南京市低龄儿童龋风险的影响因素研究

目的 分析低龄儿童龋风险的影响因素,完善低龄儿童龋风险评估模型,以便辅助诊断低龄儿童龋,提供有效的预防及治疗建议。方法 收集来自南京医科大学附属口腔医院儿童牙病预防科临床就诊患者的基线资料,使用CPI探针检查全口牙齿状况,对儿童家长进行问卷调查。所有儿童采集静脉血5 mL。采用单因素及多因素Logistic回归进行相关因素分析。结果 本研究纳入199例龋高风险儿童,多因素logistic回归分析结果显示,血液中总蛋白比值比（Odds ratio,OR）=1.092,95%可信区间（Confidence interval,CI)：1.034~1.155、血清钾（OR=2.175,95%CI：1.056~4.48）、二氧化碳（OR=1.32,95%CI：1.194~1.459）及磷酸肌酸激酶水平（OR=1.007,95%CI：1.001~1.014）与低龄儿童龋风险相关。结论 龋高风险儿童血检生化指标中总蛋白、血清钾、二氧化碳及磷酸肌酸激酶水平均高于无龋儿童,提示这些指标均可能是低龄儿童龋风险的影响因素。     

海淀区0～3岁婴幼儿龋危险因素的分析研究

目的 探讨低龄儿童龋(early childhood caries,ECC)与口腔健康行为的相关关系,为0～3岁婴幼儿龋病的综合防治提供科学依据.方法 纳入395名1岁以下无龋儿童进行2年的纵向观察,每半年定期口腔检查和问卷调查,对家长进行口腔健康指导.统计分析喂养、口腔卫生状况、定期口腔检查等因素与ECC的相关性.结果 进入课题观察终点253人,平均月龄(27.67±5.98)个月,患龋率36.76％,龋均1.04±1.68.口腔卫生状况、检查次数、奶瓶喂养、夜间喂养、睡前进食后清洁和刷牙频率是ECC的影响因素(P<0.05).口腔检查次数是婴幼儿龋的重要负相关影响因素(P<0.05),每增加1次口腔检查,患龋风险降低61.6％.结论 定期口腔检查和菌斑控制是预防婴幼儿龋的关键因素.     

一例低龄儿童龋的综合防治

低龄儿童龋（early childhood caries,ECC）包含两个主要因素,一个是年龄,即小于6岁的儿童,另外一个是任何一个乳牙的龋（无论是否成为龋洞）、失（因龋所致）、补牙数/牙面数≥1。做好ECC的早期预防,是儿童口腔保健的重要组成部分,对于ECC的综合治疗,结合儿童的生长发育特点,目的是使得患儿患龋高风险的口腔卫生状况得到有效的改善,从而恢复其口腔健康微生态,控制龋病进展和恢复牙齿的结构与功能。本文报道一例低龄儿童龋的综合防治。     

低龄儿童龋患儿中医体质分型初探

目的探索低龄儿童龋患儿的中医体质分型特点。方法依据儿童中医体质分类将232例低龄儿童龋患儿分为7种体质类型。结果心火偏旺质及热滞质患儿的患龋牙数明显多于其他体质患儿的患龋牙数,心火偏旺质患儿多易发生高龋,热滞质患儿多易发生低龋及中龋,并且心火偏旺质患儿龋坏牙数主要集中发生在上颌前段和下颌后段,而其他体质患儿的龋坏牙数则主要出现在上颌后段和下颌后段。结论低龄儿童龋患儿体质分型特点值得临床上关注,并采取相应的预防措施。     

