Non-Cochrane · intervention · PM31349691
Clinical Effectiveness and Cost-Effectiveness of Oral-Health Promotion in Dental Caries Prevention among Children: Systematic Review and Meta-Analysis.
Fraihat Nadine, Madae'en Saba, Bencze Zsuzsa, et al. · International journal of environmental research and public health · 2019 · PubMed · doi:10.3390/ijerph16152668
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
12
current version
GRADE rated
0
No studies
0
Included studies
29
linked below
No studies 0 · 0%Ungraded 12 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children aged 0 to 12 years, healthy except for dental caries; mixed parent-child populations included where children's data were presented separately | 19 studies of children aged ~0.1 to 12 years (n=19); 14 studies of children younger than 6 years, 4 of children older than 6 years, 1 unspecified |
| Intervention | Community-based oral-health promotion programs: oral-health education/training, teeth screening, supervised toothbrushing with toothbrushes/fluoride toothpaste and topical fluoride, and dietary advice | OHPPs delivered as home visits, telephone contacts, supervised toothbrushing, fluoride varnish/toothpaste, oral-health education, dietary advice, and screening (n=19) |
| Comparison | No oral-health promotion program, or a differing action than the intervention group under similar conditions | No OHPP or a differing/usual-care action (n=19) |
| Outcomes | DMFT index (permanent teeth) or dmft (deciduous teeth); OHPP cost, incremental cost, and cost-effectiveness analysis (CEA) | DMFT/DMFS (clinical effectiveness) and incremental cost / probability of lower cost (cost-effectiveness); meta-analysis of 8 studies (n=8) |
| Study designs | Trial-based and model-based economic evaluation studies | 9 trial-based and 10 model-based economic evaluation studies (n=19) |
| Timing | Not specified | Follow-up and cost horizons varied across studies (included studies published 1976 to 2018) |
Search date: 11 December 2018 (search initiated). Databases: PubMed, EMBASE, DARE, NHSEED, HTA, Cost-Effectiveness Analysis (CEA) Registry, Paediatric Economic Database Evaluation (PEDE)
Questions and results
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years (healthy except for dental caries)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Oral-health promotion programs were associated with markedly lower odds of DMFT/S in children (OR 0.19, 95% CI 0.10 to 0.39; ungraded, very high heterogeneity I2=98.5%). Source: Results 3.2; Figure 2; Abstract · same question in other reviews | OR 0.19 [0.10, 0.39] | 8 studies | Ungraded |
Incremental cost-effectiveness per DMFT/S OHPPs were associated with a lower program cost per DMFT/S in about 97 of 100 programs (OR 0.03, 95% CI 0.01 to 0.11; ungraded, very high heterogeneity I2=99%). Source: Results 3.2; Figure 3; Abstract · same question in other reviews | OR 0.03 [0.01, 0.11] | 8 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children younger than 6 years (healthy except for dental caries)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incremental cost-effectiveness per DMFT/S Age < 6 years In children younger than 6 years, OHPPs were associated with lower cost per DMFT/S (OR 0.07, 95% CI 0.02 to 0.32; ungraded). Source: Results 3.2; Figure 5 · same question in other reviews | OR 0.07 [0.02, 0.32] | 6 studies | Ungraded |
DMFT/DMFS index (dental caries experience) Age < 6 years In children younger than 6 years, OHPPs were associated with lower odds of DMFT/S (OR 0.14, 95% CI 0.05 to 0.39; ungraded). Source: Results 3.2; Figure 4 · same question in other reviews | OR 0.14 [0.05, 0.39] | 6 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 6 years and older (healthy except for dental caries)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Cost-effectiveness: probability of lower program cost per DMFT/S (incremental cost) Age >= 6 years In children aged 6 years and older, the cost-effectiveness estimate was extremely imprecise and not significant (OR 0.00, 95% CI 0.00 to 48704.6; ungraded). Source: Results 3.2; Figure 5 · same question in other reviews | OR 0.00 [0.00, 48704.6] | 2 studies | Ungraded |
DMFT/DMFS index (dental caries experience) Age >= 6 years In children aged 6 years and older, OHPPs showed no significant effect on DMFT/S (OR 0.29, 95% CI 0.08 to 1.01; ungraded). Source: Results 3.2; Figure 4 · same question in other reviews | OR 0.29 [0.08, 1.01] | 2 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years (studies published 2015 or later)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Published 2015 or later In studies published from 2015 onward, OHPPs were associated with lower DMFT (OR 0.08, 95% CI 0.01 to 0.53; ungraded). Source: Results 3.2; Figure 6 · same question in other reviews | OR 0.08 [0.01, 0.53] | 4 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years (studies published before 2015)
