Time Efficiency, Reliability, and User Satisfaction of the Tooth Memo App for Recording Oral Health Information: Cross-Sectional Questionnaire Study.

BACKGROUND: Digitalizing oral health data through an app can help manage the extensive data obtained through oral health surveys. The Tooth Memo app collects data from oral health surveys and personal health information. OBJECTIVE: This study aims to evaluate the evaluate the time efficiency, reliability, and user satisfaction of the Tooth Memo app. METHODS: There are 2 sections in the Tooth Memo app: oral health survey and personal oral health record. For the oral health survey section of the Tooth Memo app, different data entry methods were compared and user satisfaction was evaluated. Fifth-year dental students had access to the oral health survey section in the Tooth Memo app during their clinical work. The time required for data entry, analysis, and summary of oral health survey data by 3 methods, that is, pen-and-paper (manual), Tooth Memo app on iOS device, and Tooth Memo app on Android device were compared among 3 data recorders who entered patients' information on decayed, missing, and filled permanent teeth (DMFT) index and community periodontal index (CPI), which were read aloud from the database of 103 patients by another dental personnel. The interobserver reliability of the 3 different data-entering procedures was evaluated by percent disagreement and kappa statistic values. Laypeople had access to the personal oral health record section of this app, and their satisfaction was evaluated through a Likert scale questionnaire. The satisfaction assessments for both sections of the Tooth Memo app involved the same set of questions on the app design, usage, and overall satisfaction. RESULTS: Of the 103 dental records on DMFT and CPI, 5.2% (177/3399) data points were missing in the manual data entries, but no data on tooth status were missing in the Android and iOS methods. Complete CPI information was provided by all 3 methods. Transferring data from paper to computer took an average of 55 seconds per case. The manual method required 182 minutes more than the iOS or Android methods to clean the missing data and transfer and analyze the tooth status data of 103 patients. The users, that is, 109 fifth-year dental students and 134 laypeople, expressed high satisfaction with using the Tooth Memo app. The overall satisfaction with the oral health survey ranged between 3 and 10, with an average (SD) of 7.86 (1.46). The overall satisfaction with the personal oral health record ranged between 4 and 10, with an average (SD) of 8.09 (1.28). CONCLUSIONS: The Tooth Memo app was more efficacious than manual data entry for collecting data of oral health surveys. Dental personnel as well as general users reported high satisfaction when using this app.

Early childhood caries and its associated factors among 5-years-old Myanmar children.

Introduction: Children's oral health plays a crucial role in their overall well-being and there is a significant gap in our understanding of early childhood caries (ECC) in Myanmar. This study aims to bridge this knowledge deficit by investigating the prevalence, causes, and potential interventions for ECC in the Myanmar population, providing crucial insights for future dental health policies and practices. Methods: Generally healthy 5-year-old kindergarten children from 7 districts in city were recruited. ECC was assessed through clinical examinations using decayed, missed, filled teeth (dmft). Additionally, demographic data of the children and their caregivers, along with information about the children's oral health-related behaviors, were gathered using a structured questionnaire. Results: Out of the 496 children, the overall prevalence of dental caries was 87.1% (mean dmft score: 5.57, SD: 4.6). Caries experience was categorized as severe (45.8%) and non-severe (41.3%). Decayed teeth constituted the major component of the dmft index (97.8%). Multiple logistic regression analysis revealed two significant factors associated with ECC prevalence: late toothbrushing initiation (OR: 2.54, p = 0.001) and dental visit experience (OR: 2.46, p = 0.010). Discussion: The study highlights the alarming ECC prevalence in 5-year-old children in Mandalay, Myanmar, with mostly untreated decayed teeth. The findings emphasize early preventive oral health measures for young children to reduce ECC burden in Myanmar.

Self-reported oral health-related quality of life and caries experiences of 5-year-old children in Mandalay, Myanmar.

