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Spetz J, Rose J, Kahn JG, Lin T, Levy D, Pugach O, Hyde S, Borrelli B, Henshaw M, Martin M, Nelson S, Ramos-Gomez F, Gansky SA. Cost-effectiveness analysis design for interventions to prevent children's oral disease. FRONTIERS IN ORAL HEALTH 2024; 5:1428638. [PMID: 39092198 PMCID: PMC11292419 DOI: 10.3389/froh.2024.1428638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 06/12/2024] [Indexed: 08/04/2024] Open
Abstract
Introduction In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. Methods The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. Results All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Conclusions Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.
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Affiliation(s)
- Joanne Spetz
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
| | - Johnie Rose
- Center for Community Health Integration, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - James G. Kahn
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
| | - Tracy Lin
- Institute for Health and Aging, School of Nursing, University of California, San Francisco, CA, United States
| | - Douglas Levy
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Oksana Pugach
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Susan Hyde
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco, CA, United States
| | - Belinda Borrelli
- Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Michelle Henshaw
- Goldman School of Dental Medicine, Boston University, Boston, MA, United States
| | - Molly Martin
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
- College of Medicine, University of Illinois, Chicago, IL, United States
| | - Suchitra Nelson
- School of Dental Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Francisco Ramos-Gomez
- Section on Pediatric Dentistry, Center for Children's Oral Health, School of Dentistry, University of California, Los Angeles, CA, United States
| | - Stuart A. Gansky
- Philip R. Lee Institute for Health Policy Studies and Healthforce Center, University of California, San Francisco, CA, United States
- Center to Address Disparities in Children's Oral Health, School of Dentistry, University of California, San Francisco, CA, United States
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Sorazabal AL, Salgado P, Ferrarini S, Lazzati R, Squassi AF, Campus G, Klemonskis G. An Alternative Technique for Topical Application of Acidulated Phosphate Fluoride (APF) Gel: A Two-Years Double-Blind Randomization Clinical Trial (RCT). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2118. [PMID: 38138221 PMCID: PMC10744600 DOI: 10.3390/medicina59122118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Abstract
Background and Objectives: Dental caries is still a dramatic public health problem. The effectiveness of an alternative technique using acidulated phosphate fluoride (APF) gel pH 3.5 was evaluated and compared with conventional treatments in reducing dental caries incidence. Materials and Methods: A double-blind randomized controlled trial was conducted, involving 180 children aged 4-11 years. Three groups were formed: NaF varnish (NaFV), APF in tray (APFt), and APF in toothbrush (APFtbru). Clinical examinations were performed using standardized criteria and the ICDAS Index was assessed. The Caries Treatment Needs Index (CTNI) was calculated. Dental examinations were conducted at baseline, 12 months, and 24 months. Results: At baseline, 16,719 dental surfaces were included, with 15,434 surfaces being sound. After 24 months, the Kaplan-Meier analysis showed significant differences between the APFtbru group and the other two groups (p = 0.03). Cox regression analysis revealed that the surfaces treated with NaF varnish had the lowest survival rates (HR = 0.51 95%CI = 0.33/0.81). Occlusal surfaces had the lowest cumulative survival, while other tooth surfaces showed similar performance. Conclusions: The alternative technique of APF gel application with a toothbrush resulted in maintaining dental health over 24 months. This technique can be cost-effective and may offer advantages over traditional fluoride varnish application.
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Affiliation(s)
- Ana Laura Sorazabal
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
| | - Pablo Salgado
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
| | - Silvana Ferrarini
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
| | - Rocio Lazzati
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
| | - Aldo Fabian Squassi
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3012 Bern, Switzerland
- Department of Cariology, Saveetha Dental College and Hospitals, SIMATS, Poonamallee High Road, Chennai 600077, India
| | - Graciela Klemonskis
- Cátedra de Odontología Preventiva y Comunitaria, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina; (A.L.S.); (P.S.); (S.F.); (R.L.); (A.F.S.); (G.K.)
- Instituto de Investigaciones en Salud Pública, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires C1122AAH, Argentina
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Dhyppolito IM, Nadanovsky P, Cruz LR, de Oliveira BH, Dos Santos APP. Economic evaluation of fluoride varnish application in preschoolers: A systematic review. Int J Paediatr Dent 2023; 33:431-449. [PMID: 36695007 DOI: 10.1111/ipd.13049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/20/2022] [Accepted: 01/12/2023] [Indexed: 01/26/2023]
Abstract
BACKGROUND Fluoride varnish (FV) is a convenient way of professionally applying fluoride in preschoolers. However, its modest anticaries effect highlights the need for economic evaluations. AIM To assess economic evaluations reporting applications of FV to reduce caries incidence in preschoolers. DESIGN We included full economic evaluations with preschool participants, in which the intervention was FV and the outcome was related to dentin caries. We searched in CENTRAL; MEDLINE via PubMed; WEB OF SCIENCE; EMBASE; SCOPUS; LILACS; BBO; and BVS Economia em saúde, OpenGrey, and EconoLit. Clinical trial registers, thesis and dissertations, and meeting abstracts were hand searched, as well as 11 dental journals. Risk of bias in the included studies was assessed using the Philips' and Drummond's (full and simplified) tools. RESULTS Titles and abstracts of 2871 articles were evaluated, and 200 were read in full. Eight cost-effectiveness studies were included: five modeling and three within-trial evaluations. None of the studies gave sufficient information to allow a thorough assessment using the bias tools. We did not combine the results of the studies due to the great heterogeneity among them. Four studies reported that FV in preschool children was a cost-effective measure, but in one of these studies, sealants and fluoride toothpaste were more cost-effective measures than the varnish, and three studies used limited data that compromised the generalizability of their results. The other four studies showed a large increase in costs due to the application of varnish and/or low cost-effectiveness. CONCLUSION We did not find convincing overall evidence that applying FV in preschoolers is an anticaries cost-effective measure. The protocol of this systematic review is available at Open Science Framework (https://osf.io/xw5va/).
