of Cochrane Oral Health reviews has been supported financially by our Global Alliance since 2011 (oralhealth.cochrane.org/partnerships‐alliances). Contributors over the past year have been the American Association of Public Health Dentistry, USA; the British Association for the Study of Community Dentistry, UK; the British Society of Paediatric Dentistry, UK; the Canadian Dental Hygienists Association, Canada; the Centre for Dental Education and Research at All India Institute of Medical Sciences, India; the National Center for Dental Hygiene Research & Practice, USA; New York University College of Dentistry, USA; and NHS Education for Scotland, UK; Swiss Society of Endodontology, Switzerland.

Declarations of interest

Ankita Arora: no interests to declare
Shivi Khattri: no interests to declare
Noorliza Mastura Ismail: no interests to declare
Sumanth Kumbargere Nagraj: no interests to declare
Eachempati Prashanti: no interests to declare

Acknowledgements

The authors thank Ms Laura MacDonald, Managing Editor; Ms Anne Littlewood, Information Specialist; Ms Janet Lear, Administrator; and Ms Jo Weldon, Research Co‐ordinator, all from Cochrane Oral Health. We acknowledge input from Cochrane Oral Health editors Anne‐Marie Glenny, Paul Brocklehurst and May Wong. We thank our external referees Lucy Burbridge and Ayesha Masood, and copy editor Jason Elliot‐Smith. We are grateful to Ms.Shazana Binti Mohd Selva, Chief Librarian, Melaka Manipal Medical College; Professor Dr. Abdul Rashid Haji Ismail, Dean, Faculty of Dentistry; and Professor Adinegara Lutfi Abas, HoD ‒ Community Medicine, Melaka Manipal Medical College for their kind support all through the review preparation. We acknowledge all the suggestions and help from Professor Prathap Tharyan, Mr Richard Kirubakaran and Mr Jabez Paul from CMC Vellore, Cochrane South Asia Centre, during the review preparation. We express our gratitude to Ms Anette Blumle, Cochrane Deutschland, for the translation help. We sincerely thank authors Easter Joury, King's College London Dental Institute, and Suchitra Nelson, Case Western Reserve University, Ohio, who responded to our queries.

Version history

Published

Title

Stage

Authors

Version

2022 Jul 27

School dental screening programmes for oral health

Review

Ankita Arora, Sumanth Kumbargere Nagraj, Shivi Khattri, Noorliza Mastura Ismail, Prashanti Eachempati

https://doi.org/10.1002/14651858.CD012595.pub4

2019 Aug 08

School dental screening programmes for oral health

Review

Ankita Arora, Shivi Khattri, Noorliza Mastura Ismail, Sumanth Kumbargere Nagraj, Prashanti Eachempati

https://doi.org/10.1002/14651858.CD012595.pub3

2017 Dec 21

School dental screening programmes for oral health

Review

Ankita Arora, Shivi Khattri, Noorliza Mastura Ismail, Sumanth Kumbargere Nagraj, Eachempati Prashanti

https://doi.org/10.1002/14651858.CD012595.pub2

2017 Mar 09

School dental screening programmes for oral health

Protocol

Ankita Arora, Shivi Khattri, Noorliza Mastura Ismail, Kumbargere N Sumanth, Eachempati Prashanti

https://doi.org/10.1002/14651858.CD012595

Differences between protocol and review

We would have assessed reporting bias as planned if there were more than 10 studies included in a meta‐analysis.

In the case of dropouts, we intended to use the data as reported by the paper and deal with it in the 'Risk of bias' assessment. However, in the outcome 'Dental attendance', dropout was considered as a part of the outcome (not attending the dentist) and hence we redefined the term 'dropout' in this review.

We planned subgroup analysis on the basis of age group, targeted or universal screening, post‐screening treatment set‐up and treatment charges. However, we performed subgroup analyses on the basis of cluster versus parallel group study design because of substantial heterogeneity.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Child; Humans;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

A schema of school dental screening process
Figuras y tablas -
Figure 1

A schema of school dental screening process

Ir a la figura de la revisiónAbrir en una pestaña nueva

Study flow diagram
Figuras y tablas -
Figure 2

Study flow diagram

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figuras y tablas -
Figure 3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

Ir a la figura de la revisiónAbrir en una pestaña nueva

Risk of bias summary: review authors' judgements about each risk of bias item for each included study
Figuras y tablas -
Figure 4

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

Ir a la figura de la revisiónAbrir en una pestaña nueva

Forest plot of comparison: 1 Traditional screening versus no screening, outcome: 1.1 Dental attendance
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Traditional screening versus no screening, outcome: 1.1 Dental attendance

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 1 Traditional screening versus no screening, Outcome 1 Dental attendance.
Figuras y tablas -
Analysis 1.1

Comparison 1 Traditional screening versus no screening, Outcome 1 Dental attendance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 2 Criteria‐based screening versus no screening, Outcome 1 Dental attendance.
Figuras y tablas -
Analysis 2.1

Comparison 2 Criteria‐based screening versus no screening, Outcome 1 Dental attendance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 3 Criteria‐based versus traditional screening, Outcome 1 Dental attendance.
Figuras y tablas -
Analysis 3.1

Comparison 3 Criteria‐based versus traditional screening, Outcome 1 Dental attendance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 4 Criteria‐based screening with specific referral versus criteria‐based screening with non‐specific referral, Outcome 1 Dental attendance.
Figuras y tablas -
Analysis 4.1

Comparison 4 Criteria‐based screening with specific referral versus criteria‐based screening with non‐specific referral, Outcome 1 Dental attendance.

