Treating High-Caries Risk Occlusal Surfaces in First Permanent Molars through Sealants and Supervised Toothbrushing: A 3-Year Cost-Effective Analysis

Abstract

We conducted a 3-year cost-effectiveness analysis on the cavitated dentine carious lesion preventive capabilities of composite resin (CR) (reference group) and atraumatic restorative treatment (ART) high-viscosity glass-ionomer cement (HVGIC) sealants compared to supervised toothbrushing (STB) in high-risk first permanent molars. School children aged 6-7 years in 6 schools (2 per group) received CR and ART/HVGIC sealants or STB daily for 180 days each school year. Data were collected prospectively and cost estimates were made for sample data and a projection of 1,000 sealants/STB high-risk permanent molars. Although STB had the best outcome, its high implementation cost (95% of cost for supervisors visiting schools 180 days/school year) affected the results. ART/HVGIC was cost-effective compared to CR for the sample data (savings of USD 37 per cavitated dentine carious lesion prevented), while CR was cost-effective compared to ART/HVGIC for the projection (savings of USD 17 per cavitated dentine carious lesion prevented), and both were cost-saving compared to STB. Two STB scenarios were tested in sensitivity analyses with variations in caries incidence and number of supervision days; results showed STB had lower costs and higher savings per cavitated dentine carious lesion prevented than CR and ART/HVGIC. A major assumption is that both scenarios have the same high effectiveness rate experienced by STB under study conditions; however, they point to the value of further research on the benefits of adopting STB as a long-term venture in a general population of school children.

Quality appraisal of economic evaluations done on oral health preventive programs‐A systematic review

“…The 34 articles identified correspond to 33 studies, because one study was reported in more than one article. Finally, 33 complete economic evaluations were included for data extraction and analysis …”

A scoping review of cost‐effectiveness analyses of school‐based interventions for caries

“…A total of 738 articles were initially identified and reviewed and 15 met the inclusion criteria 16‐30 . Figure S1 outlines the results of the search process 31 …”

“…Table 1 summarized the key characteristics of the 15 included studies. Nearly 80% of the studies assessed the cost‐effectiveness of interventions based on topical fluoride therapy and fissure sealants at school premises 16‐18,21,23‐25,27,29,30 . Only two studies reported preference‐based health outcomes, 19,28 while all but one 16 reported an Incremental Cost‐Effectiveness Ratio (ICER).…”

“…The quality of the reporting as evidenced by compliance with the CHEERS reporting guidelines moderately differed between studies (Table 3). Four of 15 studies 19,25,28,30 met all relevant criteria in the CHEERS checklist. More details are in Supplementary material .…”

Risk factors and patterns related to dental caries evaluated with caries assessment spectrum and treatment (cast) among schoolchildren of Bhubaneswar, India

“…There was no significance of supervised tooth brushing on school premises in preventing cavitated dentine carious lesions in high-caries risk occlusal surfaces of first permanent molars [16]. Nonetheless advantages and cost effectiveness of supervised tooth brushing in children for preventing dental caries over other treatment modalities are reported [14,16].…”