母亲孕期及产后口腔行为干预对低龄儿童患龋影响的研究

目的 评价对母亲孕期及产后口腔行为干预控制低龄儿童龋发生的有效性.方法 选取110名妊娠期4~9月的孕妇及其所生孩子为干预对象,分别在孕期、儿童1岁时和2岁时3个阶段对其进行个性化口腔健康指导,每隔6个月定期回访,记录儿童牙齿萌出情况、患龋情况和早期龋的发生,并对儿童饮食喂养习惯进行问卷调查.对照组是选择月龄为11 ~14月的母子为研究对象,每隔6个月定期回访,进行口腔检查和问卷调查.结果 经过2年纵向观察,干预组儿童1岁时和2岁时失访率分别为2.7%和12.7%,而对照组儿童2岁时失访率为10.0%.干预组儿童1岁时龋齿发病率为0.9%,龋均为0.02,其中早期龋发病率为1.9%,均显著低于对照组儿童;2岁时儿童龋齿发病率为3.1%,龋均为0.07,其中早期龋发病率为6.3%,均显著低于对照组儿童.2岁时儿童问卷调查结果显示,6个月开始刷牙、1岁前断奶、吃甜食频率、饮水频率以及是否含奶瓶入睡习惯与龋齿发生有重要关系,其中吃甜食频率影响最强.经卡方检验,干预组与对照组之间均有显著差异(P<0.05).结论 通过对母亲孕期及产后进行长期的口腔健康行为干预,降低了低龄儿童龋的发生率,改善了母亲对婴幼儿的饮食喂养习惯和口腔护理行为,同时高频摄取甜食是儿童患龋的重要易感因素.     

北京市海淀区13所幼儿园3岁儿童龋病患病趋势调查

目的了解北京市海淀区3岁儿童2012～2015年间乳牙龋病的患病趋势,为海淀区低龄儿童龋病防治工作提供依据。方法 2012～2015年间对北京市海淀区13所幼儿园3岁儿童,连续4年进行口腔健康状况调查,采用WHO推荐的检查方法和龋病诊断标准,调查海淀区3岁儿童乳牙龋病的患病趋势。口腔检查由2年以上工作经验的儿童口腔医生进行,所有的检查者都经过培训和校准。结果 4年来13所幼儿园3岁儿童的患龋率为46.26%～51.62%,逐年上升(P<0.05),平均48.78%。龋均(dft)2.06～2.57,龋面均(dfs)2.63～3.37,重度低龄儿童龋(SECC)患病率为22.09%～29.54%,龋均、龋面均和SECC患病率从2012年到2014年呈上升的趋势,2015年略有下降,差异有统计学意义(P<0.01)。患龋儿童接受治疗的百分比为79.14%～41.46%,龋补充填比(ft/dft)为65.09%～31.45%,二者从2012年到2014年呈下降的趋势,2015年明显有回升,差异有统计学意义(P<0.01)。结论近年来3岁儿童患龋率逐年上升,低龄化趋势明显,患龋严重程度呈上升趋势。     

泰州市7～9岁儿童第一恒磨牙龋病流行病学调查分析

目的:调查分析泰州市7～9岁儿童第一恒磨牙患龋情况,为泰州市儿童口腔病防治工作提供科学依据.方法:按WHO龋齿调查标准,采用多阶段随机整群抽样,从全市158所小学随机抽取20所学校7～9岁儿童3653名,进行第一恒磨牙的龋病流行病学调查.采用SPSS20.0软件包对数据进行统计学分析.结果:第一恒磨牙总患龋率为24.99％,龋均为0.49,龋齿充填率为3.62％.儿童患龋率从7岁的15.37％增长到9岁的39.67％.女生患龋率为27.61％,男生患龋率为21.84％,男女患龋率有显著差异(P＜0.05).下颌牙患龋率高于上颌牙.结论:泰州市7～9岁儿童第一恒磨牙患龋率高,建议对适龄儿童第一恒磨牙进行窝沟封闭,早期防龋,降低龋病发生率.     

哈尔滨市3～6岁孤独症儿童乳牙患龋状况调查

目的 探讨3～6岁孤独症儿童乳牙患龋状况及其相关因素,以期为孤独症儿童的龋病防治提供参考.方法 采用整群抽样的方法抽取哈尔滨市3个城区3～6岁孤独症儿童进行问卷调查和口腔检查,问卷调查包括一般人口学特征、饮食习惯、口腔保健意识和行为等方面内容,问卷由儿童家长填写,专人发放与回收;口腔检查采用儿童龋补牙数作为评价儿童乳牙龋病的指标.对检查结果进行统计学分析.结果 共调查孤独症儿童93例(男81例,女12例),患龋率为59％( 55/93),龋均为3.245.随年龄增长,儿童患龋率增加.分析结果显示:母亲龋齿、每天喝甜饮料量、吃甜食频率、睡前吃零食是孤独症儿童龋齿的危险因素;饭后漱口、谁给孩子刷牙、每日刷牙次数、父母文化程度是孤独症儿童龋齿的保护因素.结论 遗传因素、不良饮食习惯及口腔卫生习惯对龋病的发生发展有一定影响,孤独症儿童乳牙龋病及口腔卫生状况的改善有待于家长及医护人员的配合和努力.     

