{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T14:12:32Z","timestamp":1774275152429,"version":"3.50.1"},"reference-count":27,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T00:00:00Z","timestamp":1774137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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 Nex\u00f8 method, which was developed in 1987 in the Municipality of Nex\u00f8 (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 \u201cgood\u201d (1 point) or \u201cbad\u201d (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 Nex\u00f8 municipality from 1985 to 2005 were analyzed, descriptively as well as statistically (Welch\u2019s t-test, 95%CI and Cohen\u2019s d), to compare the caries experience on a national level with data from Nex\u00f8 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 Nex\u00f8 was, prior to the implementation of the Nex\u00f8 method (before 1987), at the national level or worse. The mean defs\/DMFS dropped significantly (p-values &lt; 0.0001) from 1990 onwards in Nex\u00f8 in 5-, 15- and 18-year-olds compared to national data. The DMFS = 0 among 15-yr-olds in Nex\u00f8 reached 80% in 2005 compared with 40% nationally in the same year. For 15-yr-olds in 2005, the effect size expressed by Cohen\u2019s d = \u22120.43, indicating a moderate effect of the Nex\u00f8 method. The mean number of sealed surfaces in 2003 was 3.1 (1SD = 1.6) in 39 reporting municipalities, and for Nex\u00f8 the mean value was 2.8 surfaces. The cost (price\/child\/year) was under control over the years. Conclusions: The Nex\u00f8 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 Nex\u00f8 compared to most other municipalities in Denmark is expected.<\/jats:p>","DOI":"10.3390\/children13030432","type":"journal-article","created":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:07:06Z","timestamp":1774271226000},"page":"432","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Nex\u00f8 Method\u2014Clinical Evidence for the Paradigm Shift in Caries Management for Children and Adolescents in Denmark Being Cost-Effective"],"prefix":"10.3390","volume":"13","author":[{"given":"Kim Rud","family":"Ekstrand","sequence":"first","affiliation":[{"name":"Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauri Erik Christian","family":"Christiansen","sequence":"additional","affiliation":[{"name":"Former Nex\u00f8 Public Dental Health Service, Municipality of Nex\u00f8, 3730 Nex\u00f8, Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1111\/j.1600-0528.1982.tb00394.x","article-title":"Development in dental caries among children in 1961\u201379 in a Danish community with school dental service","volume":"10","author":"Hesselgren","year":"1982","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1600-0528.1973.tb01055.x","article-title":"Recording system for the Danish child dental health services","volume":"1","author":"Helm","year":"1973","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1111\/j.1600-0528.1997.tb00909.x","article-title":"Promoting changes in clinical practice: Treatment time and outcome studies in a Danish public child dental health clinic","volume":"25","author":"Thylstrup","year":"1997","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_4","unstructured":"Splieth, C.H. (2011). Non-Operative Caries Treatment in Revolutions in Pediatric Dentistry, Quintessence Publishing."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1177\/00220345890680061501","article-title":"Mechanical vs. disease-oriented treatment of dental caries: Educational aspects","volume":"68","author":"Thylstrup","year":"1989","journal-title":"J. Dent. Res."},{"key":"ref_6","first-page":"144","article-title":"In Vivo Caries Models\u2014Mechanisms for Caries Initiation and Arrestment","volume":"8","author":"Thylstrup","year":"1994","journal-title":"Adv. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1177\/00220345890680050401","article-title":"Dental plaque and caries in occlusal surfaces of first permanent molars in relation to stage of eruption","volume":"68","author":"Carvalho","year":"1989","journal-title":"J. Dent. Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1111\/j.1600-0528.1997.tb00894.x","article-title":"Concepts of dental caries and their consequences for understanding the disease","volume":"25","author":"Fejerskov","year":"1997","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1159\/000077753","article-title":"Changing paradigms in concepts on dental caries: Consequences for oral health care","volume":"38","author":"Fejerskov","year":"2004","journal-title":"Caries Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1159\/000088180","article-title":"Outcomes of a non-operative caries treatment programme for children and adolescents","volume":"39","author":"Ekstrand","year":"2005","journal-title":"Caries Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/j.1600-0528.2009.00505.x","article-title":"Factors associated with inter-municipality differences in dental caries experience among Danish adolescents. An ecological study","volume":"38","author":"Ekstrand","year":"2010","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_12","unstructured":"Kuhn, T.S. (1962). The Structure of Scientific Revolutions, University of Chicago Press."