ผลของรูปแบบบริการสุขภาพช่องปากแบบมุ่งเน้นคุณค่าต่อความเสี่ยงและการชะลอการเกิดโรคฟันผุในเด็กอายุ 0–5 ปี: การศึกษาแบบกึ่งทดลองในสองจังหวัด

Sunee Wongkongkathep; Nitichote Ninkumhaeng; Sasithorn Banditmahakun

Authors

Sunee Wongkongkathep National Health Commission Office
Nitichote Ninkumhaeng Chaiyaphum Provincial Public Health Office
Sasithorn Banditmahakun Regional Health Promotion Center 11 Nakhon Si Thammarat

Keywords:

dental caries, risk-based care, early childhood oral health, value-based care, primary health care

Abstract

Background: Early childhood caries remains a major public health problem in Thailand. Although oral health promotion activities have been continuously implemented, routine activity-based services have shown limited effectiveness in sustainably reducing caries risk and disease progression. Evidence regarding the implementation of value-based and risk-based oral health service models within Thailand’s primary care system remains limited.

Objectives: To evaluate the effects of a value-based oral health service model on oral health behaviors, caries risk, and caries progression among children aged 0–5 years.

Methods: A quasi-experimental study comparing intervention and control groups was conducted in Nan and Krabi provinces across the well-child clinics and the child development centers. A total of 1,209 children aged 0–5 years participated. The mean age was 46.9 months, with a comparable sex distribution between groups. The intervention consisted of risk assessment, risk-based service delivery, and continuous follow-up care. Outcomes included oral health behaviors, caries risk levels, early carious lesions, and decayed-missing-filled teeth (dmft) before and after implementation. Follow-up period averaged 1 year on the same children.

Results: At baseline, most children were classified as high or very high risk for caries, with more than 80% of children in some of the child development centers in Krabi categorized as very high risk. Following implementation, children in the intervention group received more continuous risk-based follow-up and preventive care than controls. Improvements in toothbrushing frequency, fluoride toothpaste use, and oral cleanliness were greater in the intervention group. Caries risk scores and early carious lesions also showed decreasing trends in several intervention settings. Changes in dmft varied across settings and service delivery models, with a smaller increase in dmft in the intervention group than in the control group in some settings. These findings suggest that the effects of the service model varied across implementation contexts.

Conclusions: The value-based oral health service model supported improvements in oral health behaviors, reductions in caries risk, and slower caries progression among young children. The findings supported integrating risk-based and outcome-oriented oral health care into primary care services and child development centers to strengthen sustainable early childhood oral health systems.

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