口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (1): 50-56.DOI: 10.12016/j.issn.2096-1456.2021.01.008
收稿日期:
2020-05-13
修回日期:
2020-06-28
出版日期:
2021-01-20
发布日期:
2020-11-18
通讯作者:
张颖
作者简介:
施宏燕,主治医师,硕士,Email: 基金资助:
SHI Hongyan1,2(),HE Xiang1,2,HUANG Rui1,2,ZHANG Ying3(
)
Received:
2020-05-13
Revised:
2020-06-28
Online:
2021-01-20
Published:
2020-11-18
Contact:
Ying ZHANG
Supported by:
摘要:
目的 探讨实施以风险评估为基础的儿童龋病分级管理的防龋效果,为制定儿童口腔疾病防治分级管理策略提供依据。方法 2018年3月至2019年3月期间,采用整群抽样法在上海市闵行区抽取512名3岁幼儿园儿童和502名6岁小学生,进行口腔检查和问卷调查,按照龋病风险评估标准分为高危、中危、低危人群。以学校为单位随机分为试验组和对照组,试验组根据龋病风险等级进行分级管理,低危试验组进行口腔健康教育干预;中危试验组半年涂1次氟,进行口腔健康教育;高危试验组3个月涂1次氟,进行口腔健康教育。对照组按照上海市政府为儿童提供的基本口腔公共卫生服务常规管理。12个月后开展口腔检查,评估防龋效果。结果 患龋高危儿童中,3岁对照组龋病发病率为51.22%,试验组为34.17%;6岁对照组为51.27%,试验组为33.15%,差异均有统计学意义(P < 0.05)。中危儿童中,3岁对照组龋病发病率为38.71%,试验组为7.32%,差异有统计学意义(P < 0.05)。但3岁儿童低风险组、6岁儿童低风险组和中风险组的两组龋病发病率差异无统计学意义。3岁、6岁儿童试验组干预1年后患龋风险等级升高比例低于对照组儿童。 结论 以风险评估为基础的儿童龋病分级管理在患龋高危儿童中防龋效果显著,值得推广应用。
中图分类号:
施宏燕,何翔,黄蕊,张颖. 龋风险评估在上海市闵行区儿童龋病分级管理中的效果评价[J]. 口腔疾病防治, 2021, 29(1): 50-56.
SHI Hongyan,HE Xiang,HUANG Rui,ZHANG Ying. Effect assessment of caries management by risk assessment in children in the Minhang district of Shanghai[J]. Journal of Prevention and Treatment for Stomatological Diseases, 2021, 29(1): 50-56.
Group | Biological | ||||||
---|---|---|---|---|---|---|---|
3 years old | Factors | Mother/primary caregiver has active cavities | Parent/caregiver has low socioeconomic status | Child has>3 between meal sugar-containing snacks or beverages pre day | Child is put to bed with a bottle containing natural or added sugar | Child has special health care needs | Child is a recent immigrant |
Risk category | High | High | High | High | Moderate | Moderate | |
6 years old | Factors | Child is of low socioeconomic status | Child has >3 between meal sugar-containing snacks or beverages per day | Child has special health care needs | Child is a recent immigrant | Child brushes teeth daily with fluoridated toothpaste | Child receives topical fluoride from health professional |
Risk category | High | High | Moderate | Moderate | Low | Low | |
Group | Protective | Clinical Findings | |||||
3 years old | Factors | Child has teeth brushed daily with fluoridated toothpaste | Child receives topical fluoride from health professional | Child has dental home/regular dental care | Child has >1 decayed/missing/filled surfaces | Child has white spot lesions or enamel defects | Child has plaque on teeth |
Risk category | Low | Low | Low | High | High | Moderate | |
6 years old | Factors | Additional home measures (e.g., gargle, floss, etc.) | Child has dental home/regular dental care | Child has >1 interproximal lesions | Child has active white spot lesions or enamel defects | Child has defective restorations | Child wearing an intraoral appliance |
Risk category | Low | Low | High | High | Moderate | Moderate |
表1 龋病风险评估表
Table1 Caries risk assessment form
Group | Biological | ||||||
---|---|---|---|---|---|---|---|
3 years old | Factors | Mother/primary caregiver has active cavities | Parent/caregiver has low socioeconomic status | Child has>3 between meal sugar-containing snacks or beverages pre day | Child is put to bed with a bottle containing natural or added sugar | Child has special health care needs | Child is a recent immigrant |