基于慢性疾病管理理念的重度低龄儿童龋管理方法

重度低龄儿童龋是威胁中国儿童口腔健康的主要疾病。目前中国龋病治疗的主要手段是充填修复,对重度低龄儿童龋患者,充填修复具有患儿难配合、新发龋多、经济及医疗负担重等局限之处。随着对龋病病因学和疾病过程的深入理解,学界提出了基于慢性疾病管理思路的龋病管理模式,通过对致龋因子和保护因子的干预来改善口腔环境,由单纯的去除龋坏组织转向控制龋病的疾病进程,由此来改善龋病的治疗效果。本文以龋病的慢性疾病管理方法及国外本专业学术组织发布的指南进行回顾综述,为中国重度低龄儿童龋防治提供参考。     

沈阳市幼儿园5岁儿童乳牙龋病流行病学抽样调查报告

目的 调查沈阳市幼儿园5岁儿童乳牙龋患病情况.方法 采用分层等容量随机抽样的方法,抽取沈阳市内5区5岁常住人口440人及其家长,男女各半.检查儿童全口乳牙牙冠龋病情况,统计患龋率、龋均等,将所得数据与本地区1995年的调查数据进行比较;并对家长进行儿童饮食习惯、刷牙情况等的问卷调查.结果 乳牙患龋率为67.05％,龋均为3.10,龋齿充填完好率5.51％,曾接受过龋齿治疗的占8.41％.与1995年沈阳市幼儿园5岁儿童乳牙龋病情况比较,患龋率有所下降(P＜0.001),龋均亦有下降(P＜0.001).问卷调查中有睡前进甜食行为者占41.28％,定期进行口腔健康检查者只占2.04％,在家长监督下有效刷牙率为10.17％,家长对儿童口腔健康状况满意率为82.91％.结论 沈阳市幼儿园5岁儿童乳牙患龋率与1995年相比虽然有所下降,但仍占较高比例.家长对儿童口腔健康认识程度低与高患龋率有关,对家长的口腔健康教育有待加强.     

Determinants of early childhood caries in low-income African American young children

PURPOSE: The aim of this longitudinal study was to evaluate the association between early childhood caries (ECC) and severe ECC (S-ECC) and social, dietary, and behavioral risk factors. METHODS: A representative sample of low-income 0- to 5-year-old children was selected from Detroit. Children and their caregivers were examined for the presence and severity of dental caries. Trained interviewers administered questionnaires assessing social, dietary, and behavioral factors. RESULTS: A total of 1,021 child and caregiver dyads were examined in wave 1. Of these, 788 (77%) were re-examined in wave 2. ECC and S-ECC were highly prevalent in this cohort By 2 years of age, 7% of the children had ECC without S-ECC (ECC-only) and 27% had S-ECC. The regression model found that age of the child and caregiver, child's gender, and caregivers' fatalistic oral health beliefs were significantly associated with higher odds ratios of developing ECC-only and S-ECC. Consumption of soda beverages was associated with developing S-ECC. Religiosity was protective against ECC-and S-ECC. CONCLUSIONS: Early childhood caries and severe early childhood caries are highly prevalent in low-income African American children. Intake of soda beverages by the children and the caregivers' fatalistic oral health beliefs and religiosity were significant determinants of ECC and S-ECC.     

上海市1296名3~5岁儿童龋病及其相关危险因素分析

目的 了解上海市3~5岁儿童低龄儿童龋患病情况及相关危险因素,为龋病防治提供参考。方法 根据第4次全国口腔健康流行病学调查要求,采用多阶段分层、等容量随机抽样方法,抽取上海市1 296名4个区、12个幼儿园中3~5岁儿童进行龋病检查,对其家长进行口腔健康知识问卷调查。采用SPSS 21.0软件包进行统计学分析。结果 上海市3~5岁儿童的乳牙患龋率、龋均分别为58.07%、2.99,各年龄组及性别间差异均有统计学意义(P<0.05)。龋病相关单因素分析及多因素Logistics回归分析均显示,饮用甜饮料频率高、睡前吃甜食、刷牙频率少于每天1次、开始刷牙年龄大于2岁、家长受教育程度低及口腔健康知识水平差是患龋的危险因素。结论 上海市3~5岁儿童乳牙患龋率较高,加强儿童的饮食习惯及口腔卫生行为教育,提高家长口腔健康知识水平,是防治儿童龋病的有效途径。     

Determinants of early childhood caries in a group of inner-city children.

