A Retrospective Secondary Data Analysis of Telemedicine Service Utilization (2020-2023) Among Patients Covered By The Universal Coverage Scheme in Thailand.

Objective: The National Health Security Office in Thailand introduced a telemedicine program called "Telehealth/Telemedicine" in December 2020, which aimed to reimburse telemedicine services for patients with stable chronic diseases under the Universal Coverage Scheme (UCS). The current study investigated patient characteristics and trends in telemedicine service utilization under the UCS in Thailand and examined the impact of COVID-19 outbreaks on telemedicine services. Methods: A retrospective secondary data analysis using e-claim data from December 1, 2020, to April 18, 2023, was conducted. The analytical methods included descriptive analysis and an interrupted time series analysis. Results: During ∼29 months, 110,153 unique patients used telemedicine services, leading to a total of 259,047 visits. The average age was 54 years, and most of patients were female (57%). Hypertension was the most common diagnosis for patients receiving telemedicine services. Patients with mental health conditions often engaged in telemedicine consultation with drug delivery. During the Delta and Omicron outbreaks, telemedicine service utilization significantly increased compared with that in any nonpandemic periods within the 29-month timeframe (odds ratio [OR]: 3.85, p-value <0.01; OR: 2.55, p-value <0.01). Conclusions: The study findings highlight the initial trend of telemedicine services in Thailand from the start of the COVID-19 pandemic to the beginning of the post-COVID-19 period. As telemedicine will play a critical role in the future of health care, this information can support the scale-up of telemedicine, including monitoring and evaluation plans, to help improve the efficiency of the system.

Exploring the ambiguity in the anatomical terminology among Dental professionals.

BACKGROUND: Anatomical terms in medical literature have been used with varying meanings, leading to confusion in clinical practice. This study aims to investigate the ambiguity of anatomical terms in clinical dentistry. METHODS: Dentists who have undergone specialised training with at least one year of clinical experience were recruited to participate in the study. They were requested to localize specific terms on a skull and provide explanations based on their experience or opinion. All data were recorded, and then descriptive statistics were used for analysis. RESULTS: Seventy-eight participating dentists gave their consent and were eligible to study. For each anatomical term presented to dentists at least two meanings were provided, with some terms having up to eight interpretations. While most meanings were consistent with medical or dental literature, some responses revealed new interpretations not documented in textbooks. CONCLUSIONS: Dentists expressed anatomical terms with diverse meanings, possibly influenced by their various subspecialties. It is crucial to acknowledge this variability to prevent confusion. Emphasizing the consistent use of anatomical terms among dental professionals in the future is essential.

What is the impact of nicotine pouches on oral health: a systematic review.

BACKGROUND: Increase in nicotine pouch (NP) users, particularly among the young, is a matter of concern requiring a comprehensive understanding of its short- and long-term oral health implications. The objective of this research was to systematically review potential oral side-effects associated with NP usage. METHODS: This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Scopus, Cochrane Trial, and Google Scholar) were searched for relevant studies up to February 2024. Modified Newcastle-Ottawa Scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool were used to assess the quality and bias of the included studies. RESULTS: Three studies were included for this review, two from Europe and one from USA, and considered of a total of 190 participants. All studies were deemed to have a high risk of bias. Participants used NP for periods ranging from 1 month to 10 years. Among these studies, only one study provided information on the usage pattern between 1 and 5 units for an average of 11 ± 7 min per session. Oral mucosal changes at the site of placement were common among NP users. Oral lesions varied from slight wrinkling to various white lesions, seemingly related to the NP units consumed per day and their duration of usage. Other oral side effects included dry mouth, soreness, gingival blisters, and a strange jaw sensation. CONCLUSIONS: Research on the use of NP and its effect on oral health are currently limited. The use of NP should take into consideration the short-and-long-term effects, especially on oral health. Further studies are crucial to understand oral health implications associated with NP usage. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registration number CRD 42,024,500,711.

Telemedicine Utilization in Tertiary, Specialized, and Secondary Hospitals in Thailand.

