Improving Oral Health

Research Gaps

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

Results from the Community Guide reviews of oral health interventions indicate that a number of these interventions are effective in promoting oral health and controlling disease across a range of settings. However, questions remain regarding more specific characteristics of how the intervention is implemented, with whom, and where. Research gaps are provided for the following categories:

• Preventing and controlling dental caries using community-wide fluoridation and sealants
• Preventing and controlling oral and pharyngeal cancers
• Preventing and controlling sports-related craniofacial injuries
• Ecologic approaches using multiple interventions with many targets of change

Preventing and Controlling Dental Caries Using Community-wide Fluoridation and Sealants

• Community water fluoridation (CWF)
  Most of the 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 effectiveness 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 not be fluoridated or may remove fluoride, respectively) on the benefits gained through 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 school 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?
• 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 morbidity and mortality 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, healthcare providers, healthcare organizations, and government agencies?
  • What are the effects of early detection on morbidity, mortality, and quality of life among population subgroups 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?
• Preventing and Controlling Sports-related Craniofacial Injuries
  Because use of mandated equipment by children in many contact sports remains 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, mouthguards, and facemasks in preventing oral-facial injuries in contact sports (including karate, judo, and other martial arts)?
• Ecologic Approaches Using Multiple Interventions with Many Targets of Change
  Research on ecologic approaches in various settings might involve multiple interventions with many targets of change and desirable health. Estimates of effectiveness might focus on increase in knowledge, behavioral intentions, and behaviors in the short term and the desirable health outcomes mentioned above in the long term. Questions such as the following need to be answered:
  • What is the effect on several oral health outcomes of community-wide interventions that combine environmental change, legislative action, policy change, and social support within families to encourage behavior change?
  • What is the effect on several oral health outcomes of community development coalitions, partnerships, mass media advocacy, and social marketing?
  • What is the effect on several oral health outcomes of multicomponent interventions in selected settings?

Evidence Review

Truman BI, Gooch BF, Sulemana I, et al. Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. [PDF - 2.52MB] Am J Prev Med 2002;23(1S):21-54.