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APHA Technical Report
Review of the National Preventive Dentistry Demonstration Program
I. GENERAL BACKGROUND

Introduction The National Preventive Dentistry Demonstration Program (NPDDP), carried out between 1976 and 1983, was the largest, most comprehensive school-based preventive dentistry program ever conducted anywhere. Its purpose was to determine the costs and effectiveness of severaltypes and combinations of generally accepted school-based preventive dental procedures in order to provide the database for developing the most effective modem school-based preventive dental program. The NPDDP was supported by grants from the Robert Wood Johnson Foundation totaling in excess of $10 million to two cooperating organizations: the American Fund for Dental Health (AFDH) and the RandCorporation. AFDH is a national, nonprofit organization designed and operated to seek and distribute funds in support of dental education, research, and service. The Rand Corporation is a nonprofit research institution that conducts policy research and analyses on a wide range of national problems including health services. The combination of the three organizations (RWJF, AFDH, and Rand) representsa unique alignment of resources and interests, as well as operating policy. The Robert Wood Johnson Foundation has a policy of having the programs it funds evaluated independently by groups or organizations separate from those conducting the programs. In the case of the NPDDP, the Rand Corporation was selected as the independent evaluator and was assigned the responsibility for data managementand the interpretation of the results. As the program evolved, however, Rand also became involved in the planning process and participated actively in data collection as well as data analysis and interpretation. The cooperative relationship and distinct roles of the three organizations represent an important component of the program. The result was a program conceived by dentists, designed largelyby dentists (with important contributions from Rand), and managed by dentists. The data were entered and analyzed chiefly by a non-dental, independent group of researchers. As the program evolved, however, Rand also became involved in the planning process and participated actively in data collection as well as data analysis and interpretation, thus destroying the original intent of having anon-dental independent group of analysts involved in the study. Rationale for the Program By the mid- 1970s, when the NPDDP was designed, many studies demonstrating the efficacy of a variety of procedures in preventing caries in children had been published. The reported success of those procedures, when applied individually, raised the question of the possible potential additive effect were they to beadministered in combination within school programs. The fact that no prior study had attempted to quantify the possible additive effects of selected combi© 1986 American Journal of Public Health 0090-0036/86$1.50

nations of preventive procedures, and that the true costs of operating different types of preventive programs had not been adequately documented, served as the rationale for thisdemonstration program project. The problems with the ultimate design which was developed to accomplish this are discussed later in this report.

Underlying Assumptions The NPDDP was based on four primary assumptions reflecting the conventional wisdom about caries prevention during the mid 1970s. First, it was assumed that the prevalence of dental caries in the United States was relatively stable.Epidemiologic data from the two US nationwide surveys of children completed up to that time indicated virtually no change in caries prevalence between 1960-61 and 1971-74.1I Second, the success of various single preventive procedures led to the assumption that if the most successful procedures were to be applied in combination it would be possible to reduce caries incidence by as much as 90 per cent....