Mouradian W E, Wehr E, Crall J J
Children's Hospital and Regional Medical Center, 4800 Sand Point Way NE, PO Box 5371 CH-47, Seattle, WA 98105, USA.
JAMA. 2000;284(20):2625-31. doi: 10.1001/jama.284.20.2625.
Dental caries can be prevented by a combination of community, professional, and individual measures including water fluoridation, professionally applied topical fluorides and dental sealants, and use of fluoride toothpastes. Yet, tooth decay is the most common chronic disease of childhood. Dental care is the most prevalent unmet health need in US children with wide disparities existing in oral health and access to care. Only 1 in 5 children covered by Medicaid received preventive oral care for which they are eligible. Children from low income and minority families have poorer oral health outcomes, fewer dental visits, and fewer protective sealants. Water fluoridation is the most effective measure in preventing caries, but only 62% of water supplies are fluoridated, and lack of fluoridation may disproportionately affect poor and minority children. Childhood oral disease has significant medical and financial consequences that may not be appreciated because of the separation of medicine and dentistry. The infectious nature of dental caries, its early onset, and the potential of early interventions require an emphasis on preventive oral care in primary pediatric care to complement existing dental services. However, many pediatricians lack critical knowledge to promote oral health. We recommend financial incentives for prioritizing Medicaid Early and Periodic Screening, Diagnostic, and Treatment dental services; managed care accountability; integration of medical and dental professional training, clinical care, and research; and national leadership. JAMA. 2000;284:2625-2631.
龋齿可通过社区、专业和个人措施相结合来预防，这些措施包括水氟化、专业应用的局部用氟化物和牙面封闭剂，以及使用含氟牙膏。然而，龋齿仍是儿童最常见的慢性疾病。在美国儿童中，牙科护理是最普遍未得到满足的健康需求，口腔健康和获得护理方面存在巨大差异。医疗补助计划覆盖的儿童中，只有五分之一获得了符合资格的预防性口腔护理。来自低收入和少数族裔家庭的儿童口腔健康状况较差，看牙次数较少，使用的保护性牙面封闭剂也较少。水氟化是预防龋齿最有效的措施，但只有62%的供水进行了氟化处理，氟化处理的缺乏可能对贫困和少数族裔儿童产生不成比例的影响。儿童口腔疾病会产生重大的医疗和经济后果，由于医学和牙科的分离，这些后果可能未得到重视。龋齿的传染性、早期发病以及早期干预的可能性要求在初级儿科护理中强调预防性口腔护理，以补充现有的牙科服务。然而，许多儿科医生缺乏促进口腔健康的关键知识。我们建议提供财政激励措施，优先提供医疗补助计划的早期和定期筛查、诊断及治疗牙科服务；管理式医疗问责制；整合医学和牙科专业培训、临床护理及研究；以及国家层面的引领。《美国医学会杂志》。2000年；284:2625 - 2631。
