Cost-effectiveness analysis of a school-based dental caries prevention program using fluoridated milk in Bangkok, Thailand

An Analytical Protocol for the Differentiation and the Potentiometric Determination of Fluorine-Containing Fractions in Bovine Milk

Free fluoride ions are effective in combating caries in children, and their supplementation in milk has been widely used worldwide for this purpose. Furthermore, it is known that ionic fluoride added to milk is distributed among its components, but little is known about their quantitative relationships. This is likely due to the absence of an analytical protocol aimed at differentiating and quantifying the most important forms of fluorine present in milk. For the first time, a comprehensive protocol made up of six potentiometric methods devoted to quantifying the most important fractions of fluorine in milk (i.e., the free inorganic fluoride, the inorganic bonded fluorine, the caseins-bonded fluorine, the whey-bonded fluorine, the lipid-bonded fluorine, and the total fluorine) has been developed and tested on real samples. Four of the six methods of the procedure are original, and all have been validated in terms of limit of detection and quantification, precision, and trueness. The data obtained show that 9% of all fluorine was in ionic form, while 66.3% of total fluorine was bound to proteins and lipids, therefore unavailable for human absorption. Beyond applications in dental research, this protocol could be extended also to other foods, or used in environmental monitoring.

Economic Evaluations of Preventive Interventions for Dental Caries and Periodontitis: A Systematic Review

OBJECTIVES

To critically examine the methods used for full economic evaluations of preventive interventions for dental caries and periodontitis.

METHODS

Published literature post-2000 was searched to April 2021. Based on a developed intervention classification framework for dental caries and periodontitis, only universal, selective or indicated interventions were included in this review. The Drummond 10-point checklist was used for quality appraisal.

RESULTS

Of 3,007 unique records screened for relevance, 73 studies were reviewed. Most model-based studies (61/73) used cost-effectiveness analysis (49%) or cost-benefit analysis (28%). Trial-based studies (16/73) commonly used cost-effectiveness analysis (59%). Four studies used both economic evaluation methods. Sixty-four papers (88%) were on dental caries, eight papers (11%) focused on periodontitis, and one paper (1%) included both oral diseases; 72% of model-based and 82% of trial-based studies were of good quality. The most frequently investigated dental caries preventive interventions were water fluoridation (universal intervention; cost-saving or cost-effective), fissure sealant and fluoride varnish (selective and indicated interventions; cost-effectiveness outcomes were inconsistent). Supportive periodontal therapy with oral health education (indicated intervention; cost-effective) was the most frequently evaluated preventive intervention for periodontitis. Thirty percent of studies with a time horizon > 1 year did not apply an appropriate discount rate and 26% did not comprehensively discuss other important considerations beyond the technical analysis.

CONCLUSIONS

Generic health outcome measures should be incorporated for economic evaluations on preventive interventions for dental caries and periodontitis, and an increased focus to prevent periodontitis using economic evaluation methods is needed to inform resource allocation and policy decision-making.

Dental Caries Experience and its Relationship to Demographic Factors in 2-6 Year Old Children in Fars - Iran in 2018

PURPOSE

Among oral conditions, tooth decay is the most common chronic childhood disease. Children's dental caries are influenced by several factors, among which diet is one of the most highlighted ones. The present study was conducted to examine the Decayed, Missing, and Filled Teeth in primary dentition (dmft) and caries-free (CF) indexes as well as the impact of nutrition and demographic factors on oral health of 2-6 year-old children in Fars Province.

METHODS

A cross-sectional study was conducted on children aged 2-6 years old to evaluate dmft and CF indices according to the latest WHO standards as well as their demographic characteristics in 2018. A questionnaire was used for data collection.

