Is Non-invasive Management Of Dental Caries In Private Practice Cost-effective? A Randomized Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$325,136.00
Summary
Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the ....Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the societal costs involved is likely to reveal this amount to be an under-estimate; consider the costs borne by sectors outside health: days lost to work, lost productivity. Further, we should consider costs to families: travel time and costs, childcare, the opportunity cost of items forgone in order to pay for the dental treatment. Despite this, a recent systematic review of dental caries prevention concluded 'there is presently no proof, in published economic evaluations of the cost-effectiveness of caries-preventive measures'. The authors highlighted a lack of methodologically sound studies. This research will compare a targeted preventive program to standard care within private dental practices. Prior to an alternative approach being introduced, an assessment of effectiveness and cost-effectiveness is needed. It is through such assessment that the value of the comparator can be assessed and our precious health dollars saved. The radical surgical approach (filling) that evolved to deal with the caries problem is entrenched in both public and private institutions that teach and deliver dental care. The strategic element is to reorient the services provided by general practices towards to goal of delivering a substantial reduction in the need to drill teeth, while maximizing the opportunity for a non-invasive remineralization approach that has been successfully demonstrated in in-vitro, in-vivo, and in small scale clinical trials.Read moreRead less
Tooth Emergence And Oral Streptococci Colonisation: A Longitudinal Study Of Australian Twins
Funder
National Health and Medical Research Council
Funding Amount
$521,600.00
Summary
We plan to include over 500 Australian families of twins in this 5-year study and to collect records of tooth emergence, cheek cells for DNA analysis, dental plaque samples for microbiological analysis, as well as other information from questionnaires. Firstly, we want to learn how genetic and non-genetic factors influence the timing and sequence of emergence of primary (baby) teeth. Most children get their baby teeth between the ages of 6 months and 2.5 years, but sometimes they appear earlier, ....We plan to include over 500 Australian families of twins in this 5-year study and to collect records of tooth emergence, cheek cells for DNA analysis, dental plaque samples for microbiological analysis, as well as other information from questionnaires. Firstly, we want to learn how genetic and non-genetic factors influence the timing and sequence of emergence of primary (baby) teeth. Most children get their baby teeth between the ages of 6 months and 2.5 years, but sometimes they appear earlier, even at birth, and some children don't get all their baby teeth until about 4 years. By studying identical twins and non-identical twins we will be able to work out whether genetic factors are most important in determining this variation or whether other factors such as diet or illness also play a significant role. Secondly, we want to find out whether there is a relationship between the timing of emergence of the primary teeth and the growth of bacteria in the mouth that may lead to dental decay. It seems that the most likely source of the bacteria that can cause dental decay is a baby's mother and that children infected before three years of age are more likely to get dental decay subsequently. We will determine when decay-producing bacteria first appear in the mouth and check whether the same types of bacteria are present in twins and their mothers. This information will enable us to sort out whether the process that allows bacteria to become established around the teeth has a strong genetic basis or not. If we can gain a better understanding of how genetic and environmental factors influence dental development, we will be in a better position to manage individuals with altered tooth emergence that can lead to crowded teeth. Furthermore, if we can demonstrate a link between tooth emergence, growth of oral bacteria, and development of dental decay, we should be able to determine the most effective time to introduce preventive measures to control dental disease.Read moreRead less
Natural History And Longterm Impact Of Dental Fluorosis
Funder
National Health and Medical Research Council
Funding Amount
$345,184.00
Summary
Dental fluorosis is an important aspect of oral health because: perception and concerns about fluorosis influence perspective and success of fluoride programs; and advices on fluoride use are based on a risk-benefit tradeoff. This study is expected to report changes in fluorosis, its longterm impact and evaluate fluorosis and caries trade-off. This will be the first study of the natural history of fluorosis. Findings will have significance for individuals, dental profession and health policy.
The Impact Of Declining Tooth Loss On Oral Health Status And Dental Care Utilisation
Funder
National Health and Medical Research Council
Funding Amount
$144,375.00
Summary
Improved oral health has been well documented in Australia. Over recent decades the average number of decayed teeth among children has decreased. Among adults, the percentage with no natural teeth has also exhibited a decrease over time. While increased retention of natural teeth is an indicator of improved oral health status within the population, there may be some unexpected consequences of this success. Improved oral health has been associated with increased rather then decreased use of servi ....Improved oral health has been well documented in Australia. Over recent decades the average number of decayed teeth among children has decreased. Among adults, the percentage with no natural teeth has also exhibited a decrease over time. While increased retention of natural teeth is an indicator of improved oral health status within the population, there may be some unexpected consequences of this success. Improved oral health has been associated with increased rather then decreased use of services. Improvements in oral health manifested in the form of greater tooth retention, coupled with demographic trends towards growth in the population, may lead to an increased risk of oral disease with flow on effects on need and demand for care. Findings from one cross-sectional study in the USA have shown that people who retained higher numbers of teeth had more periodontal disease and dental caries experience, and reported a past pattern of visiting the dentist more frequently. The specific aims of this project are to examine the association of the number of natural teeth among middle-aged Australians with their oral health status, treatment needs and subsequent use of dental services. The outcome of this project will provide answers to two research questions. Firstly, it will see whether the retention of more teeth among adults is associated with higher levels of oral disease. Secondly, by following people over time it will be able to detect whether those who are retaining more teeth into adult age ranges have higher levels of use of dental services than their counterparts with fewer teeth. The answers to both of these research questions has significance for policy and planning in the area of dental public health by providing evidence as to the size and direction of expected future demand for and use of dental services in Australia.Read moreRead less
Dental Service Utilisation In Young Adults: A Function Of Need, Health Behaviours Or Socio-demographic Variables?
