北美西北部落儿童幼儿期龋齿预防项目的长期效果：TOTS-to-Tweens 研究。

Long-term effects of a toddler-focused caries prevention programme among Northwestern US tribal children: The TOTS-to-Tweens study.

机构信息

Northwest Portland Area Indian Health Board, Portland, OR, USA.

Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, IN, USA.

出版信息

Community Dent Oral Epidemiol. 2021 Jun;49(3):284-290. doi: 10.1111/cdoe.12600. Epub 2020 Dec 3.

DOI:10.1111/cdoe.12600

PMID:33274563

Abstract

OBJECTIVES

We sought to determine whether American Indian tribe-based interventions that successfully prevented toddler dental caries in a 2005 cohort study (the Toddler Overweight and Tooth Decay Prevention Study, or TOTS) influenced the prevalence of dental caries in children ages 11 to 13 in the same communities ten years later (the TOTS-to-Tweens study).

METHODS

We recruited original TOTS participants and conducted school- and community-based dental screenings at tribal communities that received family plus community-wide interventions (F + CW), community interventions only (CW) or were control communities. We also enrolled children who did not participate in TOTS, but were exposed to CW interventions or to the control environment. Trained clinicians examined children's teeth and recorded whether each tooth was decayed, missing or filled (DMFT). We calculated DMFT scores for each child and evaluated differences in DMFT incidence rate ratios (IRR) and components of DMFT by intervention group.

RESULTS

We observed lower age- and sex-adjusted DMFT scores among F + CW children (a mean of 2.1 DMFT; 95% confidence interval [CI]: 1.4-2.7) and among CW children (2.2; 95% CI: 1.9-2.6), than control children (3.0; 95% CI: 2.3-3.7). The F + CW group had 32% lower DMFT scores than control children (IRR = 0.68; 95% CI: 0.46-1.01), and CW children had 26% lower DMFT scores than control (IRR = 0.74; 95% CI: 0.55-1.00). The proportion of children with filled teeth was higher in control than intervention communities (37.9% in F + CW, 47.1% in CW, and 67.1% in control, P = .002).

CONCLUSIONS

Our findings suggest modest yet significant long-term effects of interventions that prevented toddler dental caries on the DMFT scores of tweens evaluated ten years later. Further study of effective interventions and their sustainability is clearly warranted among tribal children, who remain at high risk for dental caries.

摘要

目的

我们旨在确定在 2005 年的一项队列研究（即幼儿超重与龋齿预防研究，简称 TOTS）中成功预防幼儿龋齿的部落干预措施是否会影响十年后同一社区 11 至 13 岁儿童的龋齿患病率（即 TOTS 至青少年研究，简称 TOTS-to-Tweens 研究）。

方法

我们招募了原 TOTS 参与者，并在接受家庭加社区范围干预（F + CW）、仅社区干预（CW）或作为对照社区的部落社区进行学校和社区基础的牙科筛查。我们还招募了未参与 TOTS 但接触过 CW 干预或对照环境的儿童。经过培训的临床医生检查了儿童的牙齿，并记录了每颗牙齿的龋坏、缺失或填充情况（DMFT）。我们为每个孩子计算了 DMFT 评分，并评估了 DMFT 发生率比（IRR）和 DMFT 组成部分按干预组的差异。

结果

我们观察到 F + CW 儿童（平均 DMFT 为 2.1；95%置信区间[CI]：1.4-2.7）和 CW 儿童（2.2；95%CI：1.9-2.6）的年龄和性别调整后 DMFT 评分均低于对照组儿童（3.0；95%CI：2.3-3.7）。F + CW 组的 DMFT 评分比对照组儿童低 32%（IRR=0.68；95%CI：0.46-1.01），CW 儿童的 DMFT 评分比对照组儿童低 26%（IRR=0.74；95%CI：0.55-1.00）。填充牙齿的儿童比例在对照组中高于干预组（F + CW 组为 37.9%，CW 组为 47.1%，对照组为 67.1%，P=0.002）。