DMFT Increment Research Articles

Cost-effectiveness of school oral health prevention program: a case study of community dentistry, Mahidol University

School may be the only place where oral health services are provided for high-risk children with limited access to dental care. We found this to be a common situation in many low-income countries, compounded by a lack of dental personnel. A school oral health prevention program is widely implemented in Thailand; however, the program's cost-effectiveness is under-investigated. This research project evaluated the cost-effectiveness of a comprehensive school oral health program implemented in the academic setting from the provider’s perspective. The retrospective study was conducted using profile data of primary school children in low socioeconomic areas during the academic years 2009–2018 from the Mahidol school oral health program database. The program's effectiveness was measured as DMFT increment scores from the first to the sixth grade between the intervention and control groups. To estimate unit costs for preventive dental services, cost data were collected according to the WHO CostIt program. The total cost was determined based on two elements: recurrent cost and capital cost. The economic costs of the program in the 2015 academic year for first- to sixth-grade children were an average of 1,196,839.37 Baht (34,944.42 USD), comprised of recurrent costs (36.1%) and capital costs (63.9%). Personnel costs and equipment depreciation costs were a major part of recurrent costs and capital costs, respectively. Specifically, capital costs were accountable for more than half of total program costs. The incremental cost-effectiveness ratio (ICER) of the completed 5-year program compared with the control group was 4,035.31 Baht per DMFT avoided. The study findings, which suggested the effectiveness of this program, are useful for its extension and expansion. The cost-effectiveness of the oral prevention program indicated that it is worth implementing, especially for outreach and children of low socioeconomic status at high risk of caries.

The effect of caries increment on oral health-related quality of life among adolescents in Brazil: a 3-year longitudinal study.

This study aimed to assess the effect of caries increment on Oral Health-related Quality of Life (OHRQoL) of Brazilian adolescents and to evaluate the responsiveness of the Child Perceptions Questionnaire (CPQ11-14) in this group. A population-based sample of 515 Brazilian 12-year-olds from a large city located in the southeast of Brazil was evaluated according to a random multistage sampling design at baseline and 291 at three years follow-up, using the DMFT index and the CPQ11-14 instrument. To evaluate the responsiveness to change, the measures of effect size and longitudinal construct validity were used. It was verified that OHRQoL among adolescents with DMFT increment across the three years worsened significantly (p<0.05) in relation to their counterparts. The effect size varied from small to moderate. The longitudinal construct validity of CPQ11-14 was satisfactory. Caries increment impacted on OHRQoL of adolescents in Brazil. The CPQ11-14 instrument demonstrated acceptable responsiveness properties.

A bridge too far? The relationship between interventive operative dentistry and future dental morbidity.

Background and aim Unscheduled dental attendances (UDA) and the associated morbidity can cause individual distress, disrupt military effectiveness and have broader societal impacts. Preventing future dental morbidity is an essential component of dentistry. This, the largest study of its type, aimed to examine the relationship between clinical and demographic variables and UDA, and to quantify how well military dental risk categorisation predicts subsequent UDA events. Methods This is a retrospective cohort analysis of a clinical dataset containing 175,558 service personnel over an 11-month period. Statistical methods examined: sensitivity and specificity of the existing NATO 'Dental fitness classification system' (NATO Cat) in predicting UDA, relative risk (RR) of UDA by selected variables, Kaplan-Meier failure analysis and multivariate analysis. Results A total of 16,722 UDA events were recorded, the majority (66.7%) were due to caries, periapical pathology and fractured teeth or restorations, or a combination thereof. NATO Cat yielded poor predictive sensitivity (sensitivity 10%, specificity 93%). NATO Cat 3 (RR 1.47), age group (RR 1.06-2.05), gender (RR 1.46) and DMFT category (RR 1.09-3.05), were all significantly associated with increased UDA. The RR of UDA increased by 5% (RR 1.05) for each additional DMFT increment in a logistic regression model. Conclusions After adjusting for confounding variables, DMFT was significantly associated with UDA events. This study indicates that, even when treatment need has been met, a residual risk remains that is directly related to exposure to dental disease and operative dentistry. Strategies which prevent downstream operative treatment need and increases in DMFT may also reduce future UDA. UDA may be a useful quality outcome indicator for the success of NHS dental services in securing oral health.

