Outcomes and costs of pre-school and school-based fluoride varnish pilots

Abstract

Objective Fluoride varnish (FV) applications reduce the risk of dental decay in research trials. These pilots were conducted to test the feasibility and costs of providing FV applications in schools. Changes in dental decay levels were also monitored.Methods Data were collected on the proportion of children with dental decay, mean number of teeth affected and whether the child had attended for dental care. The cost of delivering the intervention was calculated.Results More children were reported to be attending for dental care by the end of the pilot than at the start. The proportion of children with dental decay and the mean number of teeth affected increased, but more children seemed to have received treatment. The intervention cost about £88 per child per year, with most of the costs due to the intensive efforts needed to recruit and maintain participation in the pilots.Conclusions Establishing community FV programmes requires significant investment and the long-term benefits in practice are unclear. If dental decay levels are to be reduced, there is a need to improve diets, alongside fluoride strategies. This may be best achieved by integrating oral health improvement programmes into other health programmes, particularly sugar-reduction strategies.

A service evaluation of the “Open Wide and Step Inside” school oral health programme

“…There are challenges to working in schools, and these have been reported in other programmes which can limit success and sustainability due to time, space, and organization requirements. 9,10 We recognise some of these challenges and support the view that there is often an underestimation of the time (and resource) needed to engage and maintain a positive relationship with schools. Our community engagement “first” approach is designed to overcome these challenges by involving schools at the very start of the project cycle.…”

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

“…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].…”

“…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.…”

“…The included studies were a total of seven retrospective cohort studies [27,31,33,37,39,41,42], one uncontrolled [29], one cohort study [23], and randomized controlled trials [18,28,30,32,[34][35][36]38,40,[43][44][45][46][47][48][49] (Table 1). The summaries of the selected studies are presented in Table 2.…”

Systematic Review of Economic Evaluations of Primary Caries Prevention in 2- to 5-Year-Old Preschool Children

“…Seven studies (30% of the total number of partial EEs) investigated the costs of water fluoridation. 33,[36][37][38][39][40][41] Six (26%) investigated multicomponent interventions, [42][43][44][45][46][47] 3 investigated topical fluoride (varnish, foam, or gel), [48][49][50] and 2 compared several different interventions. 51,52 There were single studies investigating each of the following: fluoride drops (for younger children) and fluoride varnish (for older children), 53 microbiological screening, 54 age at the first preventive dental visit, 55 OH education of parents with several additional components, 56 and supervised toothbrushing in nurseries.…”