Inequality in dental care utilisation among Thai children: evidence from Thailand where universal coverage has been achieved.

AIMS: To quantify the extent of the socioeconomic-related inequality in dental care utilisation among Thai children and to examine the characteristics of dental care utilisation, after the country achieved universal coverage. DESIGN: The data to perform analyses were taken from the nationally representative Health and Welfare Survey (HWS) and Socioeconomic Survey (SES) 2007 in Thailand. PARTICIPANTS: Data of 15,736 representative Thai children (aged below 15 years) were selected. METHODS: Descriptive analyses were performed to reveal the features of dental care utilisation among Thai children, in addition to use the concentration index (CI) to measure socioeconomic-related inequality in dental care utilisation. Logistic regression was employed to determine inequality in dental care across socioeconomic strata. RESULTS: The unequivocal gradient in dental care utilisation persistence among Thai children and the socioeconomic-related inequality in dental care utilisation is more concentrated among the better-off as the positive CI value (equals 0.069) emerged. Poor children, however, are more likely to utilise dental care at public facilities, particularly primary care facilities. CONCLUSION: The evidence from Thailand, where universal coverage has been virtually achieved, provides some lesson for other countries particularly developing countries. Although the socioeconomic-related inequality in dental care utilisation among Thai children still exists, the pro-poor dental care utilisation at public facilities, particularly primary care facilities substantiate the impressive stride towards the concerted effort to reducing inequitable dental care delivery for Thai children.

Clinical application of a VSCs monitor for oral malodour assessment.

PURPOSE: The purpose of this study was to evaluate a volatile sulfur compounds (VSCs) monitor's ability to assess oral malodour in patients with and without periodontal disease in comparison with the assessment by gas chromatography (GC) or organoleptic testing. MATERIALS AND METHODS: Ninety-nine patients' mouth air was measured by GC, a VSCs monitor (Breathtron) and organoleptic test. Patients who had a periodontal pocket depth of 4 mm and more for at least two tooth surfaces were assigned to the periodontal disease group. RESULTS: Total VSCs value by the Breathtron was higher in periodontal disease group than that in non-periodontal disease group, and it showed statistically significant correlations with specific VSCs gases from GC and with the organoleptic measurement. The Breathtron had high sensitivity in both groups. CONCLUSION: The Breathtron can be a reliable instrument for the diagnosis of halitosis. However, the Breathtron should be used properly for measuring VSCs that are related to periodontal disease.

Association between oral malodor and measurements obtained using a new sulfide monitor.

OBJECTIVE: The purpose of this study was to evaluate the ability of a new volatile sulfur compounds (VSCs) monitor to assess oral malodor in subjects and compare its performance with those of organoleptic testing and gas chromatography. METHODS: The mouth air of 260 patients was measured by three methods: VSCs monitor (Breathtron), organoleptic test by two judges and gas chromatography (GC). Mcnemar test and Pearson correlation were used to analyze the data among these methods. RESULTS: The log values of VSCs measured by a sulfide monitor were significantly correlated with the organoleptic ratings, and also with log values of H(2)S, CH(3)SH, and (CH(3))(2)S determined by GC (P<0.01). Using the results of organoleptic and GC to classify subjects into normal and malodor groups, the sulfide monitor's sensitivity was shown to be more than 79% and the specificity was 61-73%. CONCLUSIONS: This sulfide monitor could be used for oral malodor measurement, moreover, according to its portability, it could be conveniently used for clinical setting and field surveys.

The process and outcome of a programme for preventing early childhood caries in Thailand.

OBJECTIVE: To evaluate the process and outcomes of a participatory dental health education (DHE) programme for preventing early childhood caries (ECC). DESIGN: A one-year intervention programme. SETTING: 21 health centres. PARTICIPANTS: 520 mothers/caregivers of 6-19 month-old children who lived in a rural area of Thailand. INTERVENTION: Small group discussion with active involvement in the intervention group and the national teaching DHE programme in the control group. MAIN OUTCOME MEASURES: Health centre staff impact evaluation, children's dental cavitated carious increment and stated changes in oral health behaviour. RESULTS: After one-year, the percent of subjects using a toothbrush and tooth brushing with fluoride toothpaste was 93% and 87% respectively in the intervention group, significantly higher (p<0.01) than the control group (73% and 58% respectively). Night time bottle-feeding, falling asleep with a bottle and sweet snack diet behaviour appeared the same in both groups. The net cavitated carious increment was 3.5 (SD=3.4) teeth in the intervention and 3.2(SD=3.5) in the control group. Health centre staff were very supportive of the programme and suggested extending the participatory format to other child health topics. CONCLUSIONS: The participatory dental health education model was shown to be a practical and effective method for increasing oral hygiene practice, but was not sufficient to prevent the development of ECC. This single intervention in the short term is not seen as sufficient to prevent the development of ECC.

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.