Data sources The following seven databases were searched: PubMed, EMBASE, DARE, NHSEED, HTA, Cost-Effectiveness Analysis Registry and Paediatric Economic Database Evaluation (PEDE).

Study selection The review included trial and model-based economic evaluation studies and the participants included children aged from 0 to 12 years old who were healthy except for having dental caries. Studies of mixed populations of parents and children were included where the data for children were presented separately.

The interventions included were:

• Community-based oral-health education/training programs related to healthy oral habits.

• Screening of children's teeth.

• Supervised toothbrushing technique through the provision of toothbrushes, an appropriate amount of fluoride toothpaste, and topical fluoride.

• Advice on dietary control, such as limitation of sugar or carbohydrates consumption, and enhanced fortified nutrition with an appropriate amount of calcium intake.

• The comparators were situations where the populations were the same as the test group, but were receiving no intervention, or a dissimilar one .The interventions were oral-health promotion programs (OHPPs) implemented by oral-health professionals in the contexts of home visits, telephone calls, healthcare centres and primary schools.

The outcome measures were reductions in the Decayed, Missing, Filled Teeth (DMFT) index for permanent teeth or (dmft) index for deciduous teeth among children and OHPP cost, incremental cost (difference between mean costs of intervention and mean costs of the comparator), and cost-effectiveness analysis (CEA).

Data extraction and synthesis The title, abstract and full text of each study were screened. During the first phase screening of titles and abstracts, irrelevant records were removed. The exclusion criteria were: participant with health-related diseases or aged older than 12 years; interventions other than OHPP (such as implant dentistry or other invasive-dentistry programs); other economic-evaluation outcomes such as cost-benefit, cost-utility or cost-minimisation; authors' opinion (unoriginal records); reviews; and study language other than English. The second-phase screening assessed full texts of the articles using the same eligibility criteria. The risk of bias was assessed using the Drummond 10-item Checklist.

Meta-analysis: The costs were converted to 2015 USA dollars. Data analysis was performed through dichotomous outcomes such as the number of children in the intervention and in the control group, the DMFT index in children, and the OHPP cost. Odds ratios (ORs), effect sizes with 95% confidence interval (CIs) and study weights were estimated from random effects analysis. Forest plots were constructed for each outcome, and chi-square tests used to assess homogeneity, where a p-value of less than 0.1 indicated statistically significant heterogeneity. An I2 test was used to quantify inconsistencies between studies as the percentage of variation across studies. Data synthesis was carried out using narrative demonstration, with a summary of the characteristics of each included study. For quantitative synthesis, a summary of the combined estimation related to the OHPP effect was measured. Three types of subgroup analysis were performed: by the age of the children (age under or equal to 6 years, and age 6-12 years), by publication year (studies published in the last five years, and earlier published studies) and by the country of the study. Egger's regression test and a funnel plot were used to assess and demonstrate publication bias. Publication bias was considered present if the p-value of the Egger test was more than 0.05.

Results 19 full texts were included into qualitative synthesis and eight articles used in quantitative synthesis.

Qualitative synthesis results: With regards to the country of origin, 32% of the studies were conducted in the United Kingdom (n = 6), 26% in Australia (n = 5), 16% in the United States (n = 3). There was also one study from each of the following countries Finland, Ireland, Japan, Nigeria and Singapore. Fifty-two percent (n = 10) were model-based economic evaluation studies and 47% (n = 9) were trial-based economic evaluations. The population of 14 studies were younger than six years of age, while in four studies the children were over the age of six years. In one paper the age of the children was not clearly stated. Just under a half of the papers (47%) were published in the last five years.

The majority of the studies had a low risk of bias (n = 12, 63%) and seven (37%) had a moderate risk of bias. Various outcome measures were used in the included studies: DMFT, average number of dental visits, number of prevented caries teeth, average number of cavity-free months, probability of less cost, caries prevalence, number of specific OHPP visits, quality-adjusted life year, cost-effectiveness ratio, and percentages of not having debris.

Quantitative synthesis results: The overall pooled impact of OHPPs showed that children with tooth decay had 81% lower odds of participating in OHPP (95% CI 61-90%, I2: 98.5%, p = 0) with considerable heterogeneity among studies. OHPPs were successful in reducing financial costs in 97 out of 100 OHPPs (95% CI 89-99%, I2: 99%, p = 0) with considerable heterogeneity among studies. The studies with participants under the age of six years old weighted 71% with an OR of 0.14 (95% CI, 0.05-0.39, I2: 99%). These children had the highest benefit of OHPPs to lower DMFT/S. The studies reporting children aged six years and over weighted 29% with an OR of 0.29 (95% CI, 0.08-1.01, I2: 99%), and these children had no benefit from OHPPs in lowering DMFT/S.

Studies with under-six-year-old participants had an OR of 0.07 (95% CI, 0.02-0.32) revealing no cost-effectiveness effect to reduce OHPP incremental cost, whereas studies reporting children aged six years and older had an OR of 0.0 (95% CI, 0.00-48,704.6). The authors concluded that OHPPs involving the later (older) children were cost-effective in reducing the OHPPs' incremental cost.

Conclusions A comprehensive analysis of the OHPPs confirmed that DMFT could be reduced, hence, lowering the financial burden of dental-care treatment. More effort is needed to manage the allocation of scarce resources, taking into account the economic impact of dental caries on healthcare systems. More studies on caries-prevention programmes among young children in high-, middle- and low-income countries are needed, in order to assess the clinical and financial effectiveness.