The Caries Management System: are preventive effects sustained postclinical trial?

ObjectivesTo report, at two and 4 years post‐trial, on the potential legacy of a 3‐year randomized controlled clinical trial (RCT) of the Caries Management System (CMS) at private general dental practices. The CMS was designed to reduce caries risk and need for restorative care.MethodsNineteen dental practices located in city, urban, and rural locations in both fluoridated and nonfluoridated communities participated in the RCT. Eight practices were lost to follow‐up post‐trial; however, baseline mean DMFT balance between CMS and control practices was maintained. At the control practices, caries management following usual practice continued to be delivered. The patient outcome measure was the cumulative increment in the DMFT index score, and the practice outcome measures included the practice‐mean and practice‐median increments of patient DMFT index scores. In covariable analysis (patient‐level unit of analysis), as the patients were clustered by practices, mean DMFT increments were determined through multilevel modeling analysis. Practice‐mean DMFT increments (practice‐level unit of analysis) and practice‐median DMFT increments (also practice level) were determined through general linear modeling analysis of covariance. In addition, a multiple variable logistic regression analysis of caries risk status was conducted.ResultsThe overall 4‐year post‐trial result (years 4–7) for CMS patients was a DMFT increment of 2.44 compared with 3.39 for control patients (P < 0.01), a difference equivalent to 28%. From the clinical trial baseline to the end of the post‐trial follow‐up period, the CMS and control increments were 6.13 and 8.66, respectively, a difference of 29% (P < 0.0001). Over the post‐trial period, the CMS and control practice‐mean DMFT increments were 2.16 and 3.10 (P = 0.055) and the respective increments from baseline to year 7 were 4.38 and 6.55 (P = 0.029), difference of 33%. The practice‐median DMFT increments during the 4‐year post‐trial period for CMS and control practices were 1.25 and 2.36 (P = 0.039), and the respective increments during the period from baseline to year 7 were 2.87 and 5.36 (P < 0.01), difference of 47%. Minimally elevated odds of being high risk were associated with baseline DMFT (OR = 1.17). Patients attending the CMS practices had lower odds of being high risk than those attending control practices (OR = 0.23, 95% CI = 0.06, 0.88).ConclusionIn practices where adherence to the CMS protocols was maintained during the 4‐year post‐trial follow‐up period, patients continued to benefit from a reduced risk of caries and, therefore, experienced lower needs for restorative treatment.

Sugar-sweetened beverages and dental caries in adults: A 4-year prospective study

ObjectivesTo explore the association between frequency of consumption of sugar-sweetened beverages (SSB) and caries increment over 4 years in adults. A second objective was to explore whether the association between frequency of SSB consumption and caries increment varied by socio-demographic characteristics and use of fluoride toothpaste. MethodsData from 939 dentate adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults’ Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours, including two questions on frequency of SSB consumption. The 4-year net DMFT increment was calculated using data from baseline and follow-up clinical oral examinations. The association was tested in negative binomial regression models and the moderating role of sex, age, education and use of fluoride toothpaste was examined by adding their two-way interaction with SSB consumption to the main effects model. ResultsA positive association was found between frequency of SBS consumption and 4-year net DMFT increment, regardless of participants’ socio-demographic and behavioural characteristics. Adults drinking 1–2 and 3+ SSB daily had, respectively, 31% (Incidence Rate Ratio: 1.31; 95%CI: 1.02–1.67) and 33% (IRR: 1.33; 95%CI; 1.03–1.72) greater net DMFT increments than those not drinking any SSB. None of the four two-way interaction terms was significant (all p>0.05). ConclusionThere seems to be a dose–response relationship between frequency of SSB consumption and caries increment in adults. That association was consistent across socio-demographic characteristics, and more importantly, use of fluoride toothpaste. Clinical significanceDrinking sugar-sweetened beverages on a daily basis is related to greater caries risk in adults.

