Efficacy

How strong is the evidence that the intervention can be effective in bringing about behavior change?

 

Efficacy: whether the intervention works under research conditions

Effectiveness: whether the intervention works under real-life conditions

Evidence-based: is there evidence to suggest that the intervention should work?

 

1. Community Water Fluoridation (CWF):

  • The Task Force on Community Preventive Services recommends Community Water Fluoridation (CWF) based on strong evidence of effectiveness in reducing dental decay
  • CWF reduces dental caries 30-50 %
  • Stopping CWF (when other fluoride sources are inadequate) can result in increases in tooth decay by 18%
  • Studies show that CWF is cost saving for populations greater than 20,000

 

2. Coordinated School Health Programs:

  • The Task Force recommends school-based and school-linked dental sealant programs on the basis of strong evidence in reducing decay
  • Sealants applied through a school-based or school-linked program were associated with a 60% decrease in tooth decay
  • School-based programs showed a higher decrease (65%) than school-linked programs (37%)
  • Scientifically rigorous evaluation of school health programs is challenging to conduct due to issues related to sample size, recruitment, random assignment to condition, implementation fidelity, costs, and adequate follow-up time

 

3. Additional Programs:

  • Evidence-based clinical recommendations on the use of pit-and-fissure sealants (published in March 2008) concluded that sealants are effective in caries prevention and that sealants can prevent the progression of early non-cavitated carious lesions

  • Programs in which sealants were re-applied showed a higher decrease (65%) than programs in which sealants were not re-applied (30%)

  • Additional systematic reviews by a work group sponsored by CDC concluded that evidence supports recommendations to seal sound surfaces and non-cavitated lesions, to use visual assessment to detect surface cavitation, to use a toothbrush or handpiece

  • Use of professionally applied topical fluoride (May 2006)

    • Recommended that periodic fluoride treatments (fluoride varnish or gel) be considered for children age 6-18 years who are at moderate or high risk of developing tooth decay

  • Insufficient evidence to determine the effectiveness of population-based interventions for early detection of pre-cancers and cancers in reducing oral cancer morbidity/mortality or in improving the quality of life