Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review.

OBJECTIVE: To develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and adolescents. METHODS: Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007. RESULTS: A total of 105 articles were identified by the literature search; relevance was determined by examining the title, abstract and body of the article. Seven original research studies met the inclusion criteria. These articles were read and scored independently by 2 reviewers, and evidence was extracted for systematic review. RECOMMENDATIONS: The following recommendations were developed on the basis of the evidence: 1. For high-risk populations (e.g., people with low socioeconomic status, new immigrants and refugees, First Nations and Inuit children and adolescents), fluoride varnish should be applied twice a year, unless the individual has no risk of caries, as indicated by past and current caries history. This schedule of application would permit sealants to be checked biannually to ensure retention. 2. Single-dose packages of fluoride varnish should be used for children; the varnish in such packages should be stirred vigorously before application, to ensure that any precipitated fluoride is redissolved. 3. There is good evidence of the complementary efficacy of preventive strategies such as sealants and varnish, as well as toothbrushing and nutritional counselling; oral health care programs should therefore include as many complementary strategies as possible.

Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review.

OBJECTIVE: To develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and adolescents. METHODS: Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007. RESULTS: A total of 105 articles were identified by the literature search; relevance was determined by examining the title, abstract and body of the article. Seven original research studies met the inclusion criteria, These articles were read and scored independently by 2 reviewers, and evidence was extracted for systematic review.

Pit and fissure sealants in the prevention of dental caries in children and adolescents: a systematic review.

OBJECTIVES: To investigate the evidence for sealants as a means to prevent caries in children and adolescents and, in the presence of suitable supporting evidence, to develop a protocol for the application of sealants. METHODS: Previous systematic reviews on this topic were used as the basis for the current review. Ovid MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007. RESULTS: A total of 303 articles were identified by the literature search; relevance was determined by examining the title and abstract of the articles. Thirty-eight original research studies met the inclusion criteria. These articles were read in full and scored independently by 2 reviewers, and evidence was extracted for development of recommendations. RECOMMENDATIONS: The following recommendations are based on the evidence gathered in this review: 1. Sealants should be placed on all permanent teeth without cavitation (i.e., teeth that are free of caries, teeth that have deep pit and fissure morphology, teeth with "sticky" fissures or teeth with stained grooves) as soon after eruption as isolation can be achieved. 2. Sealants should not be placed on partially erupted teeth or teeth with cavitation or caries of the dentin. 3. Sealants should be placed on the primary molars of children who are susceptible to caries (i.e., those with a history of caries). 4. Sealants should be placed on first and second molars within 4 years after eruption. 5. Resin-based sealants should be preferred, until such time as glass ionomer cements with better retention capacity are developed. 6. Sealants should be placed as part of an overall prevention strategy based on assessment of caries risk.

Is there a risk of harm or toxicity in the placement of pit and fissure sealant materials? A systematic review.

BACKGROUND: Recently, there has been increased interest in the in vivo release of dental sealant components, such as bisphenol A (BPA), which has the potential to bind the estrogen receptors of relevant cells at subtoxic concentrations in vitro, impairing the development, health and reproductive systems of wildlife. The purpose of this systematic review was to investigate whether the placement of pit and fissure sealant materials causes toxicity, and thus harms patients. METHODS: The literature search (from the earliest record up to March 2007) for relevant articles was done with Ovid MEDLINE, CINAHL and other bibliographic databases. RESULTS: A total of 377 articles were identified by the literature search; relevance was determined by examining the title and abstract of the articles. Eleven original studies met the inclusion criteria. These articles were read in full and scored independently by 2 reviewers. RECOMMENDATIONS: The evidence suggests that patients are not at risk for exposure to BPA from the use of dental sealants. To reduce the potential, if any, for BPA toxicity from sealants, dental providers should use a mild abrasive, such as pumice, either on a cotton applicator or in a prophy cup; have older children and adolescents gargle with tepid water for 30 seconds; or wash the sealant surface for 30 seconds with an air-water syringe while suctioning fluids and debris from a child"s mouth.

Fluoride varnish in the prevention of dental caries in children and adolescents: a systematic review.

OBJECTIVE: To develop a scientifically current and evidence-based protocol for the use of fluoride varnish for the prevention of dental caries among high-risk children and adolescents. METHODS: Previous systematic reviews on this topic were used as the basis for the current review. Ovid, MEDLINE, CINAHL and several other relevant bibliographic databases were searched for English-language articles, with human subjects, published from 2000 to 2007. RESULTS: A total of 105 articles were identified by the literature search; relevance was determined by examining the title, abstract and body of the article. Seven original research studies met the inclusion criteria. These articles were read and scored independently by 2 reviewers, and evidence was extracted for systematic review. RECOMMENDATIONS: The following recommendations were developed on the basis of the evidence: 1. For high-risk populations (e.g., people with low socioeconomic status, new immigrants and refugees, First Nations and Inuit children and adolescents), fluoride varnish should be applied twice a year, unless the individual has no risk of caries, as indicated by past and current caries history. This schedule of application would permit sealants to be checked biannually to ensure retention. 2. Single-dose packages of fluoride varnish should be used for children; the varnish in such packages should be stirred vigorously before application, to ensure that any precipitated fluoride is redissolved. 3. There is good evidence of the complementary efficacy of preventive strategies such as sealants and varnish, as well as toothbrushing and nutritional counselling; oral healthcare programs should therefore include as many complementary strategies as possible.

