Feldens Carlos Alberto, Vítolo Márcia Regina, Drachler Maria de Lourdes
Department of Paediatric Dentistry, Lutheran University of Brazil, Canoas, Brazil.
Community Dent Oral Epidemiol. 2007 Jun;35(3):215-23. doi: 10.1111/j.1600-0528.2006.00337.x.
Assess the effectiveness of home visits for advising mothers about breast feeding and weaning on early childhood caries (ECC) at the age of 12 months.
A randomized field trial was conducted in mothers who gave birth within the public health system in the Brazilian city of Sao Leopoldo (intervention group = 200; controls = 300). The intervention group received the advice 10 days after the child's birth, monthly up to 6 months, at 8, 10 and 12 months, based on the 'Ten Steps for Healthy Feeding', a Brazilian national health policy for primary care, based on WHO guidelines. Both groups had research assessment at 6 and 12 months, with dental caries investigated in this last assessment; 122 children were lost in the 1-year follow-up; 378 were assessed for caries: two predentulous children were excluded from the analysis. Mann-Whitney U was used to test if the average number of decayed surfaces (DS; white spots and cavities) differed between the intervention and control groups, and logistic regression to estimate the effects of the intervention on the odds of ECC. Chi-square test was used to test for differences between the intervention and control groups in the distribution of feeding behaviours tackled by the dietary intervention.
10.2% of the children in the intervention group and 18.3% of the controls had caries. The odds of caries was 48% lower for the intervention group, adjusted for number of teeth (OR = 0.52, 95% CI = 0.27-0.97). Mean DS were lower for the intervention group (0.37) when compared with the control group (0.63), (Mann-Whitney U, P = 0.03). The intervention group had significantly longer duration of exclusive breast feeding (P = 0.000), later introduction of sugar (P = 0.005), and smaller probability of ever having eaten biscuits (P = 0.000), honey (P = 0.003), soft drinks (P = 0.02), fromage-frais (P = 0.001), chocolate and sweets (P = 0.001).
ECC is a public health problem in that population. The home visits for dietary advice appear to help reducing dental caries in infants. Greater efforts are needed to tackle cariogenic dietary behaviours even further, as a relevant proportion of children of the intervention group were shown to present with dental caries. Further studies should examine the effect of the intervention in the longer term.
评估产后家访为母亲提供母乳喂养及断奶建议对12个月幼儿患早期儿童龋（ECC）情况的影响。
在巴西圣莱奥波尔多市公共卫生系统内分娩的母亲中开展了一项随机现场试验（干预组 = 200人；对照组 = 300人）。干预组在孩子出生后10天接受建议，之后每月一次直至6个月大，在8、10和12个月时，依据巴西初级保健国家卫生政策“健康喂养十步骤”（基于世界卫生组织指南）接受建议。两组在6个月和12个月时进行研究评估，最后一次评估中调查龋齿情况；在1年随访中有122名儿童失访；378名儿童接受了龋齿评估；两名无牙儿童被排除在分析之外。采用曼-惠特尼U检验来检测干预组和对照组之间龋坏面（DS；白斑和龋洞）的平均数量是否存在差异，并采用逻辑回归来估计干预对患ECC几率的影响。采用卡方检验来检测干预组和对照组在饮食干预所涉及的喂养行为分布方面的差异。
干预组10.2%的儿童和对照组18.3%的儿童患有龋齿。在根据牙齿数量进行调整后，干预组患龋齿的几率低48%（比值比 = 0.52，95%置信区间 = 0.27 - 0.97）。与对照组（0.63）相比，干预组的平均龋坏面数更低（0.37）（曼-惠特尼U检验，P = 0.03）。干预组纯母乳喂养的持续时间显著更长（P = 0.000），引入糖类的时间更晚（P = 0.005），食用饼干（P = 0.000）、蜂蜜（P = 0.003）、软饮料（P = 0.02）、软奶酪（P = 0.001）、巧克力和糖果（P = 0.001）的可能性更小。
ECC在该人群中是一个公共卫生问题。产后家访提供饮食建议似乎有助于降低婴儿患龋齿的几率。由于干预组中有相当比例的儿童仍患有龋齿，因此需要进一步加大力度解决致龋性饮食行为问题。未来研究应考察该干预措施的长期效果。
