ブラジル人小児における外傷性歯牙損傷後の即時治療希望の決定要因

Determinant factors for immediate care seeking after traumatic dental injury among Brazilian children.

抄録

本研究では、初生歯列における外傷性歯牙損傷（TDI）後の即時ケアを求める頻度と、子どもの特徴、社会経済的地位、TDIの特徴との関連を評価することを目的とした。本研究は，2007年から2018年の間に，初生歯列におけるTDIのリファレンスセンターに通院した9カ月から6歳の子どもの歯科記録を用いた横断的研究である．TDI後に求める即時ケア、子どもの特徴、社会人口学的条件、TDIの特徴を収集した。記述統計およびロバスト分散を用いたポアソン回帰分析を行った（p＜0.05；95％CI）。493件の歯科記録のうち，61.1％（n＝301）が男性で，50.5％（n＝249）が2歳以下の子どものものであった．対象者の3分の1以上（36.9％、n＝182）がTDI後に直ちに治療を受けた。TDIの種類別では、軟部組織損傷が59.0％（n＝291）、硬部組織損傷が51.7％（n＝255）、支持組織損傷が54.0％（n＝266）であった。TDI後の即時治療の必要性は、縫合（PR：1.39、95％CI：1.01-1.92、p＝0.039）、脱臼（側方、侵入、突出）（PR：2.36、95％CI：1.36-4.08、p＝0.002）、剥離（PR：2.18、95％CI：1.28-3.70、p＝0.004）が必要な子どもで高かった。縫合の必要性，脱臼（側方，侵入，突出），剥離は，子どもの特徴や社会経済的地位にかかわらず，TDI後にすぐにケアを求める決定要因となった。

The present study aimed to evaluate the frequency of immediate care seeking after traumatic dental injury (TDI) in primary dentition and its association with the children's characteristics, socioeconomic status, and TDI characteristics. This was a cross-sectional study with dental records of children aged 9 months to 6 years who attended a reference center in TDI in primary dentition between 2007 and 2018. Immediate care seeking after TDI, child's characteristics, sociodemographic conditions and TDI characteristics were collected. Descriptive statistics and Poisson regression analysis with robust variance were performed (p < 0.05; 95%CI). Among the 493 dental records, 61.1% (n = 301) were of males and 50.5% (n = 249) were from children aged 2 years or less. More than one third of the sample (36.9%; n = 182) sought immediate care after TDI. Among the types of TDI, the prevalence of soft tissue injuries was 59.0% (n = 291), while 51.7% (n = 255) were hard tissue injuries and 54.0% (n = 266) were supporting tissue injuries. Immediate care seeking after TDI was higher in children who needed suture (PR: 1.39; 95%CI: 1.01-1.92. p = 0.039), had luxation (lateral, intrusion, or extrusion) (PR: 2.36; 95%CI: 1.36-4.08. p = 0.002) or avulsion (PR: 2.18; 95%CI: 1.28-3.70. p = 0.004). The need for suture, luxation (lateral, intrusion and extrusion), and avulsion were determinant factors for the immediate care seeking after TDI, regardless of the child's characteristics and socioeconomic status.