Introduction: COVID-19 has accelerated the adoption of telemedicine for counseling, follow-up examination, and treatment purposes. The official guidelines in Thailand were launched to regulate or frame the protocols for health care professions and teams in different organizations. Objectives: To explore the trend of telemedicine utilization in selected hospitals in Thailand and to understand the characteristics of patients who used telemedicine from 2020 to 2023. Methods: This retrospective secondary data analysis was conducted in four hospitals in Thailand: two tertiary care (T1 and T2) hospitals, one secondary care (SN) hospital, and one specialized (SP) hospital. Data were routinely collected when services were provided and were categorized into telemedicine outpatient department (OPD) visits or onsite OPD visits. The data included demographic information (age, sex), date and year of service, location (province and health region), and primary diagnosis (using International Statistical Classification of Diseases and Related Health Problems 10th Revision codes). Descriptive analysis was conducted using R and STATA software. Results: All four hospitals reported an increase in telemedicine use from 2020 to 2023. The majority of telemedicine users were female (>65%) at all hospitals except for the SP hospital (44%). Participants aged 25-59 years reported greater utilization of telemedicine than did the other age-groups. The within-hospital comparison between OPD visits before and after telemedicine was significant (p < 0.001). Conclusion: The situation during the COVID-19 pandemic and the transition to the post-COVID-19 era impacted telemedicine utilization, which could support national monitoring and evaluation policies. However, further studies are needed to explore other aspects, including changes in telemedicine utilization over time for longer timeframes, effectiveness of telemedicine, and consumer satisfaction.

Inequalities in dental service utilization among Thai adults from 2000 to 2017.

OBJECTIVES: The Universal Coverage Health Scheme (UCS) was implemented in Thailand in 2002 to increase access to health services among the Thai population. This study aimed to evaluate socioeconomic inequalities in dental service utilization (DU) before and after UCS implementation and to assess factors associated with DU among Thai adults. METHODS: This study is based on secondary data from four Thai national oral health surveys in 2000-2001, 2006-2007, 2012 and 2017. Whether an individual from a nationally representative sample of Thai adults aged 35-44 went to see the dentist during the past year was used to define DU. The slope index of inequality (SII) and relative index of inequality (RII) were used to assess and compare education and income-related inequalities in DU. Poisson regression was used to assess factors associated with DU. Income inequalities were not reported for the year 2001 (Income data not available). RESULTS: Although DU increased after UCS implementation, socioeconomic inequalities persisted. DU was concentrated among high-education and income groups. Absolute educational inequalities were 0.16 (95% CI: 0.09-0.22), 0.21 (95% CI: 0.10-0.32), 0.26 (95% CI: 0.14-0.38) and 0.25 (95% CI: 0.18-0.32) in 2001, 2007, 2012 and 2017, respectively. Absolute income inequalities were 0.15 (95% CI: 0.04-0.26), 0.07 (95% CI: -0.04-0.18) and 0.12 (95% CI: 0.05-0.19) in 2007, 2012 and 2017, respectively. Occupation, type of health insurance scheme, sex and oral health-related behaviour were associated with DU. CONCLUSION: UCS has improved accessibility to dental services, but UCS alone might not narrow the inequalities gap for Thai adults.

Economic burden of becoming a dentist in Thailand.

OBJECTIVES: To determine the overall estimated financial impact and related expenses incurred over the duration of the undergraduate Dental Degree in Thailand. METHODS: A cross-sectional survey was conducted among all 658 dental undergraduates in Mahidol University, Thailand. Data was collected through a self-administered questionnaire, including the following information: (1) "Background and Demographics": household income, hometown, residence during study and source(s) of any financial aid received; (2) "Living Expenses": Living costs including food, transportation, rent, utility bills, and recreational expenses; (3) "Education related expenses": Including textbooks, stationeries, uniforms, and student activities fees. A cost-median was used as a baseline representation for the actual cost of each item. The mean differences of all expenses between groups before estimation was assessed by using the analysis of variance (ANOVA) method. The statistically significant differences were identified at p < 0.001. RESULTS: The estimated adjusted cost of becoming a dentist in Thailand is THB1,265,027 (36,143.63 USD) for students living at home and THB1,823,027 (52,086.49 USD) for those renting accommodation. Students who rented accommodation incurred significantly higher yearly living expenses than those who were living at home. (p < 0.001). The majority of participants (78.4%) were in households having a middle-to-high socioeconomic status. Ninety-five percentages of the participants' received 100% financial support from their families with no additional source of income, which reflects no real diversity in the socioeconomic background of Dental Degree students. CONCLUSION: The cost of a higher education Dental Degree in Thailand can be a significant barrier to entry and financial burden, especially for students from disadvantaged socioeconomic backgrounds. Government and Educational Policy makers need to pay more attention to this issue in order to provide equal opportunities for obtaining a University Dental Degree for all Thai students wishing to pursue this career path.

Effect of dentures and dietary advice on protein intake in older Thai adults with missing posterior occluding teeth.

