Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, MA, USA.
Community Dent Oral Epidemiol. 2022 Jun;50(3):147-155. doi: 10.1111/cdoe.12645. Epub 2021 May 13.
In this cross-sectional study in a large community-based sample of preschool-age children, we sought to identify distinct clusters of modifiable early childhood oral health-related behaviours (OHBs) and quantify their association with clinical and parent-reported measures of early childhood oral health.
We relied upon a questionnaire (n = 8033; 11% in Spanish) and clinical oral health data (n = 6404; early childhood caries [ECC] prevalence = 54%] collected in the context of an epidemiologic study of early childhood oral health among 3- to 5-year-old children in North Carolina. Latent class analysis was used to identify clusters of modifiable OHBs based on parents' responses to 6 questionnaire items pertaining to their children's oral hygiene, diet and dental home. The optimal number of clusters was determined based on measures of model fit and interpretability. We examined associations of OHB clusters with clinical and parent-reported child oral health status (ie, ECC prevalence, severity and proportion with untreated disease) using bivariate association tests and multivariable regression modelling with marginal effects estimation accounting for clustered data. We used Mplus v.8.6 (Muthén & Muthén, Los Angeles, CA, USA) and Stata v.16.1 (StataCorp, College Station, TX, USA) for data analyses.
We identified 2 OHB clusters, a favourable (74%) and an unfavourable (26%) one. Children in the favourable OHB cluster had better oral hygiene practices (ie, tooth brushing frequency and fluoridated toothpaste use), lower consumption frequency of sugar-containing snacks and beverages, less frequent reports of night-time bottle-feeding history and a higher likelihood of a dental home. Children in the unfavourable cluster had significantly higher ECC prevalence (57% vs 53%), caries burden (mean dmfs = 9.3 vs 7.6), untreated disease (43% vs 33%) and worse parent-reported oral health status than the favourable cluster.
Our findings demonstrate the importance and utility of clustering common, modifiable ECC risk factors in population studies - health promotion efforts may centre on groups of people rather than individual behavioural risk factors.
在这项基于大社区学龄前儿童的横断面研究中，我们旨在确定可改变的儿童口腔健康相关行为（OHB）的不同聚类，并定量评估它们与儿童口腔健康的临床和家长报告指标的相关性。
我们依赖于一份问卷（n=8033；11%为西班牙语）和临床口腔健康数据（n=6404；幼儿龋病[ECC]患病率为 54%），这些数据是在北卡罗来纳州一项针对 3 至 5 岁儿童的早期儿童口腔健康的流行病学研究中收集的。基于父母对 6 项与儿童口腔卫生、饮食和口腔保健有关的问题的回答，采用潜在类别分析识别可改变的 OHB 聚类。根据模型拟合和可解释性的衡量标准确定最佳聚类数量。我们使用二变量关联检验和多元回归模型分析了 OHB 聚类与临床和家长报告的儿童口腔健康状况（即 ECC 患病率、严重程度和未经治疗的疾病比例）之间的关联，其中考虑了聚类数据的边际效应估计。我们使用 Mplus v.8.6（Muthén & Muthén，洛杉矶，CA，美国）和 Stata v.16.1（StataCorp，德克萨斯州，学院站，美国）进行数据分析。
我们确定了 2 个 OHB 聚类，一个是有利的（74%），另一个是不利的（26%）。有利 OHB 聚类的儿童口腔卫生习惯更好（即刷牙频率和使用含氟牙膏），含糖零食和饮料的摄入频率较低，夜间奶瓶喂养的报告频率较低，并且更有可能去看牙医。不利聚类的儿童 ECC 患病率显著更高（57%比 53%），龋齿负担（平均 dmfs 为 9.3 比 7.6），未经治疗的疾病（43%比 33%）和更差的家长报告的口腔健康状况。
我们的研究结果表明，在人群研究中对常见的、可改变的 ECC 风险因素进行聚类的重要性和实用性——健康促进工作可能以人群群体而不是个人行为风险因素为中心。
