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.

Awareness of HLA-B* 15:02 screening in trigeminal neuralgia and the gene screening policy among dentists in Southern Thailand.

OBJECTIVES: To determine the factors associated with public hospital dentists' awareness of HLA-B*15:02 screening in trigeminal neuralgia (TN) and the national gene screening policy in Thailand. METHODS: Cross-sectional study. A validated questionnaire was distributed to public hospital dentists with at least 1 year of practice in Southern Thailand (n = 760) to assess their knowledge of TN, carbamazepine (CBZ) use, awareness of HLA-B*15:02 screening, and the gene screening policy. RESULTS: A total of 385 dentists participated (50.7% response rate); 81.3% of respondents were aware of HLA-B*15:02 screening. However, 18.7% of dentists were not aware of the importance of gene testing. Furthermore, dentists who were aware of gene screening had significantly better knowledge of TN diagnosis and CBZ use than "unaware" dentists. Awareness of HLA-B*15:02 screening was also significantly associated with dental specialty. Moreover, 80.5% of respondents were not aware of the gene screening policy. The primary problems related to the policy were its inefficient publication, poor implementation, and lack of clinical practice guidelines (CPGs) to encourage dentists to follow the policy and prescribe gene tests. CONCLUSION: While most hospital dentists were aware of the necessity of HLA-B*15:02 screening prior to prescribing CBZ in TN, the majority were unaware of the national gene screening policy. Dental specialty and knowledge were associated with awareness of HLA-B*15:02 screening.

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.

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.

Enhancement of salivary human neutrophil peptide 1-3 levels by probiotic supplementation.

BACKGROUND: Probiotic supplementation can reduce mutans streptococci (MS) numbers. One of its proposed mechanisms is immunomodulation. Salivary human neutrophil peptide 1-3 (HNP1-3) levels have previously been demonstrated to be higher in caries-free than in caries-susceptible children, suggesting their preventive role against caries. We aimed to compare salivary HNP1-3 levels between an intervention group with probiotics and a control group. METHODS: A randomized double-blinded clinical trial was conducted. Sixty schoolchildren were equally allocated to either an intervention or control group. The use of a probiotic strain, Lactobacillus paracasei SD1, has shown to reduce MS numbers in volunteers. In unstimulated whole saliva, HNP1-3 levels were assayed by ELISA, and MS and lactobacilli counts were assayed by colony counting at baseline (T0) and at 3 (T3), 6 (T6), and 12 months (T12). The International Caries Detection and Assessment system was used to assess caries status. RESULTS: In the intervention group, salivary HNP1-3 levels were significantly greater than those in the control group at T3 and T6 (p < 0.001), whereas MS counts were significantly decreased (p < 0.01). In the intervention group, positive and negative correlations were found between HNP1-3 levels and lactobacilli counts and between MS and lactobacilli counts, respectively. However, there was no significant correlation between enhanced HNP1-3 levels and decreased MS numbers. The caries increment for the pit and fissure surface, but not for the smooth surfaces, was significantly decreased in the intervention group compared with the control group (p = 0.01). CONCLUSIONS: Probiotics can temporarily enhance salivary HNP1-3 levels; however, their action to reduce new pit and fissure caries probably involves microbial interactions. TRIAL REGISTRATION: TCTR20130904001 (registration date: September 04, 2013).

Effect of Long-Term Consumption of Lactobacillus paracasei SD1 on Reducing Mutans streptococci and Caries Risk: A Randomized Placebo-Controlled Trial.

BACKGROUND: A previous study revealed Lactobacillus paracasei SD1, a probiotic strain, could reduce mutans streptococci (MS). The aim of this study was to evaluate the long-term effects of L. paracasei SD1 on the colonization of MS, and whether caries lesions developed. METHODS: After informed consent, 122 children were recruited and randomly assigned to the probiotic or control groups. The probiotic group received milk-powder containing L. paracasei SD1 and the control group received standard milk-powder once daily for six months. Salivary MS and lactobacilli were enumerated using differential culture at baseline and at three-month intervals for 12 months. The persistence of L. paracasei SD1 was investigated using AP-PCR for DNA-fingerprinting. Oral health was examined at baseline and at the end of the study according to WHO criteria. RESULTS: The long-term consumption could prolong colonization of L. paracasei SD1. Significantly reduced MS counts and increased lactobacilli levels were found among children in the probiotic group. There were less caries lesions in the probiotic group at the end of the study. A significant reduction of the development of new caries lesions (4.5 times) was observed in the high caries risk group but not in the low caries risk group. CONCLUSIONS: Results demonstrate that the long-term daily ingestion of the human-derived probiotic L. paracasei SD1 significantly reduces the number of MS and caries risk in the high caries group.

Optimizing the mix of basic dental services for Southern Thai schoolchildren based on resource consumption, service needs and parental preference.

