Source: Press Release
Disclosures: Braun, Clark and Kubik report no relevant financial disclosures.
December 07, 2021
3 min read

USPSTF: Primary care clinicians with younger patients should prescribe, apply fluoride

Source: Press Release
Disclosures: Braun, Clark and Kubik report no relevant financial disclosures.
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The U.S. Preventive Services Task Force has issued several final recommendations regarding the oral health of children.

The USPSTF recommended that primary care clinicians prescribe oral fluoride supplementation in asymptomatic children aged 6 months to 5 years “whose water supply is deficient in fluoride” (that is, it contains fewer than 0.6 parts fluoride per million parts water). The task force also encouraged these same health care professionals to apply fluoride varnish that contains 5% sodium fluoride to the primary teeth of all infants and children in the same age group without symptoms of dental caries once the individual’s primary tooth erupts.

NHANES data from 2011-2016 indicate that: 23% of children aged 2 to 5 years had dental caries.
Reference: USPSTF. JAMA. 2021;doi:10.1001/jama.2021.20007.

The task force also said there is not enough evidence “to assess the balance of benefits and harms of routine screening examinations for dental caries” in asymptomatic children younger than 5 years.

“About half of pediatricians report examining the teeth of more than half of their patients between birth and age 3 years,” the task force wrote. “Fewer report regularly applying fluoride varnish.”

National Health and Nutrition Examination Survey data indicate about 23% of children aged 2 to 5 years had dental caries in their primary teeth, and that dental caries is the most common chronic disease in children in the U.S., the task force wrote. Also, 33% of Mexican American children and 28% of non-Hispanic children have caries in their primary teeth, compared with 18% of white children.

Martha Kubik

“Tooth decay can lead to a variety of health issues that affect children’s development and well-being, including pain and tooth loss,” Martha Kubik, PhD, RN, a task force member and a professor with the School of Nursing, College of Health and Human Services at George Mason University, said in a press release. “Fluoride effectively prevents tooth decay in children, is safe and can be provided by a primary care clinician.”

The final recommendations are based on 32 studies with 106,694 individuals participating, the task force said, adding that the recommendations are consistent with the 2014 recommendations and a draft statement published earlier this year in this same clinical area.

The task force indicated that, in response to feedback received during this year’s public comment period, it added details to the final recommendation regarding timing and dosage information.

No studies “specifically addressed the dosage and timing of oral fluoride supplementation in children with inadequate water fluoridation,” the USPSTF wrote. Although there were also no studies that “directly assessed the appropriate ages at which to start and stop the application of fluoride varnish,” the evidence suggested applying the fluoride varnish every 6 months appeared to be sufficient, according to the USPSTF In addition, “all children with erupted teeth can potentially benefit from the periodic application of fluoride varnish, regardless of the levels of fluoride in their water,” the USPSTF wrote. The final USPSTF recommendations also include, for the first time, a CDC tool that can help primary care clinicians ascertain the amount of fluoride in a water system.

In a related editorial, Melinda B. Clark, MD, a pediatrician with Albany Medical College, and Patricia A. Braun, MD, MPH, a professor at the University of Colorado and a senior founders fellow with the Santa Fe Group in New York City, encouraged clinicians to assess the oral health of children not covered by the USPSTF recommendations.

“Dental access remains a challenge in many communities, so the absence of formal guidelines addressing school-aged children should not imply that preventive primary care oral health interventions are not indicated for this population,” they wrote.

“Moreover, recognizing that primary care health care professionals are not dental health professionals, referral of school-aged children for routine recommended dental care is appropriate, and lack of data on referrals preventing caries in this age group should not be interpreted as devaluing this important service to patients,” Clark and Braun added.


Chou R, et al. JAMA. 2021;doi:10.1001/jama.2021.15658.

Clark MB, Braun PA. JAMA. 2021; 326(21):2139-2140.

U.S. Preventive Services Task Force issues final recommendation on preventing cavities in young children. Accessed Dec. 3, 2021, under embargo. Published Dec. 7, 2021.

USPSTF. JAMA. 2021;doi:10.1001/jama.2021.20007.