Reducing early childhood caries in a Medicaid population

Edelstein, Burton L.; Hirsch, Gary B.; Frosh, Marcy; Kumar, Jayanth

doi:10.1016/j.adaj.2014.12.024

Cited by 32 publications

(30 citation statements)

References 19 publications

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“…Meanwhile, quantitative system dynamics models consist of interacting sets of differential and algebraic equations developed from the translation of the qualitative causal loop diagram to a quantitative stock and flow model from a broad range of relevant empirical data to capture dynamic interrelationship [34][35][36]. The systems modelling approach has been used to analyze various oral health problems, including modelling oral healthcare service system in the Netherlands [37], participation in oral health promotion in New York [38] and caries reductions and cost savings from early childhood caries intervention in the United States [39,40].…”

Section: Methodsmentioning

confidence: 99%

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

et al. 2020

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Background: The tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population. Methods: A qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040. Results: Under the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040. Conclusions: In countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.

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Section: Methodsmentioning

confidence: 99%

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

et al. 2020

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“…This result is relevant for public health services in the planning of oral health care programs, especially in children [8,26]. Thus, the effect of two commercial fluoride varnish formulations (Duraphat® and Duofluorid XII®) on active white spot lesions in primary teeth was tested.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness of Two Commercial Fluoride Varnish Formulations on the Control of White Spot Lesion in Primary Teeth: A Pilot Study

Itaborahy¹,

Machado²,

Elias³

et al. 2015

Pesqui. bras. odontopediatria clín. integr.

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Objective: To evaluate the in vivo clinical effectiveness of two commercial fluoride varnish formulations. Material and Methods: The sample consisted of seven children aged 2-5 years for a total of 24 active white spot lesions (WSL) in primary teeth. Children were randomly divided into two groups in accordance with the varnish used: G1 -Duraphat® -DR (n = 14 WSL); and G2 -Duofluorid XII® -DF (n = 10 WSL). Children were submitted to treatment with varnishes applied once a week for four consecutive weeks. Maximum mesiodistal and incisogengival dimensions were measured with a periodontal probe at the beginning of treatment and on the fifth week of treatment. The average between the two dimensions represented the value of the WSL dimension. The comparison of the mean final values of WSL dimensions between groups of fluoride varnishes tested was analyzed by the Mann-Whitney U test. The significance level adopted was 5%. Results: After five weeks, most WSL were ranked as inactive (G1 = 71.4% and G2 = 40%). No significant difference between G1 and G2 in relation to lesion activity was observed (p = 0.124). There was a significant decrease of 24% between initial (3.12 mm ± 1.49 mm) and final WSL dimension (2.35 mm ± 1.06 mm) (p = 0.012) in G1. In G2, there was a significant reduction of 40% in lesion dimension with initial value of 5.7 mm (± 3.82 mm) and final value of 3.4 mm (± 3.35 mm) (p = 0.013). Regarding the reduction in the WSL dimension, no significant difference between groups was observed (p = 0.931). Conclusion: Both fluoride varnish formulations tested had similar effect on the control of active white spot lesions in primary teeth.

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“…Application of effective agents is also cost-effective relative to repair as they prevent caries progression in high risk children at low cost. 2526 With further study through randomized controlled trials now underway, 2728 evidence of effectiveness for arresting agents is likely to catch up with pediatric dental educators' enthusiasm for them. 29 …”

Section: Evidentiary Review Of Conventional Ecc Dental Treatmentsmentioning

confidence: 99%

“…42 While a thorough review of the cost-effectiveness of current ECC prevention and repair is beyond the scope of this contribution, it is notable that the value propositions for the age-one dental visit and for dental rehabilitation is questionable because analyses suffer from probable selection bias in both Medicaid 43 and privately insured 44 populations and available studies engage high-cost dental professional personnel rather than low-cost non-conventional health workers. 45 System dynamics modeling of ECC prevention and management 2526 finds that all tested interventions reduce caries occurrence and progression but only those that do not involve a health professional are cost savings. Overall, “interventions targeting the highest-risk children provide the greatest return on investment and combined interventions that target ECC at several stages of its natural history have the greatest potential for cavity reduction.” 25 In reviewing the limited evidence of effectiveness and cost-effectiveness for early professional dental visits, Lee et al conclude that the rationale for early intervention is strong and that “If appropriate measures are applied sufficiently early, it may be possible to raise a cavity-free child.” 46 The question at hand is which health workers are best able to provide caries guidance early enough in a child's life and at a low cost while ensuring a long-term positive outcome.…”

Section: Evidentiary Review Of Conventional Ecc Dental Treatmentsmentioning

confidence: 99%

Pediatric Dental-Focused Interprofessional Interventions

Edelstein

2017

Dental Clinics of North America

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Synopsis Evidence of effectiveness for prevention of early childhood caries (ECC) suggests that parent engagement needs to occur perinatally and that unconventional providers—helping professionals like social workers and dietitians and lay health workers like community health workers—are most effective. This finding, coupled with the emergence of population-based accountable care, value-based purchasing with global payments, understanding of common risk factors for multiple conditions, and social determinants of health behaviors, calls for a rethinking of early childhood oral health care. A population-based model that incorporates unconventional providers is suggested together with research needed to achieve caries reductions in at-risk families.

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Reducing early childhood caries in a Medicaid population

Cited by 32 publications

References 19 publications

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

Clinical Effectiveness of Two Commercial Fluoride Varnish Formulations on the Control of White Spot Lesion in Primary Teeth: A Pilot Study

Pediatric Dental-Focused Interprofessional Interventions

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