Is non-invasive management of dental caries in private practice cost-effective? A randomized controlled trial

尽管有相反的证据，牙医通常会填补蛀牙，预防性地管理，可能会修复（逮捕）。这种做法可能给社会带来巨大的代价。建模表明，在牙齿的生命周期内，每个新的牙齿填充物可能平均花费1811美元。这个数字包括再治疗费用，以及将来更昂贵的再治疗的可能性增加，例如根管治疗和牙冠。对所涉社会成本的审查可能会发现，这一数额被低估了;考虑到卫生部门以外的部门所承担的成本：工作日损失、生产力损失。此外，我们应该考虑家庭的成本：旅行时间和成本，儿童保育，为了支付牙科治疗而放弃的项目的机会成本。尽管如此，最近一项关于龋齿预防的系统性综述得出结论，“目前在已发表的龋齿预防措施的成本效益经济评估中没有证据”。作者强调缺乏方法学上合理的研究。这项研究将比较有针对性的预防计划，私人牙科诊所的标准护理。在采用替代办法之前，需要对有效性和成本效益进行评估。通过这种评估，可以评估比较国的价值，并节省我们宝贵的卫生资金。为解决龋齿问题而发展的激进手术方法（填充）在教授和提供牙科护理的公共和私人机构中都根深蒂固。战略要素是重新调整一般做法提供的服务，以实现大幅减少钻牙需求的目标，同时最大限度地提高非侵入性再矿化方法的机会，该方法已在体外，体内和小规模临床试验中成功证明。

Despite evidence to the contrary, dentists routinely fill decayed teeth that, managed preventively, would be likely to repair (arrest). The probable cost to society of this approach is enormous. Modeling indicates that each new dental filling is likely to cost an average of $1811 (US) over the life-cycle of a tooth. This figure includes re-treatment costs, and the increased likelihood of more expensive re-treatment in future, such as root canal treatment and tooth crowning. An examination of the societal costs involved is likely to reveal this amount to be an under-estimate; consider the costs borne by sectors outside health: days lost to work, lost productivity. Further, we should consider costs to families: travel time and costs, childcare, the opportunity cost of items forgone in order to pay for the dental treatment. Despite this, a recent systematic review of dental caries prevention concluded 'there is presently no proof, in published economic evaluations of the cost-effectiveness of caries-preventive measures'. The authors highlighted a lack of methodologically sound studies. This research will compare a targeted preventive program to standard care within private dental practices. Prior to an alternative approach being introduced, an assessment of effectiveness and cost-effectiveness is needed. It is through such assessment that the value of the comparator can be assessed and our precious health dollars saved. The radical surgical approach (filling) that evolved to deal with the caries problem is entrenched in both public and private institutions that teach and deliver dental care. The strategic element is to reorient the services provided by general practices towards to goal of delivering a substantial reduction in the need to drill teeth, while maximizing the opportunity for a non-invasive remineralization approach that has been successfully demonstrated in in-vitro, in-vivo, and in small scale clinical trials.