Dental caries among long-term care (LTC) residents is a persistent and complex problem driven by social and structural factors. Systems thinking may be useful in considering novel approaches to reducing disease. This study aimed to develop a system dynamics model to simulate the progression of dentate older adults in LTC through caries severity states and estimate the effects of 3 intervention scenarios on the progression of caries: preventive topical fluoride (TF), arrest of caries with silver diamine fluoride (SDF), and a combination of TF and SDF. Dentate older adults in LTC were categorized into 4 caries severity states by their number of untreated carious lesions. The model assumed that changes in severity states were consistent with incidence rates reported in the literature and available billing data for dental care and that individuals move in and out of the system by entering and exiting the facility or experiencing edentulism. For all scenarios, the proportion of dentate older adults in LTC with 1 or more untreated lesions stays stable, the distribution of disease shifts from a high severity state, and the system approaches equilibrium after 4 y. The TF intervention predicts minimal impacts on decreasing the proportion of dentate older adults with 1 or more untreated lesions (2.5% decrease), while the SDF intervention and the combination interventions were most disruptive. There was a 29.6% and 33.6% decrease, respectively. Given the specific population dynamics in LTC, these findings suggest that long-term (greater than 4 y) interventions should be designed to address both the management of existing lesions and their incidence. This system dynamics model allows researchers to render institution-specific data points from LTCs to estimate the effects of proposed interventions at the respective site.

中文翻译：

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长期护理中龋齿严重程度状态的系统动力学建模


长期护理 （LTC） 居民的龋齿是一个由社会和结构因素驱动的持续而复杂的问题。系统思考可能有助于考虑减少疾病的新方法。本研究旨在开发一个系统动力学模型来模拟 LTC 中齿状老年人通过龋齿严重程度状态的进展，并估计 3 种干预情景对龋齿进展的影响：预防性局部氟化物 （TF）、用氟化二胺银 （SDF） 阻止龋齿，以及 TF 和 SDF 的组合。LTC 中的齿状老年人根据未经治疗的龋齿病变数量分为 4 种龋齿严重程度状态。该模型假设严重程度状态的变化与文献中报告的发病率和牙科护理的可用计费数据一致，并且个人通过进出设施或经历无牙颌来进出系统。在所有情况下，LTC 中具有 1 个或多个未经治疗的病灶的齿状老年人的比例保持稳定，疾病分布从高度严重状态转变，4 年后系统接近平衡。TF 干预预测对降低具有 1 个或多个未治疗病变的齿状老年人的比例影响最小（减少 2.5%），而 SDF 干预和联合干预最具破坏性。分别下降了 29.6% 和 33.6%。鉴于 LTC 的特定人群动态，这些发现表明应设计长期 （大于 4 y） 干预措施，以解决现有病变的管理及其发生率。 该系统动力学模型允许研究人员从 LTC 呈现机构特定的数据点，以估计拟议干预措施在相应站点的效果。