Plymouth study to investigate new approach to prevention in children

Plymouth study to investigate new approach to prevention in children

Researchers at Plymouth University Peninsula School of Dentistry have received £150,000 of funding for a study into the oral health of toddlers. This follows findings by Foundation Dean Professor Elizabeth Kay that action to prevent tooth decay in children, such as supervised tooth brushing and fluoride varnish schemes, could also result in cost savings to the NHS of hundreds of pounds per child.

The Plymouth study will aim to address a national crisis in children’s oral health, which has seen that those in the most socially deprived areas are most likely to have teeth removed under general anaesthetic.The researchers have received the sum from the Medical Research Council to support a pilot study. While the actions that can be taken to help prevent tooth decay in children, such as brushing teeth regularly, not drinking sugary drinks from bottles, not putting children to bed with a bottle and positive attitudes to oral health and visiting the dentist, are known, the best ways to support parents to carry out these actions is unknown.

The pilot is also led by Professor Elizabeth Kay, foundation dean for the Peninsula Dental School at Plymouth University. She said: “Each year around 25,000 young children attend hospital to have teeth extracted under anaesthetic, even though tooth decay is largely a preventable problem, and in my view that is a national outrage.

“Last autumn the National Institute for Health and Care excellence published guidelines recommending that local authorities focus their oral health promotion efforts on children’s early years – I was part of the group who put together those recommendations. While there is plenty that the state in its many forms can do to promote oral health awareness and good oral health practices to children and their parents, at the end of the day children’s teeth need to be cared for at home.”

Professor Kay has also carried out the first economic evaluation of public health measures to reduce tooth decay in children at high risk, in association with the National Institute for Health and Care Excellence (NICE) and the York Health Economic Consortium. She will present her findings at this year's British Society for Oral and Dental Research Annual Meeting in Cardiff, 14th to 16th September.

In her study Professor Kay found that, taking the threshold value used by NICE of £20,000 per Quality Adjusted Life Year (QALY), preventive schemes targeted at high risk children would be considered to be cost-effective even if they cost £46 per year per child for tooth brushing or £62 per child per year for fluoride varnish schemes. This would represent a saving of hundreds of pounds per child when compared with the cost of surgical treatments in hospital. The model showed that for children at high risk of oral disease, supervised brushing and fluoride varnish schemes are cost-effective options.

Said Professor Kay: "We have more work to do here to translate the results of our study into policy, but I must stress that this is about more than making better use of NHS funds, and demonstrating that oral health promotion programmes offer extremely good value for money. I think it is a national outrage that so many children in the UK are admitted to hospital for surgical procedures for conditions which are by and large preventable. If there was a health issue that resulted in this number of children having another body part removed under general or local anaesthetic there would be a justifiable national outcry, yet for many reasons tooth extraction appears to have become accepted in some circles. This study demonstrates that it is also economically viable and sensible to prevent tooth decay. By showing sound economic reasons for increasing the use of preventative measures, such as tooth brushing and fluoride varnishing, I hope that they can now compete for resource against other less cost-effective interventions."

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David Chong Kwan
fluoridation and qaly analysis
Very interesting indeed. I wonder if similar qaly analysis figures are also available for water fluoridation.
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