Why guidelines for early childhood caries prevention could be ineffective amongst children at high risk.

OBJECTIVE This paper sought to investigate whether early childhood caries (ECC) prevention guidelines were able to produce a significant, long-term, homogeneous decrease in ECC prevalence/incidence within all socio-economic strata of the population and whether their development followed methodologies specifically designed for ECC prevention guidelines. METHODS ECC prevention guidelines and specific methodologies published in English since 1995 were searched through MEDLINE, PUBMED and GOOGLE. Data regarding long-term and stratified effect of guidelines and specific methodologies were not found. The only review of methodology for guideline development which was found (produced by the Guideline Development Group of the WHO) was used and adjusted to draft a specific ECC-centred methodology. RESULTS This procedure resulted in nineteen key methodological components for the optimal ECC prevention guideline development. In order to emphasize such necessity of specific methodologies, three of these components (assessment of the strength of scientific evidence, development of consensus amongst Dental Health Care Providers, identification of appropriate outcomes) were described in detail. These examples showed the shortfalls of ECC prevention guidelines developed using methodologies explicitly designed for the development of clinical practice (e.g., therapy, diagnosis, screening) guidelines. CONCLUSIONS Guidelines for ECC prevention could help control such disease and improve quality of life of children at high ECC risk. However, the lack of specific methodologies for their development led to the consequence that, despite the fact that many ECC prevention guidelines exist, their effectiveness in the final goal of obtaining a significant, long-term and homogeneous reduction of ECC incidence, is not proved.