Abstract
Dental caries in primary teeth is a major issue in Thailand. While the national health
insurance covers restorations, pulp treatment, and extractions for primary teeth, it does not
include stainless steel crown (SSC) restorations. SSCs are a standard treatment for extensively
decayed or pulp-treated primary teeth, but only children of civil servants currently have coverage,
creating disparities in access.
This rapid assessment study developed policy recommendations for including stainless
steel crown (SSC) services in the National Health Insurance System. It reviewed evidence on SSCs'
effectiveness, safety, and cost-effectiveness, collected stakeholder feedback on feasibility, and
analyzed the budget impact of adding SSCs to the insurance benefits.
The restoration of primary teeth using metal crowns is included in the practice guidelines
of international professional organizations and is included in the benefit packages in various
countries such as Malaysia, New Zealand, and the United States, among others. Each country has
different conditions. In Thailand, SSC restoration is part of the dental degree curriculum, and the
Dental Council requires registration applicants to have at least 1 tooth restoration experience.
The literature review demonstrated that the restoration of teeth with minimal remaining
structure using stainless steel crowns has a higher success rate compared to fillings. The failure
rate for stainless steel crown restorations is found to be 0-8%, while for fillings, the failure rate
ranges from 32 to 59%. Furthermore, the restoration using stainless steel crowns is more costeffective than fillings, from both the societal and payer/government perspectives.
The analysis of data in Thailand found that Thai children of all age groups have carious
teeth that should be restored with SSCs. About 12% of 3-year-olds and 22% of 5-year-olds have
an average of 2 teeth requiring this treatment. The 5-7 age group has the highest utilization of
SSCs. Most parents accept SSC treatment, but are concerned about the cost, pain, child
cooperation, and impact on permanent teeth. Regarding the availability of SSCs services at
hospitals under Thailand's Ministry of Public Health across health regions 1–12, it was found that
every region offers these services, averaging 31,885 crowns per year. Most public hospitals agreed
that SSCs should be included in the benefits package.
In terms of budget impact, providing SSC services results in an additional cost of 92 Baht
per case compared to fillings. Annually, 830,000 children (2 million teeth) require SSCs, taking 30-
60 minutes per procedure depending on child cooperation and dentist expertise. If all Ministry of
Public Health hospitals expanded SSCs services over 5 years, the capacity could increase to
440,559 crowns per year, covering approximately 35% of molar carious teeth. The additional
budget required would be 12.6 million Baht in the first year, rising to 40.5 million Baht by the fifth
year, totaling 132.7 million Baht over 5 years.
In summary, the inclusion of SSC services in the national benefits package is highly feasible,
in terms of acceptability, demand, and implementation. However, the large number of children
and teeth requiring this treatment means the current service provision should be adapted,
integrated, and expanded to increase access for Thai children. The research team has the
following policy recommendations:
1. SSCs services should be included in the National Health Security benefits package.
2. SSCs services should be expanded to all public hospitals.
3. Prioritize services for molar teeth over anterior teeth.
4. The Ministry of Public Health should promote increasing the number of pediatric dentistry
specialists to serve uncooperative children.
5. Adjust the management system in healthcare facilities to have pediatric dentistry
specialists focus more on child dental services rather than general dentistry.
6. The Dental Council should increase the minimum experience requirement of performing
at least one SSC for new dentists.
7. Provide reimbursement to healthcare facilities offering SSC services on a fee schedule
8. Establish collaborative networks with the private sector and public dental clinics to offer
services outside regular working hours.
9. Emphasize more disease prevention and health promotion, as the prevalence of dental
caries is very high, and even with increased capacity and expanded services, it may not be
possible to fully cover all treatment needs.
10. The National Health Security Office and Ministry of Public Health should jointly monitor
and evaluate the implementation of SSC services in the benefits package, including
identifying problems, obstacles, and both positive and negative impacts.
