Abstract
Considering the significant incidence of dental caries in primary school children,
the concept of Value-based oral healthcare, which focuses on outcomes, has been implemented to improve the
quality-of-service models. This study aims to develop a value-based primary oral healthcare service system model for
school - children using participatory action research methods in six schools in Hang Dong District, Chiang Mai Province,
during the 2023 - 2024 academic year. The schools were divided into two groups: an intervention group and a control
group. The intervention group co-developed a value-based healthcare system with the students in grade 1 – 6, totaling
2,571, received oral health examination. Additionally, 1,207 students from grades 4-6 were interviewed using
a questionnaire to assess their oral health behaviors, knowledge, and self-perception. The direct costs were analyzed
based on labor costs, materials, and service delivery data from the 2023 fiscal year.
The study shows that students receiving oral health services were categorized into three groups: those
without cavities, those with a limited number of cavities (1-3 teeth), and those with numerous cavities (4 or more teeth)
need immediate treatment. The evaluation results indicated an increase in cavity-free students within the service
intervention group following the implementation of appropriate dental treatment and preventative services. The
service intervention group of primary school students in grades 1-6 exhibited a cavity-free rate of 90.6%, while the
comparison group demonstrated a rate of 45.0%. The increase in caries, encompassing both permanent and deciduous
teeth, in the intervention group was significantly different from that in the control group. The rise
in dental caries in the intervention and control groups was 21.5% and 26.5%, respectively. It was found that students in
the intervention group had improved oral health and nutritional behaviors, including
an increased number of students who brushed their teeth after lunch, brushed for 2 minutes, and refrained from eating
for 2 hours after brushing. Additionally, the consumption of soft drinks and candy decreased. Furthermore, students in
the intervention group had a higher percentage of oral health literacy scores above 80% and improved oral health
perceptions. Regarding the issue of not wanting to smile due to tooth appearance, the intervention group showed
three times better improvement than the control group. In terms of service costs, the intervention group was more
cost - effective. The service cost per student for the intervention and control groups decreased by 42.56 and 15.86
baht, respectively. The intervention group also had better cost-effectiveness, saving 9.6% to achieve a 45.6% increase in
cavity-free status, while the control group saved only 3.5% and had a cavity-free increase of only 2.6%.
The study concluded that the value-based oral health care model which developing thru the
participation of health service network teams and school teams in Hang Dong district is highly effective, leading to
positive oral health outcomes for students. Therefore, it is necessary to continue developing and expanding the
operational area.