OBJECTIVE: This study aimed to determine the prevalence of early childhood caries (ECC) and severe early childhood caries (s-ECC) in inner-city children in Ghent, Belgium, and to investigate the independent impact of its determinants. METHOD AND MATERIALS: In a non-randomized cross-sectional research design, all children between 24 and 34 months of age attending the final consultation at a participating Child and Family Health Clinic were included (n = 385). Data on oral hygiene and caries were collected by oral examination. Caries prevalence and oral hygiene were determined according to established criteria. Data on oral health habits and socioeconomic status were obtained by a validated questionnaire. All analyses were performed with ECC and s-ECC as response variables. RESULTS: The mean DMFS was 0.83 (SEM = 0.14). ECC was diagnosed in 18.5% of the children and s-ECC was found in 12.2%. Treatment need was 100%. From the multiple regression analysis it became clear that ethnicity and neighborhood significantly determined ECC. From all oral health-related behavioral variables, only daily use of a bottle with sweetened drinks other than milk or water, frequency of brushing, and quality of oral hygiene as expressed by Plaque Index scores remained significantly associated with ECC. CONCLUSION: Children whose mothers had an Eastern European nationality at birth and who live in a deprived neighborhood, daily use a bottle with sweetened drinks other than milk or water, brush less than once a day, and have plaque are at higher risk for ECC and s-ECC.     

Factors Influencing Early Childhood Caries of Cleft Lip and/or Palate Children Aged 18 to 36 Months in Southern Thailand

Objective: To clarify whether oral health care behavior or oral cleft status influences early childhood caries in southern Thailand cleft children. Design: A comparative cross-sectional study. Patients, Participants: A total of 138 southern Thai children aged 18 to 36 months comprised two groups of 69 participants, one with cleft lip and/or palate and controls with no cleft. Methods: All children were examined for early childhood caries by using the severity (DMFT/tooth) index. A structured interview was conducted among caregivers, and then multiple regression analysis was applied. Results: Children with oral clefts had a larger number of early childhood caries (ECC) and poorer feeding habits than those without. From a structured questionnaire, the caregivers of children with clefts exercised poorer oral health behavior than those of the controls, but the cleft status was not an important factor for caries prevalence when oral health behaviors were controlled. Multivariate analysis showed that sweetened bottled milk consumption, night-time feeding habit, and frequent sugary food consumption were the variables significantly associated with dental caries. Conclusions: Children with oral clefts in southern Thailand had greater caries experience when compared with noncleft subjects. However, cleft status was not significant for ECC, and night-time feeding habit was the most important factor for higher ECC in children with clefts.     

Determinants of early childhood caries (ECC) in a rural Manitoba community: a pilot study

PURPOSE: Preschool oral health is often overlooked as an important aspect of childhood health and well-being. The purposes of this study were to: (1) determine the dental status of 3-year-old children in the community of Carman, Manitoba, Canada; and (2) identify the principal determinants of Early Childhood Caries (ECC) in 2 consecutive years. METHODS: All children and mothers attending a preschool health screening fair were invited to participate. Study procedures included a retrospective interview with parents and dental examination of the child. Statistical analyses included ANOVA, chi-square, and multiple regression. A P value of <.05 denoted significance. RESULTS: A total of 61 children participated (mean age=45.7+/-3.4 months). The prevalence of ECC was 44%, while the mean deft was 2+/-3.3. Increased caries activity and ECC were associated with lower maternal level of education (P<.01). Family size was associated with deft scores (P=.03) while the presence of debris was also associated with ECC (P<.05). CONCLUSIONS: ECC prevalence among these 3-year-olds is less than exhibited among other Canadian preschool children. Factors associated with ECC included debris on the primary teeth and low maternal education. Factors most associated with increased caries activity included low maternal education and increased family size. In addition, parents were able to reliably assess their child's dental health status. Larger epidemiological studies of ECC are needed to better assess prevalence and risk factors. Such data may, therefore, assist in identifying those children at greatest risk for ECC. It may also help in the redirection of scarce resources to effective preventive oral health interventions, as these children have an increased caries burden along the continuum of childhood.     