OBJECTIVE: To compare the effectiveness of dentures with dietary advice and dentures alone on protein intake in older Thai adults. BACKGROUND: Dentures combined with nutritional advice may improve protein intake in older adults with posterior tooth loss. However, evidence is limited, especially in developing countries. METHODS: A randomised-control trial including 69 older adults with less than four pairs of posterior occluding teeth was conducted for 3 months. The experimental group received dentures and dietary advice based on the Health Belief Model (HBM); the control group received dentures alone. Three-day dietary records were collected and protein intake was assessed using INMUCAL-NUTRIENTS V.4.0 software at baseline, 1 month, and 3 months after the intervention. Data were analysed using a t-test, Mann-Whitney U test, chi-square test, and repeated-measure ANOVA. RESULTS: Both groups reported significantly increased protein intake (control group = 0.4, 0.5, 0.6 g kg BW-1 d-1 , intervention = 0.4, 0.6, 0.7 g kg BW-1 d-1 , at baseline, 1 month and 3 months, respectively). However, participants in the experimental group had significantly higher total protein (36.3 vs. 39.8 g/d, P = .032) and animal protein intake (18.9 vs. 23.2 g/day, P = .020) than those in the control group at 3 months after the intervention; plant protein intake was similar (10.9 vs. 11.5 g/day, P = .923). In addition, the HBM scores of the experimental group were higher than those of the control group after the intervention (P < .001). CONCLUSION: Dentures combined with dietary advice significantly increased the total and animal protein intake of older people with posterior tooth loss more than dentures alone. To maintain optimal protein intake, dental practitioners should incorporate dietary advice when providing dental prostheses to older adults with posterior tooth loss.

Paradigm shift in infection control practices in dental clinics in response to COVID-19 among dental professionals in Thailand.

Infection control (IC) practice routines depend mainly on knowledge, perception, and awareness of a disease among dental professionals. However, there has been no report on the perception, awareness, and adaptability to the new practice guidelines of Thai dental professionals (dentists, dental nurses, dental assistants, and dental technicians) to the COVID-19 pandemic. This study aims to investigate how dental professionals in Thailand perceive and are aware of COVID-19, and how they have changed their IC practices in response to the pandemic. Online cross-sectional surveys using convenience sampling during September 2021 were sent to Thai dental professionals. The data were analyzed using descriptive statistics and the Chi-square test. Statistical analysis was performed using the Statistical Package for Social Sciences, version 22.0. The tests were two-tailed, with a significance level of p < 0.05 and 95% confidence intervals (CIs). The 1,177 dental professionals who completed the questionnaire were from the public and private sectors. Most respondents obtained their knowledge about COVID-19 from social media (91.8%). 86.7% had adapted to the new IC practice guidelines. The respondents reported that they had modified their work practices in several aspects; changes in administrative control, 1,039 (88.3%); enhancing local source control of dental aerosols, 1,031 (87.6%); heightening sterilization and disinfection procedures, 1,032 (87.7%); and improving the ventilation system, 994 (84.5%). As of October 2021, 1,162 (98.7%) respondents were vaccinated, and 47 (3.99%) had tested positive for COVID-19 compared with 2.30% in the general population. Among infected individuals, 10 (21.3%) were suspected of being infected while working in the dental setting. In conclusion, with an average worry score well over 4.10 out of 5, more than 96% of Thai dental professionals reported seeking updated knowledge and agreed that escalation of IC measures was needed. However, only 86.7% improved their COVID-19 infection prevention practices in 4 aspects and appropriate PPE use. The infection rate in dental professionals was 3.99%, with the highest infection rate in dental assistants. Despite statistical insignificance of infection rate between changed and unchanged group, it cannot be concluded that stricter IC measures are negligible as ones might contract disease from setting other than work.

Functional dentition and changes in dietary patterns among older adults in Thailand.

OBJECTIVE: To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults. DESIGN: This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score. SETTING: Phetchaburi, Thailand. PARTICIPANTS: Totally, 788 community dwellers aged ≥ 60 years. RESULTS: In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: -0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: -0·17, 0·40) as well as larger reductions in meat-rich diet intake (-0·12; 95 % CI: -0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant. CONCLUSION: There was little support for an association between baseline FD and changes in DP.

Functional Dentition and 12-Month Changes in Body Measurements among Thai Older Adults.

This study evaluated the association of functional dentition with 12-month changes in body measurements and nutrient intake among older adults. Data from 651 community dwellers, aged 60 years and over, in Phetchaburi, Thailand, were analysed (retention rate: 83%). Data were collected via interviews (including a semi-structured food frequency questionnaire), anthropometric measurements and dental examinations. Associations were tested in linear regression models adjusted for baseline sociodemographic factors, behaviours, chronic conditions and medications. On average, participants experienced a significant increase in body mass index (BMI) and significant decreases in waist circumference (WC) and triceps skinfold thickness (TSF). A negative, albeit not significant, association between functional dentition and change in BMI was observed after adjusting for confounders. Whilst participants who had non-functional dentition without dentures experienced increases in BMI (predicted mean change: 0.25; 95% Confidence Interval: 0.09, 0.41), those who had non-functional dentition with dentures (0.21; 95%CI: -0.08, 0.50) and functional dentition (-0.07; 95%CI: -0.42, 0.28) remained stable. No similar trends were noted for WC or TSF. Functional dentition was not associated with changes in nutrient intake either. The findings provide little evidence on the association of functional dentition with short-term changes in nutrient intake or nutritional status.

