Cost-Effectiveness through the Dental-Health FRAMM Guideline for Caries Prevention among 12- to 15-Year-Olds in Sweden

2019 ◽  
Vol 53 (3) ◽  
pp. 339-346 ◽  
Author(s):  
Eva-Karin Bergström ◽  
Thomas Davidson ◽  
Ulla Moberg Sköld
Keyword(s):  
Cost Effectiveness ◽  
Dental Health ◽  
Caries Prevention ◽  
Caries Prevalence ◽  
School Based ◽  
Caries Increment ◽  
Dental Records ◽  
Caries Lesions ◽  
Approximal Caries ◽  
Approximal Surfaces

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.

scholarly journals An Economic Evaluation of a Comprehensive School-Based Caries Prevention Program

2019 ◽  
Vol 4 (4) ◽  
pp. 378-387 ◽  
Author(s):  
S.S. Huang ◽  
R.R. Ruff ◽  
R. Niederman
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Cost Effective ◽  
Prevention Programs ◽  
Caries Prevention ◽  
Health Impacts ◽  
Economic Evaluations ◽  
Posterior Teeth ◽  
School Based ◽  
The Cost

Introduction: Current economic evaluations of school-based caries prevention programs (SCPPs) do not compare multiple types of SCPPs against each other and do not consider teeth beyond permanent first molars. Objectives: To assess the cost-effectiveness of a comprehensive SCPP relative to an SCPP focused on delivering sealants for permanent first molars only and to a default of no SCPP. Based on a societal perspective, a simulation model was used that compared the health and cost impacts on 1) permanent first molars only and 2) all posterior teeth. Methods: To calibrate the model, we used data from CariedAway, a comprehensive SCPP that used glass ionomer to prevent and arrest active decay among children. We then evaluated the incremental cost-effectiveness of implementing 3 alternate school-based approaches (comprehensive, sealant only, and no program) on only first molars and all posterior teeth. Probabilistic, 1-, and 2-way sensitivity analyses are included for robustness. Cost-effectiveness is assessed with a threshold of $54,639 per averted disability-adjusted life year (DALY). Results: We first compared the 3 programs under the assumption of treating only first molars. This assessment indicated that CariedAway was less cost-effective than school-based sealant programs (SSPs): the resulting incremental cost-effectiveness ratio (ICER) for CariedAway versus SSPs was $283,455 per averted DALY. However, when the model was extended to include CariedAway’s treatment of all posterior teeth, CariedAway was not only cost-effective but also cost-saving relative to SSPs (ICER, –$943,460.88 per averted DALY; net cost, –$261.45) and no SCPP (ICER, –$400,645.52 per averted DALY; net cost, –$239.77). Conclusions: This study finds that economic evaluations assessing only cost and health impacts on permanent first molars may underestimate the cost-effectiveness of comprehensive SCPPs 1) preventing and arresting decay and 2) treating all teeth. Hence, there is an urgent need for economic evaluations of SCPPs to assess cost and health impacts across teeth beyond only permanent first molars. Knowledge Transfer Statement: The results of this study can be used by policy makers to understand how to evaluate economic evaluations of school-based caries prevention programs and what factors to consider when deciding on what types of programs to implement.

Dental Caries Prevalence in Early Polynesians from the Hawaiian Islands

1986 ◽  
Vol 65 (6) ◽  
pp. 935-938 ◽  
Author(s):  
H.J. Keene
Keyword(s):  
Young Adults ◽  
Alveolar Bone ◽  
Dental Health ◽  
Age Groups ◽  
Root Surface ◽  
Caries Prevalence ◽  
Tooth Structure ◽  
Age Related ◽  
Caries Lesions ◽  
Root Surface Caries

