System dynamics modeling for tooth decay treatment in Brazilian children

Abstract

Prevention and health promotion are considered important strategies to control oral diseases. Dental caries is preventable disease and remains the most common chronic disease that affects mainly low income children and still considered the main cause of tooth loss in adulthood in Brazil. The aim of this study is to present a System Dynamics model (SDM) specifically developed with the Stella Architect software to estimate the cost and clinical hours required to control the evolution of dental caries in preschool children in Maringá, Brazil. Two main strategies to control caries were considered in the model: the application of fluoride varnish on teeth presenting white spots, and the use of Atraumatic Restorative Treatment (ART) in cavitated carious lesions without pulp involvement. The parameters used in the model were: number of people covered by a local oral health team = 4,000; number of children up to 5 years = 7% of the population; children's decayed, missing, filled teeth (dmft) index = 2.4; time/cost of 4 applications of fluoride varnish = 5 minutes/US$ 0.716; and time/cost of each ART restoration = 15 minutes/US$ 1.475. The SDM generated an estimated total cost of US$698.00, and a total of 112 clinical hours to treat the population in question. The use of the SDM presented here has the potential to assist decision making by measuring the material and human resources required to prevent and control dental caries at an early age.

Geographic Information Systems (GIS) to Assess Dental Caries, Overweight and Obesity in Schoolchildren in the City of Alfenas, Brazil

“…Furthermore, even with better oral health status in children over the past decade [45], the association between dental caries and a healthy diet [37] and environmental/geographic factors still makes it a major challenge for the public's health [3]. In addition, the prevalence of overweight and obesity, especially among children, must be observed as a consistent signal to the health authorities to intervene with health education programs [5].…”

Adherence to the CONSORT statement of randomized clinical trials on ART restorations in children: current status and reporting characteristics

“…ART is part of the national oral health program in Brazil, with the inclusion of the technique in the curricula of Brazilian dental schools. This is probably connected to the fact that untreated dental caries is the main component in the dmf-t index (2.43) in 5-year-old children in Brazil, affecting mainly the low-income population and their access to healthcare services, 78 and ART is a protocol with the potential to expand service and dental assistance coverage for this population, 79 and it is also a key component of WHO's Basic Package of Oral Care (BPOC) for making restorative dental treatment more reachable to communities in developing nations. 66 It is encouraging to note that adherence to CONSORT recommendations has increased over time.…”

Prevención de la caries de infancia temprana.

“…Uno de los métodos más eficaces es la educación en salud oral, especialmente durante la infancia, en la prevención de este tipo de enfermedad crónica, destacándose las campañas que desestimulan el alto consumo de azúcares libres presente en la mayoría de las dietas (8). En tal sentido, la Academia Estadounidense de Odontología Pediátrica y la Asociación Dental Americana, referente a esta temática, recomienda un cepillado de dientes con una periodicidad de dos veces al día utilizando un dentífrico que contenga una concentración de fluoruro de 1000-1100 ppm de ion flúor y un cepillo de dientes lo suficientemente suave para que los padres inicien el hábito higiénico ,que debe ser mantenido hasta los 6 años de edad para que posteriormente sea realizado por los niños (9).…”

“…Si bien la adquisición de hábitos saludables relacionados con la educación en salud oral, en asociación con programas dirigidos a controlar la evolución de la caries dental, puede prevenir la pérdida de las piezas dentales en un determinado periodo de tiempo 10 , por ello es necesario entender las estrategias preventivas para la CIT son importantes en la medida que el comienzo ocurra en edades tempranas, sin lugar a dudas, evitará el inicio de la enfermedad, por ello la entrega oportuna de información educativa y terapias preventivas dirigidas a padres y/o cuidadores, la misma permite el control de aquellos factores como hábitos alimenticios e higiene oral que aceleran su aparición y progresión (6,8).…”