School of Dentistry, Cardiff University, Cardiff, UK.
Caries Res. 2010;44(1):69-80. doi: 10.1159/000279326. Epub 2010 Feb 2.
Caries in primary teeth is an ongoing issue in children's dental health. Its quantification is affected by clustering of data within children and the concurrent risk of exfoliation of primary teeth. This analysis of caries data of 103,776 primary molar tooth surfaces from a cohort study of 2,654 British children aged 4-5 years at baseline applied multilevel competing risks survival analysis methodology to identify factors significantly associated with caries occurrence in primary tooth surfaces in the presence of the concurrent risk of exfoliation, and assessed the effect of exfoliation on caries development. Multivariate multilevel parametric survival models were applied at surface level to the analysis of the sound-carious and sound-exfoliation transitions to which primary tooth surfaces are subject. Socio-economic class, fluoridation status and surface type were found to be the strongest predictors of primary caries, with the highest rates of occurrence and lowest median survival times associated with occlusal surfaces of children from poor socio-economic class living in non-fluoridated areas. The concurrent risk of exfoliation was shown to reduce the distinction in survival experience between different types of surfaces, and between surfaces of teeth from children of different socio-economic class or fluoridation status. Clustering of data had little effect on inferences of parameter significance.
乳牙龋齿是儿童口腔健康的一个持续存在的问题。其量化受到儿童数据的聚集和乳牙同时脱落的风险的影响。本研究分析了 2654 名 4-5 岁英国儿童基线时的 103776 颗乳磨牙的龋齿数据，应用多水平竞争风险生存分析方法，在同时存在乳牙脱落风险的情况下，确定与乳牙表面龋齿发生显著相关的因素，并评估脱落对龋齿发展的影响。多变量多层次参数生存模型应用于分析乳牙表面的无龋-龋齿和无龋-脱落的转换，这些转换是乳牙表面所经历的。社会经济阶层、氟化物状态和表面类型是乳牙龋齿的最强预测因素，来自社会经济阶层较低、生活在非氟化物地区的儿童的咬合面发生龋齿的比例最高，中位生存时间最短。脱落的同时风险降低了不同类型表面之间以及不同社会经济阶层或氟化物状态儿童的牙齿表面之间的生存体验差异。数据聚类对参数显著性推断的影响很小。