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Affiliation(s)
- Izabel Monteiro Dhyppolito
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Nadanovsky
- Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laís Rueda Cruz
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Branca Heloisa de Oliveira
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Ana Paula Pires Dos Santos
- Department of Community and Preventive Dentistry, Faculty of Dentistry, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Fontana M, Eckert G, Katz B, Keels M, Levy B, Levy S, Kemper A, Yanca E, Jackson R, Warren J, Kolker J, Daly J, Kelly S, Talbert J, McKnight P. Predicting Dental Caries in Young Children in Primary Health Care Settings. J Dent Res 2023; 102:988-998. [PMID: 37329133 PMCID: PMC10477774 DOI: 10.1177/00220345231173585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80-1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1-2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83-2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.
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Affiliation(s)
- M. Fontana
- University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - B.T. Levy
- University of Iowa, Iowa City, IA, USA
| | - S.M. Levy
- University of Iowa, Iowa City, IA, USA
| | - A.R. Kemper
- Division of Primary Care Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - E. Yanca
- University of Michigan, Ann Arbor, MI, USA
| | - R. Jackson
- Indiana University, Indianapolis, IN, USA
| | - J. Warren
- University of Iowa, Iowa City, IA, USA
| | | | - J.M. Daly
- University of Iowa, Iowa City, IA, USA
| | - S. Kelly
- Duke University, Durham, NC, USA
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Nguyen TM, Bridge G, Hall M, Theodore K, Lin C, Scully B, Heredia R, Le LKD, Mihalopoulos C, Calache H. Is value-based healthcare a strategy to achieve universal health coverage that includes oral health? An Australian case study. J Public Health Policy 2023; 44:310-324. [PMID: 37142745 PMCID: PMC10232653 DOI: 10.1057/s41271-023-00414-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/06/2023]
Abstract
The 2021 Resolution on Oral Health by the 74th World Health Assembly supports an important health policy direction: inclusion of oral health in universal health coverage. Many healthcare systems worldwide have not yet addressed oral diseases effectively. The adoption of value-based healthcare (VBHC) reorients health services towards outcomes. Evidence indicates that VBHC initiatives are improving health outcomes, client experiences of healthcare, and reducing costs to healthcare systems. No comprehensive VBHC approach has been applied to the oral health context. Dental Health Services Victoria (DHSV), an Australian state government entity, commenced a VBHC agenda in 2016 and is continuing its efforts in oral healthcare reform. This paper explores a VBHC case study showing promise for achieving universal health coverage that includes oral health. DHSV applied the VBHC due to its flexibility in scope, consideration of a health workforce with a mix of skills, and alternative funding models other than fee-for-service.
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Affiliation(s)
- Tan M Nguyen
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia.
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia.
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Gemma Bridge
- Queen Mary University of London, Mile End Road, London, E1 4NS, UK
| | - Martin Hall
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Katy Theodore
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
| | - Clare Lin
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
- Melbourne Dental School, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Ben Scully
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Ruth Heredia
- Dental Health Services Victoria, Level 1, Corporate Services, 720 Swanston Street, Carlton, Melbourne, VIC, 3053, Australia
| | - Long K-D Le
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Cathrine Mihalopoulos
- Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Hanny Calache
- Deakin Health Economics, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 3125, Australia
- La Trobe University, Bendigo, VIC, 3552, Australia
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Nguyen TM, Tonmukayakul U, Le LKD, Calache H, Mihalopoulos C. Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:53-70. [PMID: 36089630 PMCID: PMC9834378 DOI: 10.1007/s40258-022-00758-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis. METHODS Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal. RESULTS Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis. CONCLUSIONS Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia.
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
| | - Long Khanh-Dao Le
- Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, Deakin University, Level 3, Building BC, 221 Burwood Highway, Burwood, Melbourne, VIC, 2125, Australia
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Sousa GPD, Lima CCB, Braga MM, Moura LDFADD, Lima MDDMD, Moura MSD. Early childhood caries management using fluoride varnish and neutral fluoride gel: a randomized clinical trial. Braz Oral Res 2022; 36:e099. [PMID: 35830143 DOI: 10.1590/1807-3107bor-2022.vol36.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/04/2022] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to evaluate the clinical efficacy of varnish and neutral fluoride gel in the management of early childhood caries (ECC). A randomized clinical trial was conducted to compare two strategies for ECC management: topical application of neutral fluoride gel (NFG group) and varnish (FV group) every four months for a period of one year. The sample consisted of children between the ages of three and four years, enrolled in public daycare centers. The incidence of ECC between the groups was compared by assessing values (new dmfs) at two levels: d2 when enamel/dentin were affected and d3 when dentin affected. Pearson's Chi-square, Fisher's Exact, Kolmogorov-Smirnov and Mann-Whitney tests were used to compare the incidence and increment of caries between the NFG and FV groups (p<0.05). A total of 240 children were included in this study and 213 children (88.7%) were followed up for 12 months. The incidence of ECC was 24.1% in the GF and 21.0% in the FV groups (p=0.586). The increment of caries in d2mfs was 1.36 (95% CI = 0.83 - 1.89) in the NFG and 1.33 (95% CI = 0.75 - 1.89) in FV (p=0.756) groups. Increment of caries in d3mfs was 1.60 (95% CI = 0.95 - 2.25) in NFG and 1.40 (95% CI = 0.75 - 2.04) in FV (p=0.468). Neutral fluoride gel and fluoride varnish exhibited similar efficacy in the management of ECC after 12 months of follow-up.