BACKGROUND: This study aimed to examine the impact of dental caries and other potential socio-demographic factors on the oral health-related quality of life (OHRQoL) of preschool children from Myanmar. This was done using the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5) as reported by both the children and their parents. METHODS: A structured questionnaire was conducted to collect demographic information about the children and their caregivers, as well as socioeconomic data. The OHRQoL was assessed by interviewing the children and their parents using the Myanmar versions of SOHO-5c and SOHO-5p, respectively. Caries experience was assessed by two calibrated examiners and recorded using the dmft index. The Poisson regression model was adopted to investigate the association between OHRQoL and dental caries including socioeconomic factors. RESULTS: A total of 454 pairs participated in the study. Among them, 64% of children and 70% of parents reported a negative impact on OHRQoL (with SOHO-5c and SOHO-5p scores exceeding 0). The mean score (SD) of the child self-report and parental version of the SOHO-5 was 1.86 (2.27) and 2.65 (3.13), respectively. Difficulties in eating and sleeping were the most commonly reported by both children and parents. The overall prevalence of dental caries was 87% (mean dmft score:5.59, SD:4.65). The final multivariate-adjusted model revealed that children with higher caries experiences were more likely to have lower OHRQoL for both child self-report (RR 4.38, 95% CI 3.16-6.14, p < 0.001) and parental report (RR 6.07, 95% CI 4.38-8.41, p < 0.001), respectively. A lower family income had a negative impact on the children's OHRQoL in child self-report (RR 1.59, 95% CI 1.26-2.04, p < 0.001) and parental report (RR 1.46, 95% CI 1.19-1.78, p < 0.001). CONCLUSION: Two-thirds of the study children and their parents perceived the negative impact on children's OHRQoL. Higher caries experience and lower family income were associated with poorer OHRQoL of 5-year-old Myanmar children.

Empathy level towards patients among thai dental students: a cross-sectional study.

BACKGROUND: This study aimed to develop the Jefferson scale of Empathy - Health Professions student version (JSE-HPS) for the dental student in the Thai version and assess the empathy level in students across gender, universities, and year of dental education. METHODS: JSE-HPS original version was translated to develop the draft Thai JSE-HPS version and was administered to 5 dental students for a pilot test. The final questionnaires (JSE-HPS) were completed by 439 dental students from five public universities and one private in Thailand in the 2021-2022 academic year. The internal consistency and reliability (test-retest) of the questionnaires were tested by using Cronbach's alpha and intraclass correlation coefficient (ICC). Factor analysis was used to examine the underlying factors of the JSE-HPS (Thai language). RESULTS: The JSE-HPS represented good internal consistency (Cronbach's α = 0.83). Factor analysis revealed, "Compassionate Care", "Perspective Taking" and "Ability to stand in Patients' Shoes" as the first, second, and third factors, respectively. The mean empathy score of dental students was 114.30 (SD = 13.06) from the total score of 140. There were no significant differences in the empathy levels among genders, study programs, grades, universities, regions, types of universities, and years of study. CONCLUSION: The findings confirm the reliability and validity of the JSE-HPS (Thai version) to measure the empathy level among dental students. Integrating empathic elements into the dental curriculum will help student learning to be more effective and improve treatment outcomes.

Cross-cultural adaptation and psychometric properties of the Myanmar version of the scale of oral health outcomes for 5-year-old children.

OBJECTIVE: The aim of this study was to cross-culturally adapt the child's self-report and parental report of the scale of oral health outcomes for 5-year-old children (SOHO-5) for use in Myanmar (Burmese-speaking) population and to assess the reliability and validity of the Myanmar version. MATERIALS AND METHODS: The forward-backward translation method was used to develop the Myanmar SOHO-5 version and the final questionnaires were tested on 173 five years old children and their parents for reliability and validity. A single dentist examined the caries experience of the children (Kappa:0.90). The structural validity was assessed through confirmatory factor analysis. The internal consistency and test-retest reliability (1-2 weeks) were evaluated using Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. The association between SOHO-5 scores and additional global rating questions for child oral health status (convergent validity) and the differences between the total SOHO-5 score of children with caries and children without caries (discriminant validity) were investigated. RESULTS: A confirmatory factor analysis indicated a good fit for the one-factor structure of the SOHO-5. Cronbach's alpha coefficient values for internal consistency were 0.82 for the children's report and 0.79 for the parental report. The ICCs were 0.90 and 0.89 for the total scores of the children and parental versions in the test-retest reliability analysis. The total SOHO-5 scores for both reports were significantly associated with the global rating questions except for the 'impact on children's general health' question in the parental report. Furthermore, the Myanmar version discriminated between the children with and without caries experiences (p < 0.001). CONCLUSION: This study provided evidence that both children and parental reports of the Myanmar SOHO-5 version have good reliability and validity to assess the OHRQoL of 5-year-old children in a Burmese-speaking population.

Quality of the adaptation procedures and psychometric properties of the scale of oral health outcomes for 5-year-old children (SOHO-5): a systematic review.