RESULTS

A total of 2220 children were recruited. The mean dmft was 1.37 ± 2.69. The components of the dmft score included decay (1.23 ± 2.6), missing (0.03 ± 0.11), filling (0.11 ± 0.7) in primary dentition, and the prevalence of caries-free children was 66.5%. The results showed that dmft had a significant positive relationship with breastfeeding termination time, maternal education level, and maternal age. Birth weight, consumption of iron, vitamin A and D supplements, age at onset of complementary feeding, and maternal occupation had no significant relationship with dmft.

CONCLUSIONS

The tooth decay index of 2-6 year-old children in Fars Province is very different from WHO global standards. Therefore, educating mothers about the duration of breastfeeding is important to achieve standard values for the dental caries index.

The Current Strategies in Controlling Oral Diseases by Herbal and Chemical Materials

Dental plaque is a biofilm composed of complex microbial communities. It is the main cause of major dental diseases such as caries and periodontal diseases. In a healthy state, there is a delicate balance between the dental biofilm and host tissues. Nevertheless, due to the oral cavity changes, this biofilm can become pathogenic. The pathogenic biofilm shifts the balance from demineralization-remineralization to demineralization and results in dental caries. Dentists should consider caries as a result of biological processes of dental plaque and seek treatments for the etiologic factors, not merely look for the treatment of the outcome caused by biofilm, i.e., dental caries. Caries prevention strategies can be classified into three groups based on the role and responsibility of the individuals doing them: (1) community-based strategy, (2) dental professionals-based strategy, and (3) individual-based strategy. The community-based methods include fluoridation of water, salt, and milk. The dental professionals-based methods include professional tooth cleaning and use of varnish, fluoride gel and foam, fissure sealant, and antimicrobial agents. The individual-based (self-care) methods include the use of fluoride toothpaste, fluoride supplements, fluoride mouthwashes, fluoride gels, chlorhexidine gels and mouthwashes, slow-release fluoride devices, oral hygiene, diet control, and noncariogenic sweeteners such as xylitol. This study aimed to study the research in the recent five years (2015–2020) to identify the characteristics of dental biofilm and its role in dental caries and explore the employed approaches to prevent the related infections.

Cost-effectiveness of caries preventive interventions - a systematic review

OBJECTIVE

The primary purpose of this study was to assess the cost-effectiveness of caries preventive interventions.

MATERIAL AND METHODS

A systematic review was conducted, following the PRISMA Statement. Four electronic databases were searched (final search 16 March 2020). Studies fulfilling the inclusion criteria were independently critically appraised, by two reviewers in parallel. Data from each included study were extracted and tabulated: the analysis used a narrative approach to present the results of the estimated cost-effectiveness.

RESULTS AND CONCLUSIONS

Twenty-six publications fulfilled the inclusion criteria and were of low or moderate risk of bias. Ten publications were economic evaluations, directly based on empirical studies, and the other 16 were modelling studies. Most of the studies concerned interventions for children and the most common were analyses of fluoride varnish and risk-based programs. Some of the studies showed both reduced cost and improved outcomes, but most studies reported that the improved outcome came with an additional cost. The results disclosed several cost-effectiveness evaluations of caries preventive interventions in the literature, but these target primarily children at high risk. There is a scarcity of studies specifically targeting adults and especially the elderly.

A scoping review of cost-effectiveness analyses of school-based interventions for caries

OBJECTIVES

The aims of this study were to: identify the evidence on cost-effectiveness of school-based interventions for caries prevention globally up to 2019; summarize key characteristics of interventions applied within this setting; summarize the reporting quality of previous studies; and to identify and analyse knowledge gaps.

METHODS

A scoping review of published literature on the cost-effectiveness of school-based interventions to prevent child tooth decay was conducted. A search in Medline, Cinahl and Embase was performed with no date restriction. Reporting quality of the included studies was assessed against Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

Of the 738 records identified in the initial search, 15 studies met the pre-specified inclusion criteria. The majority were published after 2011 (n = 9,) and applied to high-income countries (n = 12). Nearly 80% of the studies assessed the cost-effectiveness of the interventions based on topical fluoride therapies and fissure sealants at school premises. Although, the outcome measures differed across the studies, almost all the caries preventive interventions were cost-saving or cost-effective when compared with usual care. Compliance with the CHEERS checklist differed.

