Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial

Effenberger, Susanne, Greenwall, Linda, Cebula, Marcus ORCID: 0000-0002-0149-1580, Myburgh, Neil, Simpson, Karen, Smit, Dirk, Wicht, Michael J. and Schwendicke, Falk . Cost-effectiveness and efficacy of fluoride varnish for caries prevention in South African children: A cluster-randomized controlled community trial. Community Dentist. Oral Epidemiol.. HOBOKEN: WILEY. ISSN 1600-0528

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DOI:10.1111/cdoe.12702

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 (d(1-4)mft 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.

Item Type:

Journal Article

Creators:

Creators	Email	ORCID	ORCID Put Code
Effenberger, Susanne	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Greenwall, Linda	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Cebula, Marcus	UNSPECIFIED	orcid.org/0000-0002-0149-1580	UNSPECIFIED
Myburgh, Neil	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Simpson, Karen	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Smit, Dirk	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Wicht, Michael J.	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED
Schwendicke, Falk	UNSPECIFIED	UNSPECIFIED	UNSPECIFIED