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Published before 2015 In studies published before 2015, OHPPs were associated with lower DMFT (OR 0.01, 95% CI 0.00 to 0.13; ungraded). Source: Results 3.2; Figure 6 · same question in other reviews | OR 0.01 [0.00, 0.13] | 4 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years in the United Kingdom
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Country: United Kingdom In UK studies, OHPPs were associated with lower DMFT/S (OR 0.04, 95% CI 0.00 to 0.58; ungraded). Source: Results 3.2; Figure 7 · same question in other reviews | OR 0.04 [0.00, 0.58] | 5 studies | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years in Japan
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Country: Japan The single Japanese study yielded a degenerate estimate of OR 0.00 (95% CI 0.00 to 0.00; ungraded, single study). Source: Results 3.2; Figure 7 · same question in other reviews | OR 0.00 [0.00, 0.00] | 1 study | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years in Ireland
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Country: Ireland The single Irish study showed lower DMFT/S with OHPP (OR 0.52, 95% CI 0.45 to 0.61; ungraded, single study). Source: Results 3.2; Figure 7 · same question in other reviews | OR 0.52 [0.45, 0.61] | 1 study | Ungraded |
Oral-health promotion programs (OHPPs): community-based oral-health education/training, supervised toothbrushing with fluoride toothpaste and topical fluoride, dental screening, and dietary advice vs No oral-health promotion program, or a differing (usual-care) action under similar conditions
Population: Children aged 0-12 years in Finland
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
DMFT/DMFS index (dental caries experience) Country: Finland The single Finnish study showed lower DMFT/S with OHPP (OR 0.48, 95% CI 0.41 to 0.56; ungraded, single study). Source: Results 3.2; Figure 7 · same question in other reviews | OR 0.48 [0.41, 0.56] | 1 study | Ungraded |
AMSTAR 2 appraisal
Two independent extractors rated each item. Their ratings are shown side by side because they have not been reconciled yet. The overall rating follows Shea et al. 2017: one critical flaw gives Low, more than one gives Critically Low.
| Item | Extractor A | Extractor B | Agree |
|---|---|---|---|
| 1Research question includes PICO components | Yes | Yes | yes |
| 2Protocol established before the reviewcritical | Partial Yes | Partial Yes | yes |
| 3Choice of study designs explained | Yes | No | no |
| 4Comprehensive literature searchcritical | Partial Yes | Partial Yes | yes |
| 5Study selection in duplicate | No | No | yes |
| 6Data extraction in duplicate | No | No | yes |
| 7List of excluded studies with reasonscritical | No | Yes | no |
| 8Included studies described in detail | Yes | Partial Yes | no |
| 9Risk of bias assessed satisfactorilycritical | RCT: No · NRSI: No | NRSI: No · RCT: No | no |
| 10Funding of included studies reported | Yes | Yes | yes |
| 11Appropriate meta-analysis methodscritical | RCT: Yes · NRSI: No | NRSI: No · RCT: No | no |
| 12Impact of risk of bias on the pooled results | No | No | yes |
| 13Risk of bias accounted for in interpretationcritical | No | No | yes |
| 14Heterogeneity explained | Yes | Yes | yes |
| 15Publication bias investigatedcritical | Yes | Yes | yes |
| 16Conflicts of interest reported | Yes | No | no |
| Overall | Critically Low | Critically Low | yes |
Included primary studies 29
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Gibbs 2015 Teeth Tales: a community-based child oral health promotion trial with migrant families in Australia. PMID:26068509 | 1 other review | not stated | not extracted yet | not extracted yet |
| Anopa 2015 Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme. PMID:26305577 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Blaikie 1977 The cost of school dental care: a preliminary economic analysis DOI:10.1111/j.1834-7819.1978.tb02901.x | this review only | not stated | not extracted yet | not extracted yet |
| Blaikie 1977 The cost of school dental care: a preliminary economic analysis. PMID:101188 | this review only | not stated | not extracted yet | not extracted yet |
| Davies 2003 An assessment of the cost effectiveness of a postal toothpaste programme to prevent caries among five-year-old children in the North West… PMID:14696738 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Donaldson 1986 DOI:10.1016/0277-9536(86)90214-3 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Donaldson 1986 Preventive dentistry in a health centre: effectiveness and cost. PMID:3099395 | this review only | not stated | not extracted yet | not extracted yet |
