Cost‐effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster‐randomized controlled community trial

Effenberger, Susanne; Greenwall, Linda; Cebula, Marcus; Myburgh, Neil; Simpson, Karen H.; Smit, Dirkie; Wicht, Michael J.; Schwendicke, Falk

doi:10.1111/cdoe.12702

Cited by 5 publications

(16 citation statements)

References 31 publications

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Section: Resultsmentioning

confidence: 99%

“…One RCT reported a 49% reduction in dental caries (P< 0.001) in high-risk pre-school children receiving fluoride varnish four times in Kosovo [25]. Two other high-quality trials reported a modest non-significant reduction in the worsening of d3mft in a low socioeconomic nursery setting in Scotland [13]; and no significant caries-preventive effect in a primary school setting within a high-risk community in South Africa [26]. A more recent fluoride varnish review -not restricted to education settings, which was rated as moderate quality, showed a modest and uncertain anti-caries effect in pre-schoolers and called for more costeffectiveness analyses [27].…”

Section: Fluoride Varnish Applicationmentioning

confidence: 99%

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International consensus on fluoride programmes for Early Childhood Caries prevention in early education settings

Abuhaloob,

Conay,

Blokland

et al. 2024

Preprint

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Background The World Health Organisation has set out a clear priority for the implementation of interventions to reduce the burden of Early Childhood Caries (ECC), a global public health problem affecting over 500 million children around the world and having a substantial impact on child well-being and health system expenditure. The aim of this study was to assess and develop international expert consensus on the evidence for fluoride-based interventions in early-year education settings (kindergartens/nursery and primary schools) for reducing ECC and to synthesise clear programme-level recommendations with regard to ECC prevention in this setting. Methods A systematic overview of systematic reviews, trials, and observational studies was performed to identify and critically appraise the available evidence on the effectiveness and cost-effectiveness of fluoride-based interventions in early-years education settings to prevent ECC. This was followed by a three-stage modified Delphi panel study (n= 21) consisting of: round 1, an online survey to gather opinions on safety, effectiveness and feasibility of interventions; round 2, an iterative survey to consider collated group opinion and gather feedback on review findings; and finally, an online workshop with presentations and facilitated in-depth, recorded group discussions. Results There was high-quality evidence and consensus on delivering supervised toothbrushing in kindergartens (nurseries) and primary/elementary schools; this is safe and cost-effective, shows greater benefit to more disadvantaged children, helps child social development, and is feasible in high and low/middle-income countries. There was more moderate support for the effectiveness and cost-effectiveness of fluoride varnish application in this setting (especially where supervised toothbrushing with fluoride is in place). It was agreed that policy makers should prioritise at-risk groups where resources are limited, and that systemic fluoride interventions (Fluoride tablets, drops, milk, and salt) in this setting are no longer a priority. Conclusion Supervised toothbrushing with fluoridated toothpaste is the most effective, cost-effective, feasible and safest mechanism for children in early education settings. Universal coverage is preferred but where resources are limited targeting based on need is indicated. Panel consensus is that it remains appropriate in water fluoridated areas and is largely feasible in low/middle-income countries.

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Section: Resultsmentioning

confidence: 99%

Section: Fluoride Varnish Applicationmentioning

confidence: 99%

International consensus on fluoride programmes for Early Childhood Caries prevention in early education settings

Abuhaloob,

Conay,

Blokland

et al. 2024

Preprint

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“…While the articles [34,49] were about similar results, the articles [43,48] represented the baseline study [43] and the follow-up study with final clinical trial results [48]. Of the 24 articles included in the systematic review, 17 articles could be classified as prevention [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41]49]. Seven studies were classified as restoration [42][43][44][45][46][47][48].…”

Section: Resultsmentioning

confidence: 99%

“…Studies were classified chronologically according to their country of study conduct, number of study participants, location (e.g., practice/clinic) of study conduct, age of study participants, and study quality assessment. Furthermore, included studies were classified into two main groups of prevention according to their primary outcome [18,[27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] and restoration [42][43][44][45][46][47][48] with different subgroups divided at prevention (outreach/education/education, sealing, fluoride varnish, and silver diamine fluoride (SDF) and atraumatic restorative treatment (ART) as well as restoration (filling and crown). For ease of synthesis and clarity, the results were summarized in tables.…”

Section: Data Sources Search Strategy and Study Selectionmentioning

confidence: 99%

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

Wolf,

Campus

2023

Medicina

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Background and Objectives: Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Materials and Methods: Observational epidemiological studies, i.e., cohort studies, case–control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. Results: The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Conclusions: Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.

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“…In the United States, the close relationship between dentists and community centres, as well as the strong cooperation and communication between doctors and policy supporters and the eligibility recognition of Medicaid issued by the government, effectively ensures the stable implementation of this recommended intervention [ 22 ]. However, a study from South Africa evaluated the effectiveness of FV in preventing caries among high-risk populations, revealing that, in addition to daily supervised tooth brushing, regular FV application had no significant effect on caries prevention [ 23 ]. This may be due to differences in national contexts and disparities between communities, as many countries and regions are still unable to effectively implement this approach [ 9 , 24 ].…”

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness and cost–benefit analyses of fluoride varnish for caries prevention in Guangxi, China

Tang,

Nong,

Chen

et al. 2024

BMC Oral Health

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Objectives The objectives of this study were to evaluate the cost-effectiveness and cost-benefit of fluoride varnish (FV) interventions for preventing caries in the first permanent molars (FPMs) among children in rural areas in Guangxi, China. Methods This study constituted a secondary analysis of data from a randomised controlled trial, analysed from a social perspective. A total of 1,335 children aged 6–8 years in remote rural areas of Guangxi were enrolled in this three-year follow-up controlled study. Children in the experimental group (EG) and the control group (CG) received oral health education and were provided with a toothbrush and toothpaste once every six months. Additionally, FV was applied in the EG. A decision tree model was developed, and single-factor and probabilistic sensitivity analyses were conducted. Results After three years of intervention, the prevalence of caries in the EG was 50.85%, with an average decayed, missing, and filled teeth (DMFT) index score of 1.12, and that in the CG was 59.04%, with a DMFT index score of 1.36. The total cost of caries intervention and postcaries treatment was 42,719.55 USD for the EG and 46,622.13 USD for the CG. The incremental cost-effectiveness ratio (ICER) of the EG was 25.36 USD per caries prevented, and the cost–benefit ratio (CBR) was 1.74 USD benefits per 1 USD cost. The results of the sensitivity analyses showed that the increase in the average DMFT index score was the largest variable affecting the ICER and CBR. Conclusions Compared to oral health education alone, a comprehensive intervention combining FV application with oral health education is more cost-effective and beneficial for preventing caries in the FPMs of children living in economically disadvantaged rural areas. These findings could provide a basis for policy-making and clinical choices to improve children’s oral health.

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Cost‐effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster‐randomized controlled community trial

Cited by 5 publications

References 31 publications

International consensus on fluoride programmes for Early Childhood Caries prevention in early education settings

International consensus on fluoride programmes for Early Childhood Caries prevention in early education settings

Cost-Effectiveness of Treatment Decisions for Early Childhood Caries in Infants and Toddlers: A Systematic Review

Cost-effectiveness and cost–benefit analyses of fluoride varnish for caries prevention in Guangxi, China

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