Improving Child Oral Health: Cost Analysis of a National Nursery Toothbrushing Programme

Anopa Y, McMahon AD, Conway DI, Ball GE, McIntosh E, Macpherson LM.
PLoS One. 2015 Aug 25;10(8):e0136211. doi: 10.1371/journal.pone.0136211. eCollection 2015.

Dental caries is one of the most common diseases of childhood. The aim of this study was to compare the cost of providing the Scotland-wide nursery toothbrushing programme with associated National Health Service (NHS) cost savings from improvements in the dental health of five-year-old children: through avoided dental extractions, fillings and potential treatments for decay.
Estimated costs of the nursery toothbrushing programme in 2011/12 were requested from all Scottish Health Boards. Unit costs of a filled, extracted and decayed primary tooth were calculated using verifiable sources of information. Total costs associated with dental treatments were estimated for the period from 1999/00 to 2009/10. These costs were based on the unit costs above and using the data of the National Dental Inspection Programme and then extrapolated to the population level. Expected cost savings were calculated for each of the subsequent years in comparison with the 2001/02 dental treatment costs. Population standardised analysis of hypothetical cohorts of 1000 children per deprivation category was performed.
The estimated cost of the nursery toothbrushing programme in Scotland was £1,762,621 per year. The estimated cost of dental treatments in the baseline year 2001/02 was £8,766,297, while in 2009/10 it was £4,035,200. In 2002/03 the costs of dental treatments increased by £213,380 (2.4%). In the following years the costs decreased dramatically with the estimated annual savings ranging from £1,217,255 in 2003/04 (13.9% of costs in 2001/02) to £4,731,097 in 2009/10 (54.0%). Population standardised analysis by deprivation groups showed that the largest decrease in modelled costs was for the most deprived cohort of children.
The NHS costs associated with the dental treatments for five-year-old children decreased over time. In the eighth year of the toothbrushing programme the expected savings were more than two and a half times the costs of the programme implementation.

Expert commentary:
Inequalities in oral health remain a significant public health challenge and the management of tooth decay imposes a substantial cost burden to the National Health Service. Getting teeth into contact with fluoride is a key preventive measure. In the absence of water fluoridation, school-based toothbrushing programmes have been shown to be effective in reducing decay, and are recommended in recent NICE guidance to local authorities. The work reported here suggests that such programmes are effective in terms of NHS dental treatment costs avoided, and particularly so in the most disadvantaged communities. Of course what this paper doesn’t account for is the avoided pain and suffering associated with dental decay in young children. This work supports the need for local authorities in England to consider such schemes.

Professor Ivor Chestnutt, Professor of Dental Public Health, Cardiff University