The authors declare that they have no competing interests.
NWJ is Chief Investigator of the NHMRC Grant: all other authors are co-investigators. NWJ, RL, JK, OT and LJ were the principal designers of the study: SK and PS provided advice on statistics and health economics; VL and YC-J provide advice on Indigenous cultural aspects; RB advises on logistics and clinical matters; SF assists with clinical interventions. All authors read and approved the final manuscript.
The aim of the study is to reduce the high prevalence of tooth decay in children in a remote, rural Indigenous community in Australia, by application of a single annual dental preventive intervention. The study seeks to (1) assess the effectiveness of an annual oral health preventive intervention in slowing the incidence of dental caries in children in this community, (2) identify the mediating role of known risk factors for dental caries and (3) assess the cost-effectiveness and cost-benefit of the intervention.
The intervention is novel in that most dental preventive interventions require regular re-application, which is not possible in resource constrained communities. While tooth decay is preventable, self-care and healthy habits are lacking in these communities, placing more emphasis on health services to deliver an effective dental preventive intervention. Importantly, the study will assess cost-benefit and cost-effectiveness for broader implementation across similar communities in Australia and internationally.
There is an urgent need to reduce the burden of dental decay in these communities, by implementing effective, cost-effective, feasible and sustainable dental prevention programs. Expected outcomes of this study include improved oral and general health of children within the community; an understanding of the costs associated with the intervention provided, and its comparison with the costs of allowing new lesions to develop, with associated treatment costs. Findings should be generalisable to similar communities around the world.
The research is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), registration number ACTRN12615000693527; date of registration: 3rd July 2015.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2163–96. PubMed
Skeie MS, Raadal M, Strand GV, Espelid I. The relationship between caries in the primary dentition at 5 years of age and permanent dentition at 10 years of age - a longitudinal study. Int J Paediatr Dent. 2006;16(3):152–60. PubMed
Selwitz RH, Ismail AI, Pitts NB. Dental caries. Lancet. 2007;369(9555):51–9. PubMed
Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366(9499):1809–20. PubMed
Mejia GC, Parker EJ, Jamieson LM. An introduction to oral health inequalities among Indigenous and non-Indigenous populations. Int Dent J. 2010;60(3 Suppl 2):212–5. PubMed
Roberts-Thomson KF, Spencer AJ, Jamieson LM. Oral health of Aboriginal and Torres Strait Islander Australians. Med J Aust. 2008;188(10):592–3. PubMed
Marinho VC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database Syst Rev. 2013;7:CD002279. PubMed
Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander Health Performance Framework 2010: detailed analyses. Canberra: Australian Capital Territory; 2011.
Roberts-Thomson K, Do L. Oral health status. In: Slade G, Spencer AJ, Roberts-Thomson KF, editors. Australia’s dental generations: the National Survey of Adult Oral Health 2004–06. Canberra: Australian Institute of Health and Welfare; 2007. p. 81–142.
Krisdapong S, Sheiham A, Tsakos G. Oral health-related quality of life of 12- and 15-year-old Thai children: findings from a national survey. Community Dent Oral Epidemiol. 2009;37(6):509–17. PubMed
Bonecker M, Abanto J, Tello G, Oliveira LB. Impact of dental caries on preschool children’s quality of life: an update. Braz Oral Res. 2012;26 Suppl 1:103–7. PubMed
Abanto J, Paiva SM, Raggio DP, Celiberti P, Aldrigui JM, Bonecker M. The impact of dental caries and trauma in children on family quality of life. Community Dent Oral Epidemiol. 2012;40(4):323–31. PubMed
Lalloo R, Kroon J: Analysis of public dental service waiting lists in Queensland. Aust J Prim Health 2013, 10.1071/PY13048.