Daily smoking and 4‐year caries increment in Finnish adults

Although the harmful effects of smoking on periodontal disease and oral cancer are now indisputable, its effect on dental caries is less well known. This study assessed whether daily smoking predicts caries increment in adults over 4 years. Data from 955 adults who participated in both the Health 2000 Survey and the Follow-Up Study of Finnish Adults' Oral Health were analysed. At baseline, participants provided information on demographic characteristics, education and dental behaviours. The 4-year net increment in the numbers of decayed (DT), filled (FT) and missing (MT) teeth and the DMFT index were calculated using the data from baseline and follow-up clinical oral examinations. Daily smoking was not associated with net DMFT increment. In subsequent analysis by components, daily smoking was associated with net DT increment, but not with net FT or MT increments. When daily smokers were split into two groups by consumption level (1-19 and 20+ cigarettes/day) and compared to nondaily smokers, a significant dose-response relationship was additionally found between levels of tobacco consumption and net DT increment. Although daily smokers reported less favourable behaviours than nonsmokers, these associations only explained partially the effect of daily smoking on net DT increment. Daily smoking was independently related to caries development (net DT increment) in adults over 4 years, but not to caries treatment (net FT and MT increments) or caries experience (net DMFT increment).

A Randomized Trial on the Inhibitory Effect of Chewing Gum Containing Tea Polyphenol on Caries

The purpose of the study was to determine the cariostatic potential of a chewing gum containing tea polyphenol. A total of 157 schoolchildren aged 8-9 years were randomly allocated into three groups. Two groups received chewing gum with or without tea polyphenol. A third group did not receive any chewing gum. A single examiner assessed the caries status for all participates at baseline, 12 months and 24 months. A one-way analysis of variance (ANOVA) was performed to evaluate differences among the groups at each interval The Chi-square test was used to compare the caries-free rate among the three groups. The mean DMFT increment was 0.17 for the polyphenol gum group, 0.60 for the control gum group, and 1.15 for the no gum group. Children who chewed gum containing tea polyphenol had a significantly lower mean DMFS increment over the 24-month period than did the other two groups (p < 0.05). The caries-free rate in the polyphenol gum group was significantly higher than that in the other two groups (p < 0.05) after two years. These findings indicated that the oral application of chewing gum with tea polyphenol has an inhibitory effect on dental caries.

Use of occlusal sealant in a community program and caries incidence in high- and low-risk children

ObjectiveThe aims of this study were to investigate the effectiveness of sealant placement under the guidelines of the Oral Health Promotion Program for Children and Adolescents (Portugal), and to test the influence of clinical and socioeconomic variables on the DMFT increment in 277 children, born in 1997. Material and MethodsA dental hygienist performed the initial examinations and sealant placement (Helioseal, Vivadent) on the permanent first molars in 2005. These activities were registered in dental records that were assessed in 2007. Children were classified according to caries risk at baseline [high (HR: DMFT+dmft>0); low (LR: DMFT+dmft=0) risk] and sealant placement as follows: HR-S and LR-S Groups (with sealant placement); HR-NS and LR-NS Groups (without sealant placement). A calibrated dentist performed the final examination in 2007 at school, based on the World Health Organization recommendations. The variables collected were: dental caries, visible dental plaque, malocclusions, and socioeconomic level (questionnaire sent to children's parents). For univariate (Chi-square or Fisher tests) and multivariate (Multiple logistic regression) analyses the DMFT increment >0 was selected as dependent variable. ResultsApproximately 17.0% of the children showed DMFT increment>0 (mean=0.25). High-risk children presented a significant increase in the number of decayed and/or filled teeth. These children had 7.94 more chance of developing caries. Children who did not receive sealant were 1.8 more prone to have DMFT increment >0. ConclusionIt appears that sealant placement was effective in preventing dental caries development. Moreover, the variables "risk" and "sealant placement" were predictors for DMFT increment in the studied children.

