Implementation and impact of a dental preventive intervention conducted within a health promotion program on health inequalities: A retrospective study.

Hélène Pichot,Stéphanie Tubert-Jeannin,Bruno Pereira,Elodie Magnat,Martine Hennequin

doi:10.1371/journal.pone.0230639

Abstract

The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program. A greater or at least equivalent quality and impact of the intervention was expected for children living in socially deprived regions with the greatest health needs. The study population was the schoolchildren, aged 6 years in 2016, who benefited from the dental sealant program (n = 2532). The study sample was randomly selected in 2017 from that population (n = 550). The children's dental status was evaluated at school in 2017 and compared with that recorded in 2016 during the sealant intervention allowing the calculation of the retention rates and one-year carious increment on first permanent molars. Socio-demographic variables (gender, public/private school) and conditions of sealant placement (school/dental office, presence of a dental assistant) were recorded. The carious increment was explained using a mixed multiple random-effects regression. A mediation analysis was conducted to assess the respective contributions of the retention rates and the region of origin on caries increment. The participation rate was very high (89%) and on average, children had 83% of their dental sealants present after one year, 31% fully and 52% partially present. Caries increment varied depending on the sealant retention rate as well as on the region (North, South, Islands). The mediation analysis showed that living in a deprived area (The Islands) was a strong determinant for high caries increment particularly when the retention rates were low. This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program. Nevertheless, the intervention was not effective enough to totally balance the influence of health determinants, especially in socially deprived sectors characterized by greater dental needs.

Highlights

Oral diseases remain a major health problem in both developing and developed countries [1]
This study showed a high participation rate and acceptable effectiveness as measured with the one-year retention rates, for a fissure sealant intervention conducted in real-life conditions and integrated in a large health promotion program
Impact of a preventive intervention depending on social determinants and local context within the French ethical committee for data management (CNIL -Commission Nationale Informatique et Liberte, No kpP1390145R)

Summary

Introduction

Oral diseases remain a major health problem in both developing and developed countries [1]. Since oral health inequalities come across the whole social body according to a gradient, the challenge is to take into account that gradient when evaluating public health interventions. An efficient intervention might have no effect on health inequalities if all socioeconomic groups benefit . Studies assessing the impact of universal interventions on children with various social or environmental backgrounds are needed to identify the differential effects as well as the impact of the implementation conditions [4]. The objective of this retrospective survey was to evaluate after one year, the conditions and impacts of a dental sealant intervention conducted in New Caledonia, within a health promotion program.

Objectives

Methods

Conclusion