基于风险评估的6岁儿童龋病分级管理临床效果评价

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 = 0.554）。 结论基于风险评估的龋病分级管理能有效降低上海6岁儿童患龋状况，值得推广。

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

ObjectiveTo perform disease management based on caries risk assessment of children aged 6 in Shanghai and to explore the clinical effect. MethodsIn 2018, 2127 6-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. ResultsA 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 (P_{control group} = 0.031, OR_{control group} = 0.573; P_{experimental group} = 0.002, OR_{experimental group} = 0.471) , the frequency of taking desserts or sweet drinks before bed at night (P_{control group} = 0.043, OR_{control group} = 0.708; P_{experimental group} = 0.026, OR_{experimental group} = 0.706) , and the frequency of brushing teeth per day (P_{control group} = 0.000, OR_{control group} = 0.456; P_{experimental group} = 0.000, OR_{experimental group} = 0.178) . The risk factor of the control group also included the age to start brushing teeth (P = 0.037, OR = 0.380) , while among the experimental group, local fluoride application (P = 0.000, OR = 0.554) was a protective factor for caries. ConclusionIt is worth popularizing disease management based on caries risk assessment, which is effective in reducing the caries status of children aged 6 in Shanghai.