ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02081.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02082.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractPublic health administrators are forced to consider efficiency as a criterion in their choice of preventive programs because of the numerous programs to choose from, restricted budgets, and declining caries experience in children. Interest in cost effectiveness in dental prevention has risen considerably since the initial conference on this issue at the University of Michigan in 1978. This article introduces the goals of the workshop, the nature of the work groups, and the data they will use.

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02083.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractData on caries increments and costs of prevention programs are presented as background information for participants in the workshop. Estimates of annual caries increments were derived from control groups in clinical trials, epidemiologic studies, and national surveys. Cost data were obtained from dental public health directors, program administrators, fluoridation engineers, and water plant operators in different parts of the US. Caries incidence data are reported for age groups: 5‐17 years (fluoridated and nonfluoridated areas), 18–44 years, 45–64 years, and 65 and over. Program costs include direct costs primarily and do not allow for program inefficiencies, nor have they attempted to include social costs. All cost data are expressed in 1988 dollars. Direct program costs are included for community water fluoridation, fluoride supplements, fluoride mouthrinses, school fluoridation, and sealant programs. For professionally and self‐applied fluoride programs, only material and salary costs are included because total costs could not be located in the literature nor obtained from program directors. All factors and necessary assumptions included in the cost assessments are de

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02084.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractCost‐effectiveness analysis (CEA) is becoming increasingly popular as society moves toward rationalizing health costs. This review describes the applications and limitations of the technique. Conceptually simple though frequently complicated in application, CEA compares the cost of a procedure with its effectiveness, thus helping an administrator to judge whether the procedure is worth its cost. CEA also permits comparison of various interventions that result in a similar health outcome. A major benefit of CEA is that it forces decision makers to confront the tradeoffs implicit in all decisions regarding alternative approaches. Limitations of the CEA philosophy and technique also have to be understood if it is to be employed effectively; it is not an assessment of cost savings, nor is it a decision‐making technique because it does not incorporate value judgments. A number of potential applications to dentistry are descri

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02085.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThe efficacy of communal water fluoridation in reducing dental caries has been reviewed based on surveys conducted in the last decade of caries prevalence in fluoridated and nonfluoridated communities in the United States as well as in Australia, Britain, Canada, Ireland, and New Zealand. The efficacy is greatest for the deciduous dentition, with a range of 30–60 percent less caries in fluoridated communities. In the mixed dentition (ages 8 to 12), the efficacy is more variable, about 20–40 percent less caries. In adolescents (ages 14–17), it is about 15–35 percent less caries. Current data on caries prevalence in adults and seniors are extremely limited and include several populations living in communities with higher than optimal fluoride levels. For these adults and seniors, a range of 15–35 percent less caries would also apply. Viewed in toto, the current data for children, adolescents, adults and seniors show a consistently and substantially lower caries prevalence in fluoridated communities. For an accurate measurement of the efficacy of water fluoridation in reducing dental caries, it is essential that only persons with a record of continuous or long‐term residency in fluoridated versus nonfluoridated areas be included in such assessments. Because of the high geographic mobility in our society and the widespread use of fluoride dentifrices, supplements, and other topical fluoride agents, such comparisons are becoming more difficult to conduct. Accordingly, the effectiveness (rather than the efficacy) of water fluoridation has decreased as the benefits of other forms of fluoride have spread to communities lacking optimal water f

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02086.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractSchool water fluoridation and school‐based fluoride tablet programs both have been shown in many studies to be effective in preventing dental caries. These studies indicate that school water fluoridation reduces dental decay by approximately 40 percent and school‐based fluoride tablet programs by about 30 percent. However, nearly all the studies were done when the prevalence of caries among US schoolchildren was greater than it is today, which makes it difficult to assess their current effectiveness. Data from dental surveys of school‐aged children conducted during the past 30 years indicate that overall caries prevalence has declined by more than 75 percent and that of approximal tooth surfaces by more than 90 percent. Recent national data indicate the difference in caries prevalence between children with lifetime residence in either fluoridated or nonfluoridated areas has also diminished, which raises questions about the cost effectiveness of initiating school‐based fluoride programs for all areas. There are still groups of children, however, seriously affected by dental caries. It is safe to assume that implementation of school water fluoridation or fluoride tablet programs will result in traditionally reported benefits among these children. Ongoing school‐based fluoride programs should not be discontinued until it is known what impact their cessation will have on denta

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02087.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractOf the five types of topical fluoride gel products available in the United States, two have not been clinically tested in randomized double blind clinical trials. For those tested, the averaged results of clinical trials involving schoolchildren in fluoride‐deficient communities indicate a caries reduction of approximately 26 percent from either a professional or self‐administered program. A similar relative reduction can be expected from programs conducted in fluoridated communities, but the absolute caries inhibition is less. Twice‐a‐year professional applications are more effective than once‐a‐year applications, and self‐applications using trays are more effective than applying the gel on a toothbrush. For subjects beyond school age, there are few clinical studies of either self‐applied or professionally applied gels; however, current epidemiological evidence does not indicate a need for public health caries preventive programs for healthy employed adults. For medically compromised patients, especially those exhibiting rampant caries associated with radiation‐induced xerostomia, a variety of topical gel procedures appear to be effective i

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02088.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractFluoride mouthrinses have been used extensively for the past 15 years to prevent dental caries in children. Their use has been especially widespread in organized school‐based programs in the US. Nearly three dozen clinical studies of fluoride mouthrinses, both with and without placebo controls, have been reported in the literature since the early 1960s. The overwhelming majority of those studies report statistically significant caries inhibition from the use of the products. Most of the studies were published prior to the knowledge of a decline in caries prevalence during the past 30 years. Consequently, the results of those studies lacking a placebo control group have been challenged. Even randomized clinical trials with appropriate control groups appear to be reporting declining differences between test and control groups. Using a model based on annual caries increments from published studies, the conclusion is reached that future use of fluoride mouthrinses is unlikely to result in annual savings in DMF increment greater than 0.4 surfaces, regardless of age of rinser

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02089.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY

摘要:

AbstractThis review addresses two major issues related to the use of pit and fissure sealants. First, the epidemiology of occlusal caries for children and adults is examined to determine if there is a basis for administering sealant programs to different age groups. Second, the effectiveness of pit and fissure sealants in fluoridated and non‐fluoridated communities is compared. Changes in effectiveness of sealant over time are evaluated in terms of percent effectiveness, complete retention, caries incidence, and reapplication rates. Based on epidemiologic evidence, sealant programs can be justified for children and young adults, but not for older age groups. Based on the literature reviewed, following one application of autopolymerized or visible‐light‐cured sealant, the median percent effectiveness declines from 83 percent after one year to 55 percent after seven years. Similarly, the median complete retention declines from 92 percent after one year to 66 percent after seven years. Conversely, the median percent of sealed first molars becoming carious and/or restored increases from 4 percent after one year to 31 percent after seven years. Large differences in sealant effectiveness are not apparent between studies performed in fluoridated and fluoride‐deficient comm

ISSN:0022-4006    

DOI:10.1111/j.1752-7325.1989.tb02090.x

出版商:Blackwell Publishing Ltd    

年代:1989

数据来源: WILEY