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Affiliation(s)
- Geovanna Peres de Sousa
- Universidade Federal do Piauí - UFPI, Department of Pathology and Dental Clinics, Teresina, PI, Brazil
| | | | - Mariana Minatel Braga
- Universidade de São Paulo - USP, School of Dentistry, Department of Pediatric Dentistry, São Paulo, SP, Brazil
| | | | | | - Marcoeli Silva de Moura
- Universidade Federal do Piauí - UFPI, Department of Pathology and Dental Clinics, Teresina, PI, Brazil
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8
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Nantanee R, Sriratanaban J. Cost‐effectiveness and estimated net monetary benefits of a fluoride varnish application program during well‐child visits by 9‐ to 30‐month‐old children in three areas of Thailand. Community Dent Oral Epidemiol 2022; 51:512-518. [DOI: 10.1111/cdoe.12769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/10/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Ratichanok Nantanee
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Department of Pediatric Dentistry, Faculty of Dentistry Chulalongkorn University Bangkok Thailand
| | - Jiruth Sriratanaban
- Department of Preventive and Social Medicine, Faculty of Medicine Chulalongkorn University Bangkok Thailand
- Thailand Research Center for Health Services System, Faculty of Medicine Chulalongkorn University Bangkok Thailand
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9
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El-Desouky DI, Hanno A, Elhamouly Y, Hamza SA, El-Desouky LM, Dowidar KML. Preventive potential of nano silver fluoride versus sodium fluoride varnish on enamel caries like lesions in primary teeth: in vitro study. BMC Oral Health 2022; 22:244. [PMID: 35725433 PMCID: PMC9208095 DOI: 10.1186/s12903-022-02271-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/09/2022] [Indexed: 11/14/2022] Open
Abstract
Background Professionally applied topical fluoride preparations have been commonly used and have proven to prevent dental decay. Alternative preparations that provide further benefits may be of interest to investigate. This study aimed to investigate the effect of experimental nano silver fluoride (NSF) formulation compared to commercial sodium fluoride varnish (FV) on prevention of in vitro demineralization of initially sound enamel in primary teeth. Methods Forty-eight extracted/exfoliated sound molars were sectioned buccolingually into 96 specimens then assigned randomly into two equal groups. Each group was further subdivided into two equal subgroups (Ia: NSF, IIa: FV, Ib and IIb as negative controls). The test materials were applied, then all the specimens were subjected to a demineralization pH cycling model for 7 days. Specimens were examined for surface microhardness using Vickers microhardness device and lesion depth was evaluated by polarized light microscope using image J 1.46r software. Data were analyzed using paired t-test, independent t-test, and Mann Whitney U test. Results The test materials were significantly superior to their negative controls, (P < 0.001) and comparable to each other, (P > 0.05) regarding microhardness and lesion depth. In comparison to FV, NSF showed lower yet statistically insignificant percent increase in microhardness and decrease in lesion depth, (P = 0.81, 0.86, respectively). Qualitative evaluation revealed that both agents reduced the lesion depth formation. Conclusion NSF showed similar effect to that of FV in limiting in vitro enamel demineralization caused by acidic challenge. Hence, it could be regarded as a promising alternative preventive agent in primary teeth. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02271-6.
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Affiliation(s)
- Dina I El-Desouky
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Azza Hanno
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Yasmine Elhamouly
- Department of Pediatric and Community Dentistry, Faculty of Dentistry, Pharos University in Alexandria, Alexandria, Egypt.
| | - Sara A Hamza
- Department of Oral Biology, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Lubna M El-Desouky
- Department of Pharmaceutics, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
| | - Karin M L Dowidar
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Davidson T, Bergström EK, Husberg M, Moberg Sköld U. Long-Term Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19041954. [PMID: 35206144 PMCID: PMC8871848 DOI: 10.3390/ijerph19041954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/04/2023]
Abstract
A guideline called FRAMM, which is an acronym in Swedish for the most important parts of this guideline, namely “fluoride”, “advice”, “arena”, “motivation” and “diet”, was implemented in 2008 in the Västra Götaland Region in Sweden. This guideline included fluoride varnish applications performed at school twice a year at six-monthly intervals for all 12- to 15-year-olds, together with lessons on oral health. The aim of this analysis was to estimate the long-term cost-effectiveness, using prognostic calculations, of the FRAMM Guideline for 12- to 15-year-olds, compared with routine care, until the participants were 23 years old. A cost-effectiveness analysis was performed from a health care perspective, based on four years of verified data and seven years of prognosis. Data from FRAMM were combined with cost data from price lists in Sweden. The cost-effectiveness was analyzed by relating the difference in costs to the difference in the number of approximal surfaces with fillings and/or dentin lesions (DFSa). The analysis shows that FRAMM was considered dominant compared to the controls in all alternative scenarios, hence costs were prognosed to be lowered and outcomes were prognosed to be improved. A dental health program like the FRAMM Guideline with fluoride varnish during the caries risk period from 12 to 15 years is predicted to be cost-effective in the longer perspective. To further study the actual long-term caries increment after a preventive dental health program would be of great interest to verify these results.
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Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
- Correspondence:
| | - Eva-Karin Bergström
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden; (E.-K.B.); (U.M.S.)
| | - Magnus Husberg
- Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 83 Linköping, Sweden;
| | - Ulla Moberg Sköld
- Department of Cariology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, SE-405 30 Gothenburg, Sweden; (E.-K.B.); (U.M.S.)
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Effenberger S, Greenwall L, Cebula M, Myburgh N, Simpson K, Smit D, Wicht MJ, Schwendicke F. Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial. Community Dent Oral Epidemiol 2021; 50:453-460. [PMID: 34676577 DOI: 10.1111/cdoe.12702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This cluster-randomized controlled community trial aimed to assess the efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk population in South Africa. METHODS 513 children aged 4-8 years from two schools in a township in South Africa were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised toothbrushing with fluoridated toothpaste in both groups, FV was applied in 3-month intervals by trained local non-professional assistants. Intraoral examinations were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment of teeth with cavitated lesions (i.e. newly developed or progressed, formerly non-cavitated lesions), requiring restoration or extraction over the study period. Additionally, treatment and re-treatment costs were analyzed. RESULTS 513 children (d1-4 mft 5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV (n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration; 3.9% FV and 4.1% CO teeth were extracted, without significant differences between groups. While FV generated high initial costs, follow-up costs were comparable in both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055 ZAR vs. 950 ± 943 ZAR, p < .001). CONCLUSIONS Regular FV application, in addition to daily supervised toothbrushing, had no significant caries-preventive effect and was not cost-effective in a primary school setting within a peri-urban, high-risk community in South Africa. Alternative interventions on community or public health level should be considered to reduce the caries burden in high-risk communities.
