Orlando, R., Turkistani, S., Louca, C. and Machuca Vargas, C., 2026. Economic evaluation of dental prevention programmes in primary schools: a scoping review. British Dental Journal.
This scoping review examines the existing evidence on the economic evaluation of school-based dental caries prevention programmes. Recognising dental caries as one of the most prevalent chronic diseases affecting children globally, the authors aim to map and assess the quality of economic evaluations (EEs) relating to school delivered oral health interventions. The review responds to the need for stronger economic evidence to inform policymakers and guide efficient allocation of the already limited healthcare resources.
A comprehensive literature search was conducted across the Web of Science, PubMed and Scopus, with no date restrictions. Eleven studies met the inclusion criteria. These were categorised into three groups: prevention-only interventions (six studies), combined prevention and treatment interventions (four studies), and screening interventions (one study). Both full economic evaluations (e.g., cost-effectiveness analysis and cost-utility analysis) and partial economic evaluations (e.g., cost analyses and cost-minimisation studies) were included. Reporting quality was assessed using the CHEERS 2022 checklist.
The findings suggest that many school based preventive interventions particularly fluoride varnish applications, fissure sealants, supervised toothbrushing and fluoridated milk programmes, are likely to be cost-effective, especially when compared with no intervention. Some studies demonstrated potential long-term cost savings through reductions in future treatment needs. However, cost-effectiveness varied depending on context, delivery model, intensity of intervention and baseline caries risk. For example, while sealants were often more clinically effective, fluoride varnish sometimes emerged as more cost-effective due to lower delivery costs.
Despite generally positive findings, the review highlights several limitations in the evidence base. Many studies focused on short-term outcomes and narrow measures such as DMFT scores, with limited modelling of long-term impacts such as quality-adjusted life years (QALYs) or broader societal benefits. Few evaluations considered equity or assessed the differential impact of interventions on disadvantaged populations. Reporting quality was moderate overall (mean CHEERS score 75%), but common gaps included limited discussion of generalisability, stakeholder engagement and heterogeneity.
The authors conclude that while school-based oral health programmes show promising economic value, the current evidence is fragmented and often methodologically limited. More comprehensive, long-term and equity-informed economic evaluations are needed to better inform policy decisions and support sustainable investment in preventive oral healthcare for children.
Research Summary Written By: Sophie Shergill, University of Manchester – BDS 3