Improving children’s oral health: evidence-based prevention programmes and economic considerations - narrative review

Abstract

Childhood dental caries remains one of the most prevalent chronic diseases worldwide, despite being largely preventable. Oral health promotion programmes (OHPPs) have been implemented in various settings, but their design, clinical effectiveness, economic consequences and long-term sustainability differ considerably. This narrative review synthesised evidence on the clinical outcomes and economic aspects of OHPPs for children and adolescents. A structured literature search was conducted in seven electronic databases - PubMed (MEDLINE), Embase, EBSCO, Web of Science, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL) and LILACS - with Google Scholar used as an additional search source. The search was initiated on 20 October 2024, continuously updated until 5 February 2025, and supplemented by a multilingual search completed on 4 April 2025. Eligible studies evaluated OHPPs for children younger than 16 years, included standard care, no OHPP, or alternative preventive approaches as comparators where applicable, had a minimum follow-up period of one year, and reported economic outcomes either in the primary or in an associated publication. PRISMA 2020 guidelines were used to enhance the transparency of the search and study-selection process. We used SANRA to assess the quality of the article. Of the 6,739 records identified, 25 publications met the inclusion criteria. Considerable heterogeneity was observed in programme design, target age groups, delivery models, outcome measurement and economic reporting. Publicly funded school- and community-based programmes incorporating multicomponent strategies, such as supervised toothbrushing, fluoride varnish application, and caregiver education, were generally associated with favourable clinical outcomes. Scotland’s Childsmile programme and Finnish municipal initiatives reported reductions in caries prevalence or severity and subsequent treatment requirements or costs. However, differences in the nature and quality of the economic evidence prevented direct comparisons across programmes. All included evidence originated from high-income countries, limiting the generalisability of the findings to low- and middle-income settings. In high-income settings, OHPPs can improve children’s oral health when interventions are sustained, appropriately targeted and integrated into established healthcare or educational systems. However, heterogeneity in programme design, outcome measurement and economic reporting limits the strength of cross-programme comparisons.