A System Dynamics Model of Caries Preventive Interventions in Thailand's School-Aged Population.

PURPOSE: To compare the long-term effects of the Ministry of Public Health's (MOPH) caries preventive interventions for 6- to 12-year-olds (supervised toothbrushing [STB], dental sealant, and combined STB+sealant) to the base case (no intervention) using the System Dynamics Model. MATERIALS AND METHODS: The System Dynamics Model was used to evaluate the intervention scenarios of supervised toothbrushing (STB), sealant, and combined STB+sealant with the base-case scenario. The effectiveness data for the model's interventions were obtained from systematic reviews and meta-analyses. RESULTS: The model determined that the caries-free population increased by 36.2%, 25.5%, and 14.5%, while the caries-affected population decreased by 8.1%, 5.5%, and 3.1% in the combined STB+sealant, sealant, and supervised toothbrushing scenarios compared to the base case at 15 years of age. CONCLUSION: Combined STB+sealant is the most efficacious intervention among those administered to children between the ages of 6 and 12 with permanent teeth. In addition, the System Dynamics Model could be helpful in comparing interventions or policies to determine the optimal intervention for a given population.

Safety and effectiveness of an innosvative SS-suction device to control moisture in dental procedures.

Control of moisture is critical for retention of sealants, which can reduce the incidence of caries in high-risk groups. OBJECTIVES: We investigated the safety and efficacy of the novel SS-suction device in the laboratory and a small clinical trial in children aged 6 to 8-years-old. METHODS: First, a laboratory test of 52 SS-suction devices was conducted to determine the pressure generated by the chin plate to maintain suction at different intervals and to determine the pressure resistance of the spring to maintain suction in a child's mouth. Second, 12 healthy children with sound lower molars participated in a clinical trial of the use of SS-suction during sealant application. RESULTS: The laboratory test showed that when pressed to the maximum distance of 25 mm, the chin plate produced a pressure of 247.5 ± 116.6 mmHg. At this pressure, the SS-suction could be used safely for up to 120 min without damaging the soft tissues. In the clinical study, the dentists inserted and removed the SS-suction in 7.80 ± 2.48 s. The range by which the chin plate was pressed down varied between 0 and 13 mm. The highest pressure on the skin was 120 mmHg (at 13 mm) and the device effectively maintained suction and effectively removed water and saliva. The time required to apply sealant was 7.01 ± 2.26 min. CONCLUSIONS: The SS-suction is a safe, effective device for two-handed application of sealants in children, with no negative side effects. CLINICAL SIGNIFICANCE: We demonstrate the unique SS-suction device can quickly drain water and saliva to help dentists treat young patients using a two-handed approach; this device provides good control of moisture during sealant application. The device prevents the tongue and cheeks from interfering with the operation area, reduces tension, and does not require a dental assistant.

A Cluster Randomized Controlled Trial of the Dental Sealants Quality in Rural Schoolchildren Using Innovative Suction without Dental Assistance.

This study examined whether the moisture control innovation (tongue and cheek retractors and saliva contamination (SS-suction)) used without dental assistance could improve the quality of dental sealant in rural Thai school children compared to a standard treatment, i.e., high power suction with dental assistance. A single blind, cluster randomized controlled trial was conducted. Participants were 15 dental nurses working in sub-district health promoting hospitals and 482 children. All dental nurses attended workshops of SS-suction and revised dental sealant procedures. Children with sound lower first permanent molar teeth were simple-randomly assigned to either an intervention or control group. The children in the intervention group were sealed with SS-suction, and the children in the control group were sealed with high power suction and dental assistance. There were 244 children in the intervention group and 238 children in the control group. Dental nurses' satisfaction on SS-suction was record by visual analogue scale (VAS) for each tooth during treatment. After 15-18 months, caries on sealed surfaces were examined. The results showed that the median satisfaction score of SS-suction was 9 out of 10, and 17-18% children experienced uncomfortable sensation during insertion or removal. The uncomfortable feeling disappeared once the suction was in place. Caries on sealed surfaces did not differ significantly between the intervention and control groups. Caries on the occlusal surface was present in 26.7% and 27.5%, and caries on the buccal surface was present in 35.2% and 36.4% of cases in the intervention and control groups, respectively. In conclusion, dental nurses were satisfied with SS-suction in terms of both function and safety. The effectiveness of SS-suction was compatible with the standard procedure after 15-18 months.

Oral Health System in Myanmar: A Review.

