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

doi:10.12016/j.issn.2096-1456.2021.01.008

口腔疾病防治 ›› 2021, Vol. 29 ›› Issue (1): 50-56.DOI: 10.12016/j.issn.2096-1456.2021.01.008

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

施宏燕^1,²(),何翔^1,²,黄蕊^1,²,张颖³()

1.上海市闵行区牙病防治所,上海（201103）
2.复旦大学公共卫生学院闵行分院,上海（201103）
3.上海市口腔病防治院,上海（200031）

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: 86259225@qq.com
基金资助:
上海市闵行区自然科学研究课题(2018MHZ032);上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划项目(16CR4018A)

Effect assessment of caries management by risk assessment in children in the Minhang district of Shanghai

SHI Hongyan^1,²(),HE Xiang^1,²,HUANG Rui^1,²,ZHANG Ying³()

1. Dental Clinics of Minhang District, Shanghai 201103, China
2. Minhang Branch, School of Public Health, Fudan University, Shanghai 201103, China
3. Shanghai Stomatological Hospital, Fudan University, Shanghai 200031,China

Received:2020-05-13 Revised:2020-06-28 Online:2021-01-20 Published:2020-11-18
Contact: Ying ZHANG
Supported by:
Minhang District of Shanghai Natural Science Research Project(2018MHZ032);Shanghai Shenkang Hospital Development Center to Promote Clinical Skills and Clinical Innovation Ability of Municipal Hospitals Three-Year Action Plan Project(16CR4018A)

摘要/Abstract

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。

关键词: 儿童, 龋病发生率, 龋病患病率, 风险评估, 分级管理, 前瞻性研究, 口腔健康教育

Abstract:

Objective To assess the effect of caries management based on risk assessment in children and to provide the basis for the government to develop strategies to prevent and treat oral diseases. Methods From March 2018 to March 2019, 512 3-year-old children and 502 6-year-old children were selected by cluster sampling from kindergartens and primary schools, respectively, in the Minhang district of Shanghai, and oral examinations and questionnaires were carried out to assess baseline status. Then, the children were divided into 3 groups, including low-, middle- and high-risk groups, according to caries risk assessment. In each caries risk group, the children were randomly divided into an experimental group and a control group. The experimental groups were managed by risk assessment, and the control groups were provided basic oral public health services by the Shanghai government. The effect of caries prevention was evaluated 12 months later. Results Among the children with a high risk of caries, the incidence of caries was 51.22% in the 3-year-old control group, 34.17% in the experimental group, 51.27% in the 6-year-old control group and 33.15% in the experimental group, with statistical significance (P < 0.05). Among the children with a middle risk of caries, the incidence of caries was 38.71% in the 3-year-old control group and 7.32% in the experimental group, with statistical significance (P < 0.05). However, there was no significant difference in caries incidence between the control group and the experimental group for the children with low risk in the 3-year-old or 6-year-old groups and middle risk caries risk in the 6-year-old group. Both 3-year-old and 6-year-old children in the experimental group had a lower risk of caries than those in the observation group in 2019. Conclusion The caries prevention effect is remarkable in high-risk children, and caries management by risk assessment is probably recommended for children with high caries risk.

Key words: children, caries incidence, caries prevalence, risk assessment, grading management, prospective study, oral health education

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.

图/表 7

参考文献 19

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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
3 years old	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
6 years old	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
3 years old	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
6 years old	Risk category	Low	Low	High	High	Moderate	Moderate

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
3 years old	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
6 years old	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
3 years old	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
6 years old	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
Low risk	Control group	52	12	46	23.08%	0.007	0.934	0.88 ± 2.19	0.225	0.411
Moderate risk	Experimental group	41	3	12	7.32%	10.548	0.001	0.29 ± 1.08	2.926	0.002
Moderate risk	Control group	31	12	20	38.71%	10.548	0.001	0.65 ± 0.98	2.926	0.002
High risk	Experimental group	120	41	91	34.17%	7.606	0.006	0.76 ± 1.31	2.667	0.004
High risk	Control group	126	65	155	51.22%	7.606	0.006	1.23 ± 1.74	2.667	0.004
Total	Experimental group	219	57	131	26.03%	13.042	<0.001	0.59 ± 1.23	3.483	<0.001
Total	Control group	209	89	221	42.58%	13.042	<0.001	1.06 ± 1.79	3.483	<0.001

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
Low risk	Control group	52	12	46	23.08%	0.007	0.934	0.88 ± 2.19	0.225	0.411
Moderate risk	Experimental group	41	3	12	7.32%	10.548	0.001	0.29 ± 1.08	2.926	0.002
Moderate risk	Control group	31	12	20	38.71%	10.548	0.001	0.65 ± 0.98	2.926	0.002
High risk	Experimental group	120	41	91	34.17%	7.606	0.006	0.76 ± 1.31	2.667	0.004
High risk	Control group	126	65	155	51.22%	7.606	0.006	1.23 ± 1.74	2.667	0.004
Total	Experimental group	219	57	131	26.03%	13.042	<0.001	0.59 ± 1.23	3.483	<0.001
Total	Control group	209	89	221	42.58%	13.042	<0.001	1.06 ± 1.79	3.483	<0.001

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
Low risk	Control group	36	5	8	13.89%	0.097	0.755	0.22 ± 0.59	0.262	0.400
Moderate risk	Experimental group	17	3	6	17.65%	0.303	0.607	0.35 ± 1.00	-0.784	0.217
Moderate risk	Control group	14	1	2	7.14%	0.303	0.607	0.14 ± 0.53	-0.784	0.217
High risk	Experimental group	181	60	98	33.15%	11.397	<0.001	0.54 ± 0.90	3.434	<0.001
High risk	Control group	158	81	146	51.27%	11.397	<0.001	0.92 ± 1.16	3.434	<0.001
Total	Experimental group	266	71	120	26.69%	12.033	<0.001	0.45 ± 0.87	3.495	<0.001
Total	Control group	208	87	156	41.83%	12.033	<0.001	0.75 ± 1.09	3.495	<0.001

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

Effect assessment of caries management by risk assessment in children in the Minhang district of Shanghai

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Metrics

Variables	OR	Unadjusted OR（95% CI）		P	OR_adj	Adjusted OR（95% CI）		P
Variables	OR	Lower	Upper	P	OR_adj	Lower	Upper	P
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	0.75	1.30	0.910	0.86	0.64	1.16	0.325
Control/experimental
Control group	1.00	0.36	0.64	<0.001	1.00	0.37	0.66	< 0.001
Experimental group	0.48	0.36	0.64	<0.001	0.50	0.37	0.66	< 0.001

Risk category	Group	3 years old		6 years old
Risk category	Group	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%）
Low risk	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%）
Moderate risk	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%）
High risk	Control group	126（60.29%）	144（68.90%）	158（75.96%）	167（80.29%）
Total	Experimental group	219	219	266	266
Total	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%	0.932	0.334	35	16.75%	4.159	0.041	161	77.03%	1.170	0.279
Total	32	7.48%			57	13.31%			339	79.21%

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