Ir a la figura de la revisiónAbrir en una pestaña nueva

Comparison 5 Traditional screening with motivation versus traditional screening alone, Outcome 1 Dental attendance.
Figuras y tablas -
Analysis 5.1

Comparison 5 Traditional screening with motivation versus traditional screening alone, Outcome 1 Dental attendance.

Ir a la figura de la revisiónAbrir en una pestaña nueva
Summary of findings for the main comparison. Traditional screening compared to no screening for increasing dental attendance

Traditional screening compared to no screening for increasing dental attendance

Population: increasing dental attendance
Setting: primary and secondary school
Intervention: traditional screening
Comparison: no screening

Outcomes

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Number of participants (studies)

Certainty of the evidence
(GRADE)

What happens

Without no screening

With traditional screening

Difference

Dental attendance

Follow‐up: 3 to 4 months

Data not pooled

6281
(4 RCTs)

⊕⊝⊝⊝
VERY LOW 1 2

There was substantial heterogeneity, in part due to study design (3 cluster RCTs and 1 individual‐level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.

*The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Praveen 2014 and Zarod 1992 trials have unclear selection bias, performance and detection bias. Downgraded by two levels

2 High heterogeneity (I2 = 91%). Downgraded by one level

Figuras y tablas -
Summary of findings for the main comparison. Traditional screening compared to no screening for increasing dental attendance
Ir a la tabla de la revisión
Summary of findings 2. Criteria‐based screening compared to no screening for increasing dental attendance

Criteria‐based screening compared to no screening for increasing dental attendance

Population: school children
Setting: primary and secondary schools
Intervention: criteria‐based screening
Comparison: no screening

Outcomes

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Number of participants (studies)

Certainty of the evidence
(GRADE)

Comment

With no screening

With criteria‐based screening

Difference

Dental attendance

Follow‐up: 3 to 4 months

RR 1.07
(0.99 to 1.16)

33.1%

35.5%
(32.8 to 38.1)

2.3% more
(0.3 fewer to 5 more)

4980
(2 RCTs)

⊕⊕⊝⊝
LOW 1

There is 7% relative increase in the dental attendance in criteria‐based screening group compared to no screening with 95% CI ranging from 1% decrease to 16% increase.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Cunningham 2009 trial has wide CI ranging from no effect to favourable effect and ICC is borrowed from Milsom 2006 trial. Downgraded by 2 levels

Figuras y tablas -
Summary of findings 2. Criteria‐based screening compared to no screening for increasing dental attendance
Ir a la tabla de la revisión
Summary of findings 3. Criteria‐based screening compared to traditional screening for increasing dental attendance

Criteria‐based screening compared to traditional screening for increasing dental attendance

Population: school children
Setting: primary and secondary schools
Intervention: criteria‐based screening
Comparison: traditional screening

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with traditional screening

Risk with criteria‐based screening

Dental attendance
follow‐up: range 3 months to 4 months

335 per 1000

338 per 1000
(315 to 362)

RR 1.01
(0.94 to 1.08)

5316
(2 RCTs)

⊕⊝⊝⊝
VERY LOW 1 2

There is 1% relative increase in the dental attendance in criteria‐based screening compared to traditional screening with 95% CI ranging from 6% decrease to 8% increase in the attendance

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1 Results of both the trials are ranging from favouring traditional screening to no effect. Downgraded by two levels.

2 Wide 95% CI in Cunningham 2009 trial crossing the line of no effect. Downgraded by one level

Figuras y tablas -
Summary of findings 3. Criteria‐based screening compared to traditional screening for increasing dental attendance
Ir a la tabla de la revisión
Summary of findings 4. Criteria‐based screening with specific referral compared to criteria‐based screening with non‐specific referral for increasing dental attendance

Criteria‐based screening with specific referral compared to criteria‐based screening with non‐specific referral for increasing dental attendance

Population: school children
Setting: secondary school
Intervention: criteria‐based screening with specific referral
Comparison: criteria‐based screening with non‐specific referral

Outcomes

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Number of participants (studies)

Certainty of the evidence
(GRADE)

Comment

With criteria‐based screening with non‐specific referral

With criteria‐based screening with specific referral

Difference

Dental attendance at general dentist

Follow‐up: mean 8 months

RR 1.39
(1.09 to 1.77)

49.0%

68.1%
(53.4 to 86.7)

19.1% more
(4.4 more to 37.7 more)

201
(1 RCT)

⊕⊕⊝⊝
LOW 1

There is 39% relative increase in the attendance to general dentist in the specific referral group compared to non‐specific group, with 95% CI ranging from 9% to 77% increase in attendance.