OBJECTIVES: The study aims at reviewing Myanmar's current situation to consider an improved oral health system and at promoting the oral health status of the Myanmar population. MATERIALS AND METHODS: This review was conducted using the World Health Organization's (WHO's) six building blocks of the health system: oral health-care service delivery, dental workforce, oral health information system, essential medicine, health financing, and leadership and governance. The review was established on scientific articles and documents and information from reliable government and nongovernment organizations' websites. RESULTS: According to the National Oral Health Survey (2016-2017), the prevalence rate of untreated caries in six-year-old Myanmar children (84.1%), and in the 35-44 and 65-74 age group (above 40%) is high, which reflects a low utilization of oral health-care services. The dentist to population ratio is approximately 1:16,000: There are around 5,000 dentists and 400 trained dental nurses in Myanmar, and only about 1,000 dentists serve in government sectors. The inequalities in dental health care are compounded by a limited dental workforce and inequality of dentists between the public and private sectors in Myanmar. In the last National Health Plan (NHP, 2006-2011), the Myanmar government's funding for required dental equipment and materials in each dental unit (around 5726 USD) has been considered inadequate. The current expenditure is not transparent. The other challenges are an insufficient supply of dental materials and instruments to all public dental sectors and a lack of oral health-care infrastructure. CONCLUSIONS: Such findings suggest a pressing need to address the effective oral health-care system and decree the specific goals for the Myanmar population's oral health.

Development and Validation of Oral Health Literacy Questionnaire for Thai Adults.

AIM: The purpose of the study was to develop a valid and reliable oral health literacy questionnaire for the Thai adults. It measures functional, communicative, and critical competency, covering four competencies according to the context of daily living, namely, oral health service, home and community, marketplace, and community public forums. MATERIALS AND METHODS: A cross-sectional study was carried out in 420 Thai adults who were the dental clients of an oral health service system. Subjects were recruited into the study by multistage stratified random sampling. Data were collected by interviewing using the newly developed oral health literacy questionnaire. After checking for the completeness and correctness of the data, the validity and reliability of the questionnaire were analyzed by calculation of the sensitivity, specificity, and positive predictive and negative predictive values. Receiving-operating characteristic (ROC) curve was performed and showed the area under ROC that indicates the diagnostic performance of the questionnaire. RESULTS: High reliability was found as Cronbach's alpha = 0.878 and the validity proved by known-group method, presented as ability to classify subjects as having adequate, or inadequate oral health literacy was also high, given the sensitivity = 0.853, the specificity = 0.848, and the area under ROC curve = 0.858. CONCLUSION: The newly developed oral health literacy questionnaire for Thai adults was valid and reliable.

Associations Between Temperament and Dental Caries Status in Thai Children.

PURPOSE: To examine the relationships between (1) the levels of each temperament traits and the levels of milk-feeding frequency, oral hygiene care and dental caries, and (2) the difference in mean numbers of decayed surfaces among temperament types. MATERIALS AND METHODS: Four hundred and ninety-three (493) 12-month-old infants were assessed for temperaments and characteristics of child-rearing practices. The data were analysed with their dental caries status at 18 months of age. The chi-squared test, Student's t test, ANOVA and Kruskal-Wallis tests were used to assess the association between temperament traits and the following variables; dental caries, oral cleaning habits and feeding frequency. Logistic regression models were used to identify the effect of temperament traits and other factors on dental caries status. RESULTS: The trait of adaptability was found to associate with feeding frequency at night, while those of activity and approach/withdrawal were significantly associated with regularity of oral cleaning habits by the children's caregiver. Three of the nine temperament traits - biological rhythmicity, approach/withdrawal and mood - were significantly associated with dental caries in bivariate analysis. Biological rhythmicity and approach/withdrawal traits were significantly associated with a higher chance of having caries after adjusting for regularity of oral cleaning habits and frequency of night feeding. CONCLUSION: Biological rhythmicity, approach/withdrawal and mood traits were related to caries in these young children.

Effectiveness of an Oral Health Promotion Program for the Elderly in Khiri Mat District, Sukhothai Province: A Randomized Control Trial.

OBJECTIVES: Oral disease is one of the most common health problems among the elderly, which impacts the quality of life. Applying the Health Belief Model (HBM) in oral health promotion is expected to improve the effectiveness of prevention and promotion that restricts oral health problems. The aim of the present study was to determine the effectiveness of an oral health promotion program on oral health behavior and oral status among the elderly in Khiri Mat, Thailand. MATERIALS AND METHODS: A prospective randomized control trial was carried out among 162 elderly people for 6 months. They were interviewed to gather oral health behaviors and perception information, followed by an oral health examination. The experimental group received oral health education based on the HBM theory and tooth brushing practice in a small group of 4-5 persons, and then they were remotivated to support behavior change at 1 and 3 months. The control group received traditional oral health activity. All the elderly were followed up at 6 months. Data were analyzed using the t-test, Mann-Whitney test, Chi-square, and logistic regression. RESULTS: The elderly in the experimental group had significantly higher oral health perception, lower plaque scores, lower gingival inflammation, and lower clinical attachment loss than those in the control group (P < 0.05). CONCLUSION: This oral health promotion program improved oral health perception, behavior, and oral health status of the elderly.