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Affiliation(s)
| | | | - Marcus Cebula
- DMG Dental-Material Gesellschaft mbH, Hamburg, Germany
| | - Neil Myburgh
- Department of Community Oral Health, University of the Western Cape, Bellville, South Africa
| | - Karen Simpson
- Department of Community Oral Health, University of the Western Cape, Bellville, South Africa
| | - Dirk Smit
- Department of Community Oral Health, University of the Western Cape, Bellville, South Africa
| | - Michael J Wicht
- Department of Operative Dentistry and Periodontology, University Hospital of Cologne, Cologne, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Graif C, Meurer J, Fontana M. An Ecological Model to Frame the Delivery of Pediatric Preventive Care. Pediatrics 2021; 148:s13-s20. [PMID: 34210842 PMCID: PMC8312252 DOI: 10.1542/peds.2021-050693d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, identify social determinants of health, and identify protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary based on features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery.
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Affiliation(s)
- Corina Graif
- Department of Sociology and Criminology, College of the Liberal Arts and Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
| | - John Meurer
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
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Davidson T, Blomma C, Bågesund M, Krevers B, Vall M, Wärnberg Gerdin E, Tranæus S. Cost-effectiveness of caries preventive interventions - a systematic review. Acta Odontol Scand 2021; 79:309-320. [PMID: 33370544 DOI: 10.1080/00016357.2020.1862293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions. MATERIAL AND METHODS A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness. RESULTS AND CONCLUSIONS Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.
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Affiliation(s)
- Thomas Davidson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Health Technology Assessment - Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Caroline Blomma
- Public Dental Service Östergötland, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mats Bågesund
- Center for Orthodontics and Pediatric Dentistry, Norrköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Barbro Krevers
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Martina Vall
- Malmö University Library, Malmö University, Malmö, Sweden
| | - Elisabeth Wärnberg Gerdin
- Odontological Research Unit, Public Dental Service, Region Örebro County, Örebro, Sweden
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
| | - Sofia Tranæus
- Health Technology Assessment - Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Pereira MBB, Pereira VBP, Pereira VBP, Pereira VGF, Paula VMB, Caetano APF, Amaral WN. Randomized trial of a photography-aided behavioural intervention to reduce risk factors for caries and malocclusion in high-risk infants. Int J Dent Hyg 2021; 20:471-478. [PMID: 33908167 DOI: 10.1111/idh.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the efficacy of a photography-aided behavioural intervention in reducing risk factors for dental caries and malocclusion in high-risk infants. MATERIALS AND METHODS In this randomized trial conducted in a maternity hospital, 55 mothers of recently born infants at high risk of developing oral diseases were allocated to either the intervention (n = 28) or usual care (n = 27). The intervention arm received the same usual care plus an enhanced, behaviour-oriented, photography-aided, two-stage (0 and +6 months) educational programme addressing nutritional, behavioural, lifestyle and familial factors that affect child's oral health. The primary outcome was the proportion of children classified as being at a 'low risk' of developing dental caries at the age of 12 months using a modified score based on the Caries-risk Assessment Form of the American Academy of Pediatric Dentistry. Secondary outcomes included risk factors for malocclusion, such as duration of exclusive breastfeeding, pacifier use and bottle-feeding and/or sippy cup usage. RESULTS At 12 months, the proportion of children considered at low risk for dental caries was significantly higher in the intervention group compared to usual care (71% vs 15%, respectively, relative risk = 4.82, 95% confidence interval = 1.89-12.3, p < 0.001). The median duration of exclusive breastfeeding in the intervention group was 1.7 times higher than in the control arm (5 months vs 3 months, p = 0.03). CONCLUSION Altogether, our findings provide evidence that a low-cost, two-stage preventive strategy using photographs to deliver a stronger visual impact might significantly reduce the incidence of risk factors for dental caries and malocclusion in 12-month-old children.
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Affiliation(s)
- Marina B B Pereira
- Serviço de Odontologia Neonatal, Hospital e Maternidade Dona Iris, Goiânia, Brazil.,Programa de Pós-graduação em Ciências da Saúde, Hospital das Clínicas, Universidade Federal de Goiás, Goiânia, Brazil
| | - Vinícius B P Pereira
- Departamento de Oftalmologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vitor B P Pereira
- Departamento de Retina e Vítreo, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Viviane M B Paula
- Serviço de Odontologia Neonatal, Hospital e Maternidade Dona Iris, Goiânia, Brazil
| | - Aline P F Caetano
- Faculdade de Odontologia, Universidade Federal de Goiás, Goiânia, Brazil
| | - Waldemar N Amaral
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, Brazil
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Yu L, Yu X, Li Y, Li J, Hua F, Song G. Is it necessary for children to receive professional fluoride in addition to regular fluoride toothpaste? Protocol for a systematic review. BMJ Open 2020; 10:e037422. [PMID: 32958490 PMCID: PMC7507841 DOI: 10.1136/bmjopen-2020-037422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Regular toothbrushing with fluoride toothpaste is a fundamental intervention for caries prevention. Professional fluoride application (PFA) is widely considered a beneficial supplement to the routine use of fluoride toothpaste. However, some recent studies have failed to demonstrate the preventive effect of PFA. In addition, an increasing number of studies have highlighted the potential adverse effects of fluoride. However, little information exists on the effectiveness of additional PFA. The objective of this review is to systematically analyse the efficacy of PFA in addition to regular fluoride toothpaste among children under the age of 16. METHOD AND ANALYSIS We will search the PubMed, Embase, Google Scholar and Cochrane Central Register of Controlled Trials databases for randomised controlled trials without language or publication date restrictions. Additional studies will be identified by manually searching the reference lists of the included studies and relevant reviews. At least two authors will carry out the selection of studies independently and in duplicate. The Cochrane Risk of Bias tool will be used to assess the risk of bias of the included studies. The random effects model will be used for meta-analyses. The data synthesis will be conducted using Review Manager software (RevMan V.5.3). The Grading of Recommendation, Assessment, Development and Evaluation will be used to assess the quality of supporting evidence for each major comparison. ETHICS AND DISSEMINATION There is no need for ethical approval. The results of this review will be disseminated through peer-reviewed publications and social networks. PROSPERO REGISTRATION NUMBER CRD42020165270.
