Fontana M, Eckert G J, Keels M A, Jackson R, Katz B, Levy B T, Levy S M
1 University of Michigan, Ann Arbor, MI, USA.
2 Indiana University, Indianapolis, IN, USA.
Adv Dent Res. 2018 Feb;29(1):24-34. doi: 10.1177/0022034517735297.
Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).
与医疗界扩大合作关系是减少龋齿差异的一项重要策略。本研究的目的是评估1岁前由医护人员按处方开具或使用的诊室氟化物（滴剂/片剂和/或氟漆）与以下两方面的关系：1）龋齿发展情况；2）其他龋齿风险因素或介导因素（如社会经济地位）的存在情况。作为一项纵向队列研究的一部分，在印第安纳州、爱荷华州和北卡罗来纳州招募了儿童 - 主要照料者（PCG）对（N = 1325），以验证一种用于初级卫生保健机构的龋齿风险评估工具。PCG完成了一份龋齿风险问卷，而儿童则在1岁、2.5岁和4岁时按照国际龋齿检测与评估系统的标准接受龋齿检查。通过应用于逻辑回归的广义估计方程模型，对有关儿童诊室氟化物使用史的基线反应与其他龋齿风险变量以及2.5岁和4岁时的龋齿经历进行关联测试。样本中48%为女性，许多儿童（61%）参加了医疗补助计划。有龋洞的龋齿病变患病率从2.5岁时的7%上升到4岁时的25%。在诊室接受氟化物治疗的儿童可能被认为龋齿风险较高，实际上在2.5岁和4岁时发生龋洞龋齿病变的可能性显著更高（P < 0.01），即使在使用氟化物之后（比值比分别为3.5和2.3）。与接受氟化物治疗显著相关的因素包括：儿童参加医疗补助计划、家庭中没有就业成年人、儿童和PCG经常饮用含糖饮料和吃零食，以及PCG近期有龋齿经历。1岁前医护人员在诊室增加氟化物使用与已知的龋齿风险因素有关。大多数（69%）儿童从未看过牙医，这表明风险因素可能在提醒医疗提供者和/或家长注意，从而影响诊室氟化物的使用建议。各州之间的差异也可能与各州特定的氟漆报销政策有关（ClinicalTrials.gov NCT01707797）。
