Faculty of Dentistry, National University of Singapore, Singapore, Singapore.
Singapore Institute for Clinical Sciences, A*STAR, Singapore, Singapore.
PLoS One. 2021 Aug 12;16(8):e0256163. doi: 10.1371/journal.pone.0256163. eCollection 2021.
Oral health status ideally warrants for a holistic biopsychosocial approach to health and wellness. Little is known about the impact of behavioral problems on oral health-related quality of life (OHRQoL) in children due to the paucity of studies in early childhood, particularly in Asian multi-ethnic populations. This study evaluated the relationship between early child's socioemotional factors and OHRQoL, as well as its association with orofacial pain (OFP) and early childhood caries (ECC) in the Asian GUSTO birth cohort. Mother-child dyads were postnatally assessed at 3 time points. The Child Behavior Checklist (CBCL) was used to assess the child's socioemotional and behavioral problems at age 4-4.5 years together with other validated questionnaires to evaluate maternal anxiety and depression. ECC detection was performed at age 5, and OHRQoL (primary) and OFP (secondary) outcomes were assessed at age 6 from a total of 555 mother-child dyads. After a univariate regression analysis was performed to identify potential predictors and confounders, a multivariate regression model was run with predisposing factors (CBCL internalization and externalization problems, OFP, ECC) and adjusted for confounders (maternal psychosocial states, maternal education) to determine associations with OHRQoL. Results showed an association between CBCL internalization scores and poorer OHRQoL (RR = 1.03, p = 0.033, 95% CI 1.01 to 1.05), although the limited risk ratio may not have a practical applicability in psychosocially healthy children, alike the majority of those evaluated in this cohort. The average OHRQoL overall score among children with OFP was 2.39 times more than those without OFP (OR = 2.39, p < 0.001, 95% CI 2.00 to 2.86). Thus, in early childhood, OFP, and to lesser extent internalizing behaviors, may negatively impact OHRQoL. This study therefore highlights the complex relationship between OHRQoL and its predisposing socioemotional and somatic pain factors, and demands further investigations in clinically relevant populations.
口腔健康状况需要采用整体的生物-心理-社会方法来促进健康和幸福。由于在幼儿期进行的研究较少，特别是在亚洲多民族人群中，因此，人们对行为问题对儿童口腔健康相关生活质量（OHRQoL）的影响知之甚少。本研究评估了幼儿社会情感因素与 OHRQoL 的关系，以及其与口腔疼痛（OFP）和幼儿期龋病（ECC）的关联，该研究基于亚洲 GUSTO 出生队列。在产后的 3 个时间点对母婴对子进行评估。在 4-4.5 岁时，使用儿童行为检查表（CBCL）评估儿童的社会情感和行为问题，同时使用其他经过验证的问卷评估母亲的焦虑和抑郁情况。在 5 岁时进行 ECC 检测，在总共 555 对母婴对子中，在 6 岁时评估 OHRQoL（主要）和 OFP（次要）结局。在进行单变量回归分析以确定潜在的预测因素和混杂因素后，进行了多变量回归模型分析，纳入了易感因素（CBCL 内化和外化问题、OFP、ECC），并调整了混杂因素（母亲的社会心理状态、母亲的教育），以确定与 OHRQoL 的关联。结果表明，CBCL 内化评分与较差的 OHRQoL 之间存在关联（RR = 1.03，p = 0.033，95%CI 1.01 至 1.05），尽管有限的风险比在心理社会健康的儿童中可能没有实际适用性，就像评估的队列中的大多数儿童一样。有口腔疼痛的儿童的 OHRQoL 总分是没有口腔疼痛的儿童的 2.39 倍（OR = 2.39，p < 0.001，95%CI 2.00 至 2.86）。因此，在幼儿期，口腔疼痛，以及在较小程度上的内化行为，可能会对 OHRQoL 产生负面影响。因此，本研究强调了 OHRQoL 与其易感的社会情感和躯体疼痛因素之间的复杂关系，并需要在临床相关人群中进行进一步的研究。
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