Prevenção de cárie na primeira infância: construindo evidências para uma diretriz para prática clínica

Abstract

Dental caries is the most prevalent oral disease worldwide, affecting more than 600 million children and generating significant healthcare costs. Early Childhood Caries (ECC) – presence of carious lesions on one or more dental surfaces (cavitated or non-cavitated), presence of lost or filled surfaces (due to caries) on any deciduous tooth of children up to six years of age –, besides its high cost to society, has a negative impact on the quality of life of children, parents, and caregivers. The objective of this study was to develop a synthesis of evidence and a decision framework for a clinical practice guideline for the prevention and control of early childhood caries in order to assist parents and/or caregivers, oral health professionals, and health managers in decision-making. The target population is children up to six years of age, regardless of oral condition, and their parents and/or guardians. The target professionals are dentists and managers of Primary HealthCare (PHC) of the Brazilian Unified Health System (SUS). For this, an organizing committee was formed, and a group of experts was invited to compose the panel to assess and define priority issues, define outcomes of interest, make judgments, and prepare recommendations. The panel determined five priority clinical questions. A systematic search of electronic databases, guideline repositories, associations, and guideline-producing organizations was conducted to select available guidelines and/or systematic reviews on ECC prevention. Working together with the expert panel, evidence was summarized by constructing a summary of finding tables (SoF) and certainty of evidence, discussed and analyzed, and submitted to the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) "evidence to decision" process. Of the 5 priority clinical questions, three questions were answered based on systematic reviews with meta-analyses, one clinical question was answered with an observational ecological study associated with expert opinion, and one clinical question was answered by adopting the recommendations of another guideline. Thus, evidence was constructed for recommendations for a clinical practice guideline on early childhood caries prevention and control. These recommendations are not included in this dissertation and will be published later by the Ministry of Health.