Cost analysis of dental caries prevention in Västerbotten county, Sweden : An investigation of preventive expenditure in a 5-year prospective cohort study in adolescents

Introduction: Treatment of dental diseases makes up 4.6% of global health expenditure and dental caries is the most prevalent condition worldwide. In higher-income countries, population-wide prevention has brought prevalence down and it is now concentrated in 20% of the population. Currently the only single predictor of future caries is caries, meaning risk cannot be assessed before the disease is already present. Additionally, studies show different types of caries patients respond differently to prevention. As resources to provide dental services are limited, there is a need to understand what these different groups are and how we currently allocate resources to optimize prevention. It has been shown that the bacteria S. mutans is cariogenic and that there is a genetic component to caries risk. Methods: A prospective cohort study in Västerbotten County, Sweden identified genetic polymorphisms (i.e. mutations) which predispose to dental caries. This thesis calculated expenditure on caries prevention based on the dental records of this study and examined allocation between different risk groups according to observed risk, professionally estimated risk, genetic and bacterial risk (S. mutans). Results: Prevention costs are distributed rather equally regardless of professionally estimated, genetic or bacterial risk. Spending was overall low (median = 26 SEK). Discussion: Compared to other diseases, this annual expenditure is negligible. There is scope to increase this and focus it on highest-risk patients. For this, more research is needed to refine risk groups as well as the development of diagnostic tools to allow early detection and effective prevention