Childhood caries management in the European Union: A cross-sectional study

Abstract

Objectives: Dental caries is one of the most widespread childhood diseases worldwide, although it is largely preventable. In Europe, there is an observable difference between caries prevalence in Eastern and Western European states. This study aimed to gather data on the characteristics of publicly financed dental preventive services for children in European Union (EU) member states.

Methods: Data on important indicators were collected through an online survey. National and international professional bodies specializing in pediatric dentistry and dental services were invited to participate in the study. Descriptive statistics and information gain were applied in the analysis to identify the strongest indicators of the availability and content of childhood caries services. Additionally, the reimbursement characteristics were examined.

Results: We received responses from 27 EU member states. The accessibility and assessment of dental preventive services among the member states vary notably. The frequency of screenings and the screened age groups differ by country and free screenings for preschool children are not common. Monitoring systems were present in only 37% of the responding countries, but brief dental interventions are available to promote caries prevention in 25 of the 27 countries. However, these interventions are mainly focused on basic oral health education. Regarding the reimbursement characteristics, we found that the amount of reimbursement is larger for higher-cost treatments targeting already developed caries than for cost-effective preventive treatments, which are less likely publicly financed.

Conclusions: The prevention of dental caries is part of oral health promotion and education efforts in the EU; unlike the treatment of already developed dental caries, the accessibility of clinical prevention services is limited and usually not free for children. Further comprehensive studies are necessary to identify key indicators for international assessment and facilitate the standardization of the screening process, thus promoting the collection of comparable data.

Keywords: Caries prevention; Childhood caries; Dental public health; Dentistry; Health policy; Health sciences; Public health.

Figure 1

Comparison of DMFT score for 12-year-old children in European Union member states. Figure 1 represents the DMFT scores of the European Union (EU) member states. The list of countries based on GDP (PPS) (gross domestic product in purchasing power standard) per capita (2017), in descending order from left to right. This comparison indicates the alteration in DMFT score for 12-year-old children in the year of 2000 (or nearest year available) and the latest updates for each member state. DMFT values reduced between since 2000 in almost all EU member states. The higher GDP (PPS) is associated with lower DMFT values. Source of GDP per capita in (PPS) data: https://ec.europa.eu/eurostat/tgm/table.do?tab=table&plugin=1&language=en&pcode=tec00114. Source of DMFT data: https://capp.mau.se/dental-caries/ Accessed: July 1, 2020.

Figure 2

Reimbursement tendency estimation with scores of preventive and operative interventions. Figure 2 horizontal axis represents the respondent countries, ranked from highest GDP (PPS) to lowest, from left to right. Right side vertical axis: GDP (PPS) per capita (represented by grey columns). Left side vertical axis: represents the reimbursement weighted average scores for preventive and operative treatment categories (preventive – orange spot or operative – blue triangle). Preventive services: fissure sealing, topical fluoride varnish, dental hygiene treatment, oral health education, oral health screening and preventive orthodontic treatment for children (e.g. space maintainer). Operative treatments: primary tooth filling, permanent tooth filling, tooth extraction, primary tooth pulp therapy and permanent tooth root canal treatment. The scores applied from 0-5, where 0 represents the lowest interest and smaller amount provided to reimburse the category, and 5 means the highest interest and higher amount provided to reimburse the category. Source of GDP per capita in (PPS) data: https://ec.europa.eu/eurostat/tgm/table.do?tab=table&plugin=1&language=en&pcode=tec00114.