Estrategias preventivas de caries dental a nivel comunitario en niños (as) menores de 6 años

Abstract

INTRODUCTION: Worldwide caries is the most common chronic non-communicable disease. Its effect in children under 6 years of age is commonly known as Early Childhood Caries (ECC). Despite the prevalence of cavities having decreased globally in recent decades, approximately 530 million children continue to suffer from cavities in primary . . OBJECTIVES: 1. To evaluate the effectiveness of biannual professional application of fluoride varnish in preventing the incidence of caries in preschoolers in rural areas without access to fluoridated water. 2. To determine the incremental cost-effectiveness ratio of fluoride varnish in preventing ECC in areas without water fluoridation. METHODS: Evaluation of the effectiveness of fluoride varnish in the management of ECC. A randomized, double-blind, parallel controlled clinical trial (RCT) was carried out for two years. The study was registered with ClinicalTrials. gov (NCT02742038). Children aged two to three years without cavitated carious lesions or previous dental treatments were included. Children with systemic diseases, disabilities, or enamel developmental defects and those in temporary residences were excluded. Children were randomized in an oral hygiene protocol, plus biannual professional application of fluoride varnish or an oral hygiene protocol only, plus placebo varnish (control). Cost-effectiveness analysis of the early childhood caries preventive protocol. A cost-effectiveness analysis (CEA) was performed to compare the two protocols evaluated in the described RCT of ECC prevention: One with fluoride varnish and the other with placebo varnish (control), following the Consolidated Health Economic Assessment Reporting Standards (CHEERS). The analysis was carried out from the perspective of public payers. RESULTS At 24 months of follow-up the incidence of cavitated caries lesions was 45. 0% for the fluoride varnish group and 55. 6% for the control group (p = 0. 081), with a mean ceod index of 1. 6 (SD = 2. 4) and 2. 1 (SD = 2. 5), respectively. The prevention fraction of the experimental group at 24 months of follow-up was 18. 9% (2. 9%-36. 2%). Per protocol analysis did not show significant differences between the groups, except in the mean number of teeth with caries lesions, which was lower in the fluoride varnish group. The ICER was an additional CLP 173. 82 or Chilean pesos, (USD 0. 25) for each child without cavitated caries lesions in two years of follow-up; this ICER is quite low and assumes a high cost-effectiveness. The highest cost percentage was the application of the oral hygiene protocol and it was identical in both groups. CONCLUSIONS • Even though the percentage of children with cavitated carious lesions was lower in the group with fluoride varnish, there were no significant differences in the incidence of cavitated carious lesions in reference to the group that received placebo. • Fluoride varnish was a safe intervention since no adverse effects were reported. • The fluoride varnish plus an oral hygiene protocol was cost-effective in preventing cavitated caries lesions in non-fluoridated areas, compared to a placebo plus an oral hygiene protocol.

Date of Award	15 Oct 2024
Original language	Spanish
Supervisor	Maria Jose Martinez Zapata (Director) & Carlos Elias Zaror Sanchez (Director)