Risk category | High | High | High | High | Moderate | Moderate | |
6 years old | Factors | Child is of low socioeconomic status | Child has >3 between meal sugar-containing snacks or beverages per day | Child has special health care needs | Child is a recent immigrant | Child brushes teeth daily with fluoridated toothpaste | Child receives topical fluoride from health professional |
Risk category | High | High | Moderate | Moderate | Low | Low | |
Group | Protective | Clinical Findings | |||||
3 years old | Factors | Child has teeth brushed daily with fluoridated toothpaste | Child receives topical fluoride from health professional | Child has dental home/regular dental care | Child has >1 decayed/missing/filled surfaces | Child has white spot lesions or enamel defects | Child has plaque on teeth |
Risk category | Low | Low | Low | High | High | Moderate | |
6 years old | Factors | Additional home measures (e.g., gargle, floss, etc.) | Child has dental home/regular dental care | Child has >1 interproximal lesions | Child has active white spot lesions or enamel defects | Child has defective restorations | Child wearing an intraoral appliance |
Risk category | Low | Low | High | High | Moderate | Moderate |
Risk category | Group | Number of people inspected | New cases | Number of new caries | Incidence | χ2 | P | New caries average | Z | P |
---|---|---|---|---|---|---|---|---|---|---|
Low risk | Experimental group | 58 | 13 | 28 | 22.41% | 0.007 | 0.934 | 0.48 ± 1.13 | 0.225 | 0.411 |
Control group | 52 | 12 | 46 | 23.08% | 0.88 ± 2.19 | |||||
Moderate risk | Experimental group | 41 | 3 | 12 | 7.32% | 10.548 | 0.001 | 0.29 ± 1.08 | 2.926 | 0.002 |
Control group | 31 | 12 | 20 | 38.71% | 0.65 ± 0.98 | |||||
High risk | Experimental group | 120 | 41 | 91 | 34.17% | 7.606 | 0.006 | 0.76 ± 1.31 | 2.667 | 0.004 |
Control group | 126 | 65 | 155 | 51.22% | 1.23 ± 1.74 | |||||
Total | Experimental group | 219 | 57 | 131 | 26.03% | 13.042 | <0.001 | 0.59 ± 1.23 | 3.483 | <0.001 |
Control group | 209 | 89 | 221 | 42.58% | 1.06 ± 1.79 |
表2 3岁年龄组龋病新发病率情况
Table 2 Incidence of dental caries at 3 years old
Risk category | Group | Number of people inspected | New cases | Number of new caries | Incidence | χ2 | P | New caries average | Z | P |
---|---|---|---|---|---|---|---|---|---|---|
Low risk | Experimental group | 58 | 13 | 28 | 22.41% | 0.007 | 0.934 | 0.48 ± 1.13 | 0.225 | 0.411 |
Control group | 52 | 12 | 46 | 23.08% | 0.88 ± 2.19 | |||||
Moderate risk | Experimental group | 41 | 3 | 12 | 7.32% | 10.548 | 0.001 | 0.29 ± 1.08 | 2.926 | 0.002 |
Control group | 31 | 12 | 20 | 38.71% | 0.65 ± 0.98 | |||||
High risk | Experimental group | 120 | 41 | 91 | 34.17% | 7.606 | 0.006 | 0.76 ± 1.31 | 2.667 | 0.004 |
Control group | 126 | 65 | 155 | 51.22% | 1.23 ± 1.74 | |||||
Total | Experimental group | 219 | 57 | 131 | 26.03% | 13.042 | <0.001 | 0.59 ± 1.23 | 3.483 | <0.001 |
Control group | 209 | 89 | 221 | 42.58% | 1.06 ± 1.79 |