Functional dentition, dietary intake and nutritional status in Thai older adults.

OBJECTIVES: To explore the relationship between functional dentition and nutritional status among Thai older adults, and the role of nutrient intake in this association. BACKGROUND: Evidence on the interplay between tooth retention, diet and nutritional status is still inconclusive, with most evidence coming from Western countries. METHODS: Seven hundred and eighty-eight Thai adults, aged 60+ years, living in Phetchaburi Province, Thailand, participated in this cross-sectional study. Data were collected through questionnaires, body measurements and dental examinations. Being underweight (Body Mass Index < 18.5) and overweight/obese (BMI > 25) were the two outcome measures. Functional dentition was defined as having 10+ functional tooth units. The association of functional dentition with each outcome was assessed in regression models adjusted for sociodemographic factors, behaviours, chronic conditions and total energy intake. The role of various nutrients in explaining the above associations was quantified via the per cent attenuation in the coefficient for functional dentition. RESULTS: Functional dentition was associated with being underweight but not with being overweight/obese. After adjustments, participants with functional dentition were 61% (prevalence ratio: 0.39, 95% CI: 0.16, 0.95) less likely to be underweight than those with neither functional dentition nor dentures. In addition, participants with functional dentition had significantly greater intake of dietary fibre and thiamine (Vitamin B1 ) than those with neither functional dentition nor dentures. The two nutrients explained a small part of the association between functional dentition and being underweight. CONCLUSION: Having a functional dentition was negatively associated with being underweight. The consumption of dietary fibre and thiamine explained a small part of this association.

Does tooth loss affect dietary intake and nutritional status? A systematic review of longitudinal studies.

INTRODUCTION/OBJECTIVE: A systematic review was conducted to explore whether tooth loss affects dietary intake and nutritional status among adults. DATA: Longitudinal studies of population-based or clinical samples of adults exploring the effect of tooth loss on food/dietary/nutrient intake and/or nutritional status were included for consideration. The risk of bias was assessed using the Newcastle-Ottawa Scale for cohort studies. SOURCES: A search strategy was designed to find published studies on MEDLINE, EMBASE and LILACS up to March 2017. STUDY SELECTION: Eight longitudinal studies in 4 countries (United States, Japan, Australia and Brazil) were included. Five of the six studies investigating the association between tooth loss and dietary intake showed significant results. The only consistent association, as reported in 2 studies, was for greater (self-reported) tooth loss and smaller reductions in dietary cholesterol. Three of the 4 studies investigating the association between tooth loss and nutritional status showed significant results. However, most results were contradicting. The quality of the evidence was weak. CONCLUSION: There is at present no strong evidence on the effect of tooth loss on diet and nutrition, with inconsistent results among the few studies identified. Additional high-quality longitudinal studies should address the limitations of previous studies identified in this review.

Oral impacts on quality of life and problem-oriented attendance among South East London adults.

BACKGROUND: Dental care seeking behaviour is often driven by symptoms. The value of oral health related quality of life (OHRQoL) measures to predict utilisation of dental services is unknown. This study aims to explore the association between OHRQoL and problem-oriented dental attendance among adults. METHODS: We analysed cross-sectional data for 705 adults, aged 16 years and above, living in three boroughs of Inner South East London. Data were collected during structured interviews at home. The short form of the Oral Health Impact Profile (OHIP-14) was used to assess the frequency of oral impacts on daily life in the last year. Problem-oriented attendance was defined based on time elapsed since last visit (last 6 months) and reason for that visit (trouble with teeth). The association between OHIP-14 (total and domain) scores and problem-oriented attendance was tested in logistic regression models adjusting for participants' sociodemographic characteristics. RESULTS: Problem-oriented attenders had a higher OHIP-14 total score than regular attenders (6.73 and 3.73, respectively). In regression models, there was a positive association between OHIP-14 total score and problem-oriented attendance. The odds of visiting the dentist for trouble with teeth were 1.07 greater (95% Confidence Interval: 1.04-1.10) per unit increase in the OHIP-14 total score, after adjustment for participants' sociodemographic characteristics. In subsequent analysis by OHIP-14 domains, greater scores in all domains but handicap were significantly associated with problem-oriented attendance. CONCLUSION: This study shows that oral impacts on quality of life are associated with recent problem-oriented dental attendance among London adults. Six of the seven domains in the OHIP-14 questionnaire were also associated with dental visits for trouble with teeth.