PURPOSE: The aim of this study was to assess the quality of the cross-cultural adaptations and psychometric properties of the Scale of Oral Health Outcomes for 5-year-old children (SOHO-5). METHODS: A systematic search was performed in three databases, PubMed, SCOPUS, and Dentistry and Oral Science Source (EBSCO). Studies relating to the cross-cultural adaptation and psychometric properties of SOHO-5 were included. The quality of cross-cultural adaptation was assessed in five aspects including translation, synthesis, back-translation, expert committee review, and pretesting. The Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to assess the psychometric properties in seven domains including responsiveness, internal consistency, reliability, measurement error, and structural, construct, and cross-cultural validity. RESULTS: The search identified 162 papers for screening; from these, 107 articles and 9 systematic reviews were excluded. 21 full papers were retrieved and 6 studies that met the inclusion criteria were included. Out of six, two reported all five aspects of cross-cultural adaptation procedures. Regarding the psychometric properties, none of the studies evaluated all aspects of psychometric properties. Almost all of the studies reported internal consistency (Cronbach's alpha ranging from 0.71 to 0.90), test-retest reliability (Intraclass Correlation Coefficient 0.46-0.98), and construct validity. None reported the cross-cultural validity and responsiveness of the measures. CONCLUSION: While these studies provided satisfactory results regarding the validity and reliability of SOHO-5, the majority of the included studies did not report all domains of the cross-cultural adaptations and psychometric properties. Overall, the quality of the cross-cultural adaptations and psychometric properties of the included studies is doubtful. Future research should follow the guidelines to assess all aspects of psychometric properties and adaptation procedures in cross-cultural settings.

Development and psychometric test of the myRisk mobile application for caries risk assessment.

OBJECTIVES: To develop a caries-risk assessment application (myRisk app) and assess the psychometric properties based on content validity, construct validity, and how well it classifies the participants into different caries risk groups using caries increments at 10 months. METHODS: The myRisk mobile application was developed using Android Studio 4.1.1. The content validity was assessed by three dental experts. To evaluate construct validity and the prediction of future dental caries, the participants (N = 88) were recruited from Rajvithi Home for Girls in Thailand by convenience sampling. The participants were completed a caries risk assessment (CRA) of myRisk app and ADA form. The oral examination was performed at the time of CRA and 10 months following the baseline. RESULTS: Eighty-eight participants aged 12-29 used the myRisk app and completed the ADA form. The app content validity was acceptable (IOC = 0.67). According to myRisk, 7.9%, 71.6%, and 20.5% of the participants were classified into the low-, moderate-, and high-risk groups, respectively. The percent agreement of the caries-risk classification with the ADA form was 30.7%. Significant differences between the three risk groups were found in active caries (p < 0.001), type, and frequency of sugary snacks (p = 0.002). The app had a sensitivity of 68%, a specificity of 61%, and an area under the receiver operating characterisitic (ROC) curve of 0.61. CONCLUSIONS: The myRisk app has acceptable content validity and sufficient diagnostic accuracy (sensitivity, specificity, and ROC curve). However, there is a different outcome in caries-risk classification compared with the ADA form.

Optimal concentration of potassium iodide to reduce the black staining of silver diamine fluoride.

BACKGROUND/PURPOSE: Potassium iodide (KI) is used for reducing the degree of black staining occurred after silver diamine fluoride (SDF) application. However, the optimal KI concentration remains unknown. This study aimed to identify the optimal concentration of KI that effectively reduces black staining after SDF application. MATERIALS AND METHODS: Twenty-four extracted teeth with similar pattern of carious lesions were assigned into 6 groups as follows: 1) SDF only, 2) SDF+7.5%KI, 3) SDF+10%KI, 4) SDF+15%KI, 5) SDF+20%KI, and 6) SDF+saturated KI. The KI solution was applied immediately after SDF application. Tooth images were obtained for color measurement at different time points as followed; before SDF application, immediately after SDF application, immediately after KI application, 1, 3, 7 and 14 days after SDF+KI application. The photographs were analyzed for mean gray value using the ImageJ program. RESULTS: The KI groups demonstrated a dose-dependent significant immediate reduction in black staining after KI application, except the saturated KI group. The teeth in the 20% KI group had the highest Δ mean gray value compared with other groups immediately after KI application, whereas a reduction in black staining in the saturated KI group appeared 1 day after KI application. The Δ mean gray value in all groups decreased over time. After 7 and 14 days, the reduction in black staining was not clearly different between KI groups. CONCLUSION: KI application was able to reduce the degree of black staining in a dose-dependent manner, but the subsequent color change was minimal over the period of 14 days.