Salivary buffer capacity in relation to menarche and progesterone levels in saliva from adolescent girls: a longitudinal study

The aim of this study was to investigate the relationship between salivary buffer capacity and menarche, and to explore any association with levels of the sex hormone progesterone in stimulated whole saliva in adolescent girls. The material comprised 162 girls, 12 years of age at baseline in the 6th grade, who were followed for 3 years. Every 4th month, a stimulated whole saliva sample was collected, secretion rate and buffer capacity were determined, and information was gathered on menarche, ongoing menses, and caries increment. Once yearly, the salivary concentration of progesterone was determined with an enzyme immunoassay kit. The results showed a significantly impaired salivary buffer capacity over the years (P <0.05). Low buffer capacity was significantly correlated with low secretion rate (r = 0.42; P<0.001) and DMFT increment (r=0.20; P<0.05). Pre-menarche buffer capacity did not differ from the post-menarche scores. The concentration of progesterone in saliva increased with age but displayed no significant relationship to buffer capacity, flow rate, or caries increment. In conclusion, the findings of this study suggest that the salivary buffer capacity may be impaired over the adolescent years in females, but the reason remains unclear.

Analyses of the caries decline and incidence among Norwegian adolescents 1985-2000

Since most studies of caries decline are descriptive time-trend analyses, the purpose of this article was to identify factors statistically associated with the caries decline among Norwegian adolescents after 1985. The DMFT scores for the age groups 12 and 18 years reported annually by 19 counties were analysed. The average caries-free proportions of 18-year-olds increased from 2% to 15% between 1985 and 2000, while the DMFT declined by 49%; 10.2 - 0.75 to 5.2 - 0.78. The decline for the 12-year-olds was 53%. The mean DT at the dentinal level remained at about 0.8 for 12-year-olds and 1.5 for 18-year-olds throughout the observation period. There was no significant difference in DMFT increment from age 12 to 18 between the birth cohorts 1973 (3.8 - 0.46) and 1982 (3.0 - 0.52) when controlling for counties. The variables migration and children per dentist were significantly associated with the DMFT decline in multivariate analyses. The caries decline for 18-year-olds was significantly steeper before than after 1990. The decline among the 18-year-olds may be attributed to fluoride and more restrictive criteria for placement of fillings in teenagers in the 1980s and fewer filled teeth before the age of 12 years in the 1990s.

A comparison of the anticaries effect on the primary dentition of two dentifrices containing 250 ppm and 1450 ppm fluoride

The purpose of the study was to compare the anticaries effects of two dentifrices containing sodium fluoride with fluoride concentrations of 250 ppm and 1450 ppm on the primary dentition of kindergarten children. A total of 319 children participated in the study (155 in the low-fluoride and 164 in the high-fluoride group) and brushed their teeth daily under supervision in their kindergartens. The children were examined by one dentist trained according to the procedures of O'Mullane et al., and carious lesions were recorded at the cavitation level according to the WHO criteria. At the final examination after 22 months, the groups comprised 83 (low-fluoride group) and 89 (high-fluoride group) children. The differences in mean dmfs and dmft increments between the two groups were not statistically significant. In both groups about 57% of the children remained caries free. Excluding these children from the analyses, the mean dmfs increment was significantly lower in the high-fluoride group, but not the mean dmft increment. The mean dmfs increment excluding occlusal surfaces was significantly lower in the high-fluoride group.

フッ化物洗口終了後のう蝕有病ならびにり患状況

The durability of cariostatic effect of school-based fluoride mouthrinsing was determined. Caries prevalence and incidence of 134 junior high school students (67 boys, 67 girls; fluoride group) who had participated in a fluoride mouthrinsing program (5times/week, 500ppm F) for 6 years in elementary school were compared with those of 222 students outside the program (control group) who had entered the same school at the same time.Caries prevalence of the fluoride group was 27% (mean DMFT) lower than that of the control group 2 years after the end of the fluoride mouthrinsing program (p<0.001), and caries increment was 32% (new DMFT) lower in the 2nd to 3rd years of junior high school. Significant difference of caries incidence (mean DMFT increment) was observed between during and after fluoride mouthrinsing.This result suggests that the cariostatic effect of fluoride mouthrinsing changed in a relatively short period after the end of the program. It is conceivable that such change was affected by caries increment of later erupted teeth, such as the second molars.