Is regular visiting associated with lower costs? Analyzing service utilization patterns in the first nations population in Canada.

OBJECTIVES: Using an administrative database of dental service records from the Non-Insured Health Benefits (NIHB) program of Health Canada for 1994-2001, the authors set out to test whether regular visitors had lower program expenditures. METHODS: The age-specific mean expenditures per client were compared among those with regular examinations in 8, 7 and fewer years. The study further examined the effect of regular visiting over the first 6 years on expenditures in the last 2 years. "Continuity of care" was measured by the numbers of consecutive years prior to 2000 in which clients had a regular examination. In a "gap analysis" individuals were classified according to the number of years prior to 2000 since they last had an initial or recall examination. Mean expenditures per client were analyzed by age group and type of service. FINDINGS: Over the 8-year period, clients with regular visits had the highest expenditures. In both the continuity of care and gap analyses, the findings were generally consistent; the more that clients visited over the first 6 years, the higher the expenditures in the final 2 years. Clients with more "regular" (initial and recall) examinations received a relatively standard, age-specific, pattern of service but incurred greater expenditures compared to clients with fewer regular, or longer gaps in, examinations. CONCLUSION: The observations of the authors in this client group do not support the thesis that regular visiting is associated with lower expenditures on dental care.

Developing management information from an administrative database of dental services: identifying factors that influence costs.

OBJECTIVE: We describe service patterns and compare changes in program expenditures with the Consumer Price Index over eight years in a dental program with a controlled-fee schedule offered to Canadian First Nations and Inuit people. METHODS: We obtained the computerized records of dental services for the period from 1994 to 2001. Each record identified the date and type of service, region and type of provider, age of the client and encrypted identifying information on clients, bands, and providers. We classified the individual services into related types (diagnostic, preventive, etc.). We aggregated the records by client and developed indices for the numbers of clients, mean numbers of services per client, cost per service, and prices. FINDINGS: Over the 8 years, 16.0 million procedures, totaling 811.8 million dollars, were provided to 538,034 different individuals, approximately 76% of the eligible population. Restorative procedures accounted for 36% of all expenditures followed by diagnostic (12.7%), preventive (12.2%), and orthodontic (8.9%) services. For much of the period, increases in program expenditures were exceeded by increases in the Consumer Price Index. This was consistent with fewer services per client, a less expensive mix of services, and relatively flat prices. However, in 2000 and 2001 higher prices and more clients resulted in increasing expenditures. CONCLUSIONS: Program expenditures were influenced by different factors over the study period. In the final two years, increasing expenditures were driven by price increases and increasing numbers of clients, but not by increasing numbers of services per client, nor a 'richer' mix of services.

The influence of dental insurance on institutionalized older adults in ranking their oral health status.

To assess whether dental insurance influences how institutionalized older adults ages 65 and older rank their oral health status, a census survey was designed for residents of Durham's (Canada) Municipal Homes for the Aged. The odds ratio (OR) and the Cochran & Mantel-Haenszel's OR were used to estimate the crude and adjusted effect of dental insurance on oral health status, respectively. Overall, 64 percent participated in the interview. Oral health status was ranked as "good," "very good" or "excellent" by 57 percent of the participants. This ranking was clearly unrelated to the residents having dental insurance, as only 28 percent had dental coverage. Significant effect modifiers included age, dental status and whether the participant had visited the dentist within the last year. Dental insurance positively influenced how dentate participants ranked their oral health status (OR = 2.26; 95 percent CI = 1.19; 4.28). In edentulous participants, age and visiting the dentist within the last year modified the effect of dental insurance on oral health status. Having dental insurance reduced the odds of reporting "good," "very good" or "excellent" oral health (OR = 0.20; 95 percent CI = 0.08; 0.49) among the participants ages 85 and older who did not visit the dentist within the last year; however, the opposite was true for their younger counterparts who visited the dentist within the last year (OR = 7.20; 95 percent CI = 1.08; 47.96). In this population, therefore, dental insurance was associated with higher oral health status rank among the dentate, but its effect on the edentulous population depended on age and the pattern of visiting the dentist.

The effect of dental insurance on the ranking of dental treatment needs in older residents of Durham Region's homes for the aged.

The effect of dental insurance on the ranking of dental needs in older adults has not been reported previously. We examined this effect using data obtained from a cross-sectional survey of older adults living in homes for the aged in Durham Region, Ontario. History of dental insurance was obtained during interviews. Dental needs, assessed during clinical examinations, were ranked from no need to urgent need according to the guideline of the American Dental Association. The associations between the rank of dental needs, dental insurance and other factors were analyzed with the Kruskal Wallis test, chi-square test, analysis of variance and multiple logistic regression. Of the 252 participants, 80 (31.7%) had been insured continuously since 1974, 69 (27.4%) had no need for dental treatment and 59 (23.4%) needed urgent dental care. More of the continuously insured than the uninsured residents were dentate (46/80 [57.5%] vs. 75/172 [43.6%], p = 0.04). Ranking of the need for care was not significantly influenced by dental insurance; need of any kind was explained by being dentate (odds ratio 12.3, 95% confidence interval 5.6 27.3).