Fisher-Owens Susan A, Gansky Stuart A, Platt Larry J, Weintraub Jane A, Soobader Mah-J, Bramlett Matthew D, Newacheck Paul W
University of California, Department of Pediatrics, 400 Parnassus Ave, Room AC01, Box 0374, San Francisco, CA 94143-0374, USA.
Pediatrics. 2007 Sep;120(3):e510-20. doi: 10.1542/peds.2006-3084.
Despite marked improvements over the past century, oral health in America is a significant problem: caries is the most common chronic disease of childhood. Much oral health research examines influences primarily in the oral cavity or focuses on a limited number of individual-level factors. The purpose of this article was to present a more encompassing conceptual model of the influences on children's oral health.
The conceptual model presented here was derived from the population health and social epidemiology fields, which have moved toward multilevel, holistic approaches to analyze the complex and interactive causes of children's health problems. It is based on a comprehensive review of major population and oral health literatures.
A multilevel conceptual model is described, with the individual, family, and community levels of influence on oral health outcomes. This model incorporates the 5 key domains of determinants of health as identified in the population health literature: genetic and biological factors, the social environment, the physical environment, health behaviors, and dental and medical care. The model recognizes the presence of a complex interplay of causal factors. Last, the model incorporates the aspect of time, recognizing the evolution of oral health diseases (eg, caries) and influences on the child-host over time.
This conceptual model represents a starting point for thinking about children's oral health. The model incorporates many of the important breakthroughs by social epidemiologists over the past 25 years by including a broad range of genetic, social, and environmental risk factors; multiple pathways by which they operate; a time dimension; the notion of differential susceptibility and resilience; and a multilevel approach. The study of children's oral health from a global perspective remains largely in its infancy and is poised for additional development. This work can help inform how best to approach and improve children's oral health.
尽管在过去一个世纪里有了显著改善，但美国的口腔健康仍是一个重大问题：龋齿是儿童最常见的慢性疾病。许多口腔健康研究主要考察口腔内的影响因素，或聚焦于有限的个体层面因素。本文的目的是提出一个更具包容性的儿童口腔健康影响因素概念模型。
这里提出的概念模型源自人口健康和社会流行病学领域，这些领域已转向多层次、整体的方法来分析儿童健康问题的复杂和相互作用的原因。它基于对主要人口和口腔健康文献的全面综述。
描述了一个多层次概念模型，其中个体、家庭和社区层面都会对口腔健康结果产生影响。该模型纳入了人口健康文献中确定的健康决定因素的5个关键领域：遗传和生物学因素、社会环境、物理环境、健康行为以及牙科和医疗护理。该模型认识到因果因素之间存在复杂的相互作用。最后，该模型纳入了时间因素，认识到口腔健康疾病（如龋齿）的演变以及随着时间推移对儿童宿主的影响。
这个概念模型是思考儿童口腔健康的一个起点。该模型纳入了社会流行病学家在过去25年中的许多重要突破，包括广泛的遗传、社会和环境风险因素；它们发挥作用的多种途径；一个时间维度；差异易感性和恢复力的概念；以及一种多层次方法。从全球视角对儿童口腔健康的研究在很大程度上仍处于起步阶段，有待进一步发展。这项工作有助于为如何最好地解决和改善儿童口腔健康提供信息。
