Caries risk determination and cost-effectiveness of targeted prevention in adolescents

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p>The aim of this study was to assess a series of caries risk indicators to find a suitable model for screening adolescents for risk cases, and to evaluate the long-term efficacy and cost-effectiveness of an one-year intervention programme provided for the resulting risk groups. </p><p>To reduce the spread of infectious diseases at 20 day-care centres, risk factors for the occurrence of salivary mutans streptococci were surveyed in 345 children before and after 8 months of intervention, i.e. withdrawal of tooth brushing in 10 centres. Dental health habits were evaluated by means of questionnaires. Four clinical and six salivary tests were related to 11-month caries increment in 181 adolescents. The 109 high-risk subjects presenting four or more risk factors were provided either with chlorhexidine or fluoride treatment, the low-risk group receiving basic prevention. An age and sex-matched control group was chosen. Life-long data on all 390 subjects were collected from their dental records. Survival analysis was applied, taking as the starting point the time of tooth eruption and as the event the first filling due to caries. The costs of the intervention and the number of fillings were compared between the groups.</p><p>The dental health of the risk groups tended to approach the average level for the control group. One tooth surface per subject was saved from filling. The costs of fillings for the control group were twice as great as those for the risk groups at the end of the intervention, but only slightly more after the five-year follow-up period.</p><p>The model (DFS, Candida and sucrase) offers additive information for finding adolescents at risk of caries, and for targeting preventive measures at the individual level and for the motivation of patients. The results stress the importance of dental age and of providing preventive procedures at the time of tooth eruption. The present risk-based strategy proved to be of moderate benefit to dental health by comparison with the costs of normal preventive and restorative care and cannot be recommended as such for a target population with a high risk of caries.</p></div>