Hilgert Leandro A, Leal Soraya C, Bronkhorst Ewald M, Frencken Jo E
Oral Health Prev Dent. 2017;15(6):537-542. doi: 10.3290/j.ohpd.a39593.
To test the hypothesis that, in high caries-risk children, supervised toothbrushing (STB) reduces visible plaque levels and gingival bleeding to a greater extent than does unsupervised toothbrushing (USTB) in comparable children and in low caries-risk USTB children over 4 years.
High caries-risk schoolchildren, ages 6 to 7, were allocated to three oral healthcare protocols using a cluster-randomised design: 1. Ultra-Conservative Treatment (UCT): small cavities in primary molars were restored using ART, while medium and large cavities were left open and cleaned under daily supervised toothbrushing together with the remaining dentition (UCT/STB); 2. Conventional Restorative Treatment (CRT): primary molars were restored with amalgam, while high caries-risk first permanent molars received resin sealants (CRT/USTB); 3. Atraumatic Restorative Treatment (ART): primary molars were restored using ART, while high caries-risk first permanent molars received ART sealants (ART/USTB). Low caries-risk children (dmft ≤ 1) formed the no-treatment/USTB group. 273 children were examined at baseline (T0) and after 4 years (T1) according to the VPI and GBI indices. Data were analysed using linear and logistic regression.
Mean VPI and mean GBI scores were statistically significantly lower at T1 than at T0. Reduction in mean VPI scores in UCT/STB children was statistically significantly higher than for CRT+ART/USTB children over 4 years (p = 0.03), but no difference was observed between UCT/STB and no-treatment/USTB children (p = 0.361). No statistically significant difference in the reduction of mean GBI scores was observed between UCT/STB and CRT+ART/USTB (p = 0.62) and no-treatment/USTB children (p = 0.74).
In high caries-risk children, the protocol based on supervised toothbrushing presented greater reduction in visible plaque levels than did protocols based on restorations and sealants over 4 years.
检验以下假设：在高龋风险儿童中，与未监督刷牙（USTB）的同龄儿童以及4岁以上低龋风险USTB儿童相比，监督刷牙（STB）能在更大程度上降低可见菌斑水平和牙龈出血。
采用整群随机设计，将6至7岁的高龋风险学童分配到三种口腔保健方案中：1. 超保守治疗（UCT）：使用非创伤性修复治疗（ART）修复乳磨牙中的小龋洞，而中龋和大龋洞则不做处理，在每日监督刷牙的同时对其余牙列进行清洁（UCT/STB）；2. 传统修复治疗（CRT）：用汞合金修复乳磨牙，而高龋风险的第一恒磨牙接受树脂封闭剂治疗（CRT/USTB）；3. 非创伤性修复治疗（ART）：使用ART修复乳磨牙，而高龋风险的第一恒磨牙接受ART封闭剂治疗（ART/USTB）。低龋风险儿童（dmft≤1）组成未治疗/USTB组。根据视觉菌斑指数（VPI）和牙龈出血指数（GBI），在基线（T0）和4年后（T1）对273名儿童进行检查。使用线性回归和逻辑回归分析数据。
T1时的平均VPI和平均GBI评分在统计学上显著低于T0。4年中，UCT/STB儿童的平均VPI评分降低幅度在统计学上显著高于CRT+ART/USTB儿童（p = 0.03），但UCT/STB儿童与未治疗/USTB儿童之间未观察到差异（p = 0.361）。UCT/STB与CRT+ART/USTB儿童（p = 0.62）以及未治疗/USTB儿童（p = 0.74）在平均GBI评分降低方面未观察到统计学上的显著差异。
在高龋风险儿童中，基于监督刷牙的方案在4年中比基于修复和封闭剂的方案能更大程度地降低可见菌斑水平。
