Lifelong Effectiveness of Caries Prevention Programs by System Dynamics Model

Abstract

Dental caries is still considered a burden of disease not only in Thailand but also around the world. Various preventive and promotion programs are implemented for dental caries in individuals and communities among the population. For long-term assessment of preventive programs, simulation models are gaining attention to be approached. Objective: This study aims to estimate the lifelong outcomes of caries prevention programs among Thai age groups by conducting the System Dynamics Model (SDM). Methodology: Systematic reviews and meta-analyses were conducted to identify the efficacy of interventions: supervised toothbrushing, fluoride varnish, dental sealant, and oral health examination for dental caries according to age groups. Based on the effectiveness of interventions from meta-analyses and their coverage rates, the SDM was simulated to estimate the lifelong dental caries outcome under interventions: supervised toothbrushing, fluoride varnish, combined supervised toothbrushing and fluoride varnish, dental sealant, combined supervised toothbrushing, and sealant, and oral health examination by comparing base case (no intervention was provided). Results: it is found that at the age of 5 years old, the population with caries in deciduous teeth was the lowest in combined supervised toothbrushing and fluoride varnish, 258,876 (38.17 %) followed by supervised toothbrushing, 266,049 (39.23%), fluoride varnish, 276,703 (40.79 %), and base case, 290,829 (42.88 %). All these interventions can reduce the caries population until above 15 years old compared to the base case. The caries population was lowest under combined supervised toothbrushing and sealant, 257,655 (37.99%), followed by a sealant, 264,507 (38.99%) at 15 years old. From above 23 years old, the caries population under all of the above interventions and the oral health examination were not different from the base case. Conclusion: according to SDM simulation, it is considered that combined interventions are more effective than other interventions provided separately. Each intervention could reduce the caries population by above 15 years from they started compared to the base case. If the interventions have better effective rates and coverage rates, the caries population could be reduced by more than the estimated result from the model.