Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial
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Date
2021
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley
Abstract
Objectives: This cluster-randomized
controlled community trial aimed to assess the
efficacy and costs of fluoride varnish (FV) application for caries prevention in a high-risk
population in South Africa.
Methods: 513 children aged 4–8
years from two schools in a township in South Africa
were randomly allocated by class to the FV or Control (CO) groups. In addition to supervised
toothbrushing with fluoridated toothpaste in both groups, FV was applied in
3-month intervals by trained local non-professional
assistants. Intraoral examinations
were conducted at baseline, 12, 21 and 24 months. Primary outcome was the increment
of teeth with cavitated lesions (i.e. newly developed or progressed, formerly
non-cavitated
lesions), requiring restoration or extraction over the study period.
Additionally, treatment and re-treatment
costs were analyzed.
Results: 513 children (d1-4mft
5.9 ± 4.3 (mean ± SD)) were randomly allocated to FV
(n = 287) or CO (n = 226). 10.2% FV and CO teeth received or required a restoration;
3.9% FV and 4.1% CO teeth were extracted, without significant differences between
groups. While FV generated high initial costs, follow-up
costs were comparable in
both groups, resulting in FV being significantly more expensive than CO (1667 ± 1055
ZAR vs. 950 ± 943 ZAR, p < .001).
Conclusions: Regular FV application, in addition to daily supervised toothbrushing,
had no significant caries-preventive
effect and was not cost-effective
in a primary
school setting within a peri-urban,
high-risk
community in South Africa. Alternative
interventions on community or public health level should be considered to reduce the
caries burden in high-risk
communities.
Description
Keywords
caries, cost-effectiveness, luoride varnish, oral health, prevention
Citation
Effenberger, S., Greenwall, L., Cebula, M., Myburgh, N., Simpson, K., Smit, D., Wicht, M. J., & Schwendicke, F. (2021). Cost‐effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster‐randomized controlled community trial. Community Dentistry and Oral Epidemiology.