We examined the skeletal remains of 1338 early Hawaiians (preserved in the Bishop Museum, Honolulu) to determine total caries and root surface caries prevalence. Specimens from seven islands were represented in the collection. Estimation of age at death was made by a combination of dental developmental staging for younger individuals and occlusal attrition and/or alveolar bone loss in adults. Museum records were also consulted for age estimation of adults which was primarily based on osteological criteria. The material was divided into six age groups. Predentate infants and edentulous adults were not included. A total of 19,425 teeth was examined. Caries lesions were observed in 462 individuals (34.5%) and 1895 teeth (9.8%). Coronal caries lesions in children and adolescents tended to be small and not particularly destructive of tooth structure. Root surface lesions in young adults were also small but increased progressively in size in the older groups, resulting in pulp exposure and coronal amputation. Although coronal caries was apparently not a significant dental health problem in children and young adults (compared with contemporary Hawaiians), root surface caries was an increasingly important source of tooth morbidity and tooth mortality in the older population groups. This age-related caries pattern was similar for all of the islands.

Computer-based Image Analysis of Natural Approximal Caries on Radiographic Films

1992 ◽  
Vol 71 (3_suppl) ◽  
pp. 846-849 ◽  
Author(s):  
T.J. Heaven ◽  
A.R. Firestone ◽  
F.F. Feagin
Keyword(s):  
Computer Software ◽  
Polarized Light ◽  
Automatic Detection ◽  
Thin Sections ◽  
Coefficients Of Variation ◽  
Computer Based ◽  
Caries Lesions ◽  
Approximal Caries ◽  
Approximal Surfaces ◽  
Good Agreement

This paper reports on the development of computer software for automatic detection and measurement of approximal caries lesions on digital images obtained from radiographic films. If the program detects a lesion, it defines the lesion's border and measures and reports these lesion parameters: percent mineralization, area, maximum enamel penetration, and mean enamel penetration. Two experiments are reported; both were conducted with the use of extracted human premolar teeth. In the first experiment, thin sections were obtained from 13 approximal surfaces with caries lesions. Microradiographs were made of the sections, and software measurements of the lesions were obtained from the microradiographs. The software was able to separate the lesions into two groups: those that had penetrated less than 100% of the enamel and those that had penetrated 100% of the enamel. The software measurements agreed with evaluation of lesion penetration by polarized light microscopy of the thin sections. In the second experiment, simulated clinical radiographs were made of 16 approximal surfaces, 12 with lesions and four without. Thin sections were obtained for microradiography. Software was used for automatic detection and measurement of the lesions on both types of film. The ability of the software to detect the lesions on the clinical films was compared with that of 10 experienced clinicians. Correlations of the same parameter from the two types of radiographic films were statistically significant, 0.86 ≤ r ≤ 0.95 and p < 0.05. The coefficients of variation were low for both microradiographs, 0.4–2.3%, and for clinical films, 0.7–8.5%. A receiver-operating characteristic (ROC) curve was constructed for the clinicians and the software. The software was more accurate than the clinicians in deciding whether or not a lesion was present. In conclusion, under the conditions of this experiment, the software was able accurately to decide whether caries was present and, when present, to provide information about the extent of the lesion which was in good agreement with that from microradiographs.

scholarly journals Study protocol for a randomized clinical trial to evaluate the effect of the use of Xylitol gum in the prevention of caries lesions in children living in Ladakh—the Caries Prevention Xylitol in Children (CaPreXCh) trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maria Grazia Cagetti ◽  
Fabio Cocco ◽  
Ezio Calzavara ◽  
Davide Augello ◽  
Phunchok Zangpoo ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Examination ◽  
Caries Prevention ◽  
Chewing Gum ◽  
Link Type ◽  
School Based ◽  
Plaque Ph ◽  
Caries Increment ◽  
Chewing Gums ◽  
Permanent Molars