数据来源搜索了以下七个数据库：PubMed，EMBASE，DARE，NHSEED，HTA，成本效益分析注册中心和儿科经济数据库评估（PEDE）。

研究选择该评价包括基于试验和模型的经济评估研究，参与者包括0至12岁的健康儿童，除了患有龋齿外，他们都是健康的。包括父母和孩子混合人口的研究，其中分别提供了孩子的数据。

干预措施包括：

•与健康的口腔习惯有关的社区口腔健康教育/培训计划。

•检查儿童的牙齿。

•通过提供牙刷，适量的氟化物牙膏和局部氟化物来监督牙刷技术。

•关于饮食控制的建议，例如限制糖或碳水化合物的消费，并通过摄入适量的钙来增强强化营养。

•比较者是人口与测试组相同但没有接受干预或不同的情况。干预是口腔保健专业人员在家庭访视中实施的口腔保健促进计划（OHPP） ，电话，医疗中心和小学。

结果衡量指标是儿童中恒牙的龋齿，缺失，实心牙齿（DMFT）指数或乳牙的（dmft）指数和OHPP成本的减少，增量成本（干预的平均成本与比较者的平均成本之间的差） ，以及成本效益分析（CEA）。

数据提取和综合筛选每个研究的标题，摘要和全文。在标题和摘要的第一阶段筛选过程中，删除了不相关的记录。排除标准为：患有健康相关疾病或12岁以上的参与者；OHPP以外的干预措施（例如种植牙或其他侵入性牙科计划）；其他经济评估结果，例如成本效益，成本效用或成本最小化；作者的意见（原始记录）；评论; 并学习英语以外的语言。第二阶段筛选使用相同的资格标准评估了文章的全文。使用Drummond 10个项目清单评估偏倚的风险。

荟萃分析：费用已转换为2015年美元。通过二项结果进行数据分析，例如干预组和对照组的儿童人数，儿童的DMFT指数以及OHPP费用。从随机效应分析中估算出赔率（OR），具有95％置信区间（CI）的效应大小和研究权重。针对每种结果构建林地，并使用卡方检验评估同质性，其中p值小于0.1表示具有统计学意义的异质性。I2检验用于量化研究之间的不一致，作为研究之间变异的百分比。使用叙述性演示进行数据综合，并总结每个纳入研究的特征。对于定量合成，测量了与OHPP效应相关的组合估算的摘要。进行了三种类型的亚组分析：按儿童年龄（6岁以下或以下，以及6-12岁），发表年份（最近五年发表的研究以及较早发表的研究）和研究的国家/地区。Egger回归测试和漏斗图用于评估和证明出版偏倚。如果Egger检验的p值大于0.05，则认为存在出版偏倚。的回归测试和漏斗图用于评估和证明出版偏倚。如果Egger检验的p值大于0.05，则认为存在出版偏倚。的回归测试和漏斗图用于评估和证明出版偏倚。如果Egger检验的p值大于0.05，则认为存在出版偏倚。

结果定性合成包括19篇全文，定量合成使用了8篇文章。

定性综合结果：关于原产国，有32％的研究在英国（n = 6），26％的澳大利亚（n = 5），16％的美国（n = 3）进行了。来自以下国家/地区的每个国家/地区也进行了一项研究：芬兰，爱尔兰，日本，尼日利亚和新加坡。52％（n = 10）是基于模型的经济评估研究，47％（n = 9）是基于试验的经济评估。14项研究的人口年龄小于6岁，而4项研究的儿童年龄超过6岁。一篇论文没有明确说明孩子的年龄。在过去的五年中，只有不到一半的论文（47％）发表过。

大多数研究偏倚风险低（n = 12，63％），而七项研究（37％）偏头痛的风险中等。在所包括的研究中使用了各种结局指标：DMFT，平均就诊次数，预防龋齿的数量，无蛀牙的平均次数，降低成本的可能性，龋齿患病率，特定的OHPP就诊次数，质量调整后的寿命年，成本效益比和没有碎屑的百分比。

定量合成结果：OHPP的总体影响表明，蛀牙儿童参加OHPP的几率降低了81％（95％CI 61-90％，I2：98.5％，p = 0），且研究之间存在相当大的异质性。OHPP成功地降低了100种OHPP中的97种的财务成本（95％CI 89-99％，I2：99％，p = 0），并且研究之间存在很大的异质性。六岁以下参与者的研究权重为71％，OR为0.14（95％CI，0.05-0.39，I2：99％）。这些儿童对降低DMFT / S的OHPP益处最大。这项研究报告称，六岁以上且体重超过29％的儿童的OR为0.29（95％CI，0.08-1.01，I2：99％），这些儿童在降低DMFT / S方面没有从OHPP中获益。

六岁以下参与者的研究OR值为0.07（95％CI，0.02-0.32），显示没有降低OHPP增量成本的成本效果，而报告6岁及以上儿童的OR值为0.0 （95％CI，0.00-48,704.6）。作者得出的结论是，涉及较年长（较大）儿童的OHPP在降低OHPP的增量成本方面具有成本效益。

结论对OHPP的综合分析证实，可以减少DMFT，从而减轻了牙科护理治疗的经济负担。考虑到龋齿对医疗保健系统的经济影响，需要做出更多努力来管理稀缺资源的分配。为了评估临床和财务效果，需要对高收入，中等收入和低收入国家的幼儿中的龋齿预防计划进行更多研究。