22 May 2019

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Is caries prevention a money saving treatment option?

Lorenzo Breschi

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How much does oral care cost?
To identify the economic weight of a disease it is worthwhile to understand the amount of resources that could be spared, if that illness would be partially or completely eradicated. Moreover, evaluation of the economic impact of dental diseases on society provides relevant information for the establishment of public health policies and decisions. Political and institutional leaders tend to give priority to diseases of high impact for the community such as cancer or cardiovascular diseases, while oral cavity diseases are often considered of secondary social and therefore economic relevance. However, caries is one of the most common diseases in the world, second only to respiratory diseases as a cause of absence from work, affecting more than 90% of the adult population (Istat 2013). It is therefore the most common chronic disease affecting children in industrialized countries, 5 times more common than asthma and 7 times more common than seasonal allergies.
Carious lesions afflict around 2.5 billion people in the world, with 190 million new cases every year. In addition, the economic crisis is leading to a progressive removal of patients from dental offices, drastically reducing the number of specialist periodical visits, reducing the possibility of early diagnosis of this disease (Istat data 2015).
The carious lesion treatment, “the dental restoration”, reconstructs the damaged portion of the tooth, but has no effect on the patient's general infectious state, as it does not eliminate cariogenic bacteria and the possibility of developing new carious lesions. The dental treatment, therefore, is to be considered a really expensive consequence of this disease, which however does not reduce its morbidity, having no preventive effects. In summary, this means resolving only the outcomes, and not the causes of the disease. With half of the world's population suffering from the consequences due to untreated oral diseases, it is easy to understand the wastefulness of this attitude. 
Therefore, proper caries management should include: 

• An individual caries risk assessment,
• The application of preventive measures to reduce the risk of new lesions,
• Stopping the progression of lesions in the initial phase, so as to limit future interventions, as well as treating their active outcomes.

To maintain good oral health, therefore, prevention based on oral hygiene and nutrition is essential; regular periodic visits to a dentist are crucial for both prevention and early treatment of carious lesions. Sticking to scrupulous preventive protocols can allow markedly lower social costs than the treatment of the carious lesion itself. In this way, it is possible to reduce the high costs of dental services, a difficult goal to reach if little is done for appropriate prevention.