Abstract Background Xylitol use is reported to be able to reduce dental plaque amount and cariogenic bacteria and, as a consequence, the caries increment. Only few data on the oral health of Ladakh’s population are available. The aim of the present protocol will be to record the caries prevalence of primary and permanent molars of schoolchildren living in Ladakh and to implement a school-based Xylitol programme, named the Caries Prevention Xylitol in Children (CaPreXCh) trial, using chewing gums. Methods The protocol is designed as a triple-blind randomized, controlled, parallel-group clinical trial in children aged 5–14 years. The study should have been carried out from August 2021 to August 2024 in Zanskar Valley (Ladakh), but the COVID-19 pandemic does not allow today to make predictions on the exact start. Participants will be randomly allocated into two groups: subjects who will receive a chewing gum with Xylitol (70% w/v) as only sweetener, and those who will receive a sugared chewing gum containing Maltitol (23% w/v). The subjects will be instructed to chew a total of 6 pellets for 5 min divided into 3 intakes a day (2 in the morning, 2 after the midday meal and 2 in the afternoon) for one school year. Clinical examination will comprise an oral examination in which caries index (ICDAS scores), bleeding on probing and plaque pH evaluation after sucrose challenge will be recorded at baseline (t0); the clinical examination will be repeated after 12 months since the beginning of the chewing gum administration period (t1), after another 12-month period (t2) and finally after further 12 months (t3) (24 months from the end of the chewing gum use). The primary outcome will be the caries increment measured both at enamel and dentinal levels on primary and permanent molars. Data analysis will be conducted through Kaplan-Meyer graphs to evaluate caries increment. A comparison of the methods will be carried out with Cox regression with shared frailty. The net caries increment for initial, moderate and severe caries levels, using ICDAS (Δ-initial, Δ-moderate and Δ-severe), will be calculated. Discussion This trial will be the first trial conducted in India assessing the efficacy of a school-based caries preventive programme through the use of chewing gum containing only Xylitol as a sweetener. The findings could help strengthen the evidence for the efficacy of Xylitol use in community-based caries prevention programmes in children. Trial registration Clinical trials.govNCT04420780. Registered on June 9, 2020

scholarly journals Longitudinal caries prevalence in a comprehensive, multi-component, school-based prevention program

2020 ◽  
Author(s):  
Jacqueline R. Starr ◽  
Ryan R. Ruff ◽  
Joseph Palmisano ◽  
J. Max Goodson ◽  
Omair M. Bukhari ◽  
...  
Keyword(s):  
Prevention Program ◽  
Phase 1 ◽  
Clinical Effectiveness ◽  
Caries Prevention ◽  
Dental Hygienists ◽  
Glass Ionomer ◽  
Caries Prevalence ◽  
School Based ◽  
Free Care ◽  
Untreated Caries

AbstractBackgroundGlobally, children’s caries prevalence exceeds 30% and has not markedly changed in 30 years. School-based caries prevention programs may be an effective method to reduce caries prevalence, obviate traditional barriers to care, and use aerosol-free interventions. The objective of this study was to explore the clinical effectiveness of a comprehensive school-based, aerosol-free, caries prevention program.MethodsWe conducted a 6-year prospective open cohort study in 33 U.S. public elementary schools, providing care to 6,927 children in communities with and without water fluoridation. Following a dental examination, dental hygienists provided twice-yearly prophylaxis, glass ionomer sealants, glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed. We used generalized estimating equations to estimate the change in the prevalence of untreated caries over time.ResultsThe prevalence of untreated caries decreased by greater than 50%: from 39% to 18% in phase 1, and from 28% to 10% in phase 2. The per-visit adjusted odds ratio of untreated decay was 0.79 (95% CI: 0.73, 0.85).Conclusions and Practical ImplicationsWe show that a school-based comprehensive caries prevention program was associated with substantial reductions in children’s caries, supporting the concept of expanding traditional practices to include office- and community-based aerosol-free care.

