The Effectiveness of a Comprehensive School-Based Caries Prevention Program: ForsythKids

Abstract

The aims of this dissertation are to describe ForsythKids program; evaluate the longitudinal temporal trends in the incidence of new caries over time; to propose a new metric that measures dental health preservation as an outcome: Proportion of Sound Teeth index (PST). We analyzed the data extracted from the clinical notes of ForsythKids, a school-based comprehensive dental preventive program. ForsythKids was first implemented back in 2004 in six Title 1 elementary schools in greater Boston area, followed by over 60 schools. Children participating in ForsythKids were eligible to receive three annual school visits, where they will receive full clinical examination and treatment planning, a range of preventive measures, and a referral to a community dentist if needed. All children aged 5-12 years seen between 2004-2010 were eligible for inclusion in the analysis. We assessed baseline demographic characteristics, and baseline oral health of participating students. Then we fitted multiple regression models to estimate the incidence rate ratio (IRR) of developing new dental caries with each additional preventive visit. We also measured the time and risk to the first dental caries during ForsythKids among caries-free children at baseline and children with caries experience. In addition, we proposed a new metric that measures dental health instead of disease: Proportion of Sound Teeth index (PST). We describe how to calculate the different variations of PST: cross-sectional (xPST), instantaneous (iPST), and cumulative (cPST); then applied xPST and cPST to evaluate ForsythKids data; and compared the results to those obtained with the conventional index, decayed and filled teeth (DFT). More than half of the children had caries before joining ForsythKids, with 1.9 decayed and filled teeth (dft) in primary teeth (xPst=83.6% sound teeth), and 0.4 DFT in permanent teeth (xPST=98.7%). Overall, each additional preventive visit was associated with an 8% reduction in new dental caries, and the reduction of was steeper among children high-risk children with caries experience at baseline. However, those children had 2.5 times the hazard of developing the first caries compared to their caries-free peers at baseline (95%CI= 2.2, 2.7). For PST over time, the average reduction in cPst was 3.7 percentage points per visit in primary dentition and 1.6-point reduction in cPST for permanent dentition. Children with caries experience at baseline had a steeper reduction in cPST, while caries-free children had a steeper increase in DFT scores. In summary, within the limitation of the clinical data and potential selection bias of the participants, the comprehensive nature of ForsythKids appears to lower the incidence of dental caries with each preventive visit, maintain dental health for longer, especially among high-risk children with caries experience at baseline.