The Nexø Method-Clinical Evidence for the Paradigm Shift in Caries Management for Children and Adolescents in Denmark Being Cost-Effective.

Introduction

In the period from the 1960s to the new millennium, dental care for children in Denmark focused mostly on drilling and filling lesions once they appeared. This often led to repeated operative treatments, not to mention the trauma related to the many anxiety-provoking dental treatments undergone by these children. Aim: It is cost-effective to document, by means of clinical data over a 25-year period, that the paradigm shift from operative management of caries to a more non-operative approach. Method: The name of the program is the Nexø method, which was developed in 1987 in the Municipality of Nexø (one of 275 municipalities) in Denmark. The method was operationalized into a structured approach based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment. The risk assessment was based on four risk criteria, each divided into a "good" (1 point) or "bad" (2 points) situation, which were eventually used to assess the length of the interval between visits to the clinic. Outcomes: National Danish oral health data (SCOR) and oral health data from the Nexø municipality from 1985 to 2005 were analyzed, descriptively as well as statistically (Welch's t-test, 95%CI and Cohen's d), to compare the caries experience on a national level with data from Nexø in terms of mean defs/DMFS and percentage of 5-, 15-, and 18-year-olds with a defs/DMFS = 0.

Results

The mean defs/DMFS or percentage of children with a defs = 0/DMFS = 0 in Nexø was, prior to the implementation of the Nexø method (before 1987), at the national level or worse. The mean defs/DMFS dropped significantly (p-values < 0.0001) from 1990 onwards in Nexø in 5-, 15- and 18-year-olds compared to national data. The DMFS = 0 among 15-yr-olds in Nexø reached 80% in 2005 compared with 40% nationally in the same year. For 15-yr-olds in 2005, the effect size expressed by Cohen's d = -0.43, indicating a moderate effect of the Nexø method. The mean number of sealed surfaces in 2003 was 3.1 (1SD = 1.6) in 39 reporting municipalities, and for Nexø the mean value was 2.8 surfaces. The cost (price/child/year) was under control over the years.

Conclusions

The Nexø Method shows the clinical evidence that the paradigm shift to prevention of the disease process, rather than operative intervention, is cost effective, even with a rather limited use of sealants. A reduction in fear and anxiety-provoking dental treatments in Nexø compared to most other municipalities in Denmark is expected.