Strategic Management of Early Childhood Caries in Thailand: A Critical Overview

Long-term costs of dental care for thailand preschool children by using a system dynamics model

BACKGROUND

A System Dynamics Model (SDM) is a computer simulation to alleviate the problem by comparing strategies and policies. Addressing the costs by using SDM helps in allocating the resources efficiently in managing the strategies.

OBJECTIVE

To describe the costs of primary, secondary, and tertiary prevention of dental caries for 0-5-year-old children by SDM.

METHODS

The SDM was developed to explore the cost of primary and secondary prevention (supervised toothbrushing, STB and fluoride varnish, FV), the treatment cost for caries (tertiary prevention), and the total cost under three scenarios; STB, FV and base case (no intervention).

RESULTS

When the children aged 5 years, the treatment cost under the base case was the highest at 57.6 million baht while 53.5 million baht in FV and 51.9 million baht in STB. As a total cost, 64.1 million baht under FV, 60.9 million baht under STB, and 57.6 million baht under base case. Sensitivity analysis reveals that the effective rate of STB must be at least 30%, and FV should be a minimum of 50% to ascertain the total cost reduction relative to the base case scenario.

CONCLUSION

Caries treatment costs were lower when STB and FV were implemented than in the base case scenario. The overall cost under FV was the highest, followed by STB, with no total cost savings observed as compared to the base case situation. Despite that, carrying out the STB rather than the FV would save a total of 3.2 million baht. Treatment costs under interventions would be lower than expected, and overall cost reductions might be obtained by comparing the base case if the intervention's effective rates are higher, according to sensitivity analysis.

A systematic review and meta-analysis on early-childhood-caries global data

OBJECTIVES

The present study systematically reviewed and provided a meta-analysis on early childhood caries (ECC) global prevalence and its association with socioeconomic indicators, both geographical and regarding unemployment rate, national income as well as income inequalities.

METHODS

Only cross-sectional or cohort studies covering ECC prevalence and experience in children younger than 71 months, reporting sample size, diagnostic criteria and conducted in urban and rural communities were considered. No language restriction was selected. Studies published from 2011 to 2022 available in PubMed, Web of Science, Embase and Open Grey literature were retrieved by ad hoc prepared search strings. The meta-analyses were conducted for both overall ECC prevalence and experience stratified by country of publication as well as measures of socioeconomic indicators using a random effects model using STATA 18®.

RESULTS

One hundred publications reporting ECC data from 49 countries (published from 2011 to 2022) were included and summarized by meta-analysis. The lowest prevalence was reported in Japan (20.6%) and Greece (19.3%). The global estimated random-effect pooled prevalence of ECC was 49% (95%CI: 0.44-0.55). The random-effect pooled caries prevalence (ECC) was 34% (95%CI: 02.20-0.48) (Central/South America), 36% (95%CI: 0.25-0.47) (Europe), 42% (95%CI: 0.32-0.53) (Africa), 52% (95%CI: 0.45-0.60) (Asia-Oceania), 57% (95%CI: 0.36-0.77) (North America) and 72% (95%CI: 0.58-0.85) (Middle East). When stratified by gross national income (GNI) the ECC prevalence ranged from 30% ($20,000-$39,999) to 57% in countries with the lowest GNI (<$5000). Stratification by inequality index (Gini index) resulted in an ECC prevalence range of 39% (low inequality) to 62% (no inequality), while for life expectancy the ECC prevalence ranged from 28% in countries with the highest life expectancy (< 80 years) to 62% in countries with 71-75 years life expectancy.

DISCUSSION

Within the limitations of this study (lack of certainty about the results as many countries are not represented and lack of uniformity in prevalence and experience data represented), results from 49 different countries reported a wide range of ECC prevalence. These reports indicated persisting high worldwide distribution of the disease. Both ECC prevalence and experience were associated with geographical areas and GNI.

REGISTRATION

PROSPERO: CRD-42,022,290,418.