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Affiliation(s)
- Lintong Yu
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xueqian Yu
- Library, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Yueyang Li
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Li
- Library, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Fang Hua
- Centre for Evidence-Based Stomatology, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
- Division of Dentistry, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Guangtai Song
- Department of Paediatric Dentistry, Hubei-MOST KLOS & KLOBM, School & Hospital of Stomatology, Wuhan University, Wuhan, China
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Zaror C, Muñoz-Millán P, Espinoza-Espinoza G, Vergara-González C, Martínez-Zapata MJ. Cost-effectiveness of adding fluoride varnish to a preventive protocol for early childhood caries in rural children with no access to fluoridated drinking water. J Dent 2020; 98:103374. [DOI: 10.1016/j.jdent.2020.103374] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 04/18/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022] Open
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Splieth CH, Banerjee A, Bottenberg P, Breschi L, Campus G, Ekstrand KR, Giacaman RA, Haak R, Hannig M, Hickel R, Juric H, Lussi A, Machiulskiene V, Manton DJ, Jablonski-Momeni A, Opdam NJM, Paris S, Santamaría RM, Schwendicke F, Tassery H, Ferreira Zandona A, Zero DT, Zimmer S, Doméjean S. How to Intervene in the Caries Process in Children: A Joint ORCA and EFCD Expert Delphi Consensus Statement. Caries Res 2020; 54:297-305. [PMID: 32610317 DOI: 10.1159/000507692] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/29/2020] [Indexed: 11/19/2022] Open
Abstract
This paper provides recommendations for dentists for the treatment of dental caries in children, with an emphasis on early childhood caries (ECC), primary teeth, and occlusal surfaces in permanent teeth. A consensus workshop followed by an e-Delphi consensus process was conducted with an expert panel nominated by the European Organization for Caries Research (ORCA) and European Federation of Conservative Dentistry (EFCD)/German Association of Conservative Dentistry (DGZ) boards. Based on 3 systematic reviews and a nonsystematic literature search, recommendations were developed. The caries decline has led to a more polarized disease distribution in children and adolescents along social gradients which should be taken into account when managing the caries process at all levels, such as the individual, the group, or a population. The control or reduction of caries activity is the basis for successful caries management. In children, caries management requires adequate daily oral hygiene and fluoride application via toothpaste, ensured by caregivers, and especially for ECC prevention an emphasis on sugar intake reduction is needed. These noninvasive interventions are also suitable to arrest or control initial or even cavitated dentine caries lesions in the absence of irreversible pulpitis. Fluoride varnish or silver diammine fluoride can be added as supplementary agents. In pits and fissures, composite resin materials can be used as preventive sealants and for defect-oriented minimally invasive restorations. In primary molars, preformed metal crowns are more successful than multisurface fillings, especially in caries-active patients. With persisting high caries activity, multiple lesions, and limited cooperation, caries control should consist of robust measures with high success rates, even including extraction in selected cases. This applies especially to treatments performed under general anesthesia.
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Affiliation(s)
- Christian H Splieth
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany,
| | - Avijit Banerjee
- Conservative & MI Dentistry, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Peter Bottenberg
- Oral Health Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lorenzo Breschi
- Department of Biomedical and Neuromotor Sciences, DIBINEM, University of Bologna - Alma Mater Studiorum, Bologna, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, Zahnmedizinische Kliniken (ZMK), University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
| | - Kim Rud Ekstrand
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigo A Giacaman
- Cariology Unit, Department of Oral Rehabilitation, Faculty of Health Sciences, University of Talca, Talca, Chile
| | - Rainer Haak
- Department of Cariology, Endodontology and Periodontology, University Leipzig, Leipzig, Germany
| | - Matthias Hannig
- Clinic of Operative Dentistry, Periodontology and Preventive Dentistry, Saarland University, Homburg, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Hrvoje Juric
- Department of Pediatric and Preventive Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
| | - Adrian Lussi
- School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Operative Dentistry and Periodontology, Faculty of Dentistry, University Medical Centre Freiburg, Freiburg, Germany
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology, Faculty of Odontology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - David J Manton
- Centrum voor Tandheelkunde en Mondzorgkunde, Universitair Medisch Centrum Groningen, University of Groningen, Groningen, The Netherlands
- Melbourne Dental School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Niek J M Opdam
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sebastian Paris
- Department of Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth M Santamaría
- Preventive and Pediatric Dentistry, Center for Oral Health, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falk Schwendicke
- Department of Oral Diagnosis, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Herve Tassery
- EA 4203 Laboratory, Faculté d'Odontologie, Université de Montpellier, Montpellier, France
- Faculté d'Odontologie Marseille, Preventive and Restorative Department, Aix-Marseille-Université, Marseille, France
| | - Andrea Ferreira Zandona
- Department of Comprehensive Care, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Domenick T Zero
- Oral Health Research Institute, Indiana University School of Dentistry, Indianapolis, Indiana, USA
| | - Stefan Zimmer
- Faculty of Health, School of Dentistry, Department of Operative and Preventive Dentistry, Witten/Herdecke University, Witten, Germany
| | - Sophie Doméjean
- Centre de Recherche en Odontologie Clinique EA 4847, UFR d'Odontologie, Département d'Odontologie Conservatrice, Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Estaing Clermont-Ferrand, Clermont-Ferrand, France
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Duane B, Stancliffe R, Miller F, Sherman J, Pasdeki-Clewer E. Sustainability in Dentistry: A Multifaceted Approach Needed. J Dent Res 2020; 99:998-1003. [DOI: 10.1177/0022034520919391] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
This article provides an introduction to environmentally sustainable dentistry and offers perspectives on managing drivers to reduce carbon emissions and make dentistry more environmentally sustainable. A sustainable world must meet the needs of the present without compromising the ability of future generations to meet their own needs. Global commitment to sustainability and demands for a sustainable world are growing. Within dentistry, travel creates the highest carbon emissions and also contributes to human health damage. Internally, there are a number of ways to reduce impact by decreasing travel and energy use, as well as carefully considering the types of items purchased (and how they are disposed of). Larger dental organizations can influence their suppliers and industry by choosing to purchase from sustainable companies with environmentally friendly products. From an external driver perspective policy, guidance and research are essential. Governments need to reevaluate decontamination policy from an environmental perspective. Decontamination documents need revision to consider both planetary and public health. Dental organizations need to support dental teams in this area. Insurance providers and health care purchasers should review policies to influence the sustainability of dental providers. Sustainability education needs to be considered as part of the curriculum of undergraduate and postgraduate students. Guidance could also be developed for the dental industry to produce sustainable products. Research needs to be prioritized. Identifying hot spots or areas of high environmental contributions using other assessments such as life cycle analysis (LCA) would allow dentistry to identify products or practices that have a disproportionate adverse impact on the environment and might be prioritized for change. This should include an analysis of single-use instruments, chemicals, and products. Building research capacity by training students and creating virtual or physical centers for sustainability is essential. Financial support is needed for priority areas of research.
