Oral health prevention measures for children Study Protocol

Background Dental caries, known widely as “tooth decay” is the most common non-communicable disease worldwide. It is a chronic condition that involves the gradual destruction of dental enamel. If untreated, dental caries can lead to pain and may require dental restorations (fillings) or extractions. Dental caries in children has a major impact on oral health and quality of life, leading to missed school days, lost working days for parents or guardians, and a significant financial burden on dental care payers (NHS, insurance, or out-of-pocket patient payments) as well as society more broadly. In 2024, Public Health England (PHE) published data showing that, in England, 22.4% of five-year-old children had experienced tooth decay. Among those who had tooth decay, on average, 3 to 4 teeth were affected. Children with dental problems miss an average of 3 days of school per year, with associated lost productivity when parents or guardians must take time off work to provide care. Tooth decay remains the leading cause of hospital admissions for general anaesthesia among children aged 5 to 9 years. In 2024, there were 30,587 episodes of tooth extraction with a primary diagnosis of dental caries among children and young people aged 0-19 years with a cost to the NHS of £45.8 million. Despite this significant health and economic burden, dental caries is a largely preventable disease. It is, therefore, crucial that healthcare systems prioritise the most effective and cost-effective prevention methods to support the well-being of children and to ensure an efficient use of scarce NHS resources. Aim Summarise the clinical and cost-effectiveness evidence of community-based interventions for oral health prevention for young children aged 0-5 years. Objectives i. To identify and summarise effectiveness data, including decayed, missing and filled teeth (dmft) outcomes, intervention costs, and resource use, to inform the update of the existing return on investment (RoI) tool used by the Department of Health and Social Care (DHSC). ii. To systematically review the existing economic evidence on community-based dental caries prevention interventions for children aged 0-5 years published in the last ten years. iii. To develop a decision analytic model to compare the cost-effectiveness of alternative community-based dental caries prevention interventions for children aged 0-5 years. Methods Two systematic reviews will be conducted looking at a) clinical effectiveness studies, and b) economic evaluation studies. The systematic reviews will be conducted in accordance with current methodological standards and reported in line with the Preferred Reporting System for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. In addition, we will develop a decision analytic model to compare the cost-effectiveness of alternative community-based interventions. Established best-practice methods for decision-analytic model development will be used. Reporting of findings will follow Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022). Impact and dissemination A Project Advisory Group with stakeholders, academic researchers, and patient and public involvement (PPI) representatives has been arranged to maximise the impact of the project findings. Results from the project will be used to inform decision making at the DHSC. Academic meeting presentations and publications are planned.