School-based prevention programs can substantially reduce children’s cavities. They also have emerged as an important way to improve access to dental services in medically underserved areas, often serving as the sole source of dental care for children. However, questions remain about which school-based strategies are the most effective.
The New York University (NYU) College of Dentistry reports that a combination of cavity prevention strategies may be more effective than single strategies for reducing tooth decay, which remains the world’s most prevalent childhood disease, affecting nearly 30% of school-age children and 50% of rural, minority, or Medicaid-receiving children in the United States.
“Given the high variability in school-based programs to prevent cavities, comparing the effectiveness of different prevention agents, frequency of care, or intensity of treatment can lead to optimal program design,” said Ryan Richard Ruff, MPH, PhD, assistant professor of epidemiology and health promotion at NYU Dentistry and lead author of the study.
The researchers compared two cavity prevention programs in elementary schools serving more than 8,200 students from 2004 to 2014. Both provided school-based care twice a year to children ages 5 to 12. One provided sealants on molars (primary prevention), while the other provided sealants on all teeth and interim therapeutic restorations (primary and secondary prevention).
Interim therapeutic restorations are a minimally invasive method for controlling tooth decay by filling a cavity with a fluoride-releasing agent. These restorations are intended to bridge the gap between identifying a cavity, particularly in a nontraditional setting or in a very young child, and having the cavity filled or crowned in a more permanent procedure.
Both programs reduced the risk of untreated decay over time. While the total number of all decayed or filled teeth increased across both programs, the comprehensive program that provided primary and secondary prevention significantly lowered the rate of new and untreated cavities compared to only sealants on molars.
“A comprehensive cavity prevention program, particularly for children without regular access to dental care, can be significantly better than the traditional molar sealant programs,” said Richard Niederman, DMD, professor and chair of the Department of Epidemiology & Health Promotion at NYU and the study’s coauthor.
Ruff and Niederman are continuing to study how to optimize school-based cavity prevention. They are currently leading two large studies, one in the Bronx and the other in New Hampshire, to compared two cavity prevention techniques in school-based dental programs.
One technique is a more complex treatment like the combined primary and secondary prevention, but the Bronx and New Hampshire studies also will introduce the use of silver diamine fluoride to halt the progression of tooth decay. The cavity prevention programs will begin in schools in the fall of 2018.
The study, “Comparative effectiveness of school-based caries prevention: a prospective cohort study,” was published by BMC Oral Health.