Teaching of silver diamine fluoride for the management of dental caries and hypersensitivity - situation in the Southeast Asia dental schools

BACKGROUND

Using silver diamine fluoride (SDF) for caries management has raised dentists' interests in Southeast Asia (SEA). However, information about the teaching of SDF in dental schools in SEA is limited. Therefore, this survey aimed to describe the extent to which SDF had been introduced into the education of undergraduate students in the dental schools in SEA.

METHODS

An online questionnaire survey was conducted on the duration, method, contents, and barriers regarding the teaching of SDF. Teachers in charge of undergraduate program in pediatric dentistry and those in community dentistry in all the 90 dental schools in SEA were approached and we required each department to reply once only. Descriptive statistics and Chi-square test were used to describe and assess the differences between the two departments in the teaching of SDF.

RESULTS

A total of 81 responses from the departments of 49 schools were received, giving a school-level response rate of 54% (49/90). SDF was taught in the undergraduate program in 86% (42/49) of the respondent schools, and 50% (21/42) of these schools had included SDF in the teaching for five or more years. Almost all (98%) of the departments taught SDF through lectures. Furthermore, 55% of them adopted SDF in clinical practice. Regarding the teaching content, the use of SDF for arresting cavitated caries lesion was the most commonly covered (82-97%), followed by for arresting early noncavitated lesions (69-82%), for preventing new caries development (66-79%) and for treating dental hypersensitivity (77%). There were variations in the post-treatment instruction taught. For the departments not teaching SDF, the most common reason (10/19, 53%) was that SDF was not available.

CONCLUSION

SDF is covered in the undergraduate program in most of the dental schools in SEA. The use of SDF to arrest cavitated caries lesions in primary teeth is usually taught. However, other applications of SDF, such as for prevention of caries and treatment of dental hypersensitivity, are less commonly mentioned in the teaching.

Comparative efficacy of topical povidone-iodine and chlorhexidine gel on dental plaque regrowth in toddlers: A randomized controlled trial

OBJECTIVES

This study aimed to compare and evaluate the efficacy of topical use of povidone-iodine (PVP-I) solution and chlorhexidine (CHX) gel on dental plaque regrowth after 3 and 7 days in toddlers aged 24-36 months.

MATERIALS AND METHODS

A randomized controlled trial that included 45 healthy toddlers aged 24-36 months, who were randomly assigned to three groups. The first group received a placebo (distilled water (DW)) (negative control). The second group received topical CHX gel (0.2% w/v) (positive control). The third group received topical PVP-I solution (10% w/v). Plaque accumulation was measured at the baseline (t0 ), after 3 days (t1 ) and after 7 days (t2 ) using the Turesky-modified Quigley-Hein plaque index (TMQHPI). Oral hygiene practices were prohibited during the trial period. The trial ID is ACTRN12623000567628.

RESULTS

In the DW group, the mean of the TMQHPI score was 1.89 ± 0.67 at t0 and decreased to 1.45 ± 0.66 at t1 (p = .028). Similarly, in the CHX group, the mean of the TMQHPI score was 1.83 ± 1.06 at t0 and decreased to 1.02 ± 0.99 at t1 (p = .033). Regarding the PVP-I group, the mean of the TMQHPI score went from 1.84 ± 0.85 to 1.01 ± 0.61 at t1 and then increased to 1.57 ± 0.74 at t2 . Those changes were statistically significant (p = .001) and (p = .002), respectively. No statistically significant difference was noted between TMQHPI scores at t0 (p = .789). Regarding t1 and t2 , no statistically significant difference was found between the three groups (p > .05).

CONCLUSION

CHX and PVP-I efficacy lasted only for 3 days, and PVP-I was not superior to CHX in terms of plaque control in toddlers. However, further studies are needed to determine the long-term efficacy of these antiplaque agents in toddlers.

Factors associated with oral health care behaviors of pregnant women in a northeastern province in Thailand: A hospital-based cross-sectional study

BACKGROUND

Oral healthcare behavior leads to oral health status. Factors associated with oral healthcare behavior might affect oral hygiene in pregnant women, who are at high risk for gingivitis and dental caries. This study aimed to explore factors associated with oral healthcare behaviors during pregnancy among pregnant women in a northeastern province of Thailand.