低濃度フッ化物溶液（Ｆ：１００ｐｐｍ）洗口によるう蝕抑制効果 第３報 洗口中止３年後のう蝕抑制効果の持続性

In our previous study, we demonstrated that supervised daily mouth-rinsing program with a weak fluoride solution (F: 100ppm) based on a six-year school dental health service (in an elementary school) had a significant cariostatic effect. When the participants in this program left school, however, they had to discontinue the fluoride mouth-rinsing. It is, therefore, necessary to assess the durability of the cariostatic effect obtained through this program. As the subjects for present study, the children who took part in this program (the fluoride group) and others who were given the same school dental care without the fluoride mouth-rinsing (the control group) were chosen. Three years after they left their elementary schools, they were given a dental examination. During this three-year period, no organized prophylaxis had been given to them. The routine dental examination was the same as that used by us in previous reports.The results may be summarized as follows:1. The new DMFT increment during the three years after the discontinuing of the fluoride mouth-rinsing was 1.76 in the fluoride group and 2.58 in the control group, showing a caries reduction of 31.8%.2. The new DMFS increments on different tooth surfaces during this three years were analyzed, showing a caries reduction of 71.9% on smooth surfaces and 20.6% on other surfaces with pits and fissures.3. No cariostatic effect was found on the second molars, especially in the newly erupted teeth.4. This means that there was no cariostatic effect on teeth with little exposure to fluoride.It is evident from this investigation that there was a prolonged cariostatic effect during the three years after discontinuing of the weak fluoride mouth-rinsing. Therefore, we suggested that the fluoride mouth-rinsing program should be continued longer, to protect the second molars from dental caries.

Tooth brushing habit and caries increment in nursery school children.

To clarify whether daily tooth brushing prevents the dental caries of deciduous teeth in a longitudinal study, the relations between caries increment over a 2-year period, tooth brushing habits such as the frequency of tooth brushing and the help of parents in children's tooth brushing, and oral cleanliness were statistically analyzed in 576 nursery school children initially aged 1 to 3 years.The children with continuously good tooth brushing habits had smaller mean dmft increment and mean Debris Score than those with continuously poor tooth brushing habits during the study period and the differences were often significant. The children with good oral cleanliness also showed a constantly smaller mean dmft increment than those with poor oral cleanliness.With respect to the effect of parents' assistance, no significant differences in dmft increment and oral cleanliness were found between the children who were helped by their parents and those who brushed by themselves.Consequently, it is concluded that continuing good tooth brushing habits produce good oral cleanliness and the reduction of caries increment and that the help of parents in tooth brushing does not reduce the dental caries of young children.

Effect on caries of self‐application of a zirconium silicate paste containing 9% stannous fluoride

Abstract A 2‐year clinical trial was conducted using an adolescent population from a low‐fluoride area to evaluate the anticaries effect of self‐applications of zirconium silicate paste containing 9 % stannous fluoride. Three study groups totaling 464 children, with an initial average age of 12.8 years, completed the study. The control group brushed with a non‐fluoride zirconium silicate paste (Zircate Prophylaxis Paste®) once each year; the first experimental group brushed with zirconium silicate paste containing 9 % stannous fluoride (Zircate Treatment Paste®) once each year; and the second experimental group brushed every 6 months with Zircate Treatment Paste. After 2 years, the DMFT and DMFS increments were virtually identical for the control group and the group that received one application of fluoride paste per year. The group that received two applications of fluoride paste per year had a DMFT increment that was about 24 % less than that of the control group; however, the DMFS increment was only 5 % less. These differences were not statistically significant at the P= 0.05 level.

A community dental health project

A dental health programme which employed group self prophylaxis by school children aged 5-9 years is described. The group used 10 per cent SnF2-ZrSiO4 paste and was supervised within the school by an auxiliary of parents under the direction of a dentist. There was a 36 per cent reduction in DMFT increment at the end of two years in the children aged 7-9 years.