コロナウイルス感染症流行時の高校生の定期的な歯科受診と口腔内の健康状態の変化。学校健診のデータを用いた検討

[Regular dental visits and changes in oral health among high school students during the coronavirus disease pandemic: A study using data from medical checkup at a school].

抄録

目的 口腔の健康を維持するためには、継続的な口腔ケアと定期的な歯科受診が重要である。コロナウイルス感染症（COVID-19）は，その高い伝播性から，個人が医療機関を受診することに消極的である．COVID-19 パンデミック時の定期的な医療サービスの中断が，住民の口腔衛生にどのような影響を及ぼしたかは，現時点では不明である．本研究では、学校で実施した定期健診のデータと、健診と同時に実施したアンケート調査から得られたデータを用いて、パンデミック時の高校生の定期歯科受診状況と口腔内の健康状態の変化の関連を検討することを目的とした。方法 本研究は、福岡県内の高校から2019年度の878名（1年生と2年生から構成）を対象とした。パンデミック時の歯科検診の頻度や歯科受診に関する不安に関するデータを質問紙調査により取得した。2019年から2020年にかけての歯の健康と歯肉の状態の変化を、同校の定期検診のデータを用いて明らかにした。ロバスト標準誤差を用いたポアソン回帰分析を用いて、歯の健康状態および歯肉の状態の変化と定期的な歯科受診の状況との関連を評価した。 結果 878名中、417名（47.5%）が定期的歯科受診をしておらず、320名（36.4%）が継続受診、141名（16.1%）が流行期間中に中断された歯科定期受診を行った。定期歯科受診中断群では，歯科受診に不安を感じている人が30.5％であり，他の群に比べ有意に高い割合であった．2019年の歯科検診時に歯肉炎を認めなかった521名のうち、2020年の歯科検診時に歯肉炎を認めたのは、定期歯科受診なし31.0%、定期歯科受診あり20.2%、定期歯科受診中断あり38.2%であった。多変量調整後の発生率比は，定期歯科受診中断群で1.95［95％信頼区間（CI），1.34-2.84］，定期歯科受診なし群で1.50（95％CI，1.07-2.10）であった．定期歯科受診の中断と歯の健康状態の変化との間に有意な関連は認められなかった。結論 本研究の結果、COVID-19パンデミック時の定期歯科受診の中断と歯科受診に関する不安には有意な関連があり、定期歯科受診の中断があった参加者は学校での健康診断時に歯肉炎を有する割合が高いことが明らかとなった。

Objective　Continuous oral health care and regular dental visits are important for maintaining oral health. As a result of the high communicability of the coronavirus disease (COVID-19), individuals are reluctant to visit medical institutions. It is as yet unclear how the oral health of the population has been affected by the interruption of regular medical services during the COVID-19 pandemic. This study aimed to examine the association between the status of regular dental visits and changes in oral health among high school students during the pandemic using data from routine medical checkups conducted at a school, as well as data obtained from a questionnaire-based survey conducted simultaneously with medical checkups.Methods　This study included 878 participants (comprising freshmen and sophomores) during the 2019 academic year from a high school in Fukuoka prefecture, Japan. Data on the frequency of dental checkups and anxiety related to dental visits during the pandemic was obtained through a questionnaire-based survey. Changes in dental health and gingival status between 2019 and 2020 were determined using data from routine medical checkups at the school. Poisson regression analysis with robust standard errors was used to evaluate the association between changes in dental health and gingival status and the status of regular dental visits.Results　Of 878 participants, 417 (47.5%) did not have regular dental visits, 320 (36.4%) continued to have regular dental visits, and 141 (16.1%) had interrupted regular dental visits during the pandemic. In the interrupted regular dental visit group, 30.5% of participants were anxious about visiting a dental institution, which was a significantly higher proportion than other groups. Of the 521 participants who did not have gingival inflammation at the time of dental checkup in 2019, gingival inflammation at the time of dental checkup in 2020 was observed in 31.0% of participants having no regular dental visits, 20.2% participants having regular dental visits, and 38.2% participants having interrupted regular dental visits. The multivariable adjusted incidence rate ratios were 1.95 [95% confidence interval (CI), 1.34-2.84] in the interrupted regular dental visit group and 1.50 (95%CI,1.07-2.10) in the no regular dental visit group. There was no significant association between interruption of regular dental visits and changes in dental health status.Conclusion　The study results showed that there was a significant association between interruptions in regular dental visits and anxiety related to dental visits during the COVID-19 pandemic, and that a higher proportion of participants who had interruptions in regular dental visits had gingival inflammation at the time of the medical checkup at the school.