Early childhood caries: prevalence and risk factors in Seoul,Korea

OBJECTIVE: The purpose of this study was to determine the prevalence of early childhood caries (ECC), including noncavitated lesions (d1), in children 6-59 months of age in relation to socioeconomic factors, feeding practices, and oral health behaviors in Seoul, Korea. METHODS: The children attended child care facilities and were selected from 32 primary sampling units. Two dentists examined 470 children. Parents of 383 of the subjects were interviewed by phone regarding caries risk factors. RESULTS: For children 6-59 months of age, the prevalence of ECC and severe ECC were 56.5 percent and 47.0 percent respectively. In bivariate analysis, the children whose nursing bottle contained sweetened solution had higher severe ECC prevalence (P=.035), and children whose parents reported a lower frequency of between-meal snacks showed lower ECC prevalence (P=.046). By logistic regression analysis, age and frequency of between-meal snacks were associated with the prevalence of ECC (P<.05). CONCLUSION: This study demonstrates that the prevalence of ECC was high among children in Seoul. Early educational intervention programs for pregnant women and mothers of young children should be developed based on the risk factors identified in this study.     

Middle ear and respiratory infections in early childhood and their association with early childhood caries

PURPOSE: The purpose of this study was to examine the risk of early childhood caries (ECC) in children who had middle ear infections (MEI) or respiratory tract infections (RTI) during early childhood. METHODS: Medicaid data from Michigan were analyzed for all continuously enrolled children born in 2001 for whom enrollment, medical, and dental claims were filed during 2001-2004. Proportional hazards survival models were used to assess the risk of ECC in children who had MEl or RTI during the first year of life. RESULTS: Included in the study were 29,485 children (51% males and 49% females). By first year of life, 47% and 69% of children had a claim for MEI and RTI, respectively. Children with at least one claim for MEI or RTI were at 29% higher risk for developing ECC compared to those with no claims (P < .001). Hispanic children with 8 or more claims showed 91% greater risk for developing ECC than those with less than 8 claims (P = .01). CONCLUSIONS: The occurrence of middle ear infections or respiratory tract infections during the first year of life is associated with a significantly increased risk for developing early childhood caries during subsequent years. Race and ethnicity are possible predictors for ECC in the studied models.     

Presence of mutans streptococci and Candida spp. in dental plaque/dentine of carious teeth and early childhood caries

This study determined the presence of mutans streptococci and Candida spp. in supragingival dental plaque and infected dentine of caries-free children, with early childhood caries and caries. Pooled samples of dental plaque and infected dentine were collected from 56 children aged 1-5 years, which were divided into 3 groups: early childhood caries (ECC); caries and caries-free. Infected dentine was collected in ECC and caries groups to compare the frequency of these microorganisms in the collected sites. The samples were inoculated in SB20 and SA medium, for mutans streptococci and Candida spp., respectively, and incubated at 37 degrees C for 48 h. Colony growth was verified and the identification was performed by biochemical tests and CHROMagar Candida. Fisher's test or chi-square (chi(2)) were applied (p=0.05). The more prevalent species were S. mutans and Candida albicans in ECC (85.4% and 60.4%, respectively), independently of the sample site. S. mutans only was significantly associated with carious teeth, whether in early childhood caries or not. However, the frequency of C. albicans in ECC was higher when compared to caries and caries-free groups. There is a significant association between the presence of C. albicans and early childhood caries.     

Prevention of early childhood caries: a public health perspective

This paper proposes strategies for preventing early childhood caries (ECC), preferably for the greatest number of children at the lowest cost. Population-based, public health approaches are more likely to reach the target population groups at risk of developing ECC than individual, private practice-based approaches. Different prevention and early intervention strategies are discussed and the following recommendations are made: 1) Continue to promote community water fluoridation. 2) Evaluate the effectiveness of other public health oriented measures to prevent ECC. 3) Develop a national ECC and rampant caries registry. 4) Link oral health screening and easily implemented, low-cost interventions with immunization schedules and public health nursing activities. 5) Increase opportunities for community-based interventions conducted by dental hygienists. 6) Change insurance reimbursement schedules to provide incentives for dentists to prevent disease. 7) Include dentistry in new child health insurance legislation for children as well as parents of infants and preschool children.