Risk category | Group | Number of people inspected | New cases | Number of new caries | Incidence | χ2 | P | New caries average | z | P |
---|---|---|---|---|---|---|---|---|---|---|
Low risk | Experimental group | 68 | 8 | 16 | 11.76% | 0.097 | 0.755 | 0.24 ± 0.74 | 0.262 | 0.400 |
Control group | 36 | 5 | 8 | 13.89% | 0.22 ± 0.59 | |||||
Moderate risk | Experimental group | 17 | 3 | 6 | 17.65% | 0.303 | 0.607 | 0.35 ± 1.00 | -0.784 | 0.217 |
Control group | 14 | 1 | 2 | 7.14% | 0.14 ± 0.53 | |||||
High risk | Experimental group | 181 | 60 | 98 | 33.15% | 11.397 | <0.001 | 0.54 ± 0.90 | 3.434 | <0.001 |
Control group | 158 | 81 | 146 | 51.27% | 0.92 ± 1.16 | |||||
Total | Experimental group | 266 | 71 | 120 | 26.69% | 12.033 | <0.001 | 0.45 ± 0.87 | 3.495 | <0.001 |
Control group | 208 | 87 | 156 | 41.83% | 0.75 ± 1.09 |
表3 6岁年龄组龋病新发病率情况
Table 3 Incidence of dental caries at 6 years old
Risk category | Group | Number of people inspected | New cases | Number of new caries | Incidence | χ2 | P | New caries average | z | P |
---|---|---|---|---|---|---|---|---|---|---|
Low risk | Experimental group | 68 | 8 | 16 | 11.76% | 0.097 | 0.755 | 0.24 ± 0.74 | 0.262 | 0.400 |
Control group | 36 | 5 | 8 | 13.89% | 0.22 ± 0.59 | |||||
Moderate risk | Experimental group | 17 | 3 | 6 | 17.65% | 0.303 | 0.607 | 0.35 ± 1.00 | -0.784 | 0.217 |
Control group | 14 | 1 | 2 | 7.14% | 0.14 ± 0.53 | |||||
High risk | Experimental group | 181 | 60 | 98 | 33.15% | 11.397 | <0.001 | 0.54 ± 0.90 | 3.434 | <0.001 |
Control group | 158 | 81 | 146 | 51.27% | 0.92 ± 1.16 | |||||
Total | Experimental group | 266 | 71 | 120 | 26.69% | 12.033 | <0.001 | 0.45 ± 0.87 | 3.495 | <0.001 |
Control group | 208 | 87 | 156 | 41.83% | 0.75 ± 1.09 |
Variables | OR | Unadjusted OR(95% CI) | P | ORadj | Adjusted OR(95% CI) | P | ||
---|---|---|---|---|---|---|---|---|
Lower | Upper | Lower | Upper | |||||
Risk category | ||||||||
Low risk | 1.00 | 1.00 | ||||||
Moderate risk | 1.02 | 0.55 | 1.86 | 0.032 | 0.97 | 0.53 | 1.80 | 0.025 |
High risk | 3.30 | 2.25 | 4.85 | < 0.001 | 3.28 | 2.22 | 4.85 | < 0.001 |
Age category | ||||||||
3 years old | 1.00 | 0.75 | 1.30 | 0.910 | 1.00 | 0.64 | 1.16 | 0.325 |
6 years old | 0.98 | 0.86 | ||||||
Control/experimental | ||||||||
Control group | 1.00 | 0.36 | 0.64 | <0.001 | 1.00 | 0.37 | 0.66 | < 0.001 |
Experimental group | 0.48 | 0.50 |
表4 龋病分级、年龄及干预措施与新发龋关系的logistic回归分析
Table 4 The association between incident caries and caries risk level, age and intervention by Logistic regression
Variables | OR | Unadjusted OR(95% CI) | P | ORadj | Adjusted OR(95% CI) | P | ||
---|---|---|---|---|---|---|---|---|
Lower | Upper | Lower | Upper | |||||
Risk category | ||||||||
Low risk | 1.00 | 1.00 | ||||||
Moderate risk | 1.02 | 0.55 | 1.86 | 0.032 | 0.97 | 0.53 | 1.80 | 0.025 |
High risk | 3.30 | 2.25 | 4.85 | < 0.001 | 3.28 | 2.22 | 4.85 | < 0.001 |
Age category | ||||||||
3 years old | 1.00 | 0.75 | 1.30 | 0.910 | 1.00 | 0.64 | 1.16 | 0.325 |
6 years old | 0.98 | 0.86 | ||||||
Control/experimental | ||||||||
Control group | 1.00 | 0.36 | 0.64 | <0.001 | 1.00 | 0.37 | 0.66 | < 0.001 |
Experimental group | 0.48 | 0.50 |
Risk category | Group | 3 years old | 6 years old | ||
