Mackay Timothy D, Thomson W Murray
Southland District Health Board, Invercargill.
N Z Dent J. 2005 Jun;101(2):35-43.
The aim of this study was to examine the prevalence, severity and associations of enamel defects and dental caries in a probability-based sample of 9- and 10-year-old children living in fluoridated Invercargill and the non-fluoridated towns of Gore, Winton and Queenstown, in Southland, New Zealand.
The study was a cross-sectional survey of enamel defects and their associations in a random sample of 9- and 10-year-old children.
Parents of 600 children were sent a postal survey questionnaire which sought information on sociodemographic characteristics and fluoride exposure from different sources. Consent for dental examinations was also obtained and the children were examined in schools by the principal investigator (TDM). The Developmental Defects of Enamel (DDE) index was used to assess 10 index teeth, which were examined wet and uncleaned. An examination for caries was also carried out. Data were recorded electronically on a laptop computer, and images were taken of each child's anterior teeth using a digital camera. After univariate and bivariate analysis of the data, multivariate modelling was used to control for confounders and derive odds ratios for the prevalence of enamel defects.
Four hundred and thirty-six children (mean age of 9.8 years) were examined, giving an effective participation rate of 74.5 percent. At the time of examination the majority of children had a mixed dentition with 77.1 percent of the children having experienced dental caries. Two-thirds of the sample had had deciduous caries experience, with a mean 4.4 surfaces affected. The prevalence of enamel defects of any type among these children was 51.6 percent, with that of demarcated opacities being 38.8 percent, and that of diffuse opacities being 24.1 percent; 5.5 percent had one or more hypoplastic defects. Diffuse opacities were more frequent among children who had lived all their lives in a fluoridated area (OR = 2.23; 95 percent CI 1.37, 3.63). Most of the diffuse opacities affected less than one-third of the labial surface of the index teeth, and the maxillary central incisors were the most commonly affected tooth.
This study suggests that the prevalence of diffuse opacities among children who have lived their whole lives in a fluoridated area has not increased. The benefits of water fluoridation as a public health measure remain, with children continuously exposed to fluoridated water during their life having half the dental caries experience of those who have not. While this benefit also exacts a "biological price" in terms of a greater prevalence of diffuse opacities, the clinical, social and public health significanceof those opacities remains unclear.
本研究旨在调查新西兰南岛因弗卡吉尔（已实施饮水氟化）以及戈尔、温顿和皇后镇（未实施饮水氟化）9至10岁儿童基于概率抽样样本中牙釉质缺陷和龋齿的患病率、严重程度及相关性。
本研究是对9至10岁儿童随机样本中牙釉质缺陷及其相关性的横断面调查。
向600名儿童的家长邮寄调查问卷，询问社会人口学特征及不同来源的氟暴露情况。同时获取牙科检查的同意书，由首席研究员（TDM）在学校对儿童进行检查。使用牙釉质发育缺陷（DDE）指数评估10颗指数牙，检查时牙齿保持湿润且未清洁。还进行了龋齿检查。数据通过笔记本电脑电子记录，并用数码相机拍摄每个儿童的前牙图像。在对数据进行单变量和双变量分析后，采用多变量建模来控制混杂因素并得出牙釉质缺陷患病率的比值比。
共检查了436名儿童（平均年龄9.8岁），有效参与率为74.5%。检查时大多数儿童处于混合牙列期，77.1%的儿童有龋齿经历。三分之二的样本有乳牙龋齿经历，平均有4.4个牙面受影响。这些儿童中任何类型牙釉质缺陷的患病率为51.6%，其中界限性浑浊的患病率为38.8%，弥漫性浑浊的患病率为24.1%；5.5%的儿童有一个或多个发育不全缺陷。弥漫性浑浊在一生都生活在氟化地区的儿童中更为常见（比值比=2.23；95%置信区间1.37, 3.63）。大多数弥漫性浑浊影响不到指数牙唇面的三分之一，上颌中切牙是最常受影响的牙齿。
本研究表明，一生都生活在氟化地区的儿童中弥漫性浑浊的患病率并未增加。饮水氟化作为一项公共卫生措施的益处依然存在，一生持续接触氟化水的儿童患龋齿的经历是未接触者的一半。虽然这种益处也在弥漫性浑浊患病率更高方面付出了“生物学代价”，但这些浑浊的临床、社会和公共卫生意义仍不明确。
