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NPR trend piece on fluoride treatments in adults should have drilled into hard evidence

Rating

4 Star

Categories

No-Drill Dentistry: Fluoride Treatments Can Prevent Cavities In Adults

Our Review Summary

The dentist will see you nowThis “better safe than sorry” story about the advantages of more intensive measures to prevent tooth decay in adults is thick with promises, but thin with evidence about who might benefit and by how much.

The strong points: The reporter did a good job talking to multiple sources, and made an effort to discuss costs and availability, including insurance factors. However, the story quoted only proponents of more intensive preventive dental treatments for adults, producing a story lacking hard-nosed scrutiny of the feel-good claims.

 

Why This Matters

Prevention is appealing as a concept, but stories about preventive strategies should give readers hard facts about how much benefit is likely and at what cost. While this story did report typical costs for a single fluoride treatment and for a single tooth filling, it didn’t tell readers how many treatments would be needed in order to prevent a cavity. It also glossed over an important detail about a lot of the research in this field: Most study subjects are people at very high risk for cavities, like those with medication-related severe dry mouth. That left the story heavy with an “everybody’s a winner!” tone, which in reality, may not be the case.

 

Criteria

Does the story adequately discuss the costs of the intervention?

Satisfactory

The story does include a discussion of price, reporting that a fluoride varnish treatment can cost $23 to $55, while a filling can cost $86 to $606. That’s enough to be rated Satisfactory.

However, the story also should have stated that those numbers aren’t a head-to-head comparison, since the varnish treatment must be repeated many times over many years–which would add up. In fact, a cost-effectiveness analysis done by one of the quoted experts concluded the “Caries Management System” he advocates costs almost $1,800 for every cavity or lost tooth prevented.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

While the story includes links to some studies that report specific results, the only number reported in the story is a reduction in adult tooth fillings of 30 to 50 percent. But without any absolute numbers, this number isn’t useful. Is it a cavity a year? A cavity a decade? The story refers to people at “high risk” for cavities, but does not define what that term means. Without some anchoring in absolute numbers, all readers are left with is a vague sense that preventive treatment is “better” for some people, without pinning down how much better or for whom.

Does the story adequately explain/quantify the harms of the intervention?

Not Applicable

Fluoride for dental health has been extensively studied for decades and is considered safe, so we’ll file this rating as not applicable to the story.

But, as some dentists might point out, there is an argument to be made for discussing one known–though minor–risk: Some people living in areas with naturally high levels of fluoride in their water may experience tooth discoloration or other issues if they are given additional fluoride treatment.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The story portrays the evidence for fluoride treatments as clear and convincing, when there are actually just a few studies, and a lot of expert opinion. That’s not to say the experts quoted in the story are wrong, but the story elevates beliefs to the level of evidence-based conclusions.

Does the story commit disease-mongering?

Satisfactory

Cavities in adults can cause serious health problems if left untreated, and any new effective treatment or trends in this area is worthy of press coverage.

However, the studies discussed in the story focused on a relatively small group of people with unusually high risk of tooth decay–and so these results may not apply to the adult population at large, which this piece implies.

 

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story quotes a number of sources discussing this trend in dentistry, instead of just relying on one dentist.

But the piece would be more balanced had it included at least one source pointing out that some of the techniques advocated in the story could be overkill or wasteful for many people who are at just average risk for tooth decay. As the piece was written, all the sources are very rosy about more aggressive preventive dental care. We also found via an internet search that source John Featherstone has accepted consultation fees from dental companies that make products for these purposes. However, since he wasn’t specifically endorsing one of these products in this story, we’ll give this a pass.

Does the story compare the new approach with existing alternatives?

Not Satisfactory

The story does not quantify the benefits of these new preventive treatments, or similar approaches, so it fails to give readers a useful comparison with standard dental care or advice for most adults–such as fluoride toothpastes, community water fluoridation, flossing, and mouthwashes.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

It is clear that the treatments mentioned in the story are widely available, and we were pleased to see the story went a step further and let us know how insurance impacts availability.

 

Does the story establish the true novelty of the approach?

Satisfactory

The story reports that the concepts are not new, and that fluoride varnishes have normally been the purview of pediatric dentistry, but are now catching on among adult dentists.

However, it never really explains why practice would be changing now–did research spur this change? There is a reference to “more effective preventive techniques,” but it’s not clear what that means, and how a reader might act on that.

Does the story appear to rely solely or largely on a news release?

Satisfactory

This piece doesn’t appear to rely on a news release; the reporter interviewed a number of experts and referred to several publications.

 

Total Score: 6 of 9 Satisfactory

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