Comparing protection-motivation theory-based intervention with routine public dental health care.

OBJECTIVES: Tooth brushing with fluoride toothpaste has a major effect on the reduction in dental caries. However, among young children, tooth brushing requires skill and motivation from caregivers and is not widely practised. To find a more effective way to train caregivers, Protection-Motivation Theory (PMT)-based educational programmes were compared with the basic one with regard to the incremental caries rate in children, caregiver's motivation and caregiver's awareness. METHODS: In a quasi-experimental study, 9- to18-month-old children and their caregivers (N = 102) were allocated to PMT or control groups. The PMT group received PMT-based oral health education programme while the control group received public hospital's current one. Children's caries status and motivation and awareness among caregivers were measured. Mann-Whitney U test was used to find out the difference between control and test groups. RESULTS: After 12 months, the PMT group showed lower dmft, dmfs and incremental caries rate compared with control. Chi-square test showed the control group was at more risk of developing additional dental caries (RR 2.23, 95% C.I.: 1.41-3.54, p < 0.001), and when early carious lesions were included (RR 2.40, 95% C.I.: 1.56-3.69, p < 0.001). In terms of motivation and awareness among caregivers, the PMT group rated their perception of disease severity and belief in self-efficacy significantly higher than the control group. CONCLUSIONS: PMT-based education programmes encourage suitable motivation and awareness that changes oral healthcare behaviour of caregivers, relating to decreased incremental caries rate in infants and toddlers comparing with regular health education methods.

Comparison of two caries prevention programs among Thai kindergarten: a randomized controlled trial.

BACKGROUND: Intensified preventive regimen based on a 'high-risk' approach has been proposed instead the routine prevention that is generally given to the whole population. The effectiveness of these regimens may still be an issue. Therefore, the aim of this study was to compare two preventive programs carried out in a Public School for kindergarten children. METHODS: The data from clinical examinations were used to assess the caries risk for 121 children. Children with at least 2 carious lesions were considered as high risk for dental caries development. These children were randomized into two groups. Half (High risk basic-HRB group) were provided the basic prevention regimen (oral-hygiene instruction and hands-on brushing practice for teachers and caregivers, daytime tooth brushing supervised by teachers at least once a week, newly erupted first permanent molar sealant, provision of toothbrush, fluoride-containing dentifrice, and a guidebook), which was also given to low-risk children (Low risk basic-LRB group). The other half (High risk intensive-HRI group) were additionally given an intensified preventive regimen (F-varnish application, primary molar sealant, and silver diamine fluoride (SDF) application on carious lesions). Clinical examinations were performed semiannually to determine the dmfs caries increment of the three groups. RESULTS: The 89 children completed the 24-month examination were 3- to 5-year-old with 19, 35, and 35 children in the LRB, HRB, and HRI group, respectively. The new caries development at 24 months of the HRB group (75%) was higher than that of the HRI group (65.7%) and the LRB group (21.1%). One-way analysis of variance (ANOVA) indicated no significant differences of caries increment between the HRB and HRI groups at the end of our study (p = 0.709). CONCLUSIONS: The negligible difference in caries increment between the HRI and HRB groups implies that intensified prevention produced minimal additional benefit. Offering all children only basic prevention could have obtained virtually the same preventive effect with substantially less effort and lower cost. TRIAL REGISTRATION: Thai Clinical Trials Registry (TCTR), TCTR20180124001. Registered 24 January 2018 - Retrospectively registered.

Dental school tracks related to the retention of dentists in Thai government service: a cross-sectional survey.

BACKGROUND: The shortage of dentists working in rural hospitals is an important public health problem resulting from dentist distribution inequity. The Ministry of Public Health of Thailand (MoPH) has implemented a policy of recruiting students with a rural background to be dental students and return home after graduating. This study aims to examine the relationship between admission tracks during the academic years 2005-2011 on retaining dentists in Thai government service and identify the factors associated with retention and resignation. METHODS: A cross-sectional survey was conducted using an online questionnaire from 287 dentists who graduated from Chulalongkorn University (CU) between 2010 and 2016. Follow-up data consisted of the admission track, number of years spent in Thai government service, and factors that influenced their decision to stay or resign from Thai government service. Chi-squared analysis was used to analyze the data. RESULTS: The overall retention rate in Thai government service was 58.2%. Dentists in the rural track had a significantly higher retention rate than the normal track (p = 0.023). Female dentists who were married and graduated less than 3 years had a significantly higher resignation rate than others (p < 0.05). The main reasons for retention were "security in the profession," "high chance to pursue specialty training in the future," and "close proximity to hometown." Dentists from the CU rural admission tracks chose "close proximity to hometown" as the top reason, while others selected "security in the profession." The main reasons influencing resignation were "workplace far away from hometown" and "getting specialty training." CONCLUSIONS: These results indicate that dentists in the rural track had a significantly higher retention rate than the normal track. The most important factor influencing both retention and resignation was workplace location, where being near to their hometown improved the retention rate of rural dentists. Therefore, the MoPH should increase student admission into the rural track to resolve the inequity in dentist distribution.

