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ORIGINAL RESEARCH

A Simulation Model for Designing Effective Interventions in Early Childhood Caries

This flow chart shows how children move to and from disease states related to early childhood caries. The progression of early childhood caries begins at the left with children who have had no caries activity and continues with a flow to the right of those who develop early-stage caries (eg, white spots). These are initially untreated, although some fraction may be treated. The flow continues to the right as children with untreated caries develop cavities. Again, some fraction may be treated and some fraction of those may develop additional cavities. The final stage at the right of the diagram is the progression of children with untreated cavities to symptomatic cavities. These children can be treated but may also and often do develop additional cavities in the future.

Figure 1. Stages of early childhood caries development among children aged 0 to 5 years. Symbols with 2 triangles touching at their vertices represent “valves,” indicating that various factors control the rates of flow. These factors include both biological variables such as normal rates of caries development and effects of interventions such as fluoride varnish in slowing those rates of progression.

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Intervention Beginning Value End of Year
2 4 6 8 10
Baseline 66,368 66,191 66,240 66,307 66,353 66,381
Fluoride varnish 66,368 60,448 54,168 49,833 47,167 45,597
Xylitol for moms 66,368 65,761 61,799 55,108 48,255 42,865

Figure 2. Number of Colorado children aged 2 to 5 years projected to experience cavities during a 10-year period, given 1 of 2 interventions in a simulation model, compared to baseline. The 2 interventions were xylitol treatment of mothers to limit cariogenic bacterial transmission and fluoride varnish application to all children aged 6 months or older.

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