Top 100 most cited economic evaluation papers of preventive oral health programmes: A bibliometric analysis.

4. Discussion

The 100 most-cited papers on the economic evaluation of preventive oral health programs were published between 1978 and 2023, a relatively short time. The USA contributes most articles in this field, followed by Australia and Sweden. Africa was the only continent with null citations.²⁰ Among upper middle income countries China, South Africa and Thailand exhibit a growth in scientific production. Among lower income countries, Nepal could contribute to the research field. Indeed, preventive dental care does not receive the same level of attention as medical care among policymakers when taking into consideration the effective allocation of healthcare resources.²² The healthcare system requires consistent, large investments in research and development. High-income countries spend between 2 % and 4 % of their respective gross domestic product (GDP) on R&D.²³ Western countries have robust funding and abode most of the leading research institutes in the world.²⁴ Low-income countries face numerous challenges for large-scale investments. South Asian and sub-Saharan African countries contribute the world’s lowest R&D expenditure on an average of 0.65–0.69 % of their respective GDP.²⁵ While countries having high levels of English proficiency showed more productivity and output from publishers having global stature, local researchers tend to target national journal publishers due to the language requirements and research standards that seem more suitable.²⁶

Two recent reviews have highlighted the economic evaluations of preventive oral health programs. Mariño and Zaror (2020) conducted a scoping review on the economic evaluations of community water fluoridation (CWF).¹⁶ Their review included 24 studies, with the majority demonstrating that CWF is a cost-effective strategy for preventing dental caries, yielding substantial savings in dental treatment costs and averted caries. Davidson et al.⁴ (2021) performed a systematic review assessing the cost-effectiveness of various caries preventive interventions. Their review included 26 studies, focusing primarily on children, with most studies reporting cost savings and improved outcomes, especially for fluoride varnish and risk-based programs. However, they noted a lack of studies targeting adults and the elderly. These reviews underscore the importance of economic evaluations in guiding resource allocation for preventive oral health programs.

In this study, the top cited articles give information about randomized controlled trials (RCT), which are instrumental in assessing the effectiveness of various policy interventions to alleviate resource scarcity.²⁷ A randomized controlled trial is an experiment that is designed to isolate the influence that an inevitable intervention or variable has on an outcome or event. RCT receives high citations due to the most substantial experimental evidence in clinical care.²⁸ In the UK, healthcare resources are primarily funded through the National Health Service (NHS). The NHS is a publicly funded healthcare system that provides medical services to all residents of the UK. It is mainly funded through general taxation, including income tax, National Insurance contributions, and other government revenues.²⁹

In the US, the National Institute of Dental and Craniofacial Research (NIDCR) promotes the timely transfer of knowledge gained from research to the public by conducting various research training programs. NIDCR is one of the 27 institutes of the National Institutes of Health (NIH), the world’s foremost medical research centre.³⁰ Regarding developing countries, the only difficulty lies in estimating the benefits, which is challenging for the programs and decision-makers, and managing various funds received from the health sector. Economic analysis of preventive dental programs is often tricky as it requires epidemiologic and demographic data (the reason for fewer citations is due to the reduced number of literature). This study also reveals that fluoride interventions are the commonly adopted preventive oral health programs at a community level regardless of age, income, or education.³¹

The World Health Organization (WHO) promotes community water fluoridation as an effective approach to oral health. Salt fluoridation is considered the second-best choice where water fluoridation becomes impractical.³² The fluoride programs are advantageous due to the ability to frequently take around low fluoride levels to saliva with high reach and substantial cost savings. Community water fluoridation is a cost-saving intervention in small communities.³¹ CEA identifies neglected opportunities by calling attention to economic interventions, redirecting resources to use better and priority settings, and fetching relevant contributions for improved program management.²⁷

The h-index is an important measure that indicates the quality and quantity of a given author’s publications.¹⁶ The g-index is a measure of impact such that the number of articles is cited an average of g times or g² times. The i10-index calculates the number of significant publications. In this study, h index 30 represents the number of articles that have received at least 30 citations. The g index 48 represents the number of articles that have received citations of around 48 or 96 (g²) citations.¹⁵

The choice of WoS and Scopus allowed us to gather many citations from papers published in scholarly journals.²⁰ Over the last 15 years, researchers from the majority of countries made contributions to WoS and Scopus-related papers. China, the USA, and the UK were the leading contributors to WoS-related research. Relatively, the USA, UK, and Australia were the highest contributors to Scopus-related research. Hence, the major participation in academic research belongs to developed economies.²⁹

The topic of interest, “Economic evaluation of preventive oral health programs” was a vast discussion area without a subjective preference. In addition, the selected sample sizes were limited to 100 papers. Even though this study comprises RCT as the prime sort of exploration, the quality of these programs has yet to be discovered. Therefore, the scrutiny of provided shreds of evidence remains to be debated. A steadiness between the inputs and outputs and available resources will determine if the program can be suggested for general use.²⁹

5. Conclusion

This bibliometric analysis identified that the 100 most-cited articles on the economic evaluation of preventive oral health programs were mainly program data economic evaluation, with the majority of the papers published in the USA, aiming at the proper allocation of resources. Papers were predominantly published in Community Dentistry and Oral Epidemiology, and Griffin P M was the most frequent author. Despite its limitations, this bibliometric analysis helps researchers identify the emerging trends in preventive oral health care and the need for more studies in upper middle income countries and lower middle income countries to eliminate the disparity in the allocation of healthcare resources and ensure equity in delivering oral care.