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Longitudinal caries prevalence in a comprehensive, multicomponent, school-based prevention program.
| Journal of the American Dental Association | Starr JR, Ruff RR, Palmisano J, Goodson JM, Bukhari OM, Niederman R. | 52(3):224-233.e11.
Caries-preventive program
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Abstract

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

 

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Biography

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.

Biography

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.

Biography

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

Biography

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

Biography

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

Biography

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.

Article Info

Footnotes

Disclosures. None of the authors reported any disclosures.

This work was supported in part by grant U24MDD006964 from the National Institutes of Health and National Institute on Minority Health and Health Disparities . This work was also supported by GC America, which provided glass ionomer, and Colgate-Palmolive, which provided fluoride varnish, fluoride toothpaste, and toothbrushes. Seed and continuing finding was provided by Dental Service of Massachusetts (now DentaQuest), Bingham Trust, the Massachusetts State Legislature, and the American Dental Trade Alliance.

The authors thank the above funding organizations. The authors thank the following people who contributed to the clinical and analytic work reported in this article: Alice Bisbee, Howard Cabral, MaryAnn Cugini, Ralph Kent, Ellen Gould, Denise Guerrero, Carolina Hommes, Timothy Martinez, Valarie Osborn, John Roberge, Aronita Rosenblatt, Karina Roldan, Jennifer Soncini, Michael Stanley, Philip Stashenko, Mary Tavares, Xiaoshan Wang, and Barbara Yates. The authors thank the following community organizations that facilitated care for the children enrolled in the study: The Lynn and Harbor Community Health Centers (T. Martinez) and the Lynn, Boston, and Cape Cod, Massachusetts, school systems. The authors particularly thank New England Survey Systems (J. Roberge and M. Stanley) for their work in developing the proprietary electronic patient record software used in data collection for this study. The authors also thank the Massachusetts Department of Health (M. Foley and L. Bethel) for background guidance. Finally, the authors posthumously thank and dedicate this article to Drs. Dominick DePaola and James Ware. Dr. DePaola from the Forsyth Institute inspired this work, and Dr. Ware from the Harvard School of Public Health assisted in developing the statistical analysis plan.