Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Freiburgstrasse 7, 3010 Bern, Switzerland.
Department of Periodontology and Operative Dentistry, University Medical Center of the Johannes Gutenberg University Mainz, 55116 Mainz, Germany.
Medicina (Kaunas). 2023 Oct 20;59(10):1865. doi: 10.3390/medicina59101865.
Early childhood caries (ECC) is a multifactorial, biofilm-mediated, sugar-related, dynamic disease of primary dental hard tissues occurring in varying degrees of severity in infants and toddlers. Untreated ECC may lead to pain, infections, and severe systemic complications. The aim of this study was to systematically review and evaluate the scientific evidence on the cost-effectiveness of treatment decisions in ECC in infants and toddlers. Observational epidemiological studies, i.e., cohort studies, case-control studies, and randomized controlled trials, reporting cost-effectiveness of treatment decisions in ECC in infants and toddlers were included in the systematic review following the PRISMA guidelines. Using an ad hoc search with search terms or keywords (MeSH), electronic databases Embase, MEDLINE via PubMed, Scopus, and gray literature were searched. The search identified 494 articles, of which 446 remained after removing duplicates. A total of 417 articles were excluded after title and abstract evaluation; 29 full-text articles were screened for eligibility, and five articles were discarded. Twenty-four full-text articles were included in the systematic review, assigning 17 to prevention and seven to restoration. Results were heterogeneous; comparability of included studies is difficult because of the different methodologies used. Conflicting efficacies were demonstrated for different interventions implemented, and cost-effectiveness data were documented. Socioeconomic, cultural, and ethnic differences must be considered when comparing conditions in terms of cost-effectiveness. A paradigm shift from surgical towards preventive treatment decisions can be observed. Cost-effectiveness studies on therapies for ECC in infants and toddlers are needed to identify the best practice approach and the most cost-effective therapy decisions.
婴幼儿龋（ECC）是一种多因素、生物膜介导、与糖相关的原发性牙硬组织疾病，在婴儿和幼儿中以不同程度的严重程度发生。未经治疗的 ECC 可能导致疼痛、感染和严重的全身并发症。本研究旨在系统回顾和评估婴幼儿 ECC 治疗决策的成本效益的科学证据。
根据 PRISMA 指南，本系统评价纳入了观察性流行病学研究，即队列研究、病例对照研究和随机对照试验，报告了婴幼儿 ECC 治疗决策的成本效益。使用特定的搜索词（MeSH）进行了电子数据库 Embase、MEDLINE 通过 PubMed、Scopus 和灰色文献的搜索。
搜索共确定了 494 篇文章，去除重复项后，有 446 篇文章保留。在标题和摘要评估后，共排除了 417 篇文章；对 29 篇全文文章进行了资格筛选，有 5 篇文章被排除。24 篇全文文章被纳入系统评价，其中 17 篇用于预防，7 篇用于修复。结果具有异质性；由于使用了不同的方法学，很难比较纳入研究的可比性。对于实施的不同干预措施，疗效存在冲突，并且记录了成本效益数据。
在比较成本效益方面，必须考虑社会经济、文化和种族差异。可以观察到从手术治疗决策向预防治疗决策的范式转变。需要对婴幼儿 ECC 的治疗进行成本效益研究，以确定最佳实践方法和最具成本效益的治疗决策。
