Rogers J G, Adams G G, Wright F A C, Roberts-Thomson K, Morgan M V
1 Oral Health Cooperative Research Centre (CRC), Melbourne Dental School, University of Melbourne, Australia.
2 Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
JDR Clin Trans Res. 2018 Jul;3(3):272-278. doi: 10.1177/2380084418764312. Epub 2018 Mar 15.
An increasing number of Australians are being admitted to hospitals and day procedure centers to have dental treatment under a dental general anesthetic (DGA). Children younger than 2 y are having DGAs. These operations are costly and, although there have been improvements in safety, are not without risk. Most DGAs in children are to treat dental caries and have been defined as potentially preventable dental hospitalizations (PPDHs). This article reports on an analysis of the impact of access to community water fluoridation (CWF), availability of oral health professionals (OHPs), and socioeconomic status (SES) on PPDHs of 0- to 4-y-olds in 2012-2013 in Victoria, Australia. Data on these variables were obtained at the community (postcode) level. From the negative binomial multivariate analysis, each of the 3 independent variables was independently significantly associated with PPDHs at the postcode level. Children residing in postcodes without CWF on average had 59% higher rates than those with access (incident rate ratio [IRR], 1.59; P < 0.0001), children in postcodes with the lowest level of availability of OHPs had 65% higher rates than those with the highest access (IRR, 1.65; P < 0.0001), and children living in the most disadvantaged SES quintiles had 57% higher rates than children in the most advantaged quintiles (IRR, 1.57; P < 0.0001). There was a stepwise social gradient by SES quintile. In analysis of access to CWF and SES status, children without access to CWF had 86% higher PPDH rates than children with access (IRR, 1.86; P < 0.0001). In summary, no access to CWF, poor availability of OHPs, and lower SES status were independently associated with higher PPDH rates among 0- to 4-y-olds in Victoria at the postcode level. The study highlights the importance of considering 3 interacting factors-access to CWF, access to OHPs, and SES-in efforts to reduce PPDH rates in young children. Knowledge Transfer Statement: Extending access to water fluoridation, increasing the availability of dental services, and raising disadvantaged families' socioeconomic status are each likely to decrease the rate of dental general anesthetics in young children.
越来越多的澳大利亚人因需要接受全身麻醉下的牙科治疗而被收治入院或进入日间手术中心。2岁以下的儿童也在接受全身麻醉下的牙科治疗。这些手术费用高昂，而且尽管安全性已有改善，但仍存在风险。儿童接受的大多数全身麻醉下的牙科治疗是用于治疗龋齿，这些治疗被定义为潜在可预防的牙科住院治疗（PPDHs）。本文报告了一项关于社区水氟化（CWF）的可及性、口腔健康专业人员（OHPs）的可获得性以及社会经济地位（SES）对2012 - 2013年澳大利亚维多利亚州0至4岁儿童PPDHs影响的分析。这些变量的数据是在社区（邮政编码）层面获取的。从负二项式多变量分析来看，这3个自变量在邮政编码层面均与PPDHs独立且显著相关。居住在没有社区水氟化地区的儿童，其PPDHs发生率平均比有社区水氟化地区的儿童高59%（发病率比[IRR]，1.59；P < 0.0001），口腔健康专业人员可获得性最低地区的儿童，其PPDHs发生率比可获得性最高地区的儿童高65%（IRR，1.65；P < 0.0001），生活在社会经济地位最不利五分之一阶层的儿童，其PPDHs发生率比最有利五分之一阶层的儿童高57%（IRR，1.57；P < 0.0001）。社会经济地位五分之一阶层呈现出逐步上升的社会梯度。在对社区水氟化可及性和社会经济地位状况的分析中，无法获得社区水氟化的儿童，其PPDHs发生率比可获得的儿童高86%（IRR，1.86；P < 0.0001）。总之，在邮政编码层面，无法获得社区水氟化、口腔健康专业人员可获得性差以及社会经济地位较低与维多利亚州0至4岁儿童较高的PPDHs发生率独立相关。该研究强调了在努力降低幼儿PPDHs发生率时考虑3个相互作用的因素——社区水氟化的可及性、口腔健康专业人员的可获得性以及社会经济地位——的重要性。知识转移声明：扩大水氟化的可及性、增加牙科服务的可获得性以及提高弱势家庭的社会经济地位，都可能降低幼儿接受全身麻醉下牙科治疗的比率。
