Caries and costs: an evaluation of a school-based fluoride varnish programme for adolescents in a Swedish region.

UNLABELLED: In 2003, 19 public dental clinics in Västra Götaland Region implemented a population-based programme with fluoride varnish applications at school every six months, for all 12 to 15 year olds. In 2008, the programme was extended to include all 112 clinics in the region. OBJECTIVE: To evaluate caries increment and to perform a cost analysis of the programme. BASIC RESEARCH DESIGN: A retrospective design with caries data for two birth cohorts extracted from dental records. Three groups of adolescents were compared. For Group 1 (n = 3,132), born in 1993, the fluoride varnish programme started in 2003 and Group 2 (n = 13,490), also born in 1993, had no fluoride varnish programme at school. These groups were compared with Group 3 (n = 11,321), born in 1998, when the programme was implemented for all individuals. The total cost of the four-year programme was estimated at 400SEK (≈ 44€) per adolescent. RESULTS: Caries prevalence and caries increment in 15 year olds were significantly lower after the implementation of the programme. Group 2, without a programme, had the highest caries increment. The cost analysis showed that it was a break-even between costs and gains due to prevented fillings at the age of 15. CONCLUSIONS: This school-based fluoride varnish programme, implemented on a broad scale for all 12 to 15 year olds, contributed to a low caries increment at a low cost for the adolescents in the Västra Götaland Region in Sweden.

Approximal caries increment in relation to baseline approximal caries prevalence among adolescents in Sweden with and without a school-based fluoride varnish programme.

OBJECTIVE: Approximal surfaces are a focal point for caries prevention among adolescents in Sweden and the aims of this study were therefore to evaluate approximal caries incidence and caries progression among adolescents with and without a three-year school-based fluoride varnish programme in relation to approximal caries prevalence at baseline. BASIC RESEARCH DESIGN: In all, 758 (89%) 13-year-olds completed the three-year randomised controlled trial. They all used fluoride toothpaste at home and had regular dental check-ups at the public dental clinics. RESULTS: The mean approximal caries incidence for the adolescents who were caries free on these surfaces at baseline was 0.13 (SD 0.54) in the fluoride varnish group and 0.79 (1.93) in the control group. The corresponding values for those who had caries at baseline in these groups were 1.29 (2.21) and 2.62 (3.22) respectively. The latter two groups also had 0.34 (1.00) and 0.70 (1.13) approximal enamel lesions that progressed. All differences were statistically significant (p⟨0.001). Among those individuals who had approximal caries at baseline, double the number of early approximal enamel lesions in the control group progressed compared with the fluoride varnish group. CONCLUSIONS: The school-based fluoride varnish programme inhibited new approximal lesions to a great extent and effectively kept approximal enamel lesions within the enamel among 13-16-year-olds. It is therefore recommended that such a programme is warranted when the approximal surfaces are still caries free in order to keep these surfaces free from caries and keep upcoming approximal enamel lesions within the enamel.

'I take for granted that patients know' - oral health professionals' strategies, considerations and methods when teaching patients how to use fluoride toothpaste.

OBJECTIVES: The aim of this study was to explore the oral health professionals' (OHPs') perspectives regarding their strategies, considerations and methods when teaching their patients the most effective way of toothbrushing with fluoride (F) toothpaste. METHODS: A qualitative research method was used to collect data. To stimulate interactivity among the participants, interviews were performed in focus groups. Five groups of OHPs, including dentists, dental hygienists and dental nurses, were interviewed a total of 23 individuals. The interviews were analysed using manifest and latent qualitative content analysis. Data were systematically condensed and coded to the relevant phrases that identified their content. RESULTS: Three categories were identified in the manifest and latent content analysis: (i) strategies and intentions, (ii) providing oral hygiene information and instruction and (iii) barriers to optimal oral healthcare education. Health promotion and seeing to the patients' best interest were driving forces among the OHPs as well as personal success in their preventive work. They focused on toothbrushing techniques more than on how to use F toothpaste. Barriers to oral health information were cost to the patients and, to some extent, the opinion of the OHPs that some patients were impossible to motivate or that patients already know what to do. CONCLUSION: The OHPs described toothbrushing with F toothpaste as very important, although the plaque removal perspective dominated. They did not focus on how to use F toothpaste, because they believed that knowledge about and appropriate behaviour concerning F toothpaste were already familiar to their patients.

