Recruitment and participation in pre-school and school-based fluoride varnish pilots – the South Central experience

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.

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Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

Palacio

Shen

Vale

et al. 2019

Comm Dent Oral Epid

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Objectives This study illustrates the use of a decision analytic model (DAM) to evaluate whether fluoride varnish application (FV) increases the proportion of caries‐free children in the Chilean preschool population, at an acceptable cost. Methods Different FV interventions were compared with an oral health counselling‐only intervention. The FV interventions were tested (with and without screening) every 6 months over 2 years, in either a preschool setting or during a well‐child programme appointment in a primary care setting. A Markov model was developed to simulate the FV performance. The model was populated with data obtained from Chilean epidemiologic studies, a systematic review and a costing study. The counselling‐only intervention was compared with FV interventions to estimate the incremental cost per child. As there was uncertainty in terms of precise parameter values both probabilistic and deterministic sensitivity analyses were performed. Results Delivery of FV in a primary care setting without screening was the most effective and the least costly intervention. Compared with counselling‐only intervention, this intervention increased the prevalence of caries‐free children in the population by 3.7%, with an extra cost (in March 2015) of £3 per caries‐free child. The results were sensitive to the starting age of FV application; increasing age would reduce the cost‐effectiveness of the FV intervention. Furthermore, cost‐effectiveness improves if some equipment such as an oral hygiene kit was not used and if less costly but qualified staff applied FV rather than dentists. Conclusions This analysis allowed the comparison of the performance of FV in realistic scenarios incorporating important aspects of health and education policies. The application of FV in a primary care setting was the most cost‐effective strategy. The work demonstrated that both the methodology and results are useful for decision‐makers.

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Recruitment and participation in pre-school and school-based fluoride varnish pilots – the South Central experience

Cited by 4 publications

References 9 publications

Evaluation of a pilot oral health promotion programme 'Keep Smiling': perspectives from GDPs, health champions and school staff

Evaluation of a pilot oral health promotion programme 'Keep Smiling': perspectives from GDPs, health champions and school staff

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

Assessing the cost‐effectiveness of a fluoride varnish programme in Chile: The use of a decision analytic model in dentistry

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