介護者の口腔保健リテラシーと特別な健康管理が必要な子ども・若者の口腔保健との関連性

Association between the caregivers' oral health literacy and the oral health of children and youth with special health care needs.

抄録

目的:

これまでの研究で、口腔衛生リテラシー（OHL）が低い養育者の子どもは、OHLが十分な養育者の子どもに比べ、未処置のう蝕が多いことが示されてきた。しかし、特別な医療を必要とする子どもや若者（CYSHCN）におけるこの関係については、情報が乏しい。そこで本研究では、養育者の OHL と CYSHCN の口腔保健状態との関連について評価することを目的とした。

AIM: Previous studies have shown that children of caregivers with low oral health literacy (OHL) had more untreated caries than children of caregivers with adequate OHL. However, there is a paucity of information on this relationship among children and youth with special health care needs (CYSHCN). Accordingly, this study aims to assess the association between the caregivers' OHL and the oral health status of CYSHCN.

方法:

METHODS: This cross-sectional study was conducted in four schools dedicated for CYSHCN. A 48-item questionnaire gathered information about the demographic and socioeconomic factors, the child/adolescent's medical condition, dental characteristics, caregiver self-efficacy and the child's dental attitude. The Comprehensive Measure of Oral Health Knowledge (CMOHK) questionnaire was used to assess the caregivers' OHL. The Löe & Silness gingival index (GI) and the Silness & Löe plaque index (PI) were used to assess gingival health and plaque levels, respectively. Directed acyclic graphs (DAGs) were utilized for the selection of the appropriate set of confounding variables for regression analysis. The mean score differences and 95% confidence intervals (CI) were estimated to quantify the associations of the various covariates with oral health outcome variables.

結果:

本研究では、214組の子ども・保護者を対象とした。対象者の多くは身体障害者（56.1％）で、次いで聴覚障害児（9.8％）、先天性異常・症候群（7.9％）であった。PIとGIの平均値はそれぞれ1.26±0.52と1.30±0.47であった。CMOHKスコアの中央値は12点であり，中央値に基づいて二分化させた．介護者の口腔保健概念知識の低さは，より高いPIスコアと有意に関連していた（β [95% CI] = -0.26 [-0.41, -0.13]; p<0.001.高齢の参加者（12～21歳）は、若年参加者（6～12歳）と比較してプラークスコアが有意に高かった（β [95% CI] = 0.33 [0.18, 0.51]; p<0.001）．毎日2回以上歯を磨いた参加者は、有意に低かった（β [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046）。概念的知識スコアは、GIと有意な関連はなかった。

RESULTS: This study included 214 child/caregiver dyads. Most participants were physically disabled (56.1%) followed by children with hearing difficulty (9.8%) and congenital anomalies/syndromes (7.9%). The mean PI and GI of the children was 1.26±0.52 and 1.30±0.47, respectively. The median CMOHK score was 12 and the respondents were dichotomized based on the median value. Low caregiver oral health conceptual knowledge was significantly associated with higher PI scores (β [95% CI] = -0.26 [-0.41, -0.13]; p<0.001. Older participants (12-21-year-olds) had significantly higher plaque scores compared with younger participants (6-12-year-olds) (β [95% CI] = 0.33 [0.18, 0.51]; p<0.001). Participants who brushed their teeth twice or more daily had significantly lower (β [95% CI] = -0.15 [-0.43, -0.01]; p = 0.046). Conceptual knowledge score was not significantly associated with GI.

結論:

本研究では、介護者のOHLレベルが低いほど、その子どものプラークスコアが高いことが明らかになった。

CONCLUSION: This study found lower caregiver OHL levels to be associated with higher plaque scores for their child.