Cost‐effectiveness of preventing dental caries and full mouth dental reconstructions among Alaska Native children in the Yukon–Kuskokwim delta region of Alaska

Abstract

Objective We conducted a cost-effectiveness analysis of five specific dental interventions to help guide resource allocation. Methods We developed a spreadsheet-based tool, from the healthcare payer perspective, to evaluate the cost effectiveness of specific dental interventions that are currently used among Alaska Native children (6-60 months). Interventions included: water fluoridation, dental sealants, fluoride varnish, tooth brushing with fluoride toothpaste, and conducting initial dental exams on children <18 months of age. We calculated the cost-effectiveness ratio of implementing the proposed interventions to reduce the number of carious teeth and full mouth dental reconstructions (FMDRs) over 10 years. Results A total of 322 children received caries treatments completed by a dental provider in the dental chair, while 161 children received FMDRs completed by a dental surgeon in an operating room. The average cost of treating dental caries in the dental chair was $1,467 (~258,000 per year); while the cost of treating FMDRs was $9,349 (~1.5 million per year). All interventions were shown to prevent caries and FMDRs; however tooth brushing prevented the greatest number of caries at minimum and maximum effectiveness with 1,433 and 1,910, respectively. Tooth brushing also prevented the greatest number of FMDRs (159 and 211) at minimum and maximum effectiveness. Conclusions All of the dental interventions evaluated were shown to produce cost savings. However, the level of that cost saving is dependent on the intervention chosen.

A Markov cost‐effective analysis of biannual fluoride varnish for preventing dental caries in permanent teeth over a 70‐year time horizon

“…Our findings were consistent with a study that showed biannual fluoride varnish applications are more expensive and more effective than current practice . Other studies have shown that the intervention is cost‐saving for children under 6 years . A possible reason for cost savings among young children is that the intervention was compared to the costs of subsequent dental treatments that are often performed under general anaesthesia.…”

Dental health aides in Alaska: A qualitative assessment to improve paediatric oral health in remote rural villages

“…Evidence‐based clinical practices already proven to be effective in controlling dental caries and recommended by leading national authoritative bodies are already being used, but need to be consistently provided. Such guidelines should include (i) an annual oral health assess‐and‐treat campaign to assess dental needs and provide follow‐on care to stop the decay activity of all children in the villages; (ii) a daily fluoride toothbrushing programme at school‐like settings to promote oral health; and (iii) a semiannual or more frequent professional application of topical fluoride to prevent tooth decay …”

“…Such guidelines should include (i) an annual oral health assess-andtreat campaign to assess dental needs 34,36 and provide follow-on care to stop the decay activity of all children in the villages; [37][38][39][40][41] (ii) a daily fluoride toothbrushing programme at school-like settings to promote oral health; 42,43 and (iii) a semiannual or more frequent professional application of topical fluoride to prevent tooth decay. [44][45][46] With respect to quality improvement in a complex setting, the literature suggests that distribution of new guidelines will not be sufficient to improve care delivery.…”

Provider and community perspectives of dental therapists in Alaska’s Yukon‐Kuskokwim Delta: A qualitative programme evaluation

“…For example, US settler colonial practices introduced sugar into indigenous communities, and sugar‐sweetened foods and beverages are now among the most commonly consumed items in Alaska Native Communities . Furthermore, Alaska Native Communities are small, geographically isolated and situated on permafrost, making the cost of piped fluoridated water prohibitive . Complicating local acceptance of water fluoridation is the only documented death due to insufficient monitoring of water fluoridation, which occurred in the 1990s in an Alaska Native Community .…”