---|---|---|---|---|---|
Number of people in 2018 | Number of people in 2019 | Number of people in 2018 | Number of people in 2019 | ||
Low risk | Experimental group | 58(26.48%) | 68(31.05%) | 68(25.56%) | 75(28.20%) |
Control group | 52(24.88%) | 40(19.14%) | 36(17.31%) | 28(13.46%) | |
Moderate risk | Experimental group | 41(18.72%) | 45(20.55%) | 17(6.39%) | 20(7.51%) |
Control group | 31(14.83%) | 25(11.96%) | 14(6.73%) | 13(6.25%) | |
High risk | Experimental group | 120(54.8%) | 106(48.40%) | 181(68.05%) | 171(64.29%) |
Control group | 126(60.29%) | 144(68.90%) | 158(75.96%) | 167(80.29%) | |
Total | Experimental group | 219 | 219 | 266 | 266 |
Control group | 209 | 209 | 208 | 208 |
表5 儿童龋病风险评估的情况
Table 5 Caries risk assessment
Risk category | Group | 3 years old | 6 years old | ||
---|---|---|---|---|---|
Number of people in 2018 | Number of people in 2019 | Number of people in 2018 | Number of people in 2019 | ||
Low risk | Experimental group | 58(26.48%) | 68(31.05%) | 68(25.56%) | 75(28.20%) |
Control group | 52(24.88%) | 40(19.14%) | 36(17.31%) | 28(13.46%) | |
Moderate risk | Experimental group | 41(18.72%) | 45(20.55%) | 17(6.39%) | 20(7.51%) |
Control group | 31(14.83%) | 25(11.96%) | 14(6.73%) | 13(6.25%) | |
High risk | Experimental group | 120(54.8%) | 106(48.40%) | 181(68.05%) | 171(64.29%) |
Control group | 126(60.29%) | 144(68.90%) | 158(75.96%) | 167(80.29%) | |
Total | Experimental group | 219 | 219 | 266 | 266 |
Control group | 209 | 209 | 208 | 208 |
Reduced risk of caries | Increased risk of caries | Caries risk unchanged | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | |
Experimental group | 19 | 8.68% | 0.932 | 0.334 | 22 | 10.05% | 4.159 | 0.041 | 178 | 81.27% | 1.170 | 0.279 |
Control group | 13 | 6.22% | 35 | 16.75% | 161 | 77.03% | ||||||
Total | 32 | 7.48% | 57 | 13.31% | 339 | 79.21% |
表6 3岁年龄组患龋风险等级变化情况
Table 6 Changes of caries risk grade at 3 years old
Reduced risk of caries | Increased risk of caries | Caries risk unchanged | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | |
Experimental group | 19 | 8.68% | 0.932 | 0.334 | 22 | 10.05% | 4.159 | 0.041 | 178 | 81.27% | 1.170 | 0.279 |
Control group | 13 | 6.22% | 35 | 16.75% | 161 | 77.03% | ||||||
Total | 32 | 7.48% | 57 | 13.31% | 339 | 79.21% |
Reduced risk of caries | Increased risk of caries | Caries risk unchanged | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | |
Experimental group | 24 | 9.02% | 0.107 | 0.744 | 20 | 7.52% | 8.188 | 0.004 | 222 | 83.46% | 4.127 | 0.042 |
Control group | 17 | 8.10% | 33 | 15.70% | 158 | 76.20% | ||||||
Total | 41 | 8.64% | 53 | 11.18% | 380 | 80.18% |
表7 6岁年龄组患龋风险等级变化情况
Table 7 Changes of caries risk grade at 6 years old
Reduced risk of caries | Increased risk of caries | Caries risk unchanged | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | Number of people | Percentage | χ2 | P | |
Experimental group | 24 | 9.02% | 0.107 | 0.744 | 20 | 7.52% | 8.188 | 0.004 | 222 | 83.46% | 4.127 | 0.042 |
Control group | 17 | 8.10% | 33 | 15.70% | 158 | 76.20% | ||||||
Total | 41 | 8.64% | 53 | 11.18% | 380 | 80.18% |
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