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Affiliation(s)
| | - R. Stancliffe
- Centre for Sustainable Healthcare, Oxford, Oxfordshire, UK
| | - F.A. Miller
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - J. Sherman
- Yale School of Medicine, New Haven, CT, USA
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Mariño R, Ravisankar G, Zaror C. Quality appraisal of economic evaluations done on oral health preventive programs-A systematic review. J Public Health Dent 2020; 80:194-207. [PMID: 32311103 DOI: 10.1111/jphd.12368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 01/01/2020] [Accepted: 03/23/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES If economic evaluations are to be used by decision makers, such evidence has to be robust so that the relevant policy maker use them. This study was undertaken with the purpose of identifying economic evaluations done on oral health preventive programs and to assess the standard of economic evidence in this field. METHODS A systematic search was conducted using four major electronic databases in order to search for economic evaluations done on oral health preventive programs. This included economic evaluations that were published between January 1975 and May 2018 on preventive interventions for periodontal disease, oral cancer screening, and other common oral health conditions. To avoid duplications with previous studies, for dental caries interventions, this review included studies from April 2012 and May 2018. "Guidance to undertaking reviews in health care," developed by York University, was used to assess the quality of reporting in the evaluations, using which strengths and shortcomings were identified. RESULTS A total of 2026 records were initially found. After title and abstract screening, and elimination by full text review, 33 relevant economic evaluations were identified. Majority of the economic evaluations included were conducted on dental caries prevention; a few were done on oral cancer screening, periodontal disease, and general preventive dentistry (health promotion, oral hygiene etc.). CONCLUSIONS In comparison to the findings observed in previous reviews, there has been improvements in the quality of reporting in economic evaluations. Several areas still in need for improve were identified (e.g., productivity costs, currency and prices, and generalizability issues).
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Affiliation(s)
- Rodrigo Mariño
- Melbourne Dental School, University of Melbourne, Melbourne, Australia
| | | | - Carlos Zaror
- Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
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Lewis CW. Teeth: Small but Mighty and Mighty Important. A Comprehensive Review of Children's Dental Health for Primary Care Clinicians. Curr Pediatr Rev 2020; 16:215-231. [PMID: 32108010 DOI: 10.2174/1573396316666200228093248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 12/12/2019] [Accepted: 01/27/2020] [Indexed: 11/22/2022]
Abstract
Healthy teeth allow us to eat and stay well-nourished. Although primary care clinicians receive limited training about teeth, given the common nature of dental problems, it is important that they understand and recognize normal and abnormal dental conditions and can implement primary and secondary prevention of dental conditions in their practice. PubMed has been used to search the scientific literature for evidence on the following topics: normal dental development, dental abnormalities, malocclusion, teething, dental caries and related epidemiology and prevention, fluoride, dental injury and its management and prevention; and identification, prevention and treatment of gingivitis and periodontal disease. Literature review relied on randomized controlled trials, meta-analyses, systematic reviews, and Cochrane reviews when relevant and available. Other sources of evidence included cohort and case-control studies. Consensus statements and expert opinion were used when there was a paucity of high-quality research studies. The literature has been synthesized on these topics to make them relevant to pediatric primary care clinicians, and as available, the strength of evidence has been characterized when making clinical recommendations.
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Affiliation(s)
- Charlotte W Lewis
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine,Seattle Children’s Hospital, Seattle, WA, USA
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Guidelines on the use of fluoride for caries prevention in children: an updated EAPD policy document. Eur Arch Paediatr Dent 2019; 20:507-516. [PMID: 31631242 DOI: 10.1007/s40368-019-00464-2] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 06/21/2019] [Indexed: 10/25/2022]
Abstract
AIM To update the exisitng European Academy of Paediatric Dentistry (EAPD) 2009 fluoride guidelines. METHODS Experts met in Athens, Greece duirng November 2018 for the following groups: I Fluoride toothpastes, II Fluoride gels, rinses and varnishes, III Fluoridated milk, fluoridated salt, tablets/lozenges and drops, IV Water fluoridation. Systematic reviews and meta-analyses were reviewed and discussed for each of the groups. The GRADE system was used to assess the quality of evidence which was judged as HIGH, MODERATE, LOW or VERY LOW based on the assessment of eight criteria which can influence the confidence of the results. Following the quality assessment, GRADE was then used to indicate the strength of recommendation for each fluoride agent as STRONG or WEAK/CONDITIONAL. RESULTS Parents must be strongly advised to apply an age-related amount of toothpaste and assist/supervise tooth brushing until at least 7 years of age. The EAPD strongly endorses the daily use of fluoride as a major part of any comprehensive programme for the prevention and control of dental caries in children. Regardless of the type of programme, community or individually based, the use of fluoride must be balanced between the estimation of caries-risk and the possible risks of adverse effects of the fluorides. Fluoride use is considered safe when the manufacturer's instructions are followed. Preventive programmes should be re-evaluated at regular intervals and adapted to a patient's or population's needs and risks. CONCLUSIONS For the majority of European Countries, the EAPD recommends the appropriate use of fluoride toothpaste in conjunction with good oral hygiene to be the basic fluoride regimen.
