Kopczynski Kayla, Meyer Beau D
Adams School of Dentistry, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
Division of Pediatric Dentistry, College of Dentistry, Ohio State University, Columbus, OH, USA.
Patient Prefer Adherence. 2021 Mar 25;15:645-652. doi: 10.2147/PPA.S300684. eCollection 2021.
The primary objective of this study was to compare relationships between child, parent, and clinical factors with patient-level treatment decisions for early childhood caries. A secondary objective was to describe children that received silver diamine fluoride (SDF) as interim versus long-term treatment.
Parents of 2-6-year-old children seeking care at a multi-center pediatric dentistry private practice were enrolled in this cross-sectional study. Demographic data and dental anxiety data according to the Modified Corah's Dental Anxiety Scale were collected via questionnaire. A dental visit behavior rating and decayed, missing, and filled tooth (dmft) index were recorded from the child's dental record. The primary outcome was treatment decision categorized into three groups: (1) treatment with SDF (n=25), (2) conventional restorative treatment under local anesthesia (n=32), and (3) restorative treatment under general anesthesia (n=33). Analyses included descriptive statistics, bivariate analysis, and ordered logistic regression.
Child age, parent education level, family income, dental insurance status, dental visit behavior rating, and dmft were significantly different across treatment groups in bivariate comparisons. However, when included in multivariable, ordered logistic regression, child dental anxiety was the only significant covariate associated with treatment decisions (Odds Ratio=5.01, 95% confidence interval: 1.51 to 16.63). In secondary analysis, two distinct subgroups were identified within the SDF group: one as long-term treatment (n=9) and one as interim treatment prior to general anesthesia (n=16). The long-term group was younger (mean=3.2 versus 3.7), had lower dmft (mean=4 versus 11.1), and had lower frequency of very high dental anxiety (0% versus 15%).
The present study identified child dental anxiety as the primary factor associated with treatment decisions at this private practice. The characterization of two subgroups of children treated with SDF has meaningful implications for studies evaluating the economic and public health impacts of SDF.
本研究的主要目的是比较儿童、家长和临床因素与幼儿龋齿患者层面治疗决策之间的关系。次要目的是描述接受氟化亚锡（SDF）作为临时治疗与长期治疗的儿童情况。
本横断面研究纳入了在多中心儿科牙科私人诊所寻求治疗的2至6岁儿童的家长。通过问卷调查收集了根据改良科拉牙科焦虑量表得出的人口统计学数据和牙科焦虑数据。从儿童的牙科记录中记录牙科就诊行为评分以及龋失补牙（dmft）指数。主要结果是治疗决策分为三组：（1）使用SDF治疗（n = 25），（2）局部麻醉下的传统修复治疗（n = 32），以及（3）全身麻醉下的修复治疗（n = 33）。分析包括描述性统计、双变量分析和有序逻辑回归。
在双变量比较中，治疗组之间的儿童年龄、家长教育水平、家庭收入、牙科保险状况、牙科就诊行为评分和dmft存在显著差异。然而，在多变量有序逻辑回归中，儿童牙科焦虑是与治疗决策相关的唯一显著协变量（优势比 = 5.01，95%置信区间：1.51至16.63）。在次要分析中，SDF组内确定了两个不同的亚组：一个作为长期治疗（n = 9），另一个作为全身麻醉前的临时治疗（n = 16）。长期治疗组年龄更小（平均 = 3.2岁对3.7岁），dmft更低（平均 = 4对11.1），且非常高牙科焦虑的频率更低（0%对15%）。
本研究确定儿童牙科焦虑是该私人诊所治疗决策的主要相关因素。对接受SDF治疗的儿童的两个亚组进行特征描述，对评估SDF的经济和公共卫生影响的研究具有重要意义。
