Costs and benefits of Papacarie in pediatric dentistry: a randomized clinical trial.

Papacarie gel is an agent that eliminates the need for local anesthesia and reduces the need for using a drill. However, there is no information regarding the cost per procedure. Therefore we analyzed the cost, per procedure, of Papacarie gel compared to the traditional method (drilling), and performed a comparison between these methods of carious tissue removal. A randomized clinical trial was performed with 24 children with an average age of 5.9 years old. Of these children, 12 were boys and 12 were girls, which resulted in a total of 46 restorations. Patients were separated into: Papacarie group (caries removal with the chemical-mechanical method - Papacarie gel) and Drill group (caries removal with the traditional method - drilling). Values of the materials used in the procedures, heart rate (before, 5 minutes during, and after dental treatment), and the total consultation duration were recorded. A level of significance of 5% was adopted. Papacarie had a lower cost per procedure ($ 0.91) when compared to the traditional method ($ 1.58). Papacarie provided a cost reduction of 42% compared to the traditional method. Using local anesthesia ($ 2.17), the cost reduction increased to 58%. In the procedure using drill + Papacarie ($ 1.37), the cost reduction was 33%. Heart rate, consultation duration, and number of restorations were not statistically different. Papacarie shows an excellent cost benefit for minimally invasive removal of carious tissue and is a feasible alternative for public health care.

Fluoride Varnish for Caries Prevention: Efficacy and Implementation.

Many reviews support fluoride varnish (FV) as a caries-inhibitory agent. Evidence from 6 Cochrane systematic reviews involving 200 trials and more than 80,000 participants further confirms the effectiveness of FV, applied professionally 2-4 times a year, for preventing dental caries in both primary and permanent teeth. The relative benefit of FV application seems to occur irrespective of baseline caries risk, baseline caries severity, background exposure to fluorides, use of fluoride toothpaste and application features such as prior prophylaxis, concentration of fluoride or frequency of application. While the efficacy of FV is acknowledged in clinical practice guidelines globally, the implementation of this recommendation may still be an issue. Factors that may facilitate FV application in the USA include Medicaid eligibility, relationships with dentists/community centers and strong cooperation and communication between physicians and support staff. Barriers include insufficient time to integrate oral health services into well-child visits, difficulty in applying FV (lack of skills/training) and resistance among colleagues and staff. Research in the UK/Scotland also suggests encouraging clinicians in their motivation to perform this treatment and addressing professional and parental concerns relating to possible negative consequences may be influential. Further research targeting cost-effectiveness and how FV in routine care may fit in with political agendas relating to, for example, inequalities in health care provision and access will also play a key part in stakeholder decisions to put resources into this issue.

Economic modeling of sealing primary molars using a "value of information" approach.

The objective was to evaluate 2 primary molar sealant strategies for publicly insured children using an "expected value of perfect information" (EVPI) approach. We converted a 10,000-observation tooth-level cost-effectiveness simulation model comparing 2 primary molar sealant strategies - always seal (AS) and standard care (SC) - with a 1,250-observation child-level model. Costs per child per restoration or extraction averted were estimated. Opportunity losses under the AS strategy were determined for children for whom SC was the optimal choice. We determined the EVPI by multiplying mean opportunity losses by the projected incident population of publicly insured 3-year-olds in the US over 10 years with costs discounted at 2%. All analyses were conducted under assumptions of high and low intrachild correlations between at-risk teeth. The AS strategy cost $43.68 over SC (95% CI: -$5.50, $92.86) per child per restoration or extraction averted under the high intrachild correlation assumption and $15.54 (95% CI $7.86, $23.20) under the low intrachild correlation. Under high intrachild correlation, mean opportunity losses were $80.28 (95% CI: $76.39, $84.17) per child, and AS was the optimal strategy in 31% of children. Under low correlation, mean opportunity losses were $14.61 (95% CI: $12.20, $17.68) and AS was the optimal strategy in 87% of children. The EVPI was calculated at $530,813,740 and $96,578,389 (for high and low intrachild correlation, respectively), for a projected total incident population of 8,059,712 children. On average, always sealing primary molars is more effective than standard care, but widespread implementation of this preventive approach among publicly insured children would result in large opportunity losses. Additional research is needed to identify the subgroups of publicly insured children who would benefit the most from this effective and potentially cost-saving public health intervention.