Funder
National Health and Medical Research Council
Funding Amount
$58,190.00
Summary
Over the past 20 years there have been significant gains made in the oral health of children, with the majority of 12 year olds in Australia in 1996 having no dental decay. There are however some indications that young adulthood may have become a period of increased risk of dental disease, as young adults leave home, become increasingly independent, have financial pressures whilst establishing themselves and change their diet and other habits. In 1998-99 a baseline study was conducted on a sampl ....Over the past 20 years there have been significant gains made in the oral health of children, with the majority of 12 year olds in Australia in 1996 having no dental decay. There are however some indications that young adulthood may have become a period of increased risk of dental disease, as young adults leave home, become increasingly independent, have financial pressures whilst establishing themselves and change their diet and other habits. In 1998-99 a baseline study was conducted on a sample of Adelaide young adults 20-24 years using telephone interviews and oral examinations. Data was obtained on dental visiting patterns, socio-economic status, living arrangements, and health behaviours such as smoking and playing sport, as well as oral health. This study seeks to follow-up the sample of 1265 young adults who were interviewed in 1998-99 to ascertain any changes in oral health and utilisation of dental services. Data on socio-economic status, living arrangements and health behaviours will also be collected to determine whether any changes in those factors may explain changes in visiting behaviour and oral health. In addition participants will be asked to complete a questionnaire on satisfaction with dental care. Permission will be sought to gain access to participants School Dental Service records to determine whether any relationship exists between childhood visiting patterns and those in adulthood. This study will enable identification of the factors which affect oral health and dental utilisation in young adults to assist in the development of oral health promotion strategies to encourage timely, effective and appropriate dental service utilisation and preventive behaviours. To improve the oral health of Australians the maintenance of gains made in childhood is essential.Read moreRead less
The Effectiveness Of Consuming Fluoridated Water In Reducing Children's Caries Experience.
Funder
National Health and Medical Research Council
Funding Amount
$507,090.00
Summary
The extent to which water fluoridation has contributed to the considerable reduction of dental decay in children in recent times in Australia is unclear, due perhaps to the increasing availability of fluoride in other sources such as toothpaste, drops, tablets, and professional applications. It is proposed to monitor for approximately three years a sample of 23,140 primary and secondary school children to examine the precise contribution of consuming fluoridated water to new tooth decay. The pro ....The extent to which water fluoridation has contributed to the considerable reduction of dental decay in children in recent times in Australia is unclear, due perhaps to the increasing availability of fluoride in other sources such as toothpaste, drops, tablets, and professional applications. It is proposed to monitor for approximately three years a sample of 23,140 primary and secondary school children to examine the precise contribution of consuming fluoridated water to new tooth decay. The project also aims to examine the comparative role of diet, toothbrushing, socioeconomic status, and other factors in the development of tooth decay. Given the widespread fluoridation of water supplies in Australia, and the continuing public debate over the extent of its effectiveness in preventing tooth decay, one of the project's most significant features is its capacity to contribute to a calculation of the cost effectiveness of water fluoridation as a public health strategy for the reduction of decay experience in children. The findings of the project will provide a strong argument for either eliminating fluoride from the water supply due to it's negligable public benefit or extending water fluoridation to the remaining quarter of the Australian population who are currently being disadvantaged by not having access to the health benefits derived from consuming fluoridated water.Read moreRead less
Development Of Antimicrobial Peptides Targeting Oral Pathogenic Bacteria
Funder
National Health and Medical Research Council
Funding Amount
$663,350.00
Summary
The bacterial associated oral diseases; periodontitis and caries are major public health problems. The prevalence of these diseases and increasing bacterial antibiotic resistance has meant there is a need to develop new therapies. This project addresses this by modifying a novel class of antibiotics/antiseptics �antimicrobial peptides� to target oral bacteria and testing them using a newly developed screening method. This project will lead to new therapies for periodontitis and caries.