Vertical transmission of mutans streptococci and lactobacillus in Thai families.

PURPOSE: The purpose of this study was to investigate the vertical transmission of mutans streptococci (MS) and lactobacilli in a group of Thai families. METHODS: One hundred eighty-one mother-child pairs were included in this study. Unstimulated saliva was collected using the spatula method and counted for evaluating the number of MS and lactobacilli on a selective medium. Genotyping of MS and Lactobacillus species were performed in 37 and 22 child-mother pairs, respectively. Typically, 3 to 4 isolates of MS and/or Lactobacillus strains from each mother and child were collected for genotyping by an arbitrarily primed polymerase chain reaction (OPA-02 primer for MS and enterobacterial repetivive intergenic consensus primers for Lactobacillus species). RESULTS: Generally, MS and lactobacilli levels in children were associated with their mothers' levels. Genotyping of most isolates of MS and Lactobacillus strains in both mothers and children found diversity, and each individual showed a distinct genotypic pattern. The presence of matching genotypes of MS and Lactobacillus strains of mother-child was approximately 76% and 50%, respectively. The genotypes acquired from the maternal route show effective persistence in the children's oral cavities. CONCLUSIONS: In Thai families, mothers can be the source for transmission of mutans streptococci and Lactobacillus strains to their children.

Acid production and growth by oral Lactobacillus species in vitro.

AIM: To analyze the acid-producing and growth abilities of different oral Lactobacillus species. METHODS: Thirty-nine oral clinical strains and type strains of Lactobacillus, representing nine species, including Lactobacillus casei/paracasei, Lactobacillus fermentum, Lactobacillus gasseri, Lactobacillus mucosae, Lactobacillus oris, Lactobacillus plantarum, Lactobacillus rhamnosus, Lactobacillus salivarius, and Lactobacillus vaginalis were studied. Anaerobically-grown bacterial cells were inoculated overnight in de Man, Rogosa, and Sharpe broth containing 2% glucose (pH 7.0). Acid production and growth were measured at 0, 1.5, 3, 5, 7, and 24 h. RESULTS: Lactobacillus salivarius, Lactobacillus rhamnosus, Lactobacillus casei/paracasei, and Lactobacillus plantarum grew rapidly and reached an optical density higher than other species. They also produced more acid than the others. Lactobacillus vaginalis showed the lowest rate of growth and acid production. These findings demonstrated that the different species of Lactobacillus showed different abilities to generate acid, allowing the species to be categorized into three groups: strongly, moderately, and weakly acidogenic. CONCLUSION: There was variation in acid production and growth between the Lactobacillus species. The strongest acid producers were Lactobacillus salivarius, Lactobacillus rhamnosus, Lactobacillus plantarum, and Lactobacillus casei/paracasei, respectively. It seems possible that these species might play a more important role in caries development than the others.

A longitudinal study of early childhood caries in 9- to 18-month-old Thai infants.

OBJECTIVE: To examine the rate and pattern of early childhood caries (ECC) development and to investigate the transitional changes of the carious lesions during a follow-up period of 3-9 months. METHODS: A longitudinal observational community-based survey of 599 children, 9-18 months old. The children's dental examinations were first carried out at the age of 9 months with re-examination at 12 and 18 months by five dentists using standardized methods. The affected rates of dental caries were determined for prevalence, incidence density for risk of caries per person (IDp) and risk by surface (IDs). Changes in dental status over time were explored from unerupted (U) to sound (S), including enamel caries (D1), dentine caries (D2) and caries involving pulp (D3) by computing transitional probabilities. RESULTS: The prevalence of caries was 2.0%, 22.8% and 68.1% among 9-, 12- and 18-month olds, respectively. The IDp observed for newly affected children 9-12 and 12-18 months old was 10.32 and 15.70 persons/100 person-months, respectively. The IDs for children 9-12 months old was 2.17 newly affected surfaces/100 surface-months whereas it was 2.22 surfaces/100 surface-months for children 12-18 months old. The buccal surface of maxillary incisors was the most affected (44.9%) followed by lingual, mesial and distal surfaces, respectively. The transitional probability of caries progression ranged between 1.79% and 15.38% during the follow-up period from 9 to 12 months old. It was 3.43-39.60% from 12 to 18 months old. CONCLUSIONS: An extremely high caries-affected rate was found among the study children even before the age of 18 months. The buccal surface of the maxillary incisors was the most affected. The teeth acquired caries at 3-6 months after initial eruption and carious lesions developed continuously over time.