Caries incidence in adolescents with low caries prevalence after cessation of weekly fluoride rinsing.

The aim of this study was to determine whether cessation of weekly fluoride rinsing leads to an increase in caries incidence in a group of adolescents with low caries prevalence. Sixty randomly selected 12- to 14-year-olds were asked to stop rinsing at school (test group). After 3 years caries increment and caries progression were compared with an age- and sex-matched control group (n = 60), who continued to rinse weekly with a 0.2% sodium fluoride solution. All children in both groups had followed a school-based fluoride rinsing program from the age of 6 years. The mean (standard deviation) caries increment, including only open lesions, during the 3 years was 1.58 (1.73) in the test group and 1.48 (1.80) in the control group. The corresponding figures for incipient lesions were 3.13 (3.63) and 4.03 (4.23), respectively. The mean caries progression was 0.92 (1.34) in the test group and 0.72 (1.03) in the control group. None of these differences were statistically significant. Thus, this study showed that a cessation of weekly fluoride rinsing did not lead to an increase of caries incidence in a group of adolescents with low caries prevalence.

Differences in caries recording with and without bitewing radiographs. A study on 5-year old children in the County of Bohuslän, Sweden.

In Sweden, when caries prevalence was much higher, bitewing radiographs (bwg's) were taken on all school children at their annual examination. It has been argued that bwg's should also be taken on 4- to 6-year-olds, with approximal surfaces in the molar area in contact (Stecksén-Blicks & Wahlin 1983). However, discussion about radiation-risk in combination with low caries prevalence seem to have made Swedish dentists reluctant to take radiographs on pre-school children. The aim of this study was to find out if there was a difference in caries recording when information from bwg's was added to that from clinical examination. Therefore 180 5-year-old children were randomly selected to constitute a test group examined both by the dentists who see the patients at the annual examination and do not use bwg's and by two of the authors, who had access to bwg's. No statistically significant difference in carries prevalence was noted from the registrations made by the clinicians and the authors when bwg's were not used (x = 1.8 versus 2.0). When the authors had access to bwg's they considered 1.8 more surfaces to be carious compared to when bwg's were not used (x = 3.8 versus 2.0). Of these, 1.0 surfaces were open lesions and 0.8 were incipient lesions. The difference was statistically significant (p < 0.001) as tested by paired t-test. Extreme differences were noted in single cases. It was concluded that clinical examination only, underestimates the correct caries status.

Is caries prevalence underestimated in today's caries examination? A study on 16-year-old children in the county of Bohuslän, Sweden.

When caries prevalence was higher than today incipient lesions constituted 70% of carious lesions. Incipient lesions were often neglected in caries recordings and hence the true caries prevalence was underestimated. Moreover, it has been shown that there were evident differences in caries status between different areas in the same county though the preventive measures were supposed to be the same (Moberg Sköld et al 1984). To find out if the conditions were the same when caries prevalence has decreased a total number of 240 16-year-old children were examined concerning caries in 1987 and 1990. The results showed that the caries prevalence was still underestimated. Incipient lesions constituted 80% of the total number of carious lesions which was approximately the same as when caries prevalence was higher. The difference in caries status within the country had decreased compared with the study in 1984 (Moberg Sköld et al 1984).

Differences in caries status and caries recording within and between two counties in Sweden.

One-hundred and seventy-six randomly selected 16-year-old children from six clinics in two neighbouring counties were examined by the dentists who see the patients every year, as well as by two calibrated examiners (two of the authors). Compared to the dentists, working in the dental clinics, the authors consistently noted a higher total caries score (DMFS + incipient lesions). The differences were statistically significant in four of the six clinics and most pronounced on incipient lesions. Furthermore, there was a significant difference in caries prevalence between the two counties. Possible explanations for the difference are resources available and efforts put into preventive dentistry.