Is caries prevention cost-effective? Does anybody care?

The aim of this article is to review current issues concerning the cost-effectiveness of caries prevention. Several decades after considerable improvements in the oral disease situation were documented in Scandinavia, doubts are still expressed about whether preventive measures are cost-effective. An analytic model is suggested to explore the relationships between the dental profession, which provides the prevention, the research and development activities, which provide the material and data basis for prevention, and political/societal responses to the professional input. The four elements considered were the definition of prevention, the practical perception of effective prevention, the appropriateness of traditional cost-effectiveness analysis, and the time factor with regard to when a preventive effect should be evaluated. The main arguments of the discussion are that caries prevention is not uniformly defined by the profession, that dental research is casting doubt on the effectiveness of traditionally accepted preventive measures, that political pressures on health care are motivated by economic pressures, but that traditional cost-benefit/effectiveness analyses have not been able to help the decision-makers choose wisely. Often the time perspective for the real effects of prevention lies beyond the interests of decision-makers. Although caries prevention may be viewed as an investment in health by the profession, this contention may not be acceptable to a society with very short-term perspectives.