Development of Dental Public Health Guidelines to Prevent Dental Fluorosis in Earty Primary School Children in Fluoride-Risk Areas, Sukhothai Province.

Abstract

     This quasi-experimental study aimed to objectives: 1) to develop public oral health practice guidelines for the prevention of dental fluorosis among early primary school children residing in areas with fluoride-containing drinking water in Sukhothai Province, 2) to evaluate the effects of these guidelines on parents’ knowledge, health beliefs, preventive behaviors, and the dental fluorosis status of their children. The study was conducted in four phases. Phase 1 involved assessing fluoride levels in water sources, household water-use practices, the dental fluorosis status of children, and the knowledge, beliefs, and preventive behaviors of parents living in three high-risk districts characterized by limestone mountain terrain and recurrent drought. In Phase 2, practice guidelines were developed based on the Health Belief Model, the KAP model, and the concept of oral-health literacy, combined with participatory processes involving community leaders, teachers, parents, and public health personnel. Phases 1 and 2 constituted the instrument-development stage. Phase 3 implemented the guidelines using a quasi-experimental one-group repeated-measures design, with data collected at three time points (pre-intervention, and at 4 and 12 weeks post-intervention) among 45 parents of early primary school children. Phase 4 focused on evaluating the outcomes and synthesizing policy recommendations. The research instruments included a general information questionnaire, a knowledge assessment, a health-belief scale, and a preventive-behavior assessment for dental fluorosis, as well as a dental fluorosis recording form using Dean’s Index. Data were analyzed using descriptive statistics and repeated-measures ANOVA.

     The results indicated that after the implementation of the guidelines, parents’ mean knowledge scores increased from 5.76 to 11.67 and 11.78 at weeks 4 and 12, respectively. Health-belief scores increased from 51.27% to 74.69% and 73.44%, while preventive-behavior scores rose from 34.89% to 64.40% and 63.98%. All improvements were statistically significant (p < 0.001). Furthermore, the enhanced levels of knowledge, beliefs, and preventive behaviors were sustained for at least 12 weeks. Meanwhile, the proportion of children with dental fluorosis remained unchanged during the follow-up period, consistent with the irreversible nature of the condition in the short term.