Notizen: Objectives: It has been suggested that changes in the distribution of dental caries mean that targeting high-risk groups can maximize the cost effectiveness of dental health programs. This study aimed to assess the effectiveness of a targeted school-based dental screening program in terms of the proportion of children with dental care needs it identified. Methods: The target population was all children in junior and senior kindergarten and grades 2, 4, 6, and 8 who attended schools in four Ontario communities. The study was conducted in a random sample of 38 schools stratified according to caries risk. Universal screening was implemented in these schools. The parents of all children identified as having dental care needs were sent a short questionnaire to document the sociodemographic and family characteristics of these children. Children with needs were divided into two groups: those who would and who would not have been identified had the targeted program been implemented. The characteristics of the two groups were compared. Results: Overall, 21.0 percent of the target population were identified as needing dental care, with 7.4 percent needing urgent care. The targeted program would have identified 43.5 percent of those with dental care needs and 58.0 percent of those with urgent needs. There were substantial differences across the four communities in the proportions identified by the targeted program. Identification rates were lowest when the difference in prevalence of need between the high- and low-risk groups was small and where the low-risk group was large in relation to the high-risk group. The targeted program was more effective at identifying children from disadvantaged backgrounds. Of those with needs who lived in households receiving government income support, 59.0 percent of those with needs and 80.1 percent of those with urgent needs would be identified. Conclusions: The targeted program was most effective at identifying children with dental care needs from disadvantaged backgrounds. However, any improvements in cost effectiveness achieved by targeting must be balanced against inequities in access to public health care resources.

Notizen: Objectives: In Canada and the United States, professionally applied topical fluorides (PATF) are usually applied as a gel or foam. However, fluoride varnish has also been found to be effective for caries prevention and may be a preferred method because less time is required and fluoride exposure can be better controlled. The goal of this study was to compare the costs and patient acceptability of two methods of PATF (foam and varnish). Methods: The study population was a convenience sample of high-risk children from the York Region and the city of Hamilton, Ontario, Canada, who had been identified as requiring fluoride therapy (n=256). Children received from dental hygienists either fluoride foam applied in trays or fluoride varnish painted on tooth surfaces. An observer recorded the time to perform each procedure, adverse outcomes, and the satisfaction of children with treatment. Results: The varnish technique took significantly less time compared to foam (5.81 vs 7.86 minutes; P〈.0001). Significant differences between procedure times were found in all age groups, but the largest difference was for children aged 3–6 years (5.22 vs 8.61 minutes; P〈.0001). Signs of gagging were observed in a lower proportion of participants who received varnish (3.8% vs 15.1 % P〈.01), and this difference was largest for children aged 3–6 years (2.6% vs 29.7% P〈.01). The cost per varnish application, for children aged 3–6 years, was substantially less after labor costs were considered ($3.43 vs $4.43, CDN). Conclusions: Varnish applications were found to take less time and resulted in fewer signs of discomfort. These results support the use of fluoride varnish in caries prevention programs, especially for younger children.