OBJECTIVES: To identify the optimal levels and mix of basic dental services (sealants and fillings for permanent teeth and extraction of primary teeth) under two different dental settings: hospital-based and mobile dental clinics under specified resource constraints. METHODS: A linear programming model is used based on explicit identification of system objectives and resource constraints. The objective was to maximize benefits as measured by parental willingness to pay (WTP) for basic dental services provided to schoolchildren subject to constraints on total resources, service need and parental preferences among different dental care settings. RESULTS: Optimization was identified to require 270, 180, 552, 828, 228 and 532 cases of hospital sealant, mobile sealant, hospital filling, mobile filling, hospital extraction and mobile extraction, respectively. The corresponding current service levels were 48, 281, 191, 170, 479, and 677 respectively. The optimal service configuration produced a total WTP of 485 860 baht which exceeded the WTP for the current service configuration by more than 75.4%. CONCLUSIONS: Mobile clinic fillings were the highest priority among basic dental services. The current service configurations fail to reflect the setting preferences and provide greater emphasis to extractions than the optimal configuration with less emphasis given to preventive and restorative services.

Comparison of the effects of secondary prevention in schoolchildren between hospitals with and without mobile dental services in Southern Thailand.

The aim of the present study was to compare the performance of hospital clinics with and without adjunct mobile services for the delivery of secondary prevention for caries in Thai schoolchildren. A dental survey was conducted in schools served by different dental services. 711 schoolchildren were selected from primary schools in Southern Thailand by multistage cluster random sampling. WHO basic oral health survey methods were employed to evaluate three outcomes of secondary prevention: 1) Coverage of secondary prevention - all filled teeth (FT+D(F)T) among caries experienced teeth (DMFT), 2) Effectiveness of secondary prevention - successfully filled teeth (FT) among all filled teeth (FT+D(F)T) and 3) Protective effect of secondary prevention- successfully filled teeth (FT) among caries experienced teeth (DMFT). The respective percentages were 74.3, 97.5 and 72.5 in the children served by hospital-only services, and 41.3, 97.2 and 40.2 in the other group. From clustered logistic regression modeling, only the first and third outcomes were significantly different between the two access groups. This study showed that adjunct mobile service may be less effective in secondary prevention.

Estimating unit costs for dental service delivery in institutional and community-based settings in southern Thailand.

In this cross-sectional study, the cost of different dental services was estimated and the unit costs of dental services for schoolchildren were compared between 2 settings: hospital-based and community-based mobile dental clinics. Heads of all departments in a selected community hospital were invited to attend 2 workshops to collect relevant data. Unit costs of different dental services varied from 41 to 2693 baht, with services falling into 4 unit cost groups: very high, high, moderate, and low. The very-high-unit-cost services included rehabilitative dental services. The high-unit-cost services covered removal of an impacted tooth, root canal treatment, and tooth-color fillings. The moderate-unit-cost group included a wide range of other dental services, with screening and oral hygiene instruction in community-based dental clinics falling into the low-unit-cost group. Generally, services provided in the community-based mobile clinic had lower unit costs than the same services provided in the hospital dental clinic.

Prevention versus cure: measuring parental preferences for sealants and fillings as treatments for childhood caries in Southern Thailand.

OBJECTIVES: To determine the parental relative preferences for prevention versus cure in the treatment of caries in children to inform service planning for publicly funded children's dental care services. We measure parents' Willingness to pay (WTP) for two basic dental treatments: prevention (sealant) and cure (filling) and consider whether the relative preferences between the two services are affected by differences in parents' incomes. METHODS: Two hundred and five parents of primary school children in Southern Thailand were asked questions about their WTP for the different services as well as background information. Comparative information on caries process, treatment procedure and effectiveness was presented to subjects. Each subject's WTP was determined for sealants and fillings provided in hospital dental clinic using a bidding game approach. RESULTS: Mean WTP for sealants and fillings were not significantly different. After adjustment for parents' characteristics, the WTP for sealants and fillings remained similar. Adjusted WTP for both services among higher income group were greater than those in lower income group. CONCLUSIONS: Valuing of prevention versus cure was similar after controlling for parents' characteristics. Parent's income was a factor affected to WTP. Parental preferences might be a constraint to extending service utilization for the prevention of caries among primary school children.

Different dental care setting: does income matter?

In this paper we consider the use of mobile dental clinics as a means of improving access to dental care among primary school children in Southern Thailand by reducing the opportunity cost of service use to parents. Parents' willingness to pay (WTP) is measured for three different services provided in a community hospital dental clinic and a school-based mobile clinic. Although the service setting does not affect significantly the WTP for treatment directly, the estimated positive association between WTP and income is modified by setting. The results indicate that the potential for mobile clinics to increase utilization of services among primary school children is associated with parents' income, with the difference in valuation of dental services between the two settings being less among lower income parents than higher income parents. However, even among lower income parents our results indicate that the potential for increasing service utilization among children depends on the improvements in access associated with the mobile clinic not being achieved at the opportunity cost of lower levels of effectiveness.