CONCLUSIONS

There is evidence to suggest that school-based caries preventive interventions are cost-effective, and in some cases cost-saving. Further evidence is required from low- to middle-income countries to confirm the generalizability of these findings. Future studies should consider adopting Quality Adjusted Life Years as a generic outcome measure that would enable the cost-effectiveness findings to be compared across different types of interventions and diseases. Improved standardization and quality of reporting are also required.

Use of oral health care services in Peru: trends of socio-economic inequalities before and after the implementation of Universal Health Assurance

Background

Oral health inequalities are profound worldwide. Despite major improvements in oral health, inequalities exist for many racial and ethnic groups, by socioeconomic status, gender, age, and geographic location. Therefore, the purpose of this study was to investigate trends of socio-economic inequalities in access to oral health services in Peru before and after the implementation of Universal Health Assurance (AUS).

Methods

Analytical cross-sectional study based on the National Household Survey on Living Conditions and Poverty (ENAHO) 2004, 2008, 2010 and 2017. Two periods were defined before and after the AUS Law (2009). Use of oral health services was the dependent variable, for the general population and according to ages, the area of residence, and natural region. Measurements of inequality in the use of health services were made based on the concentration curves (CC), dominance test and concentration index (CI).

Results

We included a number of 85,436 (2004), 88,673 (2008), 87,074 (2010) and 124,142 (2017) participants. The proportion of people who used oral health services was 8.4% (2014), 10.1% (2008), 10.6% (2010) and 10.4% (2017). Use of oral health services showed an increase in different age groups, urban and rural areas, and natural regions of residence during the study period. The CC were distributed below the line of equality, indicating an inequality of use of oral health services, in favor of the richest groups and dominance of the CC in 2017 over the previous years. Changes in the CI were statistically significant for < 5 years and in the rural area, and for the period 2010-2017 they were also significant in the general population, children aged 5-17 years, urban area, and Andean and Jungle regions, which indicates a reduction in the concentration of use of these services in these groups.

Conclusions

The use of oral health services in Peru increased and inequality decreased in the period 2004-2017, coinciding with the implementation of the AUS. However, the use of these services continue having a distribution in favor of the richest populations. It requires the introduction of new strategies and oral health programs in the Peruvian population, with the aim of closing the gap currently mediated by the economic possibilities.

Effect of acetylcholinesterase inhibitors donepezil and rivastigmine on the activity and expression of cyclooxygenases in a model of the inflammatory action of fluoride on macrophages obtained from THP-1 monocytes

Inflammation is an important factor in the development of many diseases of the central nervous system, including Alzheimer's disease and other types of dementia. ‪Given that acetylcholinesterase inhibitors are also currently believed to have anti-inflammatory properties, the purpose of this study was to investigate the effect of acetylcholinesterase inhibitors (rivastigmine, donepezil) on cyclooxygenase activity and expression using the proinflammatory action of fluoride (F^-) on cultured macrophages obtained from THP-1 monocytes. COX-1 and COX-2 activity was determined through measurement of the products of prostaglandin E2 (PGE2) and thromboxane B2 (TXB2) in cell culture supernatants. Expression of COX-1 and COX-2 proteins was examined immunocytochemically, and mRNA expression was determined by qRT PCR. ‪‪ Our study confirmed the inhibitory effects of donepezil and rivastigmine on the production of PGE2, TXB2, COX-1 and COX-2 mRNA and protein expression in macrophages. We also demonstrated that the pro-inflammatory effect of fluoride may be reduced by the use of both drugs. The additive effect of these drugs cannot be ruled out, and effects other than those observed in the use of one drug should also be taken into account.