| Folayan 2016 Use of caries prevention tools and associated caries risk in a suburban population of children in Nigeria DOI:10.1007/s40368-016-0227-y | this review only | not stated | not extracted yet | not extracted yet |
| Folayan 2016 Use of caries prevention tools and associated caries risk in a suburban population of children in Nigeria. PMID:27160760 | this review only | not stated | not extracted yet | not extracted yet |
| Hietasalo 2009 Cost‐effectiveness of an experimental caries‐control regimen in a 3.4‐yr randomized clinical trial among 11–12‐yr‐old Finnish schoolchildren DOI:10.1111/j.1600-0722.2009.00687.x | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Hietasalo 2009 Cost-effectiveness of an experimental caries-control regimen in a 3.4-yr randomized clinical trial among 11-12-yr-old Finnish… PMID:20121937 | this review only | not stated | not extracted yet | not extracted yet |
| Koh 2015 Comparison of a predictive algorithm with receptionist triage for priority public dental care DOI:10.1111/cdoe.12188 | this review only | not stated | not extracted yet | not extracted yet |
| Koh 2015 Relative cost-effectiveness of home visits and telephone contacts in preventing early childhood caries. PMID:26110399 | this review only | not stated | not extracted yet | not extracted yet |
| Kowash 2006 Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries DOI:10.1007/bf03262553 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Kowash 2006 Cost-effectiveness of a long-term dental health education program for the prevention of early childhood caries. PMID:17140541 | this review only | not stated | not extracted yet | not extracted yet |
| Lai 2018 Clinical efficacy of a two-year oral health programme for infants and toddlers in Singapore. PMID:28540394 | this review only | not stated | not extracted yet | not extracted yet |
| O'Neill 2017 DOI:10.1177/0022034517708628 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| O'Neill 2017 Cost-Effectiveness of Caries Prevention in Practice: A Randomized Controlled Trial. PMID:28521109 | this review only | not stated | not extracted yet | not extracted yet |
| Plonka 2013 A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries DOI:10.1111/j.1365-263x.2011.01219.x | this review only | not stated | not extracted yet | not extracted yet |
| Plonka 2013 A controlled, longitudinal study of home visits compared to telephone contacts to prevent early childhood caries. PMID:22251427 | this review only | not stated | not extracted yet | not extracted yet |
| Pukallus 2013 Cost-effectiveness of a telephone-delivered education programme to prevent early childhood caries in a disadvantaged area: a cohort study. PMID:23674443 | this review only | not stated | not extracted yet | not extracted yet |
| Quinonez 2006 Simulating Cost-effectiveness of Fluoride Varnish During Well-Child Visits for Medicaid-Enrolled Children DOI:10.1001/archpedi.160.2.164 | this review only | not stated | not extracted yet | not extracted yet |
| Quinonez 2006 Simulating cost-effectiveness of fluoride varnish during well-child visits for Medicaid-enrolled children. PMID:16461872 | this review only | not stated | not extracted yet | not extracted yet |
| Reiss 1976 Behavioral community psychology: encouraging low-income parents to seek dental care for their children. PMID:826516 | this review only | not stated | not extracted yet | not extracted yet |
| Samnaliev 2015 Assessing the contribution of the dental care delivery system to oral health care disparities. PMID:24964016 | this review only | not stated | not extracted yet | not extracted yet |
| Samnaliev 2015 Cost-effectiveness of a disease management program for early childhood caries. PMID:25040019 | this review only | not stated | not extracted yet | not extracted yet |
| Stearns 2012 Cost-effectiveness of preventive oral health care in medical offices for young Medicaid enrollees. PMID:22926203 | this review only | not stated | not extracted yet | not extracted yet |
| Takeuchi 2017 Evaluation of the child oral health promotion 'MaliMali' Programme based on schools in the Kingdom of Tonga. PMID:27943266 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
| Tickle 2016 A randomised controlled trial to measure the effects and costs of a dental caries prevention regime for young children attending primary… PMID:27685609 | this review only | DMFT/DMFS index (dental caries experience) | not extracted yet | not extracted yet |
Overlap with other reviews
Reviews that include the same primary studies are not independent evidence. Shared counts match studies by PMID, DOI or NCT, and otherwise by author and year (a probable match).
| Review | Shared studies | Jaccard |
|---|---|---|
| The effectiveness of behaviour change interventions delivered by non-dental health workers in promoting children's oral health: A… (2022) | 1 | 0.01 |