陳昕,張建軍,任洪芋

(襄陽市口腔醫(yī)院湖北襄陽441003)

中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目預(yù)防兒童齲病的2年效果評(píng)價(jià)

陳昕,張建軍,任洪芋

(襄陽市口腔醫(yī)院湖北襄陽441003)

目的:探討以口腔健康教育和窩溝封閉為主要內(nèi)容的中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目對(duì)二年級(jí)小學(xué)生齲病的預(yù)防作用.方法:隨機(jī)選取襄陽市樊城區(qū)5所小學(xué)二年級(jí)學(xué)生共546人,記錄(第一次檢查)所有學(xué)生口腔保健知識(shí)知曉分?jǐn)?shù)、是否正確刷牙和第一磨牙的齲壞情況.隨機(jī)選擇2所學(xué)校(學(xué)生222人)為對(duì)照組,對(duì)照組學(xué)生不作任何干預(yù).另3所學(xué)校(學(xué)生324人)為干預(yù)組,干預(yù)組所有學(xué)生首先接受口腔健康教育,然后對(duì)其中238名學(xué)生(窩溝組)進(jìn)行第一磨牙窩溝封閉,剩余86人(教育組)未進(jìn)行窩溝封閉.兩年后,對(duì)選取的546名學(xué)生進(jìn)行第二次檢查.結(jié)果:第一次檢查保健知識(shí)知曉分?jǐn)?shù)、正確刷牙率和第一磨牙齲均,對(duì)照組、教育組和窩溝組兩兩比較均無明顯統(tǒng)計(jì)學(xué)差異.第二次檢查中,干預(yù)組的保健知識(shí)知曉分?jǐn)?shù)、正確刷牙率均明顯高于對(duì)照組(<0.01);教育組和對(duì)照組的第一磨牙齲均無明顯統(tǒng)計(jì)學(xué)差異(>0.05);窩溝組的第一磨牙齲均明顯低于對(duì)照組.結(jié)論:中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目可顯著減少齲病的發(fā)生,從而預(yù)防兒童齲病.

口腔健康教育;窩溝封閉;齲病

衛(wèi)生部自2008年開始在中西部地區(qū)開展兒童口腔疾病綜合干預(yù).我院自2011年起承擔(dān)本地區(qū)的干預(yù)工作,目前已對(duì)湖北襄陽市近萬名適齡兒童實(shí)施了口腔疾病綜合干預(yù).齲病是青少年兒童的多發(fā)病[1-2],屬于細(xì)菌性疾病,如不及時(shí)治療,病變繼續(xù)發(fā)展,可形成齲洞,導(dǎo)致牙冠完全破壞消失,甚至引起牙槽骨和頜骨炎癥[3-4].因此如何有效預(yù)防齲病就顯得尤其重要.本研究的目的在于探討以口腔健康教育和窩溝封閉為主要內(nèi)容的中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目對(duì)二年級(jí)小學(xué)生齲病的預(yù)防作用.

1 資料和方法

1.1 一般資料:本研究隨機(jī)選取襄陽市樊城區(qū)5所小學(xué)二年級(jí)學(xué)生共546人,對(duì)所有學(xué)生進(jìn)行第1次口腔問卷調(diào)查和口腔檢查,記錄口腔保健知識(shí)知曉分?jǐn)?shù)、是否正確刷牙和第一磨牙的齲壞情況.問卷調(diào)查使用國(guó)家項(xiàng)目辦制定的標(biāo)準(zhǔn)問卷.

1.2 方法:隨機(jī)選擇2所學(xué)校(學(xué)生222人)為對(duì)照組,對(duì)照組學(xué)生不作任何干預(yù).另3所學(xué)校(學(xué)生324人)為干預(yù)組,干預(yù)組所有學(xué)生接受口腔健康教育.根據(jù)學(xué)生家長(zhǎng)的意愿,對(duì)其中238名學(xué)生(窩溝組)進(jìn)行第一磨牙窩溝封閉,剩余86人(教育組)未進(jìn)行窩溝封閉.實(shí)施干預(yù)的成員由我院數(shù)名口腔臨床醫(yī)師組成.兩年后,對(duì)選取的546名學(xué)生進(jìn)行第二次口腔問卷調(diào)查和口腔檢查,同時(shí)記錄窩溝組學(xué)生窩溝封閉劑的存留.

