An evaluation of the Saskatchewan pit and fissure sealant program: a longitudinal followup

Implementation and impact of a dental preventive intervention conducted within a health promotion program on health inequalities: A retrospective study

Background

The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program. A greater or at least equivalent quality and impact of the intervention was expected for children living in socially deprived regions with the greatest health needs.

Methods

The study population was the schoolchildren, aged 6 years in 2016, who benefited from the dental sealant program (n = 2532). The study sample was randomly selected in 2017 from that population (n = 550). The children's dental status was evaluated at school in 2017 and compared with that recorded in 2016 during the sealant intervention allowing the calculation of the retention rates and one-year carious increment on first permanent molars. Socio-demographic variables (gender, public/private school) and conditions of sealant placement (school/dental office, presence of a dental assistant) were recorded. The carious increment was explained using a mixed multiple random-effects regression. A mediation analysis was conducted to assess the respective contributions of the retention rates and the region of origin on caries increment.

Results

The participation rate was very high (89%) and on average, children had 83% of their dental sealants present after one year, 31% fully and 52% partially present. Caries increment varied depending on the sealant retention rate as well as on the region (North, South, Islands). The mediation analysis showed that living in a deprived area (The Islands) was a strong determinant for high caries increment particularly when the retention rates were low.

Conclusions

This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program. Nevertheless, the intervention was not effective enough to totally balance the influence of health determinants, especially in socially deprived sectors characterized by greater dental needs.

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.

Incidence of caries in an infant population in Mostoles, Madrid. Evaluation of a preventive program after 7.5 years of follow-up

OBJECTIVE

To assess the efficacy and effectiveness of a dental-health programme after 7.5-years of follow-up.

DESIGN

The study follows a prospective cohort design without randomization.

POPULATION AND METHODS

The study group cohort consisted of 547 school children, 266 girls and 281 boys, the control group was composed of 237 school children, 121 girls and 116 boys. Dental examinations were carried out using WHO criteria. Preventive measures included health education, a weekly mouth rinse using sodium fluoride (NaFI) at 0.2% concentration, fissure sealants to first permanent molars and topical application of fluoride gel. The outcomes using different indices of tooth decay and socio-demographic variables were compared between study and control groups and statistical significance determined through the Mann-Whitney U-test. Logistic regression was used in the multivariate analysis.

RESULTS

There were statistically significant differences between cohorts in the indices of decay. The mean DMFT value for study group children was 1.52 and for first permanent molars (DMFM) 1.10 per child, mean DMFS was 2.09. In the control group, values were DMFT-3.07, DMFM-2.03 per child, DMFS-4.33. Logistic regression showed the preventive programme to have a significant independent effect.

CONCLUSION

The preventive programme had been effective and had a clear protective effect.

[Incidence of dental caries in a child population from Mostoles: evaluation of a preventive program after 2 years]

OBJECTIVE

To know the efficacy and effectivity od dental health program after 2 years.

DESIGN

The study of prospective cohorts not aleatorized.

POPULATION AND METHODS

The exposed cohort is composed of 583 school children, 296 girls and 287 boys, the non-exposed cohort is composed of 261 school children, 132 girls and 129 boys. We carried out and odontological exploration following the criteria of the WHO the preventive measures we carried out are health education, weekly mouthrinse of NaFl at 0.2%, occlusive sealant in the first permanent molar and external application fluorine gel. We measured and compared the different indexes of tooth decay and sociodemographic variables between both cohorts, the statistic meaning has been determined through the U est of Mann Whitney.

RESULTS

We have found statistically significant differences between both cohorts in the indexes of decay in the exposed cohorts. The indexes of decay in the exposed cohort being DMFT: 0.31; DMFM (first permanent molar): 0.31; DMFS: 0.4. And in the non-exposed cohort DMFT: 0.81; DMFM: 0.81; DMFS; 1.09. Existing an epidemiological association between the preventive program and the prevention of dental decay with a relative risk of 0.24 (95% CI, 0.17-0.33) and the prevention fraction of 76.3% (95% CI, 67-83).

CONCLUSIONS

The preventive program after two years elapsed is effective and has a clear protector effect.

The economic evaluation of pit and fissure sealants

This paper reviews the literature relating to the economic evaluation of sealants. Economic issues are commonly cited for lack of sealant utilization, although there are no adequate economic analyses on which to base this belief. The design of much of the existing economic literature regarding sealants is inappropriate, for example many analyses do not consider the advantages of a sound tooth in the calculation of budget. In general the recent literature supports the efficiency and the effectiveness of sealants. However, there is a need for well designed studies, examining modern materials and populations with current caries prevalence. In particular there is a need for well conducted cost-benefit analyses and cost-utility analyses, which should encompass discounting for time and sensitivity analyses. Results from such research would assist clinicians and policy makers alike, in decisions regarding the provision of care with regard to sealant provision at the individual and community level.

The relationship between clinical tooth status and receipt of sealants among child Medicaid recipients

This study investigated the association between caries status and sealant need at a prior survey and subsequent sealant use in a Medicaid program. Clinical data from a 1986-87 statewide epidemiological survey (N = 8026) representative of North Carolina (NC) schoolchildren (grades K-12) were linked with all NC Medicaid dental claims submitted during 1987-92, yielding 570 children in the survey who had at least one dental visit during 1987-1992. From the 570, 390 children were included: 71 who received sealants (S) and 319 who received non-sealant care (NS). Children were excluded based on age, having preexisting sealants, or having no sealant-eligible molars or premolars. S and NS were compared on baseline dfs, DMFS, and sealant need, controlling for the patient's age, number of visits, and the provider's propensity to seal. At all ages, NS was twice as likely to have had prior dfs or DMFS (OR = 2.04, 95% CI = 1.15, 3.70). The association between sealant receipt and prior sealant need varied by age. At 6 to 11 years, S and NS had equal likelihood of sealant need (OR = 1.41, 95% CI = 0.62, 3.18). At 12 to 15 years, NS had a greater likelihood of sealant need (OR = 6.82, 95% CI = 1.60, 29.08). Caries-free status was associated with subsequent sealant receipt. Prior sealant need caused variability in dentists' decisions, depending on the child's age and past caries experience. Sealants were used infrequently by most providers and for a minority of patients. These findings are important for the Medicaid program and for future non-randomized studies of sealant effectiveness.