基于风险评估的6岁儿童龋病分级管理临床效果评价  

Clinical effect evaluation of disease management of caries based on risk assessment in children aged 6

作　　者：郁莹 张皓 曾晓莉[1,2] 江一巍 易芳羽 翁清清 张颖 Yu Ying;Zhang Hao;Zeng Xiaoli;Jiang Yiwei;Yi Fangyu;Weng Qingqing;Zhang Ying(Department of Preventive Dentistry,Shanghai Stomatological Hospital,Shanghai 200001,China;Fudan University Oral Biomedical Engineering Laboratory,Shanghai 200001,China)

机构地区：[1]上海市口腔病防治院口腔预防处,200001 [2]复旦大学附属口腔医院口腔生物医学工程实验室,上海200001

出　　处：《中华口腔医学研究杂志（电子版）》2020年第6期345-352,共8页Chinese Journal of Stomatological Research(Electronic Edition)

基　　金：上海市促进市级医院临床技能与临床创新能力三年行动计划(16CR4018A)。

摘　　要：目的基于风险评估对上海6岁儿童进行龋病分级管理,并评价临床效果。方法2018年在上海采用随机整群抽样的方法,抽取城郊4个区19所学校2127名儿童参与调查,按学校随机整群分为试验组和对照组。参照美国儿童牙科学会(AAPD)提出的龋病风险评估指南(CAT),评估所有参与研究儿童的患龋风险等级,得到基线。试验组儿童根据高、中、低患龋风险等级,按照CAT中相对应的干预措施实施龋病分级管理。对照组儿童按照上海市基本口腔公共卫生服务项目管理。采用EpiData3.1软件建立数据库,应用SPSS 21.0软件进行统计分析。采用卡方检验的方法分析干预1年前后的患龋情况及新发龋发病状况。采用多因素Logistic一般线性回归分析的方法建立回归模型,分析比较试验组和对照组儿童的龋病相关影响因素。结果共1691名儿童参与了2019年复查,失访率为20.50%。去除部分无效问卷后,最终获得有效口腔检查表与问卷调查表的儿童共1655名,其中试验组826人、对照组829人。2018年参与研究儿童总患龋率为62.25%,干预1年后,总患龋率升高至68.22%,其中试验组儿童患龋率的升高程度低于对照组。试验组儿童干预1年后患龋风险等级升高比例远低于对照组儿童。试验组和对照组儿童的新发龋发病率分别为37.6%、47.6%,差异有统计学意义(χ2=16.954,P=0.000)。每天三餐之外进食含糖零食或饮料的频率(P对照=0.031,OR对照=0.573;P试验=0.002,OR试验=0.471)、晚上睡前吃甜点或喝甜饮料的频率(P对照=0.043,OR对照=0.708;P试验=0.026,OR试验=0.706)、每天刷牙次数(P对照=0.000,OR对照=0.456;P试验=0.000,OR试验=0.178)是试验组和对照组儿童共同的龋病相关危险因素。对照组儿童的龋病相关危险因素还包括孩子开始刷牙的年龄(P=0.037,OR=0.380),开始刷牙年龄越小,患龋可能性越低。局部涂氟为试验组儿童的龋病保护性因素(P=0.000,OR=0.5Objective To perform disease management based on caries risk assessment of children aged 6 in Shanghai and to explore the clinical effect.Methods In 2018,21276-year-old children from 19 primary schools in four districts were sampled by random cluster sampling in Shanghai,which were divided into the control group and the experimental group.Referring to the Caries-risk Assessment Tool proposed by the American Academy of Pediatric Dentistry,all children included were evaluated to obtain the baseline.The children in the experimental group were managed by the intervention measures in CAT according to the high,medium and low caries risk levels.The children in the control group were managed according to Shanghai Basic Oral Public Health Service Project.EpiData3.1 was used to establish the database,and SPSS 21.0 was used for statistical analysis.Dental caries prevalence and the incidence of new cavitation of the two groups were analyzed by Chi-square test.Multiple logistic regression analysis was used to analyze and compare the factors related to dental caries in children in the two groups.Results A total of 1691 children were included in the study in 2019,and the lost rate of follow-up was 20.50%.1655 children finally completed the whole survey after removing some invalid questionnaires,including 826 children in the experimental group and 829 in the control group.In 2018,dental caries prevalence of all children included was 62.25%which increased to 68.22%after one year of intervention,but the increase rate of the experimental group was lower than that in the control group.Children in the experimental group had a lower risk of caries than those in the control group in 2019.The incidence of new cavitation of the experimental and control group was 37.6%and 47.6%(χ2=16.954,P=0.000),respectively.The factors related to dental caries in the two groups included the frequency of taking sugar snacks or drinks between meals a day(Pcontrol group=0.031,ORcontrol group=0.573;Pexperimental group=0.002,ORexperimental group=0.471),the

关 键 词：儿童 龋齿 疾病管理 危险性评估 临床效果评价 

分 类 号：R788.1[医药卫生—口腔医学]