Screening and treatment time in school-based caries prevention: A randomized clinical trial

Background: School-based caries prevention can increase access to dental services for underrepresented children and reduce the risk of tooth decay. Methods: The CariedAway study was a longitudinal pragmatic randomized trial of silver diamine fluoride (SDF), fluoride varnish, dental sealants, and atraumatic restorations (ART) provided as part of a school caries prevention program. Using electronic health record software and reproducible procedures, we estimated the total time required to screen and treat program participants. Differences at initial treatment between interventions, provider (registered nurse and dental hygienist), dentition mix, and caries burden were determined using linear regression with cluster standard error estimation, and longitudinal effects were estimated using linear mixed effects models. Results: A total of 7418 children were enrolled in the CariedAway trial, of which 7176 (97%) had viable data recorded for screening and treatment time. Overall treatment time for children receiving SDF and fluoride varnish was 283 seconds (SD=739), compared to 753 seconds (SD=2166) for children receiving dental sealants and ART. At the initial program visit, treatment time using SDF was significantly shorter than sealants and ART (B = -458.8, 95% CI = -650.1, -266.8) and treatment time decreased with each subsequent observation (B = -51.9, 95% CI = -68.4, -35.4). Treatment time significantly increased as the number of carious teeth per child increased, and there were no differences in treatment time using SDF between registered nurses and dental hygienists. Conclusions: The sustainability of school-based caries prevention can be supported by robust data on program logistics and treatment time. These results can be leveraged by future school-based sealant and SDF programs to estimate the total reach and effectiveness of intended treatments.