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Skeie, M.S., and Klock, K.S. (2014). Scandinavian systems monitoring the oral health in children and adolescents; an evaluation of their quality and utility in the light of modern perspectives of caries management. BMC Oral Health, 14.","DOI":"10.1186\/1472-6831-14-43"},{"key":"ref_14","unstructured":"(2026, March 14). T Test Calculator. Available online: https:\/\/www.graphpad.com\/quickcalcs\/ttest2\/."},{"key":"ref_15","first-page":"26","article-title":"Frequency and distribution patterns of sealants among 15-year-olds in Denmark in 2003","volume":"24","author":"Ekstrand","year":"2007","journal-title":"Community Dent. Health"},{"key":"ref_16","unstructured":"Gravetter, F.J., and Wallnau, L.B. (2017). Statistics for the Behavioral Sciences, Cengage Learning. [10th ed.]."},{"key":"ref_17","unstructured":"Danish Health Authority Copenhagen, Denmark (2026, March 14). SCOR Tables from 1985-2005, National Level and Nex\u00f8 Municipality, Available online: https:\/\/sundhedsdatastyrelsen.dk\/data-og-registre\/nationale-sundhedsregistre\/boerne-og-ungdomstandpleje."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1034\/j.1600-0528.2003.00016.x","article-title":"Time and duration of eruption of first and second permanent molars: A longitudinal investigation","volume":"31","author":"Ekstrand","year":"2003","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"241","DOI":"10.3109\/00016358109162285","article-title":"Rational use of fluorides in caries prevention. A concept based on possible cariostatic mechanisms","volume":"39","author":"Fejerskov","year":"1981","journal-title":"Acta Odontol. Scand."},{"key":"ref_20","first-page":"27","article-title":"Diagnosis and treatment of dental caries: The clinicians\u2019 dilemma. Scope for change in clinical practice","volume":"78","author":"Elderton","year":"1985","journal-title":"J. R. Soc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000503309","article-title":"Terminology of Dental Caries and Dental Caries Management: Consensus Report of a Workshop Organized by ORCA and Cariology Research Group of IADR","volume":"54","author":"Machiulskiene","year":"2020","journal-title":"Caries Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e208127","DOI":"10.20396\/bjos.v19i0.8658127","article-title":"Dental anxiety and the effectiveness of local anesthesia","volume":"19","author":"Esmaeili","year":"2020","journal-title":"Braz. J. Oral Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"104841","DOI":"10.1016\/j.jdent.2024.104841","article-title":"Global prevalence of early childhood dental fear and anxiety: A systematic review and meta-analysis","volume":"142","author":"Sun","year":"2024","journal-title":"J. Dent."},{"key":"ref_24","first-page":"CD002278","article-title":"Fluoride toothpastes for preventing dental caries in children and adolescents","volume":"1","author":"Marinho","year":"2003","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_25","first-page":"CD007868","article-title":"Fluoride toothpastes of different concentrations for preventing dental caries","volume":"4","author":"Walsh","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_26","first-page":"CD002279","article-title":"Fluoride varnishes for preventing dental caries in children and adolescents","volume":"7","author":"Marinho","year":"2013","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_27","first-page":"CD003067","article-title":"Pit and fissure sealants versus fluoride varnishes for preventing dental decay in the permanent teeth of children and adolescents","volume":"11","author":"Kashbour","year":"2020","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/432\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,23]],"date-time":"2026-03-23T13:37:42Z","timestamp":1774273062000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/3\/432"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,22]]},"references-count":27,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["children13030432"],"URL":"https:\/\/doi.org\/10.3390\/children13030432","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,22]]}}}