Gillcrist J A, Brumley D E, Blackford J U
Oral Health Services, Tennessee Department of Health, Cordell Building, 5th Floor, 425 5th Ave., North Nashville, Tenn. 37247, USA.
J Am Dent Assoc. 2001 Feb;132(2):216-22. doi: 10.14219/jada.archive.2001.0158.
Although a substantial decline in dental caries has occurred among U.S. children, not everyone has benefited equally. The first-ever surgeon general's report on oral health in America indicates that the burden of oral diseases is found in poor Americans. This study investigates the relationship between community socioeconomic status, or SES, and dental health of children.
An oral health survey of 17,256 children, representing 93 percent of children residing in 62 Tennessee communities, was conducted in public elementary schools during the 1996-1997 school year. Portable dental equipment was used for examinations, and data from each examination were entered directly into a laptop computer. The authors performed analyses of covariance to examine the relationship between community SES (low/medium/high) and dental health, controlling for community fluoridation.
Community SES was significantly related to caries experience in the primary teeth, the proportion of untreated caries in the primary and permanent teeth, dental treatment needs, dental sealants and incisor trauma. Overall, dental health was significantly worse for low-SES communities than for medium- and high-SES communities.
The authors conclude that all specific dental indexes used to measure children's dental health in this study, with the exceptions of caries experience in the permanent teeth and sealant presence, were inversely related to the communities' SES. The percentage of children with dental sealants was directly related to the community's SES.
Further improvements in oral health will necessitate that community-based preventive programs and access to quality dental care be made available to children who are identified as being at highest risk of experiencing oral disease.
尽管美国儿童的龋齿率已大幅下降，但并非所有人都能平等受益。美国有史以来第一份关于口腔健康的卫生局局长报告指出，美国贫困人口面临着口腔疾病的负担。本研究调查了社区社会经济地位（SES）与儿童牙齿健康之间的关系。
在1996 - 1997学年期间，对田纳西州62个社区中93%的儿童（共17256名）在公立小学进行了口腔健康调查。使用便携式牙科设备进行检查，并将每次检查的数据直接输入笔记本电脑。作者进行了协方差分析，以检验社区SES（低/中/高）与牙齿健康之间的关系，并控制社区的氟化物使用情况。
社区SES与乳牙龋齿经历、乳牙和恒牙未治疗龋齿的比例、牙科治疗需求、牙面封闭剂和门牙外伤显著相关。总体而言，低SES社区儿童的牙齿健康状况明显比中SES和高SES社区差。
作者得出结论，在本研究中用于衡量儿童牙齿健康的所有特定牙科指标，除了恒牙龋齿经历和牙面封闭剂的使用情况外，均与社区SES呈负相关。有牙面封闭剂的儿童比例与社区SES呈正相关。
要进一步改善口腔健康，就必须为被确定为患口腔疾病风险最高的儿童提供基于社区的预防项目和获得优质牙科护理的机会。
