Introduction The development and progression of dental disease amongst the Irish population is

Introduction The development and progression of dental disease amongst the Irish population is an ongoing concern that needs addressing. Over time, traditional treatment-based methods have slowly been overthrown by preventative interventions that are aimed at putting a halt to the disease before it progresses to a stage where treatment is required. This report will thoroughly examine six preventative oral health interventions using evidence to compare their efficacy in reducing dental disease. The interventions to be explored include: community dissemination of toothpastes and toothbrushes, toothbrushing programs, fluoride varnish programs, water fluoridation, fissure sealants, and oral health education. The overall objective is to assess the benefits and requirements of each program along with their respective costs in order to identify the most effective health prevention program that the Irish government should deliver to the Irish population. Community Dissemination of Toothpastes and Toothbrushes A community study by Davies et al. (1) looked at the association between the regular supply of free toothbrushes and toothpaste and the level of caries in deciduous dentition in children from deprived communities in Northwest England. From the age of 1 year to 5 years old, children were provided with toothpaste containing 1,450 ppm of fluoride at regular 3-month intervals (1). The researchers (1) found that compared to the control group (dmft: 2.57) where no free toothbrushes or toothpaste was supplied, the experimental group that received toothpaste showed a 16% reduction in their dmft score (dmft: 2.15). This direct correlation between dissemination of fluoride toothpastes and toothbrushes and a decrease in the dmft score of children suggests that this oral health intervention may prove beneficial in reducing the level of dental disease in children across a community. To implement such a program, the requirements would be relatively minimal. The essentials would include: a soft-medium bristled toothbrush, around 500ppm fluoride toothpaste for children under six years old in order to prevent fluorosis via excess fluoride ingestion, and for individuals above six years old a fluoride toothpaste greater than 1000ppm (2). As was the case in the Davies et al. study (1), an oral hygiene instruction pamphlet with diagrams and stepwise descriptive aids should also be provided in order to promote the use of proper toothbrushing technique while emphasizing the participants to brush at least twice daily. Over the 4 year experimental period in the above study (1), the cost of supplying the toothbrush, toothpaste, and pamphlet package via post was estimated to be £27.93 per child. Without the direct need for a dental healthcare professional, the community wide distribution of toothpastes and toothbrushes would be of relatively low-cost (3). Toothbrushing Programs The Childsmile nursery-based and school-based toothbrushing programs (4) have been implemented as part of the Scottish Dental Action Plan to target reducing inequalities in dental health and access to services while with the underlying goal of improving the oral health of children. Although the toothbrushing program is implemented in all nurseries, priority is given to the bottom 20% of nurseries and school that contain the highest number of students from deprived areas in Scotland (4). This program teaches children to use an effective quantity of toothpaste, appropriate toothbrushing techniques, supervised toothbrushing, and the teaching of procedures aimed at minimizing the risk for cross-contamination (5). Since the implementation of initial 3-year period of Childsmile in 2006, the National Dental Inspection Program (6) has identified a reduction in the mean dmft scores of deciduous teeth for the P1 population from a dmft of 2.18 in 2006 to a dmft of 1.14 in 2018. However, this drop in dfmt score may be multifactorial as other interventions in the Childsmile program which will be discussed in the next section may synergistically work with the toothbrushing program to decrease the incidence of dental disease. A separate study carried out by Jackson et al. (7) discovered that when comparing 5-year old children who underwent supervised toothbrushing to others who were not supervised, their dmft scores were 2.60 and 2.92, respectively. This suggests that supervised toothbrushing programs are successful in improving the oral health in children while narrowing the inequality gap between access to dental services. The essential requirements for such a program to run smoothly and efficiently are toothbrushes for every participant, adequate toothpaste supply, properly trained nursery/school teachers, and potentially supervision by a dental healthcare professional in some cases. Although this oral health intervention has more requirements than the simple distribution of toothpastes/toothbrushes, the overall emphasis on preventing dental disease from a young age especially in areas with children from families of low socioeconomic status will prove in the long run to be cost saving.Fluoride Varnish Programs The Childsmile nursery-based and school-based fluoride varnish application program (4) has been implemented in parallel to the toothbrushing program mentioned in the previous section. This program also targets areas of greater deprivation by providing priority nurseries and schools with fluoride varnish application twice a year to children from the age of three onwards (4). According to the Cochrane Oral Health Group (8) who carried out a review of studies on children under the age of 16 who were given fluoride varnish compared to a non-treatment control group, they observed a 43% reduction in DMFS scores in adult dentition and a 37% reduction in dmfs scores for deciduous dentition. These results confirm that fluoride varnish plays a role in the prevention of dental disease. The requirements for implementing a fluoride varnish program include: the fluoride varnish itself which is either 0.25ml of Duraphat (5% w/v sodium fluoride) to children with deciduous teeth or 0.4ml of Duraphat to adolescence with permanent teeth, a dental healthcare professional trained in the application of fluoride varnish, and potentially any transport of these individuals to a community center if the fluoride varnish is being applied outside of the dental practice. According to a study by Atkins et al. (9), the annual cost of a fluoride varnish program per child was $662 which lead to an annual averted cost of $2,056 per child by preventing caries that would have needed treatment in the future. These figures support that the application of fluoride varnish to children is an effective preventative intervention to reduce dental disease.

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