The cost-utility of school-based first permanent molar sealants programs: a Markov model.

BACKGROUND: Evidence of the cost-effectiveness of school-based first permanent molar sealants programs is not yet fully conclusive. The aim of this study was to determine the incremental cost-utility ratio (ICUR) of school-based prevention programs for the application of sealants in molars of schoolchildren compared with non-intervention. METHODS: A cost-utility analysis based on a Markov model was carried out using probability distribution. The utility was measured in quality-adjusted tooth years (QATY). The assessment was carried out from the public payer's perspective with a six-year time horizon. Costs and benefits were discounted at 3% per year. Only direct costs were evaluated, expressed in Chilean pesos (CLP) at 7th May at 2019 values (exchange rate USD = CLP 681.09). Univariate deterministic sensitivity analysis and probabilistic analysis were carried out. RESULTS: After a six-year follow up, the cost of sealing all first permanent molars was found to be higher than non-intervention, with a mean cost difference of USD 1.28 (CLP 875) per molar treated. The "seal all" strategy was more effective than non-intervention, generating 0.2 quality-adjusted tooth years more than non-intervention. The ICUR of the "seal all" strategy compared to non-intervention was USD 6.48 (CLP 4,412) per quality-adjusted tooth years. The sensitivity analysis showed that the increase in caries was the variable which most influenced the ICUR. CONCLUSIONS: A school-based sealant program is a cost-effective measure in populations with a high prevalence of caries.

Child, neglect and oral health.

BACKGROUND: Despite advancements in oral health policies, dental caries still a problem. The lack of parents/caregiver's care regarding child's oral health, which characterizes neglect, may lead to a high prevalence of caries. Therefore, the objective of this study was to analyze the relation between dental caries and neglect in five year-old children. METHODS: Quantitative study performed in two different moments. First, the children underwent oral examinations and physical inspection. Then, a semi-structured interview was performed with parents of children with high and low caries rate. RESULTS: In all, 149 physical inspections and oral exams were performed. The number of decayed, missing and filled teeth - dmf-t was 2.75 (SD 2.83); 16 children had extremely high values (dmf-t ≥ 7), 85 intermediate values (1 ≤ dmf-t ≥ 6) and 48 extremely low (dmf-t = 0). Nearly all caregivers were female (96.7%; n = 29), mostly mothers (93.3%; n = 28). Associations were found between caries experience and reason of the last consultation (p = 0.011), decayed teeth and child's oral health perception (p = 0.001). There was a trend towards a significant association between general health and decayed teeth (p = 0.079), general hygiene and caries experience (p = 0.083), and caries experience and number of times the child brushes the teeth (p = 0.086). CONCLUSION: There's a relation between caries experience and children's oral health perception by caregivers, as well as between caries experience and children's access to dental care. There is a trend towards association between caries experience and risk factors suggestive of neglect.

[Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children]. / Custo-efetividade da escovação dental supervisionada convencional e modificada na prevenção da cárie em molares permanentes de crianças de 5 anos de idade.

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of 18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50% lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

Custo-efetividade da escovação dental supervisionada convencional e modificada na prevenção da cárie em molares permanentes de crianças de 5 anos de idade / Cost-effectiveness of conventional and modified supervised toothbrushing in preventing caries in permanent molars among 5-year-old children

O custo-efetividade de um programa modificado de escovação dental supervisionada foi comparado ao programa convencional. Participaram 284 crianças de 5 anos com, pelo menos, um molar permanente com a superfície oclusal irrompida/hígida. Nas unidades de controle, o programa convencional composto de atividade educativa com distribuição de escova e creme dental fluorado foi desenvolvido quatro vezes por ano. Nas unidades de teste, as crianças receberam também escovação profissional nas superfícies oclusais desses dentes, realizada por auxiliar de saúde bucal, empregando-se a técnica de escovação vestíbulo-lingual cinco vezes por ano. Cárie de esmalte/dentina foi registrada nas superfícies vestibular, oclusal e lingual dos molares permanentes durante 18 meses. A razão da densidade de incidência (RDI) foi estimada usando o modelo de regressão de Poisson, sendo 50 por cento menor entre os meninos no grupo de teste (p = 0,016). O programa modificado custou R$ 3,04 por criança. A razão de custo-efetividade marginal foi de R$ 10,71 por lesão evitada entre os meninos. O programa modificado foi custo-efetivo nos meninos.

The cost-effectiveness of a modified supervised toothbrushing program was compared to a conventional program. A total of 284 five-year-old children presenting at least one permanent molar with emerged/sound occlusal surface participated. In the control group, oral health education and dental plaque dying followed by toothbrushing with fluoride dentifrice was carried outfour times per year. With the test group, children also underwent professional cross-brushing on surfaces of first permanent molar rendered by a dental assistant five times per year. Enamel/dentin caries were recorded on buccal, occlusal and lingual surfaces of permanent molars for a period of18 months. The incidence density (ID) ratio was estimated using Poisson's regression model. The ID was 50 percent lower among boys in the test group (p = 0.016). The cost of the modified program was US$ 1.79 per capita. The marginal cost-effectiveness ratio among boys was US$ 6.30 per avoided carie. The modified supervised toothbrushing program was shown to be cost-effective in the case of boys.

