Evidence is lacking to support pediatric dental exams by primary care clinicians, the US Preventive Services Task Force (USPSTF) says in new guidelines.

The conclusion conflicts with guidelines of the American Academy of Pediatrics, which call for primary care physicians to examine the teeth of their youngest patients.

Updating a version published in 2004, the new USPSTF guidelines are published online May 5 in Pediatrics.

The conflict between the guidelines of the 2 organizations highlights the need for more research, Jonathan Maguire, MD, told Medscape Medical News.

“We need to get that evidence,” said Dr. Maguire, a pediatric researcher at St. Michael’s Hospital in Toronto, Ontario, Canada. “We need to arm pediatricians and see if it’s effective.”

For the first time, the USPSTF guidelines also call for primary care physicians to paint fluoride varnish on the teeth of patients 5 years old and younger.

They also repeat an earlier recommendation that primary care physicians should prescribe systemic fluoride supplements for children who do not get sufficient fluoride in drinking water.

Recent research has found benefits for programs in which primary care physicians apply varnish and also look for signs of dental disease in their youngest patients, referring to dentists those who appear to be at risk for caries. However, such studies have not typically separated out the benefits of exams and the benefits of fluoride application, Dr. Maguire said.

Multiple professional organizations, including the American Dental Association, have recommended that children begin seeing a dentist by age 1 year or when their first teeth appear, whichever comes first.

However, few children see dentists that early. In a survey of 2771 urban Canadian children, also published online May 5 in Pediatrics, Dr. Maguire and colleagues found that fewer than 1% had seen a dentist by their first birthdays.

The statistics are similar in the United States, he said.

Dentists are not part of Canada’s nationalized healthcare system, and dental care there closely resembles dental care in the United States, Dr. Maguire said. In both countries, multiple impediments are preventing children from getting the dental care they need.

One key problem is that parents do not know they should take their children to a dentist in the first year. “When I tell them, they look at me like I’m from Mars,” said Dr. Maguire, who worked on the survey with researchers from the University of Toronto and the Hospital for Sick Children in Toronto, as well as the University of Manitoba, Winnipeg, Canada.

In addition, many primary care physicians do not know that children are supposed to see dentists by age 1 year, and many dentists do not know how to care for children that young, he said. The problem is particularly severe among impoverished parents, he added. Among children in the study, the odds of never having been to a dentist were 2.73 times higher for those in the lowest-income group ($0 – $59,999).

Those who used bottles longer than the length of time recommended for dental health were 43% more likely never to have seen a dentist, and with each cup increase in the amount of sweetened drinks consumed daily, the odds of never having seen a dentist increased by 20%.

“Exactly the people who need to go to the dentist are the people who are not going to the dentist,” he said.

Because children are more likely to see primary care providers before age 1 year, programs that train these providers to examine children’s teeth are intended to fill some of this gap. However, the USPSTF finding that such programs lack a foundation in evidence throws cold water on the idea.

“Until we have that, I think we should do what we believe at this time works,” said Dr. Maguire. “And the best available evidence, as per the [American Dental Association], is that children under the age of 1 should visit a dentist.”

Long term, governments should take on the responsibility for making sure these very young children get to the dentist, Dr. Maguire said. “It really breaks your heart to have children have disease, and if it saves society in the end, it just makes sense,” he said.

Pediatrics. Published online Mary 5, 2014.