Dental disease is largely preventable. Many older adults, however, experience poor oral health. National data for older adults show racial/ethnic and income disparities in untreated dental disease and oral health-related quality of life. Persons reporting poor versus good health also report lower oral health-related quality of life. On the basis of these findings, suggested public health priorities include better integrating oral health into medical care, implementing community programs to promote healthy behaviors and improve access to preventive services, developing a comprehensive strategy to address the oral health needs of the homebound and long-term-care residents, and assessing the feasibility of ensuring a safety net that covers preventive and basic restorative services to eliminate pain and infection.

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To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self- and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self- and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16-0.42) carious coronal and 0.22 (95%CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages.

Although older adults are keeping their teeth longer, no national data are available on new caries in this age group. To characterize the extent of caries among older adults, we systematically reviewed studies on root caries incidence, increment, attack rate, and annual total (root + coronal) caries increment. We used a random-effects model to estimate annual summary measures and their 95% confidence intervals (CI) and tested for heterogeneity. For the 9 studies reporting root caries incidence, the summary measure equaled 23.7% (CI = 17.1-30.2%). For the 9 studies reporting root caries increment, the summary measure was 0.47 surfaces (CI = 0.34-0.61). For the 7 studies reporting total caries increment, the summary measure equaled 1.31 surfaces (95% CI = 1.01-1.61 surfaces). Because of heterogeneity, summary measures should be interpreted with caution. This research suggests, however, that older adults experience high rates of new caries and could benefit from caries-prevention programs.

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In this paper we explore the impact of power structure on price, sensitivity of market price, and profits in a two-stage supply chain with a single-product, -supplier and -buyer. We develop and analyze the case where the supplier has dominant bargaining power and the case where the buyer has dominant bargaining power, and consider a pricing scheme for the buyer that involves both a multiplier and a constant mark up. We show that it is optimal for the buyer to set the mark-up to zero and use only a multiplier and that the market price and its sensitivity are higher when operational costs (namely distribution and inventory) exist. We also observe that the sensitivity of the market price increases nonlinearly as the wholesale price increases, and derive a lower bound for it. Through experimental analysis, we show that marginal impact of increasing shipment cost and carrying charge (interest rate) on prices and profits are decreasing in both cases.

Untreated cavities can have far-reaching negative consequences for people’s ability to eat, speak, and learn. By adolescence, 27 percent of low-income children in the United States will have untreated cavities. School-based sealant programs typically provide dental sealants (a protective coating that adheres to the surface of molars) at little or no cost to students attending schools in areas with low socioeconomic status. These programs have been shown to increase the number of students receiving sealants and to prevent cavities. We analyzed the cost-effectiveness of school sealant programs using data (from school programs in fourteen states between 2013 and 2014) on children’s cavity risk, including the effects of untreated cavities on a child’s quality of life. We found that providing sealants in school programs to 1,000 children would prevent 485 fillings and 1.59 disability-adjusted life-years. School-based sealant programs saved society money and remained cost-effective across a wide range of reasonable values.