Longitudinal caries prevalence in a comprehensive, multicomponent, school-based prevention program

Jacqueline R. Starr, Ryan R. Ruff, Joseph Palmisano, J. Max Goodson, Omair M. Bukhari, Richard Niederman

Research output: Contribution to journalArticlepeer-review


Background: Globally, children's caries prevalence exceeds 30% and has not markedly changed in 30 years. School-based caries prevention programs can be an effective method to reduce caries prevalence, obviate traditional barriers to care, and use aerosol-free interventions. The objective of this study was to explore the clinical effectiveness of a comprehensive school-based, aerosol-free, caries prevention program. Methods: The authors conducted a 6-year prospective open cohort study in 33 US public elementary schools, providing care to 6,927 children in communities with and without water fluoridation. After dental examinations, dental hygienists provided twice-yearly prophylaxis, glass ionomer sealants, glass ionomer interim therapeutic restorations, fluoride varnish, toothbrushes, fluoride toothpaste, oral hygiene instruction, and referral to community dentists as needed. The authors used generalized estimating equations to estimate the change in the prevalence of untreated caries over time. Results: The prevalence of untreated caries decreased by more than 50%: from 39% through 18% in phase 1, and from 28% through 10% in phase 2. The per-visit adjusted odds ratio of untreated caries was 0.79 (95% confidence interval, 0.73 to 0.85). Conclusions and Practical Implications: This school-based comprehensive caries prevention program was associated with substantial reductions in children's untreated caries, supporting the concept of expanding traditional practices to include office- and community-based aerosol-free care.

Original languageEnglish (US)
Pages (from-to)224-233.e11
JournalJournal of the American Dental Association
Issue number3
StatePublished - Mar 2021


  • Caries prevention
  • aerosol-free
  • community-based care

ASJC Scopus subject areas

  • General Dentistry


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