1.3 統(tǒng)計(jì)學(xué)分析:對(duì)照組、教育組和窩溝組學(xué)生保健知識(shí)知曉分?jǐn)?shù)和齲均的差異比較采用"完全隨機(jī)設(shè)計(jì)多組間均數(shù)比較的方差分析",正確刷牙率的差異比較采用2檢驗(yàn).采用SPSS11.0軟件進(jìn)行統(tǒng)計(jì)分析,雙側(cè)<0.05為有明顯統(tǒng)計(jì)學(xué)差異.

2 結(jié)果

第1次檢查對(duì)照組、教育組和窩溝組的保健知識(shí)知曉分?jǐn)?shù)分別為36.40±7.40、37.41±6.19和36.22±6.38;3組間兩兩比較均無明顯統(tǒng)計(jì)學(xué)差異(>0.05).第2次檢查對(duì)照組、教育組和窩溝組的保健知識(shí)知曉分?jǐn)?shù)分別為48.69±6.72、78.25± 5.83和80.47±6.14;3組間兩兩比較均有明顯統(tǒng)計(jì)學(xué)差異(<0.01),見表1.

第1次檢查對(duì)照組、教育組和窩溝組的正確刷牙率分別為30.63%、31.40%和29.41%;3組間兩兩比較均無明顯統(tǒng)計(jì)學(xué)差異(>0.05).第2次檢查對(duì)照組、教育組和窩溝組的正確刷牙率分別為49.10%、73.26%和82.77%;教育組和對(duì)照組、窩溝組和對(duì)照組之間均有明顯統(tǒng)計(jì)學(xué)差異(<0.01),見表2.

表1 保健知識(shí)知曉分?jǐn)?shù)

表2 正確刷牙率

表3 第一磨牙齲均

第1次檢查對(duì)照組、教育組和窩溝組的第一磨牙齲均分別為0.04±0.23、0.03±0.24和0.04± 0.23;3組間兩兩比較均無明顯統(tǒng)計(jì)學(xué)差異(> 0.05).第2次檢查對(duì)照組、教育組和窩溝組的第一磨牙齲均分別為0.25±0.57、0.17±0.49和0.11±0.35;教育組和對(duì)照組之間無明顯統(tǒng)計(jì)學(xué)差異(>0.05),窩溝組和對(duì)照組之間有明顯統(tǒng)計(jì)學(xué)差異(<0.01),見表3.窩溝組238名學(xué)生于兩年前進(jìn)行窩溝封閉815顆牙,現(xiàn)有554顆尚有窩溝封閉劑存留,存留率為68.02%.

3 討論

中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目旨在加強(qiáng)中西部地區(qū)兒童口腔疾病綜合防治工作,主要人群是8歲小學(xué)生.齲病是青少年兒童的多發(fā)病[1-2].本研究的目的在于探討以口腔健康教育和窩溝封閉為主要內(nèi)容的中西部地區(qū)兒童口腔疾病綜合干預(yù)項(xiàng)目對(duì)二年級(jí)小學(xué)生齲病的預(yù)防作用,從而進(jìn)一步尋找項(xiàng)目實(shí)施中的薄弱環(huán)節(jié),為項(xiàng)目的改進(jìn)提供參考意見.

良好的飲食習(xí)慣和正確的刷牙方式可以有效潔凈牙齒,從而減少齲病的發(fā)生[5].本研究中,教育組的保健知識(shí)知曉分?jǐn)?shù)、正確刷牙率均明顯高于對(duì)照組(<0.01),與馬松波等的研究結(jié)果一致[6].雖然兩組的第一磨牙齲均無明顯統(tǒng)計(jì)學(xué)差異(>0.05),但從數(shù)值上看,對(duì)照組和教育組的第一磨牙齲均分別為0.25±0.57和0.17±0.49,我們?nèi)匀豢梢酝茢嗫谇唤】到逃龑?duì)于齲病預(yù)防的積極作用.值得注意的是,經(jīng)過口腔健康教育后,教育組的正確刷牙率僅達(dá)到73.26%,這說明兒童口腔健康教育還有很多工作需要加強(qiáng)、改進(jìn).

窩溝封閉是對(duì)容易發(fā)生齲病的窩、溝、點(diǎn)隙,用一些有機(jī)高分子材料進(jìn)行封閉,隔絕口腔致齲因素的作用,從而預(yù)防齲病[7-8].本研究中,窩溝組的保健知識(shí)知曉分?jǐn)?shù)和正確刷牙率均明顯高于對(duì)照組(<0.01),且其第一磨牙齲均明顯低于對(duì)照組(<0.01).這些結(jié)果均表明,口腔健康教育和窩溝封閉可顯著減少齲病的發(fā)生,與雷志紅和諶東明等的研究結(jié)果一致[9-10].但同時(shí)應(yīng)注意到,兩年后窩溝封閉劑的存留率低于70%,這說明窩溝封閉的相關(guān)工作還有待進(jìn)一步加強(qiáng)、規(guī)范.