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Nguyen TM, Tonmukayakul U, Warren E, Cartwright S, Liew D. A Markov cost-effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70-year time horizon. Health Promot J Austr 2019; 31:177-183. [PMID: 31373066 PMCID: PMC7187475 DOI: 10.1002/hpja.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 05/27/2019] [Accepted: 07/28/2019] [Indexed: 11/08/2022] Open
Abstract
ISSUE ADDRESSED Biannual application of fluoride varnish is effective for dental caries prevention, but its cost-effectiveness using quality-adjusted life years (QALY) is unknown. This study performed a cost-effectiveness analysis, from the Australian health care system perspective of biannual application of fluoride varnish versus current practice (non-routine application) for an individual aged 15 years and older over a 70-year time horizon. METHODS Health outcomes measured were the number of prevented decayed, missing, and filled teeth (prevented-DMFT) and QALY gained. The calculated incremental cost-effectiveness ratio (ICER) was compared against the reference cost-effectiveness ICER threshold of AUD$28 033 per QALY gained. A published Markov model capturing dental caries progression of eight permanent molars was used. This 6-monthly cycle model represented ten possible health states for an individual tooth. A 5% discount rate was applied with relevant sensitivity analysis. RESULTS In the base-case scenario, the net cost for the intervention was $3600 compared to $2303 in the current practice arm. The intervention arm yielded 13.99 DMFT and 15.44 QALY gained, whereas the current practice arm yielded 15.52 DMFT and 14.74 QALY gained. The estimated ICER was $849 per prevented-DMFT and $1851 per QALY gained. Sensitivity analysis shows the ICER ranged from $424-$1807 per prevented-DMFT and $1851-$3941 per QALY gained. CONCLUSION Biannual professional application of fluoride varnish appears to be a highly cost-effective strategy and should be considered for universal funding in Australia's health care system.
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Affiliation(s)
- Tan Minh Nguyen
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia.,Melbourne Dental School, The University of Melbourne, Melbourne, Vic., Australia
| | - Utsana Tonmukayakul
- Deakin Health Economics, Institute of Health Transformation, Faculty of Health, Deakin University, Waurn Ponds, Vic., Australia
| | | | | | - Danny Liew
- Nursing and Health Sciences, School of Public Health & Preventive Medicine, Faculty of Medicine, Monash University, Clayton, Vic., Australia
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Al Dehailan L, Martinez-Mier EA. Prevention Program Including Fluoride Varnish and 1450-ppm Fluoride Toothpaste Targeting Young Children in Clinical Setting in UK did not Stop Sental Caries From Developing but Slowed Lesion Progression. J Evid Based Dent Pract 2019; 19:207-209. [PMID: 31326059 DOI: 10.1016/j.jebdp.2019.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION A randomized controlled trial of caries prevention in dental practice. Tickle M, O'Neill C, Donaldson M, Birch S, Noble S, Killough S, Murphy L, Greer M, Brodison J, Verghis R, Worthington HV. J Dent Res 2017; 96:741-46. SOURCE OF FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme in UK. TYPE OF STUDY/DESIGN Randomized clinical trial with a parallel design.
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de Sousa F, dos Santos A, Nadanovsky P, Hujoel P, Cunha-Cruz J, de Oliveira B. Fluoride Varnish and Dental Caries in Preschoolers: A Systematic Review and Meta-Analysis. Caries Res 2019; 53:502-513. [DOI: 10.1159/000499639] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to assess the effectiveness of fluoride varnish (FV) in reducing dentine caries at the patient, tooth, and surface levels as well as caries-related hospitalizations in preschoolers. We performed a systematic review of clinical trials of FV, alone or associated with an oral health program, compared with placebo, usual care, or no intervention. Bibliographical search included electronic searches of seven databases, registers of ongoing trials, and meeting abstracts, as well as hand searching. We performed random-effects meta-analyses and calculated confidence and prediction intervals. The search yielded 2,441 records; 20 trials were included in the review and 17 in at least one meta-analysis. Only one study had low risk of bias in all domains. We found no study reporting on caries-related hospitalizations. At the individual level, the pooled relative risk was 0.88 (95% confidence interval [CI] 0.81, 0.95); this means that in a population of preschool children with 50% caries incidence, we need to apply fluoride varnish in 17 children to avoid new caries in one child. At the tooth level, the pooled weighted mean difference was –0.30 (95% CI –0.69, 0.09) and at the surface level –0.77 (95% CI –1.23, –0.31). Considering the prediction intervals, none of the pooled estimates were statistically significant. We conclude that FV showed a modest and uncertain anticaries effect in preschoolers. Cost-effectiveness analyses are needed to assess whether FV should be adopted or abandoned by dental services.
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Abstract
Over the past 30 years and fueled by both a rapidly evolving understanding of dental diseases and technological advances in diagnostics and therapy, dentistry has been changing dramatically. Managing dental caries and carious lesions had, for nearly a century, encompassed only a small number of basic concepts that were applied to virtually all patients and lesions, namely, invasive removal of any carious tissue regardless of its activity or depth and its replacement with restorative materials (amalgams or crowns for most of the past) or tooth removal and prosthetic replacement. Grounded in a deeper understanding of the disease "caries," its management-aiming to control the causes of the disease, to slow down or alleviate existing disease, and, only as a last resort, to remove its symptoms using a bur or forceps-has become more complex and diverse. In parallel and at nearly unprecedented speed, our patients are changing, as mirrored by ongoing debates as to the demographic and, with it, the social future of most high-income countries. This article describes how these changes will have a profound future impact on how we practice dental medicine in the future. It will deduce, from both demographic and epidemiologic trends, why there is the need to apply not one but rather the whole range of existing evidence-based concepts in an individualized (personalized) manner, hence increasing the effectiveness and efficiency of dental management strategies, and also describe how these strategies should be tailored according not only to our patients (their age and risk profiles) but also to the specific tooth (or site or lesion).
