Cost-effectiveness of adding fluoride varnish to a preventive protocol for early childhood caries in rural children with no access to fluoridated drinking water

Zaror, Carlos; Muñoz-Millán, Patricia; Espinoza-Espinoza, Gerardo; Vergara-González, Carolina; Martinez‐Zapata, Maria José

doi:10.1016/j.jdent.2020.103374

Cited by 17 publications

(54 citation statements)

References 21 publications

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“…Dental caries is significantly greater among ethnic minorities, people living in rural areas, and socially disadvantaged children [30,31]. However, studies conducted in lower socioeconomic areas have shown that fluoride use was effective in preventing caries development, as it reduced the incidence of caries [32][33][34]. Children in a higher socioeconomic position might already have good oral health behaviors, such as better utilization of dental services, higher frequency of toothbrushing, and fluoride toothpaste, while those in a lower socioeconomic position are less likely to practice better oral health behaviors [28].…”

Section: Discussionmentioning

confidence: 99%

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

Shen

Bernabé

Sabbah

2021

IJERPH

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(1) Background: The objective is to systematically review the evidence on intervention programs aiming at reducing inequality in dental caries among children. (2) Methods: Two independent investigators searched MEDLINE, Cochrane library, and Ovid up to December 2020 to identify intervention studies assessing the impact on socioeconomic inequalities in dental caries among children. The interventions included any health promotion/preventive intervention aiming at reducing caries among children across different socioeconomic groups. Comparison groups included children with alternative or no intervention. Cochrane criteria were used to assess interventional studies for risk of bias. (3) Results: After removal of duplicate studies, 1235 articles were retained. Out of 43 relevant papers, 13 articles were identified and used in qualitative synthesis, and reported quantifiable outcomes. The included studies varied in measurements of interventions, sample size, age groups, and follow-up time. Five studies assessed oral health promotion or health-education, four assessed topical fluorides, and four assessed water fluoridation. Interventions targeting the whole population showed a consistent reduction of socioeconomic inequalities in dental caries among children. (4) Conclusion: The quality of included papers was moderate. High heterogeneity did not allow aggregation of the findings. The overall findings suggest that whole population interventions such as water fluoridation are more likely to reduce inequalities in children’s caries than target population and individual interventions.

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Section: Discussionmentioning

confidence: 99%

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

Shen

Bernabé

Sabbah

2021

IJERPH

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“…Another shortcoming was that no health-economic evaluation was performed. Recent studies indicate that fluoride varnish programs may be cost-effective in preschool children, particularly when performed in primary health care settings [Scherrer and Naavaal, 2019;Zaror et al, 2020]. The calculated NNT values were favorable, on both the subject and tooth levels, and applications every third month may therefore be a suitable procedure for caries-active Polish preschoolers.…”

Section: Discussionmentioning

confidence: 95%

Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial

et al. 2021

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The prevention of dental caries in preschool children is a priority for dental services. The aim of the study was to investigate the caries-preventive effect of 2 fluoride varnishes in caries-active preschool children, and then compare the outcome with a non-varnish control group. After screening, 180 preschool children aged 36–71 months, with at least 1 noncavitated lesion, were enrolled and randomly allocated into 3 parallel groups, namely A: 1.5% ammonium fluoride varnish (Fluor Protector S), B: 5% NaF varnish (Duraphat), and C: professional tooth-cleaning. All children were recalled every third month for intervention and their parents were instructed to have them brush their teeth with a 1,000-ppm fluoride toothpaste twice daily. Caries were recorded at baseline and after 12 months by a calibrated examiner and the incidence was scored on noncavitated (d2) and cavitated (d3) level. We tested differences between the groups with the χ2 and two-sided t tests. One hundred and seventy-two children (95.6%) completed the trial and 56 (32.6%) and 35 (19.2%) developed new d2 and d3 lesions, respectively. Both varnishes reduced the incidence of caries compared with the control group, but there was no significant difference between group A and group B. Compared with group C, the relative risk for developing cavitated lesions was 0.39 (95% CI 0.22–0.62) in group A and 0.26 (95% CI 0.14–0.50) in group B. The total prevented fraction (Δd2d3mft) for group A and group B was 19.9 and 22.5% (p < 0.05), respectively. No adverse effects were observed or reported during the study period. In conclusion, the 2 fluoride varnishes demonstrated an equal capacity to reduce the incidence of caries in caries-active preschool children over a 12-month period in comparison with a control group.

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“…[ 57 ] A cost-effectiveness analysis based on a clinical decision tree found the application of fluoride varnish as a cost-effective community strategy to prevent early childhood caries among rural children in nonfluoridated areas. [ 58 ] Cost-effectiveness of varnish against sealant was assessed over a period of 4 years in a school-based setting. Varnish appeared to be more cost-effective than sealants as the latter required expertise in application.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of casein phosphopeptide-amorphous calcium phosphate varnish in remineralizing white spot lesions: A systematic review and meta-analysis

et al. 2022

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Background: This systematic review aimed to evaluate the efficacy of casein phosphopeptide-amorphous calcium phosphate (CPP-ACPF) varnish for remineralization of white spot lesions (WSLs) “ in vitro ” in human teeth. Materials and Methods: Literature search included three databases, namely Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Google Scholar from 2010 to January 2021. The studies assessing WSL depth, calcium, phosphate ion release, and microhardness due to artificial demineralization or remineralization were considered for review. Reference articles were retrieved, and a customized risk assessment tool was used. The Cochrane risk of bias assessment tool was used to generate the risk of bias summary graph. Meta-analysis was performed using RevMan 5.4. Heterogeneity was evaluated by Cochrane's test, and random effects model was used to pool estimate of effect and its 95% confidence intervals (CIs) for surface microhardness. Results: Eighteen studies were selected for review based on the eligibility criteria. Four studies showed superior remineralizing effect of CPP-ACPF compared to fluoride varnishes. Four studies involving 120 human permanent teeth samples were included in the meta-analysis. Efficacy of CPP-ACPF varnish was equivalent to other fluoride varnishes in improving surface microhardness after remineralization during 7-day period (mean surface microhardness: 3.94, 95% CI [−9.08–1.21], I 2: 75%, P = 0.13). Major risks of bias associated with the studies included in the review were inadequate sample size, improper sample preparation, and unexplained blinding. Conclusion: CPP-ACPF varnish appears to be equally effective as other fluoride varnishes in remineralizing artificially induced WSLs, but quality of evidence is low.

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Cost-effectiveness of adding fluoride varnish to a preventive protocol for early childhood caries in rural children with no access to fluoridated drinking water

Cited by 17 publications

References 21 publications

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

Systematic Review of Intervention Studies Aiming at Reducing Inequality in Dental Caries among Children

Clinical Effect of Two Fluoride Varnishes in Caries-Active Preschool Children: A Randomized Controlled Trial

Efficacy of casein phosphopeptide-amorphous calcium phosphate varnish in remineralizing white spot lesions: A systematic review and meta-analysis

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