Department of Cariology and Endodontics, Dental Faculty of Copenhagen, Denmark.
Community Dent Oral Epidemiol. 2010 Feb;38(1):29-42. doi: 10.1111/j.1600-0528.2009.00505.x. Epub 2009 Nov 18.
Caries on children and adolescents in Denmark has declined significantly over the last 30 years. Our first analysis in 1999, however, disclosed huge inter-municipality disparities in mean DMFS values as well as in prevalence of caries on Danish children; that fluoride in the water supply and the length of the education of the mothers could explain up to 45% of the above-mentioned disparity and that very few municipalities were positive outliers, i.e. were providing significant better caries results than expected from the background variables. Three of the aims of this second analysis were to repeat the analyses done on the 1999 sample, but now on a 2004 sample and then compare it with the results from 1999. A fourth aim was by means of an interview of CDOs to determine their interpretation of relevant conditions in the public dental health service in relation dental health outcome.
A total of 204 (99%) and 191 (93%) municipalities were involved in 1999 and 2004, respectively. Unit of analysis were the municipalities. Mean DMFS of 15-year-olds was used as outcome variable. Eight background variables were accounted for during the analysis: For the fourth aim, a sample of CDOs representing municipalities with positive (n = 10), with no change (n = 10), or with negative change (n = 10) in mean DMFS, relative to all municipalities, between 1999 and 2004 was selected.
The inter-municipality variation in mean DMFS 1999 was 0.88 to 8.73 and in 2004 was 0.56 to 6.19. The analyses found that fluoride level of the drinking water and mothers' length of education were significant variables explaining about 44% of the variations in mean DMFS in both years. Only one municipality was characterized as a positive outlier in 1999 as well as in 2004. The dose-response relations between increasing fluoride concentrations in the water supply and DMF-S values diminished in both years at a level above 0.35 ppm. The structured interview disclosed that municipalities with significant improvement in mean DMFS from 1999 to 2004 had established goals and were committed to the prevention of dental caries at the individual level. Instability in manpower; number of children in the service and economy was associated to municipalities with negative changes in caries experience.
在过去的 30 年里，丹麦儿童和青少年的龋齿发病率显著下降。然而，我们在 1999 年的首次分析显示，丹麦儿童的平均 DMFS 值以及龋齿患病率存在巨大的市际差异；饮用水中的氟化物和母亲的受教育程度可以解释上述差异的 45%，而且很少有城市是正的异常值，也就是说，它们提供的龋齿防治效果明显好于背景变量所预期的效果。本次第二次分析有三个目的，是对 1999 年的样本进行重复分析，然后用 2004 年的样本进行比较，并将结果与 1999 年的结果进行比较。第四个目的是通过对 CDO 的访谈，确定他们对公共牙科服务中与牙齿健康结果相关的条件的解释。
共有 204（99%）和 191（93%）个城市参与了 1999 年和 2004 年的研究。分析的单位是城市。15 岁青少年的平均 DMFS 作为因变量。在分析过程中考虑了 8 个背景变量：为了第四个目的，选择了一个代表 1999 年至 2004 年间 DMFS 平均值相对于所有城市呈正（n=10）、无变化（n=10）或负变化（n=10）的 CDO 样本。
1999 年和 2004 年，15 岁青少年平均 DMFS 的市际差异分别为 0.88 至 8.73 和 0.56 至 6.19。分析发现，饮用水中的氟化物水平和母亲的受教育程度是两个年份中平均 DMFS 变化的重要解释变量，约占 44%。1999 年和 2004 年，只有一个城市被确定为正异常值。在氟化物浓度超过 0.35ppm 的水平上，饮用水中氟化物浓度与 DMF-S 值之间的剂量-反应关系在两年中都有所减弱。结构访谈显示，在 1999 年至 2004 年期间，DMFS 平均值显著改善的城市设定了目标，并致力于预防个体水平的龋齿。人员配置不稳定、服务和经济中的儿童数量与龋齿发病率负相关的城市有关。
