The Monitor Practice Programme: is non‐invasive management of dental caries in private practice cost‐effective?

Abstract

Background: The objective of this research was to assess the efficacy and cost-effectiveness of a non-invasive approach to dental caries management in private dental practice. Methods: Private dental practices from a variety of locations in New South Wales were randomly allocated to either noninvasive management of caries, or continue with usual care. Patients were followed for three years and caries incidence assessed. A patient-level decision analytic model was constructed to assess the cost-effectiveness of the intervention at two years, three years, and hypothetical lifetime. Results: Twenty-two dental practices and 920 patients were recruited. Within the clinical trial there was a significant difference in caries increment favouring non-invasive therapy at both two and three years. Efficacy was independent of age, gender, medical concerns, fluoride history, or previous history of dental caries, in a population of patients attending for treatment in private dental practices, in a variety of locations both urban and rural. Cost per DMFT avoided estimate was A$1287.07 (two years), A$1148.91 (three years) decreasing to A$702.52 in (medium) and A$545.93 (high) risk patients (three years). Conclusions: A joint preventive and non-invasive therapeutic approach appears to be cost-effective in patients at medium and high risk of developing dental caries when compared to the standard care provided by private dental practice.

Experiences of dental care: what do patients value?

“…The RCT final results showed a highly significant difference in the incremental DMFT score in favour of the intervention group (two-year mean difference: 0.8; p < 0.001, three-year mean difference: 0.9; p < 0.001) [3]. Patients in the intervention group had fewer repeat dental fillings at both two (p < 0.001) and three (p < 0.001) years [3]. Having an increased risk of developing dental caries was observed in 11% of patients in the intervention group compared to 24% in the control group (p < 0.001) [3].…”

'Minimum intervention' – MI inspiring future oral healthcare?

“…It is clear that significant financial investment (or redistribution of existing funding) will have to be made at the outset of implementing MI oral healthcare, with the benefits only being evident several years down the line, indeed, a political lifetime. [19][20][21] The socio-economic improvements in quality of life and population wellbeing are nearly impossible to measure and cost quantifiably, but have a significant part to play in the successful outcomes of MI dentistry.…”

'MI'opia or 20/20 vision?

“…6 There has been some work published using business modelling systems to extrapolate data and predict the outcomes of the clinical and financial benefits of MI dentistry but there is no doubt that further practicebased research is required to provide the evidence of the benefits of minimum intervention dentistry. [6][7][8][9] As mentioned earlier, there is a need for practice-based research networks populated by dentists and teams trained in delivering MI oral care to allow this valuable information to be collected where it matters.…”