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Palacio R, Shen J, Vale L, Vernazza CR. Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry. Community Dent Oral Epidemiol 2019; 47:217-224. [DOI: 10.1111/cdoe.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/28/2018] [Accepted: 12/10/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Raul Palacio
- School of DentistryPontificia Universidad Católica de Chile Santiago Chile
| | - Jing Shen
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
| | - Luke Vale
- Institute of Health and SocietyNewcastle University Newcastle Upon Tyne UK
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Bergström EK, Davidson T, Moberg Sköld U. Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden. Caries Res 2019; 53:339-346. [DOI: 10.1159/000495360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 11/10/2018] [Indexed: 11/19/2022] Open
Abstract
Since 2008, FRAMM has been a guideline for caries prevention for all 3- to 15-year-olds in the Västra Götaland Region in Sweden and a predominant part is school-based fluoride varnish applications for all 12- to 15-year-olds. The aims were to evaluate dental health-economic data among 12- to 15-year-olds, based on the approximal caries prevalence at the age of 12, and to evaluate cost-effectiveness. Caries data for 13,490 adolescents born in 1993 who did not take part and 11,321 adolescents born in 1998 who followed this guideline were extracted from dental records. Those with no dentin and/or enamel caries lesions and/or fillings on the approximal surfaces were pooled into the “low” subgroup, those with 1–3 into the “moderate” subgroup and those with ≥4 into the “high” subgroup. The results revealed that the low subgroup had a low approximal caries increment compared with the moderate and high subgroups during the 4-year study period. In all groups, there were statistically significant differences between those who took part in the guideline and those who did not. The analysis of cost-effectiveness revealed the lowest incremental cost-effectiveness ratio (ICER) for the high subgroup for decayed and/or filled approximal surfaces (DFSa) and approximal enamel lesions together and the highest ICER for the low subgroup for DFSa alone. To conclude, the FRAMM Guideline reduced the caries increment for adolescents with low, moderate and high approximal caries prevalence. The subgroup with the most favourable cost-effectiveness comprised those with a high caries prevalence at the age of 12.
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Donovan TE, Marzola R, Murphy KR, Cagna DR, Eichmiller F, McKee JR, Metz JE, Albouy JP, Troeltzsch M. Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2018; 120:816-878. [DOI: 10.1016/j.prosdent.2018.09.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 02/08/2023]
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Julihn A, Soares FC, Hjern A, Dahllöf G. Socioeconomic Determinants, Maternal Health, and Caries in Young Children. JDR Clin Trans Res 2018; 3:395-404. [PMID: 30263967 PMCID: PMC6139990 DOI: 10.1177/2380084418788066] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Introduction Maternal health during pregnancy plays a part in child health, and several conditions have been associated with adverse child outcomes. Objectives To determine the socioeconomic determinants and maternal health factors associated with dental caries in young children. Methods This cross-sectional study is part of a register-based cohort study including all children who were born from 2000 to 2003 and were residing in Stockholm County, Sweden, at age 3 y (n = 73,658). The study followed the cohort until individuals were 7 y old. The final study cohort comprised all children examined at 3 and 7 y (n = 65,259). Data on socioeconomic conditions, maternal health, and maternal health behavior were extracted from Swedish national registries. The multivariate analyses used 2 outcomes: caries experience at age 3 and 7 y (deft > 0 [decayed, extracted, and filled teeth]). Results The results of this study show that socioeconomic and maternal health behaviors during pregnancy are important determinants of oral health in their preschool offspring. When all significant risk factors were present, the cumulative probability of being diagnosed with dental caries at age 7 y was 75%. Conclusion This study also showed that maternal obesity and smoking during pregnancy were predictors of dental caries in preschool children. Strategies must be developed for increasing maternal motivation and self-efficacy and providing mothers with knowledge and caries-preventive tools. Knowledge Transfer Statement The results of this study inform clinicians about the importance of including a more detailed history regarding maternal health and maternal health behaviors during pregnancy to assess caries risk in preschool children. Education, income, and other socioeconomic factors are difficult to modify in the short term. Therefore, strategies must be developed to increase parental motivation and self-efficacy to give parents the determination, knowledge, and tools for prevention.
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Affiliation(s)
- A Julihn
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Specialist Dental Care, Public Dental Health Service, Region Västra Götaland, Sweden
| | - F C Soares
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Hjern
- Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden
| | - G Dahllöf
- Division of Orthodontics and Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.,Center for Pediatric Oral Health Research, Stockholm, Sweden
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Schwendicke F, Foster Page LA, Smith LA, Fontana M, Thomson WM, Baker SR. To fill or not to fill: a qualitative cross-country study on dentists' decisions in managing non-cavitated proximal caries lesions. Implement Sci 2018; 13:54. [PMID: 29625615 PMCID: PMC5889601 DOI: 10.1186/s13012-018-0744-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 03/26/2018] [Indexed: 12/01/2022] Open
Abstract
Background This study aimed to identify barriers and enablers for dentists managing non-cavitated proximal caries lesions using non- or micro-invasive (NI/MI) approaches rather than invasive and restorative methods in New Zealand, Germany and the USA. Methods Semi-structured interviews were conducted, focusing on non-cavitated proximal caries lesions (radiographically confined to enamel or the outer dentine). Twelve dentists from New Zealand, 12 from Germany and 20 from the state of Michigan (USA) were interviewed. Convenience and snowball sampling were used for participant recruitment. A diverse sample of dentists was recruited. Interviews were conducted by telephone, using an interview schedule based on the Theoretical Domains Framework (TDF). Results The following barriers to managing lesions non- or micro-invasively were identified: patients’ lacking adherence to oral hygiene instructions or high-caries risk, financial pressures and a lack of reimbursement for NI/MI, unsupportive colleagues and practice leaders, not undertaking professional development and basing treatment on what had been learned during training, and a sense of anticipated regret (anxiety about not restoring a proximal lesion in its early stages before it progressed). The following enablers were identified: the professional belief that remineralisation can occur in early non-cavitated proximal lesions and that these lesions can be arrested, the understanding that placing restorations weakens the tooth and inflicts a cycle of re-restoration, having up-to-date information and supportive colleagues and work environments, working as part of a team of competent and skilled dental practitioners who perform NI/MI (such as cleaning or scaling), having the necessary resources, undertaking ongoing professional development and continued education, maintaining membership of professional groups and a sense of professional and personal satisfaction from working in the patient’s best interest. Financial aspects were more commonly mentioned by the German and American participants, while continuing education was more of a focus for the New Zealand participants. Conclusions Decisions on managing non-cavitated proximal lesions were influenced by numerous factors, some of which could be targeted by interventions for implementing evidence-based management strategies in practice. Electronic supplementary material The online version of this article (10.1186/s13012-018-0744-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Schwendicke
- Department for Operative and Preventive Dentistry, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - L A Foster Page
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - L A Smith
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - M Fontana
- Department of Cariology, Restorative Sciences and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, USA
| | - W M Thomson
- Department of Oral Sciences, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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