Dental attendance at orthodontist

Follow‐up: mean 8 months

RR 1.90
(1.18 to 3.06)

19.4%

36.8%
(22.9 to 59.3)

17.4% more
(3.5 more to 39.9 more)

201
(1 RCT)

⊕⊕⊝⊝
LOW 1

There is 90% relative increase in the attendance to orthodontist in the specific referral group compared to the non‐specific group with 95% CI ranging from 18% to 206% increase in attendance.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1Burden 1994 is a single study of secondary school children (11 to 12 years) at unclear risk of selection bias. Downgraded by two levels

Figuras y tablas -
Summary of findings 4. Criteria‐based screening with specific referral compared to criteria‐based screening with non‐specific referral for increasing dental attendance
Ir a la tabla de la revisión
Summary of findings 5. Traditional screening with motivation compared to traditional screening for increasing dental attendance

Traditional screening with motivation compared to traditional screening for increasing dental attendance

Patient or population: school children
Setting: primary and secondary schools
Intervention: traditional screening with motivation
Comparison: traditional screening

Outcomes

Relative effect
(95% CI)

Anticipated absolute effects* (95% CI)

Number of participants (studies)

Certainty of the evidence
(GRADE)

What happens

Without traditional screening with motivation

With traditional screening with motivation

Difference

Dental attendance

Follow‐up: mean 3 months

RR 3.08
(2.57 to 3.71)

10.0%

30.9%
(25.8 to 37.2)

20.9% more
(15.7 more to 27.2 more)

2486
(1 RCT)

⊕⊕⊝⊝
LOW 1

There is 208% relative increase in the attendance of the motivation group compared to control group with 95% CI ranging from 157% to 271% increase in attendance.

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; RR: risk ratio; OR: odds ratio

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect

1 Hebbal 2005 trial has unclear risk of selection bias and high risk of performance bias. Downgraded by two levels

Figuras y tablas -
Summary of findings 5. Traditional screening with motivation compared to traditional screening for increasing dental attendance
Ir a la tabla de la revisión
Table 1. Data adjusted to minimise clustering effect

Data values for total number and events to be divided by effect estimate across all studies

Effect estimate: 1 + (M − 1)ICC

M = average cluster size

ICC = 0.03 (borrowed from Milsom 2006)

Total number of

participants

(original)

Total number

of participants

(adjusted)

Events ‒ original

children attending

dental office)

Events ‒ adjusted

(children attending

dental office)

Cunningham 2009

1 + (15 − 1).03 = 1.42

Control arm

Traditional arm

Criteria‐based arm

819

1175

958

577

827

675

129

165

151

91

116

107

Milsom 2006

1 + (42 − 1).03 = 2.23

Control arm

Traditional arm

Criteria‐based arm

4226

4418

4087

1895

1981

1833

1624

1838

1695

728

824

760

Praveen 2014

1 + (8 − 1).03 = 1.21

Control arm

Intervention arm

300

300

248

248

80

54

67

45
Figuras y tablas -
Table 1. Data adjusted to minimise clustering effect
Ir a la tabla de la revisión
Comparison 1. Traditional screening versus no screening

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dental attendance Show forest plot

4

Risk Ratio (IV, Random, 95% CI)

Subtotals only

1.1 Cluster RCT with ICC 0.03

3

5776

Risk Ratio (IV, Random, 95% CI)

1.10 [0.89, 1.35]

1.2 Individual‐level RCT

1

505

Risk Ratio (IV, Random, 95% CI)

1.74 [1.47, 2.05]
Figuras y tablas -
Comparison 1. Traditional screening versus no screening
Ir a la tabla de la revisión
Comparison 2. Criteria‐based screening versus no screening

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dental attendance Show forest plot

2

4980

Risk Ratio (IV, Random, 95% CI)

1.07 [0.99, 1.16]
Figuras y tablas -
Comparison 2. Criteria‐based screening versus no screening
Ir a la tabla de la revisión
Comparison 3. Criteria‐based versus traditional screening

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dental attendance Show forest plot

2

5316

Risk Ratio (IV, Random, 95% CI)

1.01 [0.94, 1.08]
Figuras y tablas -
Comparison 3. Criteria‐based versus traditional screening
Ir a la tabla de la revisión
Comparison 4. Criteria‐based screening with specific referral versus criteria‐based screening with non‐specific referral

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dental attendance Show forest plot

1

402

Risk Ratio (IV, Random, 95% CI)

1.52 [1.15, 2.00]

1.1 Attending general dentist

1

201

Risk Ratio (IV, Random, 95% CI)

1.39 [1.09, 1.77]

1.2 Attending orthodontist

1

201

Risk Ratio (IV, Random, 95% CI)

1.90 [1.18, 3.06]
Figuras y tablas -
Comparison 4. Criteria‐based screening with specific referral versus criteria‐based screening with non‐specific referral
Ir a la tabla de la revisión
Comparison 5. Traditional screening with motivation versus traditional screening alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Dental attendance Show forest plot

1

2486

Risk Ratio (IV, Random, 95% CI)

3.08 [2.57, 3.71]
Figuras y tablas -
Comparison 5. Traditional screening with motivation versus traditional screening alone
Ir a la tabla de la revisión