Abstract
BackgroundDental caries is the world’s most prevalent childhood disease. School-based caries prevention can reduce the risk of childhood caries by increasing access to care. However, the optimal mix of treatment services, intensity, and frequency of care is unknown.MethodsData were derived from two prospective cohorts of US children participating in two caries prevention programs with different treatment intensities. One program provided primary and secondary prevention (glass ionomer sealants and interim therapeutic restorations) and one primary prevention only (glass ionomer sealants), both given twice yearly in six-month intervals. Primary study outcomes included untreated decay and the total observed caries experience. Analysis used generalized additive models to estimate nonlinear effects and trends over time. Results were compared to those estimated using generalized estimating equations and mixed-effects multilevel Poisson regression.ResultsPrimary and secondary prevention combined did not significantly reduce total caries experience compared to primary prevention alone, but did reduce the risk of untreated decay on permanent dentition. Additionally, the rate of new caries experience was slower in the primary and secondary prevention group. Nonlinear trends for dental caries across both programs were statistically significant from zero (p < .001).ConclusionCaries prevention consisting of primary and secondary prevention agents may be more effective than primary prevention alone in reducing the risk of tooth decay over time. Results suggest that the impact of caries prevention may not be constant over the medium- and long-term, suggesting reduced effectiveness with continued treatments.
Highlights
Dental caries is the world’s most prevalent childhood disease
Questions remain as to the effectiveness of caries prevention, such as how much prevention is needed, with what frequency, or whether secondary prevention methods are more effective when combined with primary prevention, compared to primary prevention alone
The average total observed caries experience at baseline was larger in the exposed group (2.19 ±2.83) compared to those unexposed (1.55 ±2.13)
Summary
Dental caries is the world’s most prevalent childhood disease. School-based caries prevention can reduce the risk of childhood caries by increasing access to care. Dental caries is the world’s most prevalent childhood disease [1], accounts for 3.5 million disability-adjusted life years [2], and affects nearly 30% of school-age children and 50% of rural, minority, or Medicaid recipient children in the United States [3, 4]. Caries prevention programs such as one-chair services, mobile dental vans, and school-based health programs or dental centers can be used to reduce the risk of tooth decay [5]. Research on the long-term impact (e.g., at least one or two years of follow-up) of
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