# The Nexø Method—Clinical Evidence for the Paradigm Shift in Caries Management for Children and Adolescents in Denmark Being Cost-Effective

## TL;DR

The Nexø Method, a non-operative dental care approach in Denmark, effectively reduces tooth decay in children and adolescents while being cost-effective.

## Contribution

The study provides clinical evidence that a non-operative caries management approach is cost-effective and reduces anxiety-provoking treatments in children.

## Key findings

- The Nexø method significantly reduced caries in children aged 0-18 years compared to national averages.
- 80% of 15-year-olds in Nexø had no caries (DMFS = 0) in 2005, compared to 40% nationally.
- The method was cost-effective and reduced the need for anxiety-inducing dental procedures.

## Abstract

What are the main findings?
•The Nexø method—a Danish non-operative caries-control program based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment—was very effective in controlling caries disease in children aged between 0 and 18 yrs of age.•It is highly likely that the Nexø method promoted a marked reduction in anxiety-provoking dental treatments in Nexø, as nearly 80% of the 15-year-old population in Nexø had a DMFS = 0, compared to 40% at the Danish national level.

The Nexø method—a Danish non-operative caries-control program based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment—was very effective in controlling caries disease in children aged between 0 and 18 yrs of age.

It is highly likely that the Nexø method promoted a marked reduction in anxiety-provoking dental treatments in Nexø, as nearly 80% of the 15-year-old population in Nexø had a DMFS = 0, compared to 40% at the Danish national level.

What are the implications of the main findings?
The overall objective with the Nexø method was to keep teeth healthy, which requires due diligence.
•For primary dentition, non-operative interventions should start at the time of eruption of the first primary teeth, which occurs when the child reaches the age of 8 months.•For permanent dentition, non-operative interventions should start at the time of eruption of the permanent first molar teeth, which happens at around the age of 5–7 years old.

The overall objective with the Nexø method was to keep teeth healthy, which requires due diligence.

For primary dentition, non-operative interventions should start at the time of eruption of the first primary teeth, which occurs when the child reaches the age of 8 months.

For permanent dentition, non-operative interventions should start at the time of eruption of the permanent first molar teeth, which happens at around the age of 5–7 years old.

Introduction: In the period from the 1960s to the new millennium, dental care for children in Denmark focused mostly on drilling and filling lesions once they appeared. This often led to repeated operative treatments, not to mention the trauma related to the many anxiety-provoking dental treatments undergone by these children. Aim: It is cost-effective to document, by means of clinical data over a 25-year period, that the paradigm shift from operative management of caries to a more non-operative approach. Method: The name of the program is the Nexø method, which was developed in 1987 in the Municipality of Nexø (one of 275 municipalities) in Denmark. The method was operationalized into a structured approach based on three principles, dosed at individually assessed recalls according to diagnosis and risk assessment. The risk assessment was based on four risk criteria, each divided into a “good” (1 point) or “bad” (2 points) situation, which were eventually used to assess the length of the interval between visits to the clinic. Outcomes: National Danish oral health data (SCOR) and oral health data from the Nexø municipality from 1985 to 2005 were analyzed, descriptively as well as statistically (Welch’s t-test, 95%CI and Cohen’s d), to compare the caries experience on a national level with data from Nexø in terms of mean defs/DMFS and percentage of 5-, 15-, and 18-year-olds with a defs/DMFS = 0. Results: The mean defs/DMFS or percentage of children with a defs = 0/DMFS = 0 in Nexø was, prior to the implementation of the Nexø method (before 1987), at the national level or worse. The mean defs/DMFS dropped significantly (p-values < 0.0001) from 1990 onwards in Nexø in 5-, 15- and 18-year-olds compared to national data. The DMFS = 0 among 15-yr-olds in Nexø reached 80% in 2005 compared with 40% nationally in the same year. For 15-yr-olds in 2005, the effect size expressed by Cohen’s d = −0.43, indicating a moderate effect of the Nexø method. The mean number of sealed surfaces in 2003 was 3.1 (1SD = 1.6) in 39 reporting municipalities, and for Nexø the mean value was 2.8 surfaces. The cost (price/child/year) was under control over the years. Conclusions: The Nexø Method shows the clinical evidence that the paradigm shift to prevention of the disease process, rather than operative intervention, is cost effective, even with a rather limited use of sealants. A reduction in fear and anxiety-provoking dental treatments in Nexø compared to most other municipalities in Denmark is expected.