綜上所述,口腔健康教育和窩溝封閉可顯著減少齲病的發(fā)生,顯示兒童口腔疾病綜合干預(yù)項(xiàng)目啟到了較好的效果.

[1]Kemparaj U,Chavan S,Shetty NL.Caries risk assessment among school children in davangere city using cariogram[J]. Int J Prev Med,2014,5(5):664-671.

[2]樊麗軍,杭彥龍.張家口市小學(xué)生六齡齒齲病的抽樣分析[J].中國(guó)美容醫(yī)學(xué),2011,20(z3):296-297.

[3]Costa S M,Abreu M H,Vargas A M,et al.Dental caries and endemic dental fluorosis in rural communities,Minas Gerais, Brazil[J].Rev Bras Epidemiol,2013,1(4):1021-1028.

[4]Medina-Solis CE,Pontigo-Loyola AP,Mendoza-Rodriguez M,et al.Treatment needs for dental caries,restorative care index and index of extractions in adolescents 12 and 15 years old[J].West Indian Med J,2013,62(7):636-641.

[5]臺(tái)保軍,江漢,杜民權(quán),等.學(xué)?？谇唤】到逃?xiàng)目的3年效果評(píng)價(jià)[J].上海口腔醫(yī)學(xué),2006,15(6):591-595.

[6]馬松波,高紅媛,段義峰,等.口腔健康教育對(duì)泰州市城區(qū)小學(xué)生口腔衛(wèi)生知識(shí)和口腔健康行為改變的影響[J].口腔醫(yī)學(xué),2011,31(12):753-754.

[7]Paris S,Lausch J,Selje T,et al.Comparison of sealant and infiltrant penetration into pit and fissure caries lesions in vitro[J].J Dent,2014,42(4):432-438.

[8]萬呼春,盧展民.非創(chuàng)傷性治療技術(shù)充填和窩溝封閉年輕恒牙2年效果觀察[J].華西口腔醫(yī)學(xué)雜志,1999,17(1): 42-45.

[9]雷志紅,任輝.Helioseal F,窩溝封閉劑在6~12歲兒童第一恒磨牙早期窩溝中的臨床應(yīng)用[J].中國(guó)美容醫(yī)學(xué), 2011,20(7):1152-1153.

[10]諶東明.窩溝封閉術(shù)在兒童防齲應(yīng)用中的臨床觀察[J].重慶醫(yī)學(xué),2011,40(8):815-816.

編輯/何志斌

Two-year evaluation of preventive effects of the comprehensive intervention project of children's oral diseases in central and western china for children's dental caries

CHEN Xin,ZHANG Jian-jun,REN Hong-yu
(Xiangyang Stomatological Hospital,Xiangyang 441003,Hubei,China)

ObjectiveThe aim of this study is to discuss preventive effects of the Comprehensive Intervention Project of Children's Oral Diseases in Central and Western China for second-year pupils. Methods This study randomly selected 546 second-year pupils from 5 primary schools in Fancheng district,Xiangyang.The awareness score of oral health care,rightly brushing or not,and caries of the first molars were recorded for all students(the first survey).Two schools were randomly selected as the control group(222 students),and students in the control group didn't received any treatment.The other three schools were selected as the intervention group(324 students),and all students in the intervention group received oral health education.238 of them(the pit and fissure group)received pit and fissure sealant,the other 86(the education group)received no treatment.Two years later,all the pupils'oral health conditions were investigated again(the second survey).Results In the first survey, there was no significant difference among the three groups in the awareness score of oral health care, the rate of rightly brushing,and the caries prevalence of the first molars(>0.05).In the second survey,the intervention group's awareness score of oral health care and rate of rightly brushing were significantly higher than that of the control group(<0.01);there was no significant difference in the caries prevalence rate of the first molars between the education group and the control group(>0.05);the pit and fissure group's caries prevalence rate of the first molars was significantly lower than that of the control group(<0.01).Conclusion The comprehensive intervention project of children's oral diseases in central and western China can significantly reduce the occurrence of caries.

oral health education;pit and fissure sealant;caries

R783

A

1008-6455(2014)21-1835-03

2014-07-14

2014-08-10