Development and Evaluation: The Satisfaction of Using an Oral Health Survey Mobile Application.

INTRODUCTION: Surveying oral health at the community level should be done at regular intervals. Dental health personnel must assess the oral health status and needs of the community through the collection and interpretation of reliable health information. Thus, the aims of this study were (1) to develop a mobile application for oral health surveys, (2) to analyze the oral status of school children in Bangkok using the newly developed application, and (3) to evaluate user satisfaction with using the Oral Health Survey Mobile Application (OHSMA). MATERIALS AND METHODS: The OHSMA Android app was created to facilitate the collection and transfer of oral health status data. The survey data on the oral health status of Grades 1-6 Thai schoolchildren were collected and analyzed using the OHSMA. A 5-point Likert scale questionnaire was used to evaluate the satisfaction of 125 dental students when using this new application compared with using paper forms. RESULTS: The prevalence of dental caries in 441 schoolchildren was 79.7%. The total mean decayed, missing, and filled for primary teeth (dmft) and decayed, missing, and filled for permanent teeth (DMFT) were 4.09 (d + D = 3.29, m + M = 0.15, and f + F = 0.65). Users indicated high satisfaction scores for three OHSMA features: font, color, and proper size. The results showed that paper forms were easier for inputting and recording the data compared with the OHSMA. However, the OHSMA was significantly easier for searching data and reporting data compared with paper forms (OHSMA 3.80, paper forms 3.35; p < 0.001, and OHSMA 3.80, paper forms 3.51; p < 0.001), respectively. CONCLUSIONS: Despite some limitations, this study suggests that the mobile application has the potential to collect valuable oral health survey data.

DENTAL CARIES AND RELATED ORAL HEALTH FACTORS AMONG 9 TO 18 MONTH OLD THAI CHILDREN.

Dental caries can occur as soon as the first tooth erupts. We studied the caries prevalence and related risk factors among children aged 9-18 months in U Thong District, Suphan Buri Province, Thailand. A total of 151 children, whose primary caregivers were willing to participate in this study, were evaluated for decayed, missing, and filled tooth surfaces (dmfs). Questionnaires were given to the primary caregivers of the study subjects to ascertain their socio-economic status, oral hygiene habits, and child-feeding habits. The Mann-Whitney U and Kruskal-Wallis tests were used to evaluate bivariate outcome data. Hierarchical multiple regression analysis was used to determine variables predictive of dental caries in the studied children. The prevalence of dental caries among the 151 subjects was 32.5%; 15.9% had at least one cavity (cavitated caries) and 16.6% had white lesions (non-cavitated caries). The mean dmfs score was 2.83 ± 6.48. Significant associations were seen between the dmfs score and the number of erupted teeth (p < 0.001) and toothpaste usage (p < 0.01). Hierarchical multiple regression analysis revealed four factors significantly associated with caries: number of erupted teeth, which had the highest Beta value (P = 0.35, p < 0.01), nighttime bottle feeding (P = 0.17, p < 0.05), frequency of drinking sweetened milk (P = 0.17-0.18, p < 0.05) and falling asleep with a bottle in the mouth (P = 0.18, p < 0.05). Nighttime bottle feeding, frequency of drinking sweetened milk and falling asleep with a bottle in the mouth were important caries risk factors and the number of erupted teeth was a strong caries risk predictor. Dentists should educate caregivers about these risk factors.

Success rates of a mixture of ciprofloxacin, metronidazole, and minocycline antibiotics used in the non-instrumentation endodontic treatment of mandibular primary molars with carious pulpal involvement.