Temporary Tooth Separation to Improve Assessment of Approximal Caries Lesions: A School-Based Study

2020 ◽  
Vol 45 (6) ◽  
pp. 581-588
Author(s):  
MM Nascimento ◽  
AP Ribeiro ◽  
AJ Delgado ◽  
L Cassiano ◽  
MGD Caraballo ◽  
...  
Keyword(s):  
Caries Risk ◽  
Diagnostic Aid ◽  
Health Records ◽  
Lesion Depth ◽  
Lesion Location ◽  
School Based ◽  
Threshold Criterion ◽  
Oral Biofilms ◽  
Caries Lesions ◽  
Approximal Caries

Clinical Relevance Radiographic lesion depth should not be used as the single determinant of the restorative threshold for clinically inaccessible approximal caries lesions. Temporary tooth separation is a feasible and effective diagnostic aid for assessment and appropriate management of approximal lesions. SUMMARY In the era of tooth-preserving dentistry, the decision to restore approximal caries lesions must be based on the accurate assessment of tooth cavitation, as the accumulation of oral biofilms in these areas encourages lesion progression. However, lesions radiographically into dentin remain the main threshold criterion for restoring approximal lesions even though most of these lesions may not be cavitated. A school-based clinical protocol for temporary tooth separation (TTS) was developed to improve visual-tactile assessment and management of clinically inaccessible approximal lesions. TTS data retrieved from electronic health records were used to correlate radiographic lesion depth and surface cavitation status with lesion location and the patient’s caries risk and to evaluate the effectiveness of TTS as a diagnostic aid for approximal lesions. Of the 206 lesions assessed, 66.5% (n=137) were located in the maxillary arch, 56.6% (n=116) in distal surfaces, 61.3% (n=114) in premolars, and 21.5% (n=40) in molars. After tooth separation, 79.6% (n=164) of the lesions were diagnosed as noncavitated, including 90% (n=66) of the lesions radiographically at the inner half of enamel (E2) and 66% (n=49) of those at the outer-third of dentin (D1). Logistic regression analysis using E2 and D1 lesions showed no significant association between lesion depth or cavitation status with lesion location and caries risk. TTS is a feasible and effective diagnostic aid for the assessment and appropriate management of approximal caries lesions. There is a need to reevaluate the use of radiographic lesion depth as the single determinant of the restorative threshold for clinically inaccessible approximal lesions.

Effective Caries Prevention in a Hebridean Island Population

2015 ◽  
Vol 4 (4) ◽  
pp. 27-32
Author(s):  
Margaret Formby
Keyword(s):  
Dental Health ◽  
School Age Children ◽  
Caries Experience ◽  
Control Group ◽  
Island Population ◽  
Caries Prevalence ◽  
School Based ◽  
Permanent Molars ◽  
The Mean ◽  
Care Index

Background The Isle of Islay has a remote-rural population. Two dentists have been responsible for the care of the majority of the school-age children for 15 years. The island affords a unique situation to measure caries prevalence in a relatively static population. Aim This study measures the changes in the dental caries experience of five and 12-year olds exposed to a preventive-based approach to improving dental health, which included a school-based tooth-brushing programme (four to 12-year-olds). Design Data from practice-based records were collected for children aged five and 12 in the years 1999–2003 and 2012–2014. Indices including percentage of children with no obvious caries, decayed, missing or filled teeth (dmft/DMFT) and care indexes were calculated, translated into graphs and compared to Scotland's National Dental Inspection Programme (NDIP) data. Results 478 children were included in the study. The mean number in each year group for five-year-olds was 28 (SD±5.65) and for 12-year-olds was 31.75 (SD±8.30). The percentage of children caries-free increased from 39% to 85% (five-year-olds) and 31% to 97% (12-year-olds). DMFT decreased from 3.04 to 0.30 (five-year-olds) and 3.74 to 0.03 (12-year-olds). Figures for care index and percentage of first permanent molars fissure sealed were higher than national data averages. Conclusion Caries prevalence decreased in children in Islay aged five and 12 years over the period 1999–2014. There was no control group but the differences described above can be associated with the introduction of a preventive approach, however they cannot be assumed to be causative.

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