Effectiveness of MTA pulpotomy in primary molars: a critical assessment of relevant studies.

DATA SOURCES: Medline. STUDY SELECTION: Studies that evaluated the efficacy of MTA as a pulpotomy medicament in primary teeth were included, abstracts, observational studies and case reports were excluded. Only English language studies were considered. DATA EXTRACTION AND SYNTHESIS: Studies were assessed and graded by two reviewers using a weighted criteria based system and a qualitative summary of the evidence provided. RESULTS: Twenty-two studies were included, 17 studies compared MTA with formocresol, four studies compared MTA with calcium hydroxide, ferric sulphate, Portland cement, calcium-enriched mixture cement (CEM) and one study compared white MTA with grey MTA. CONCLUSIONS: Based on the assessment criteria employed, there was no evidence that MTA was better than present materials and techniques as a pulpotomy medicament.

The effects of lead exposure on urban children: the Institute of Child Health/Southampton Study.

A study of the associations between level of tooth lead, behaviour, intelligence and a variety of other psychological skills was carried out in the child population aged six to seven years in three London boroughs. Tooth lead was estimated from the chemical analysis of shed teeth donated by children. 2663 (62.4 per cent) of the eligible children donated teeth. A study of the total population was carried out to see if those who donated teeth were representative of that population. There were small but consistent and statistically significant differences--tooth-givers being of slightly higher intelligence and showing fewer behaviour problems. 403 children, selected on the basis of their tooth-lead levels and social class, were studied more intensively. They were classified into six pre-arranged groups--high, medium and low tooth-lead levels, with each lead group divided into two social groups, manual and non-manual. The parents of these children were intensively interviewed in their homes regarding parental interest and attitudes to education, family characteristics and relationships, the early history of the child and the child's physical environment. The intelligence of the mother was measured. The child was then studied in school using tests of intelligence, educational attainment and other cognitive tasks. Teachers and parents completed standardised behaviour questionnaires. The results showed that intelligence and other psychological measures were strongly related to social factors, especially social grouping. Lead level was linked to a variety of factors in the home, especially the level of cleanliness, and to a lesser extent, maternal smoking. There was no significant link between lead level and behaviour, though when rated by teachers, but not by parents, there were small and reasonably consistent non-significant tendencies for high-lead children to show more difficult behaviour. Before social factors were controlled for, there were significant differences between the lead groups in measures of intelligence and two other psychological tests, the children in the high-lead groups performing worse. Once a number of social factors had been taken into account, the differences between the three lead groups (high, medium and low) became small and statistically nonsignificant, although they remained in the same direction.(ABSTRACT TRUNCATED AT 400 WORDS)

Biologic assessment of copper-containing amalgams.

In order to reduce creep and avoid marginal fractures in amalgam restorations, new alloys containing higher proportions of copper have been introduced. Fillings of these materials were placed in cavities prepared in the deciduous teeth of monkeys or placed in polyethylene tubes and implanted subcutaneously in rats. Conventional silver/tin alloys and zinc oxide eugenol cement were used as reference materials. Despite limitations due to the varying depths of cavities and the small number of animals involved it was concluded that the high copper alloys caused more severe pulp damage than the other materials studied. In the implantation studies many of the high copper specimens were exfoliated before the end of the experimental period. It is concluded that in deep cavities these materials require the use of a non-toxic base or lining material although as they are commonly used in young children's teeth the placement of linings and the isolation of the cavity pose problems.