Cost-effectiveness considerations in planning a preventive dental programme for British Columbia.

The Government of British Columbia, Canada, with organized dentistry, in 1974, sponsored research towards the introduction of a comprehensive children's dental programme. Dental care was at that time primarily provided by private practitioners on a personal fee-for-service basis, which system was working close to capacity. Educational and preventive dental programmes in school and health centres were sponsored by governments. Utilization of treatment services by children was estimated at a maximum of 60 per cent per annum. For the improvement of overall dental health, it was adjudged this should be at least 90 per cent. Approximately 45 per cent of children's treatment was related to dental caries. Four possible dental care delivery systems were costed. It was essential that the comprehensive programmed include proven anti-cariogenic measures and that they be the most effective in cost and in the utilization of professional personnel. Techniques for measurement of effectiveness were reviewed. Using a modified Davies cost-benefit ratio, four professionally applied and four self-administered topical fluoride systems were compared. The Knutson-Szwejda technique scored highest when used by community dental health programmes. In a private practice system or in large paediatric clinics the annual application of acidulated phosphate fluoride would be preferable. In British Columbia, experience has indicated problems with continuing school cooperation in mouth rinse programmes. Statistical proof of the effectiveness of "brush-in" programmes was adjudged as inconclusive but hopeful.