Heyduck C, Meller C, Schwahn C, Splieth C H
Department of Preventive and Pediatric Dentistry, Ernst Moritz Arndt University, Greifswald, Germany.
Caries Res. 2006;40(5):375-81. doi: 10.1159/000094281.
The aim of this 3-year longitudinal study was to analyze caries increment and the caries-preventive effect of sealants in adolescents in the setting of the German national health system. 434 pupils (193 male, 241 female) took part in compulsory school examinations at age 12 (mean 12.3 +/- 0.4 years) and 15 (mean 15.6 +/- 0.3 years) according to WHO criteria, including the examination of sealants. Mean DMFT increased from 1.78 (+/- 2.15) to 3.97 (+/- 3.68), mean DMFS from 2.79 (+/-4.07) to 6.94 DMFS (+/- 8.34), respectively. Logistic regression analysis showed that high caries incidence at the individual level was mostly associated with the type of school ('Gymnasium', RR = 0.3), gender (female, RR = 2.08) and high baseline DMFS (RR = 1.2 per surface), but not with the number of sealants. In an interaction model, adolescents with high baseline DMFS values had an even higher risk of caries increment with an increasing number of sealants compared to adolescents with fewer sealants (p = 0.047). At the tooth level, this effect was detected for first permanent molars, while sealants in premolars and second permanent molars did not result in a statistically significant caries-preventive effect due to the low caries incidence on these surfaces. Thus, sealants on occlusal surfaces of first permanent molars were only protective in individuals with low or moderate caries activity (p = 0.006), which indicates the need for other measures to reduce caries activity in high risk adolescents. In addition, rates of 19% lost sealants and 18% carious or filled surfaces in 3 years suggest a discrepancy between sealant retention under real-life conditions and the results of controlled clinical trials.
这项为期3年的纵向研究旨在分析在德国国家卫生系统背景下，青少年龋齿的增量以及窝沟封闭剂的防龋效果。434名学生（193名男生，241名女生）按照世界卫生组织标准，在12岁（平均12.3±0.4岁）和15岁（平均15.6±0.3岁）时参加了义务教育阶段的检查，包括窝沟封闭剂检查。平均龋失补牙面数（DMFT）从1.78（±2.15）增加到3.97（±3.68），平均龋失补牙面总和（DMFS）分别从2.79（±4.07）增加到6.94（±8.34）。逻辑回归分析表明，个体层面的高龋齿发病率主要与学校类型（“文理中学”，相对风险RR = 0.3）、性别（女性，RR = 2.08）和高基线DMFS（每个牙面RR = 1.2）有关，但与窝沟封闭剂的数量无关。在一个交互模型中，与窝沟封闭剂较少的青少年相比，基线DMFS值高的青少年随着窝沟封闭剂数量的增加，龋齿增量风险更高（p = 0.047）。在牙齿层面，这种效应在第一恒磨牙上被检测到，而前磨牙和第二恒磨牙上的窝沟封闭剂由于这些牙面的低龋齿发病率，没有产生统计学上显著的防龋效果。因此，第一恒磨牙咬合面上的窝沟封闭剂仅对低或中度龋齿活动的个体有保护作用（p = 0.006），这表明需要采取其他措施来降低高危青少年的龋齿活动。此外，3年内19%的窝沟封闭剂脱落率和18%的龋坏或充填牙面率表明，现实生活条件下窝沟封闭剂的保留情况与对照临床试验结果之间存在差异。
