The Cost and Effectiveness of School-Based Preventive Dental Care

Results with 9,566 children who participated for four years in a 10-site, school-based preventive care program indicated that dental health lessons, brushing and flossing, fluoride tablets and mouthrinsing, and professionally applied topical fluorides were not especially effective in reducing a clinically significant amount of dental decay. This was true when the procedures were used singly or in combination. The only study procedure that consistently reduced decay involved applying occlusal sealants to the chewing surfaces of the posterior teeth. Although this measure prevented 23 to 65 percent of all new carious lesions, this amounted to only one to two carious surfaces in four years. Children who were especially susceptible to decay did not benefit appreciably more from any of the preventive measures than did children in general. The direct costs of sealants or prophy/gel treatments were about $23 per child per year (in 1981 dollars). The cost of adding a fluoride mouthrinse program to an existing supervised health education program was about $3.29 per child per year. Communal water fluoridation was reaffirmed as the most cost effective measure for reducing dental decay in children.