Fluoride Action Network

Longitudinal caries prevalence in a comprehensive, multicomponent, school-based prevention program.

Source: Journal of the American Dental Association | Authors: Starr JR, Ruff RR, Palmisano J, Goodson JM, Bukhari OM, Niederman R.
Posted on March 1st, 2021

Background: Globally, children’s caries prevalence exceeds 30% and has not markedly changed in 30 years. School-based caries prevention programs can be an effective method to reduce caries prevalence, obviate traditional barriers to care, and use aerosol-free interventions. The objective of this study was to explore the clinical effectiveness of a comprehensive school-based, aerosol-free, caries prevention program.

Methods: The authors conducted a 6-year prospective open cohort study in 33 US public elementary schools, providing care to 6,927 children in communities with and without water fluoridation. After dental examinations, dental hygienists provided twice-yearly prophylaxis, glass ionomer sealants, glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed. The authors used generalized estimating equations to estimate the change in the prevalence of untreated caries over time.

Results: The prevalence of untreated caries decreased by more than 50%: from 39% through 18% in phase 1, and from 28% through 10% in phase 2. The per-visit adjusted odds ratio of untreated caries was 0.79 (95% confidence interval, 0.73 to 0.85).

Conclusions and practical implications: This school-based comprehensive caries prevention program was associated with substantial reductions in children’s untreated caries, supporting the concept of expanding traditional practices to include office- and community-based aerosol-free care.

*Original abstract online at https://jada.ada.org/article/S0002-8177(20)30842-4/fulltext


Dr. Starr is the director of Strategic Initiatives, Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA; and a lecturer, Harvard School of Dental Medicine and the Harvard Medical School, Boston, MA.


Dr. Ruff is an associate professor, New York University College of Dentistry, New York, NY; and an associated professor, New York University School of Global Public Health, New York, NY.


Mr. Palmisano is the associate director, Data Management, Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA.


Dr. Goodson is a senior member of the staff, The Forsyth Institute, Cambridge, MA.


Dr. Bukhari is an assistant professor, Umm Alqura University, Faculty of Dentistry, Makkah, Saudi Arabia.


Dr. Niederman was a senior member of the staff, The Forsyth Institute, Cambridge, MA, when this article was written and now is a professor, New York University College of Dentistry, New York, NY.