Abstract
The aim of this report was to advocate early childhood caries (ECC) and share strategic management in Thailand, despite over two decades of free Universal Health Coverage including oral healthcare. The recent Thai national oral health survey in 2017 indicates the very high prevalence of ECC, with an average of three carious teeth affected in 53% of 3-year-old children. This is despite the efforts of the Ministry of Public Health that has launched several interventional programs ranging from an upstream policy that prohibits sugar additions in baby formula milk to downstream remediations such as advocating and encouraging toothbrushing with fluoride toothpastes. Nevertheless, ECC is strongly predicated by other key factors including the family and community commitment and participation, as embodied in the current World Health Organization guidelines. These encompass three different tiers of community-level prevention: primary, secondary, and tertiary. Accordingly, the following strategies for ECC management in Thailand should be based at primary care clusters (PCC) in sub-district health centers, with the assistance of inter-professional health teams. These include community education on the importance of deciduous teeth and effective toothbrushing with fluoride toothpaste (primary prevention), regular examination and detection of ECC lesions and early intervention (secondary prevention), insertion of non-invasive preventive restorations using cost-effective atraumatic restorative treatment (ART) or simplified and modified ART (SMART) (tertiary prevention), and, finally, effective follow-up and monitoring systems. It is anticipated that this triple tier approach to ECC management will improve not only the oral health but also the overall children's health.
Highlights
Childhood Caries (ECC) is a major public health problem in Thailand
The newest national oral health survey from Thailand in 2017 indicates the very high prevalence and severity of Early Childhood Caries (ECC) in the country, with an average of three carious teeth affected in 53% of 3-year-old children [1]
The healthcare system in Thailand is grounded on the principle of free universal health coverage, with emphasis on the primary care clusters (PCC) that are focused on the family unit and its well-being [11]
Summary
Childhood Caries (ECC) is a major public health problem in Thailand. The newest national oral health survey from Thailand in 2017 indicates the very high prevalence and severity of ECC in the country, with an average of three carious teeth affected in 53% of 3-year-old children [1]. The above revelations of the oral health surveys and related findings have led the Thai authorities to promote oral health literacy among families through parental education These include education on the importance of primary dentition and its impact on the child’s quality of life, as well as motivation to introduce early tooth brushing with appropriate fluoridated toothpastes immediately after tooth eruption. A recent randomized control study of Thai children aged 0.5–1.5 years, where health education and hands-on training in toothbrushing were provided (with the assistance of the mothers), and triennial monitoring, reported a significant 2.5 times reduced incidence of ECC after 1 year [25] Another similar randomized control trial reported that dental health education to parents or caregivers significantly improved oral hygiene practices, such as toothbrushing activities and feeding behavior, this was still inadequate in preventing ECC increments [26]. Both ART and SMART are ideal for field setting as tertiary management tools for ECC
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