The association between low-socioeconomic status mother's Sense of Coherence and their child's utilization of dental care.

OBJECTIVES: The objective of this study was to investigate the relationship of low-socioeconomic status mother's Sense of Coherence (SOC) and their child's utilization of dental care services in a city of Southeast Brazil. METHODS: A cross-sectional study was conducted on a sample of 190 schoolchildren aged 11-12 and their mothers in Sao João de Meriti-RJ, Southeast Brazil. The outcome variables were children's use of dental care services and visiting dentists mainly for check-ups. Demographic and socioeconomic characteristics and data regarding children's dental care use were collected through interviews with mothers. Children's oral health-related behaviours as well as dental status (DMFS index), dental pain, Visible Dental Plaque and Bleeding on Probing Index were registered. Mother's SOC was assessed through the validated short version (13-item) of Antonovsky's scale. Multiple logistic regression was used in the data analysis. RESULTS: Of the mothers, 81.1% reported on their child's utilization of dental care services. Of them, 42.9% considered check-ups as the main reason for taking their children to dental services. Children whose mothers had higher levels of SOC were more likely to utilize dental care services (OR=2.08 95%CI=1.17-3.64) and visit a dentist mainly for check-ups (except for dental treatment) (OR=2.02 95%CI=1.06-3.81) than those whose mothers had lower levels of SOC. These findings were adjusted for socioeconomic status, children's oral health-related behaviours and oral health measures. CONCLUSIONS: Mother's SOC was a psychosocial factor associated with their child's pattern of use of dental care services in low-socioeconomic status families.

False hope: effects of social class and health policy on oral health inequalities for migrant farmworker families.

Few studies have engaged issues of social class and access related to dental health care policy from an ethnographic perspective. The state of Florida in the US has one of the poorest records in the nation for providing dental care for low-income children, falling especially short for Medicaid-enrolled children. In this paper, we discuss unmet dental health needs of children in migrant farmworker families. Although one of the most marginalized populations, most are eligible for Medicaid and are thus covered for dental services. However, serious disparities have been linked to the lack of access through the public insurance system. This study was informed by participant observation at dental clinics and a Migrant Head Start Center and interviews with dental health providers (n = 19) and migrant farmworker parents (n = 48) during 2009. Our results indicate that some typical factors associated with poor oral health outcomes, such as low dental health literacy, may not apply disproportionately to this population. Instead, we argue that structural features and ineffective policies contribute to oral health care disparities. Dental Medicaid programs are chronically underfunded, resulting in low reimbursement rates, low provider participation, and a severe distribution shortage of dentists within poor communities. We characterize the situation for families in Florida as one of "false hope" because of the promise of services with neither adequate resources nor the urgency to provide them. The resulting system of charity care, which leads dentists to provide pro bono care instead of accepting Medicaid, serves to only further persistent inequalities. We provide several recommendations, including migrant-specific efforts such as programs for sealants and new mothers; improvements to the current system by removing obstacles for dentists to treat low-income children; and innovative models to provide comprehensive care and increase the number of providers.

Efficiency of a schoolchildren program for oral care.

The aim of this investigation was to evaluate the efficiency of an oral school program, applied during 3 years. DMFT index, the component D and CTNI of a sample of 590 children (Group I, aged 12.0 +/- 1.1 years) which received regular oral treatment during 3 consecutive years were compared with the same indicators of 586 children (Group II, aged 12.6 +/- 1.0 years) without treatment. The cost-benefit ratio of the current required treatments in both groups was calculated. Results revealed: (a) in Group I the component D of DMFT was 0.9 +/- SEM = 0.3, and in Group II, 5.5 +/- SEM = 1.5; and (b) the cost-benefit ratio of the required treatment for Group I ranged from 1.5 to 7.5 times lower than that required for cumulative pathology resolution in groups lacking preventive coverage. It seems advisable to introduce management strategies to change spontaneous demand into programmed care with a strong preventive component. The accomplishment of this regular school program appears to contribute to strengthen equity and could reduce the differences in oral health care among schoolchildren at different social risk.

Predictors of the utilization of oral health services by children of low-income families in the United States: beliefs, cost, or provider?

PURPOSE: This study examined the predictive factors enabling access to children's oral health care at the level of financial barriers, beliefs, and the provider. METHODS: In-depth interviews were conducted with 320 immigrant mothers of low-income families regarding their use of oral health services for children aged four to eight years old. Access to oral health care was measured with frequency of planned dental visits, continuity of care, and age at first visit to dentist. RESULTS: The mother took her child to the dentist at a younger age if she received referrals to a dentist from pediatrician. Regular dental visits were significantly related to household income, provider availability on weekends, and insurance coverage. The extended clinic hours in the evenings, and the belief in the importance of the child's regular dentist visits increased the likelihood of continuing care. The mothers perceiving a cost burden for the child's dental care were also less likely to return to the dentist. CONCLUSION: The available care delivery system, coordinated medical care, and health beliefs were among important predictors of the health service use. The study findings suggest need for culturally competent dental health interventions to enhance access to oral health care among particularly vulnerable populations such as low-income children in Korean communities.