Johnson NW, Lalloo R, Kroon J, Fernando S, Tut O. Effectiveness of water fluoridation in caries reduction in a remote Indigenous community in Far North Queensland. Aust Dent J. 2014;59(3):366–71. PubMed
Ahovuo-Saloranta A, Forss H, Walsh T, Hiiri A, Nordblad A, Makela M, et al. Sealants for preventing dental decay in the permanent teeth. Cochrane Database Syst Rev. 2013;3:CD001830. PubMed
Zhan L, Featherstone JD, Gansky SA, Hoover CI, Fujino T, Berkowitz RJ, et al. Antibacterial treatment needed for severe early childhood caries. J Public Health Dent. 2006;66(3):174–9. PubMed
Marino RJ, Khan AR, Morgan M. Systematic review of publications on economic evaluations of caries prevention programs. Caries Res. 2013;47(4):265–72. PubMed
Savage MF, Lee JY, Kotch JB, Vann Jr WF. Early preventive dental visits: effects on subsequent utilization and costs. Pediatrics. 2004;114(4):e418–423. PubMed
Ramos-Gomez FJ, Shepard DS. Cost-effectiveness model for prevention of early childhood caries. J Calif Dent Assoc. 1999;27(7):539–44. PubMed
Lee JY, Bouwens TJ, Savage MF, Vann Jr WF. Examining the cost-effectiveness of early dental visits. Pediatr Dent. 2006;28(2):102–5. discussion 192–108. PubMed
Gooch BF, Griffin SO, Gray SK, Kohn WG, Rozier RG, Siegal M, et al. Preventing dental caries through school-based sealant programs: updated recommendations and reviews of evidence. J Am Dent Assoc. 2009;140(11):1356–65. PubMed
Tam A, Shemesh M, Wormser U, Sintov A, Steinberg D. Effect of different iodine formulations on the expression and activity of Streptococcus mutans glucosyltransferase and fructosyltransferase in biofilm and planktonic environments. J Antimicrob Chemother. 2006;57(5):865–71. PubMed
Lopez L, Berkowitz R, Zlotnik H, Moss M, Weinstein P. Topical antimicrobial therapy in the prevention of early childhood caries. Pediatr Dent. 1999;21(1):9–11. PubMed
Milgrom PM, Tut OK, Mancl LA. Topical iodine and fluoride varnish effectiveness in the primary dentition: a quasi-experimental study. J Dent Child (Chic). 2011;78(3):143–7.
Walsh LJ, Tsang AK. Chair side testing for cariogenic bacteria: current concepts and clinical strategies. Journal of Minimum Intervention Dentistry. 2008;78(3):143–7.
Gabris K, Nagy G, Madlena M, Denes Z, Marton S, Keszthelyi G, et al. Associations between microbiological and salivary caries activity tests and caries experience in Hungarian adolescents. Caries Res. 1999;33(3):191–5. PubMed
Ollila PS, Larmas MA. Long-term predictive value of salivary microbial diagnostic tests in children. Eur Arch Paediatr Dent. 2008;9(1):25–30. PubMed
Pieper K, Weber K, Margraf-Stiksrud J, Heinzel-Gutenbrunner M, Stein S, Jablonski-Momeni A. Evaluation of a preventive program aiming at children with increased caries risk using ICDAS II criteria. Clin Oral Investig. 2012;17(9):2049–55. PubMed
Braga MM, Oliveira LB, Bonini GA, Bonecker M, Mendes FM. Feasibility of the International Caries Detection and Assessment System (ICDAS-II) in epidemiological surveys and comparability with standard World Health Organization criteria. Caries Res. 2009;43(4):245–9. PubMed
Stevens KJ. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res. 2009;18(9):1105–13. PubMed
Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994;11(1):3–11. PubMed
Gherunpong S, Tsakos G, Sheiham A. Developing and evaluating an oral health-related quality of life index for children; the CHILD-OIDP. Community Dent Health. 2004;21(2):161–9. PubMed
Caro JJ, Briggs AH, Siebert U, Kuntz KM, Force I-SMGRPT. Modeling good research practices--overview: a report of the ISPOR-SMDM Modeling Good Research Practices Task Force--1. Value Health. 2012;15(6):796–803. PubMed
National Health & Medical Research Council. Values and Ethics:Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research. Canberra: Commonwealth of Australia; 2003.
Australian Institute of Aboriginal and Torres Strait Islander Studies. Guidelines for Ethical Research in Australian Indigenous Studies. Canberra: Australian Institute of Aboriginal and Torres Strait Islander Studies; 2011.
- Effectiveness, cost-effectiveness and cost-benefit of a single annual professional intervention for the prevention of childhood dental caries in a remote rural Indigenous community
Lisa M. Jamieson
Paul A. Scuffham
Newell W. Johnson
- BioMed Central
Neu im Fachgebiet Zahnmedizin
Mail Icon II