Messer L B
School of Dental Science, University of Melbourne.
Aust Dent J. 2000 Mar;45(1):10-6. doi: 10.1111/j.1834-7819.2000.tb00235.x.
With the dramatic improvements in the oral health of children in Australia that have occurred over the past two decades, the option of, and the need for, targeted prevention of dental caries for those at high risk has become apparent. Since caries is of multifactorial aetiology, the clinical outcome varies depending on which factor, or combination of factors, is prominent in a particular individual; this may be related to both age and stage of life. Tests for caries risk can assist in prediction, but clinical signs and history are as important in assessing the main cause(s) of caries in an individual. In studies involving several factors, past caries experience (especially of the first permanent molar) continues to be the best predictor of future caries in children. Despite their ready availability, tests in the form of commercial kits are still expensive; no one test is an adequate predictor of caries risk, and the specificity and sensitivity of the tests are not reliably diagnostic for an individual. There is a need for regional longitudinal risk assessment studies in which potential risk factors are identified before the onset of caries in order to maximize predictive power and then validated against subsequent caries. Caries activity may not be able to be predicted in a population with low disease prevalence. Any risk assessment strategy must be followed by appropriate preventive interventions.
在过去二十年里，澳大利亚儿童的口腔健康状况有了显著改善，因此，针对高危人群进行有针对性的龋齿预防的选择和必要性已变得显而易见。由于龋齿的病因是多因素的，临床结果会因特定个体中突出的因素或因素组合而异；这可能与年龄和生活阶段都有关系。龋齿风险测试有助于进行预测，但临床体征和病史在评估个体龋齿的主要原因时同样重要。在涉及多个因素的研究中，过去的龋齿经历（尤其是第一恒磨牙的龋齿经历）仍然是儿童未来患龋的最佳预测指标。尽管商业试剂盒形式的测试随时可用，但仍然昂贵；没有一种测试能够充分预测龋齿风险，而且这些测试的特异性和敏感性对个体而言并不能可靠地用于诊断。需要开展区域性纵向风险评估研究，在龋齿发病前确定潜在风险因素，以最大限度地提高预测能力，然后根据后续的龋齿情况进行验证。在疾病患病率较低的人群中，可能无法预测龋齿活动情况。任何风险评估策略都必须辅之以适当的预防性干预措施。