METHOD

A total of 405 pregnant women who attended antenatal care clinics at one of the government hospitals in the province were invited to participate in this cross-sectional study. Dentists in the hospitals measured pregnant women's gingivitis and dental calculus status using mouth mirrors and explorers. A structured questionnaire was used to obtain variables of interest. Linear regression analysis, Beta and 95% confidence interval (CI) were applied.

RESULTS

The majority were 20-24 years old (33.6%). Most of the participants had received upper secondary education (37.6%). Majority had gingivitis (88.1%) and dental calculus (88.6%). The findings revealed that age (Beta = -0.129, 95%CI = -0.269, -0.016), educational level (Beta = 0.118, 95% CI = 0.110, 0.183), and oral health literacy (Beta = 0.283, 95% CI = 0.156, 0.319) were statistically significant factors associated with oral healthcare behaviors.

CONCLUSION

Younger pregnant women had better oral healthcare behaviors than older pregnant women and pregnant women had better oral healthcare behaviors due to higher educational levels and oral health literacy. Oral health promotion should be improved through oral health literacy, and interventions should be added to improve oral care skills particularly in older pregnant women as they are at a greater risk for poor oral healthcare behaviors.

Multivariable Projections of Caries-Free Prevalence and the Associated Factors from 2019 to 2030 among Schoolchildren Aged 6, 12 and 16-Year-Old in Malaysia

This study identified caries-free associated factors and conducted multivariable projections of the caries-free prevalence until 2030 among six-, 12-, and 16-year-old schoolchildren in Malaysia. It was a secondary data analysis of caries-free prevalence and potential associated factors obtained from the Health Information Management System (HIMS), Department of Statistics Malaysia (DOSM), and Food Balance Sheets (FBS). Multiple linear regression and regression with ARMA errors were employed to determine the associated factors and predict the caries-free prevalence from 2019 or 2020 until 2030 for the six-, 12-, and 16-year-old groups, respectively. Gross Domestic Product (GDP) and household income, sugar consumption, and water fluoridation were significantly associated with caries-free status, with the most impactful in all age groups being water fluoridation. With the projected values of the associated factors, the caries-free prevalence in schoolchildren of all age groups in Malaysia is predicted to increase in the next decade. Similar to the past decade, the prevalence trend will remain the highest among the 12-year-olds and the lowest among six-year-olds. Caries-free prevalence was predicted to increase by 9.10%, 15.52%, and 15.10% in the six-, 12-, and 16-year-old groups, respectively. The prevalence multiplied the highest at four times greater than in the past ten years among 16-year-olds, compared with less than 2% in the six- and 12-year-old groups. In conclusion, by factoring in economic factors, sugar consumption, water fluoridation, and age groups, the caries-free prevalence of schoolchildren in Malaysia is projected to increase at different rates in the next decade until 2030. Thus, strategic oral health plans to recognise effective promotion programmes and strengthen others for each age group are crucial.

Silver diamine fluoride therapy for dental care

Silver diamine fluoride (SDF) was developed in Japan in the 1960s. It is used to control early childhood caries, arrest root caries, prevent fissure caries and secondary caries, desensitise hypersensitive teeth, remineralise hypomineralised teeth, prevent dental erosion, detect carious tissue during excavation and manage infected root canals. SDF is commonly available as a 38% solution containing 255,000 ppm silver and 44,800 ppm fluoride ions. Silver is an antimicrobial and inhibits cariogenic biofilm. Fluoride promotes remineralisation and inhibits the demineralisation of teeth. SDF also inactivates proteolytic peptidases and inhibits dentine collagen degradation. It arrests caries without affecting dental pulp or causing dental fluorosis. Indirect pulp capping with SDF causes no or mild inflammatory pulpal response. However, direct application of SDF to dental pulp causes pulp necrosis. Furthermore, SDF stains carious lesions black. Patients must be well informed before SDF treatment. SDF therapy is simple, painless, non-invasive, inexpensive, and requires a simple armamentarium and minimal support. Both clinicians and patients generally accept it well. In 2021, the World Health Organization included SDF as an essential medicine that is effective and safe for patients. Moreover, it can be used for caries control during the COVID-19 pandemic because it is non-aerosol-generating and has a low risk of cross-infection.