高う蝕リスクの成人における局所フッ化物の有効性

Topical Fluoride Effectiveness in High Caries Risk Adults.

抄録

この縦断的データのレトロスペクティブ分析は、高う蝕リスクの成人において、どの種類、組み合わせ、強さの局所フッ素剤がより効果的に新しいう蝕関連の修復や抜歯を防ぐかを明らかにするために開発された。2008年10月1日から2018年6月30日までの、米国退役軍人省の電子歯科・医療記録および薬局データベースからのデータを対象とした。継続的かつ包括的なケアの対象となり、高う蝕リスクの基準（365日以内に2回以上のう蝕関連修復を受けた）を満たし、3yのフォローアップがあった退役軍人を対象とした。多変量ロジスティック回帰モデルにより，年齢，性別，人種および民族，疾病負担（Selim comorbidity index），処方薬の使用，歯科予防のための予約への出席，指標年の齲蝕関連修復の回数，指標年の最初の齲蝕関連修復から最後の齲蝕関連修復までの時間を制御し，1年間の観察期間における齲蝕関連治療の確率を算出した．調査対象者は68,757人の退役軍人で、主に男性（91.5%）、白人（73.6%）、平均年齢59.2 ± 13.5 歳、Selim指数（身体診断3.7 ± 2.4 、精神診断1.3 ± 1.2 ）で測定される著しい医療共存性を持っていた。また，10.8 ± 6.3 の処方VA薬クラスを有し，0.6 ± 0.8 の強い抗コリン薬を服用し，指標年に 3.9 ± 2.6 本の歯がう蝕のために修復された．調整された多変量ロジスティック回帰モデルは、フッ化物無添加に対してワニスまたはジェル/リンスのフッ化物介入を受けた退役軍人は、観察期間中にう蝕関連の治療を受ける確率が約29％減少することを示した（ジェル/リンス調整オッズ比 [AOR] = 0.72; 95％信頼区間 [CI], 0.67-0.76; ワニス AOR = 0.71; 95％ CI, 0.67-0.75 ）。ワニスおよびジェル/リンスの受領は、それぞれの介入単独よりも統計的に良好なオッズを示さなかった（AOR = 0.69; 95% CI, 0.64-0.75）。用量反応効果が観察された。ワニスの2回以上の塗布 vs なし（AOR = 0.73; 95% CI, 0.69-0.77） およびジェル/リンスの2回以上の塗布 vs なし（AOR = 0.71; 95% CI, 0.67-0.75） は、いずれかの方法の1回の塗布 vs なしよりも効果的であった。

This retrospective analysis of longitudinal data was developed to determine which types, combinations, and intensities of topical fluorides more effectively prevent new caries-related restorations and extractions in high caries risk adults. We included data from October 1, 2008, through June 30, 2018, from electronic dental and medical records and pharmacy database from the US Department of Veterans Affairs. Veterans who were eligible for continuing and comprehensive care, met the criteria of high caries risk (received 2 or more caries-related restorations within a 365-d period), and had 3 y of follow-up were included. Multivariable logistic regression models estimated the odds of caries-related treatment during the 1-y observation period, controlling for age, gender, race and ethnicity, illness burden (Selim comorbidity index), use of prescription medications, attendance at dental prophylaxis appointments, number of caries-related restorations during the index year, and time between first and last caries-related restoration during the index year. The study sample included 68,757 veterans, who were primarily male (91.5%), were White (73.6%), had a mean age of 59.2 ± 13.5 y, and had significant medical comorbidity as measured by the Selim index (3.7 ± 2.4 physical and 1.3 ± 1.2 mental diagnoses). They had 10.8 ± 6.3 prescription VA drug classes, took 0.6 ± 0.8 strong anticholinergic medications, and had 3.9 ± 2.6 teeth restored due to caries during the index year. Adjusted multivariable logistic regression models showed veterans who received a varnish or gel/rinse fluoride intervention versus no fluoride had an approximately 29% decreased odds of receiving caries-related treatment during the observation period (gel/rinse adjusted odds ratio [AOR] = 0.72; 95% confidence interval [CI], 0.67-0.76; varnish AOR = 0.71; 95% CI, 0.67-0.75). The receipt of a varnish and gel/rinse did not demonstrate statistically better odds than each intervention alone (AOR = 0.69; 95% CI, 0.64-0.75). A dose-response effect was observed. Two-plus applications of varnish versus none (AOR = 0.73; 95% CI, 0.69-0.77) and 2-plus applications of gel/rinse versus none (AOR = 0.71; 95% CI, 0.67-0.75) were more effective than 1 application of either modality versus none.