The following describes the research questions that were identified through a systematic review of population-based interventions designed to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. These questions were published as part of the comprehensive evidence review conducted by the Task Force and published in a special supplement to the American Journal of Preventive Medicine (see Am J Prev Med 2002;23(1S), pp.54)

Public health practitioners, policy makers, employers/purchasers, and funders are encouraged to use these findings to help guide research priorities and build a broader evidence base.

RESEARCH ISSUES

Preventing and Controlling Dental Caries Using Community Water Fluoridation and Sealants

The following gaps in knowledge relating to community water fluoridation and the use of pit and fissure sealants.

Community Water Fluoridation (CWF)

The preponderance of evidence indicates that CWF is safe and effective in reducing dental caries in communities. However, important research questions with practical applications remain unanswered, including:

• What is the difference of laws, policies, and incentives to encourage communities to start or continue water fluoridation?
• What is the effectiveness of CWF in reducing socioeconomic or racial and ethnic disparities in caries burden?
• What is the effectiveness of CWF among adults (aged > 18 years)?
• What, if any, are the effects of the increasing use of bottled water and in-home water filtration systems (which may note be fluoridated or remove fluoride, respectively) on the benefits gained from CWF?
• How effective is CWF in preventing root-surface caries?

School-based or school-linked pit and fissure sealant delivery programs

The evidence is clear and convincing that sealants delivered through schools and school-affiliated clinics are safe and effective in preventing dental caries among children. Important research questions yet to be answered include:

• What is the effect of sealant delivery programs among adults aged > 18 years (e.g. military recruits)?
• How do state dental practice laws and regulations affect use of sealants in school-based programs?
• How do state district oral health policies and curricula affect use of sealants?
• What is the effectiveness of sealants in primary teeth?

Statewide or community-wide sealant promotion programs

The available evidence of the effectiveness of statewide or community-wide sealant promotion programs was insufficient to support a recommendation by the Task Force. Therefore, research in the following areas is a high priority:

• What is the effect of public education on awareness, community mobilization (through coalitions) and resource allocation for sealant promotion?
• What is the effect of professional education, combined with provider reminders and other system oriented strategies, on knowledge, skills, and appropriate use of sealants?
• What is the effect of insurance coverage and managed care plans on access to and use of sealants?
• How cost effective are models of sealant delivery other than school based?

top of page

Research Issues for Preventing and Controlling Oral and Pharyngeal Cancers

The available evidence on the effectiveness of population-based interventions for early detection of pre-cancers and cancers was insufficient to support a recommendation by the Task Force. Therefore, research in the following areas is a high priority:

• How sensitive and specific is oral examination as a screening tool?
• How valid and reliable is oral examination conducted by various dental and medical practitioners in detecting pre-cancerous and cancerous lesions?
• How sensitive and specific is oral examination aided by endoscopy, brush biopsy, vital staining, genetic markers, and other emerging clinical technologies?
• Is the use of oral self-examination kits feasible, valid and reliable?
• How effective are individual or population-based interventions in detecting pre-cancers and reducing the incidence of invasive cancer?
• Are population based interventions effective in detecting pre-cancers and early cancers? And is early detection of pre-cancers and cancers effective in reducing cancer mortality and morbidity or improving quality of life?
• How effective are population-based interventions in reducing disparities (e.g. socioeconomic, racial, and ethnic) in oral cancer incidence and mortality?
• What is the effect on oral cancer incidence, stage distribution, and mortality of reducing alcohol and tobacco exposure?
• What effects do education interventions and materials have on awareness of oral cancer and the prevention behavior of consumer groups, health care providers, healthcare organizations, and government agencies?
• What are the effects of early detection or morbidity, mortality, and quality of life among population sub-groups at high risk for oral cancer (e.g. tobacco users, alcohol abusers, the elderly, racial or ethnic minorities and the poor)?
• How effective are laws, policies, and incentives in encouraging healthcare providers to conduct oral examinations for cancer detection in high-risk populations?

top of page

Research Issues for Preventing and Controlling Sports-Related Craniofacial Injuries

Because use of mandated equipment by children in many contact sports remains far too low, important questions about the continuing prevalence of equipment use and of the effect of increasing equipment use on injuries remain to be answered. These questions include:

• How effective are laws, policies, and incentives in increasing the use of protective equipment in various sports?
• How effective are organized programs in increasing the use of protective equipment?
• What is the effect on injury risk of increasing use of protective equipment in particular sports?
• What are the extent and causes of disparities in equipment use and injury risk by age, gender, race or ethnicity, type of sport, and other factors?
• How effective are various kinds of helmets, mouth guards, and facemasks in preventing oral-facial injuries in contact sports (including karate, judo and other martial arts)?