OBJECTIVE: To evaluate the clinical and radiographic success rates of three mixed antibiotics in the non-instrumentation endodontic treatment of primary mandibular molars at 24-27 months postoperatively. METHODS: Eighty cariously involved lower primary molars from 58 children (ages 3-8 years) received a 3Mix medicament by non-instrumentation endodontic treatment and were then sealed with glass-ionomer cement and composite resin before permanent restoration with stainless steel crowns. The patients received a clinical and radiographic assessment every 6 months over a 2-year follow-up period with an intra-examiner reliability of 0.83-1.00 (κ value). RESULTS: In 60 cases at 24- to 27-month follow-up, the success rates as determined by clinical and radiographic evaluation were 75% and 36.7%, respectively; however, the overall success rate of 3Mix non-instrumentation endodontic treatment was 36.7% with 15.8% of cases demonstrating a pulpal response of internal resorption. CONCLUSIONS: Non-instrumentation endodontic treatment using 3Mix-MP showed good clinical success but had a low success rate based on radiographic evaluation at 2-year follow-up. Hence, 3Mix antibiotic treatment cannot replace a conventional root canal treatment agent as a long-term therapy.

Is there equity in oral healthcare utilization: experience after achieving Universal Coverage.

OBJECTIVES: To assess the socioeconomic-related (in)equality and horizontal (in)equity in oral healthcare utilization among Thai adults after Universal Coverage (UC) policy implemented nationwide, and to decompose the source of inequality in utilization. Further, to identify the determinants that effect to out-of-pocket payments for oral healthcare. METHODS: Using the data of 32748, Thai adults aged 15 years and over from nationally representative Health and Welfare Survey and Socio-Economic Survey in 2006. This study employs concentration index (CI) and horizontal inequity index (HI) to measure the socioeconomic-related inequality and horizontal inequity in oral healthcare utilization, respectively. Further, employing decomposition method to identify the sources of inequality comprising of a contribution of income, need determinants (i.e. self-assessed oral health, demographic characteristics), non-need determinants (i.e.working status, educational level attainment, type of insurance entitlement, geographic characteristics and marital status) and residual term. Two-part model is used to determine the factors effect to out-of-pocket payments for oral healthcare. RESULTS: There are the pro-rich inequality and inequity in oral healthcare utilization among Thais as indicated by significantly positive values of CI (=0.199) and HI (=0.206). The poor are more likely to access and utilize services at subsidized public facility particularly community hospital, as opposed to the better-off who tend to utilize services at private facility. Income and non-need determinants principally contribute to the pro-poor in public sector utilization, unlike pro-rich in private sector utilization. Need factors account for most of the pro-poor utilization. Type of treatment obtained and insurance used in the last visit are the substantial determinants effect to incurring out-of-pocket payments for oral healthcare. CONCLUSION: Notwithstanding the UC policy implementation made impressive strides toward improving of welfare coverage and an increase in accessibility of health services among Thais, inequality and inequity in oral healthcare utilization persist even when the country achieved universal coverage. Decomposition analyses demonstrate the association of each determinant to inequality in utilization which provides information for policy amendment to achieve the goal of equity in healthcare system.

Early childhood caries in children aged 6-19 months.

OBJECTIVES: To investigate the relationship between socioeconomic factors, behaviors and the severity of early childhood caries (ECC) in 6-19 month-old Thai children. The severity of ECC was estimated using the proportion of ECC teeth to erupted teeth. This was termed the 'Intensity of ECC' (I-ECC) index. METHODS: Cross-sectional questionnaire survey, dental examinations, and mutans streptococci counts were obtained from children and mothers/caregivers who participated in the ECC prevention program. RESULTS: The 520 children from rural areas were categorized into four age groups by the mean number of erupted teeth. In the 15-19-month-old children, the prevalence of ECC was 82.8% (cavitated caries, 40.8%; noncavitated caries, 42.0%) with a mean ECC teeth score of 4.18 +/- 3.19. The mean I-ECC severity score was 0.45 +/- 0.30 in these toddlers. Children from low-income families, those with low education, and mothers/caregivers with decayed teeth had higher I-ECC scores (P < 0.05). Children who were breast fed or had high counts of mutans streptococci also had higher I-ECC scores (P < 0.05). The logistic regression model revealed that only children's mutans streptococci level was a statistically significant predictor of ECC, with an odds ratio = 4.5 (95% CI = 1.8, 11.7). CONCLUSIONS: ECC is not only a public health problem but also a social problem in Thailand, because it relates to family income and education level. The community development approach to assisting disadvantaged Thai children should be combined with an effective preventive program at a very young age. Future longitudinal research should be performed to improve the I-ECC for measuring the severity of ECC.