幼児期う蝕に関連するリスクファクターについて

Risk Factors associated with Early Childhood Caries.

抄録

目的:

幼児期う蝕（ECC）感受性に関連する因子を分析するため、ECCリスクの高い集団をスクリーニングし、ECC予防のためのガイダンスを提案した。

OBJECTIVE: To analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention was proposed.

方法論:

青島で24ヶ月から71ヶ月の小児392名を選び、口腔内検査を行った。両親または保護者がアンケートに回答し、decayed missing filled surface（dmfs）が記録された。異なる家族におけるう蝕状態および口腔保健行動の違いを比較した。ECCに関連するリスクファクターがスクリーニングされた。最終的に、得られたdmfsに基づいて、被験者をカリエスフリー、ECC、S-ECC（重度のECC）の3群に分類した。危険因子とう蝕状態との関連は、Kruskal-Wallis検定、カイ二乗検定、ロジスティック回帰分析を用いて分析された。

METHODS: A total of 392 children aged 24 to 71 months were selected for oral examination in Qingdao. Parents or guardians of the participants completed the questionnaires and decayed missing filled surface (dmfs) were recorded. Differences in caries condition and oral health behaviour in different families were compared. Risk factors related to ECC were screened. The subjects were finally grouped based on the obtained dmfs into three groups: caries-free, ECC and S-ECC (severe ECC). Association of risk factors with the caries status was analysed using the Kruskal-Wallis test, the chi-square test and logistic regression analysis.

結果:

毎日お菓子を食べ過ぎる、寝る前と寝た後の歯磨き、親が歯磨きを手伝うかどうかの3つのパラメータで、う蝕なし群、ECC群、S-ECC群の間に有意差があった（P＜0.01）。また、両親の教育レベル、口腔衛生知識、態度、家庭の年収、子供がブラッシングを始める年齢、定期的にブラッシングをしていないなどの複合的な要因もECCと有意に関連していた（P<0.05）。出生時の状態や授乳状態、妊娠中の母親の体調、授乳状況、睡眠中のおしゃぶりの使用有無、歯磨きの時間、毎日の食後の洗口回数、フッ素入り歯磨き粉での歯磨きなどについては、3群間で有意差は認められなかった（P＞0.05）。

RESULTS: There were significant differences among the caries-free, ECC and S-ECC groups in three parameters: eating too many sweets each day, brushing before and after sleeping, and whether parents helped to brush (P < 0.01). Combined factors such as the parents' level of education, oral health knowledge, attitudes, the family's annual income, the age of children when they start to brush and not brushing regularly were also significantly related to ECC (P < 0.05). No significant differences were observed among the three groups for these factors, including birth condition and nursing state, physical condition of the mother during pregnancy, feeding situation, if a pacifier was used during sleep, duration of brushing, frequency of mouth rinsing after meals each day and brushing with fluoride toothpaste (P  > 0.05).

結論:

甘いものをたくさん食べること、間違ったブラッシング方法、ブラッシングを始める時期が遅いこと、定期的にブラッシングをしていないことは、ECCの影響を受けやすい要因です。保護者への口腔衛生知識の啓発、正しいブラッシング方法の実施、甘いものを食べる頻度の制限、甘いものを食べる不適切な習慣の回避は、ECCを予防する上で非常に重要な要素です。

CONCLUSION: Eating a lot of sweets, an incorrect brushing method, starting brushing at a later stage and not brushing regularly are susceptible factors for ECC. Emphasising oral health knowledge to parents and guardians, conducting proper brushing methods, limiting the frequency of sweets being eaten and avoiding an inappropriate habit of eating sweets are very important factors in the prevention of ECC.