Twetman S, Petersson L G
Department of Pediatric Dentistry, Medical and Dental Health Center, Halmstad, Sweden.
Eur J Oral Sci. 1996 Oct-Dec;104(5-6):523-8. doi: 10.1111/j.1600-0722.1996.tb00136.x.
The levels of salivary mutans streptococci and caries experience were used as predictors for caries incidence in 3 groups of pre-school children from areas with different levels of natural and topical fluoride exposure. Altogether 1022 children, 4-5 years of age at baseline, were examined according to the WHO-criteria and followed for 2 years. The low fluoride group (n = 374) had a low fluoride level in the piped water and no topical fluoride applications; the F-varnish group (n = 442) had low water fluoride but semiannual topical applications of a fluoride varnish; the optimal fluoride group (n = 206) had an optimal level of fluoride in the drinking water and semiannual F-varnish applications. The number of salivary mutans streptococci was estimated and scored at baseline with the Strip mutans chair-side method. The sampling procedure was repeated in 337 children of the low fluoride group 3 weeks after baseline. In comparison with the low fluoride group, caries incidence was 30% and 60% lower in the F-varnish and the optimal fluoride group respectively. The caries predictive ability decreased with increasing fluoride exposure. The sum of sensitivity and specificity decreased from 151% (65% + 86%) in the low fluoride group to 131% (40% + 91%) in the optimal fluoride group. The positive predictive value was highest (62%) in the low fluoride group. Repeated salivary samplings at baseline did not improve the caries predictive power. The results suggest that the overall fluoride exposure should be taken into account when caries risk assessment strategies for preschool children are developed and implemented.
在来自自然和局部氟暴露水平不同地区的3组学龄前儿童中，唾液变形链球菌水平和龋齿经历被用作龋齿发病率的预测指标。共有1022名儿童，基线时年龄为4 - 5岁，按照世界卫生组织标准进行检查，并随访2年。低氟组（n = 374）的管道水中氟含量低且未进行局部氟应用；氟漆组（n = 442）水氟含量低但每半年进行一次氟漆局部应用；最佳氟组（n = 206）饮用水中氟含量处于最佳水平且每半年进行一次氟漆应用。基线时采用变形链球菌试纸椅旁法估计并记录唾液变形链球菌数量。在低氟组的337名儿童基线后3周重复采样程序。与低氟组相比，氟漆组和最佳氟组的龋齿发病率分别降低了30%和60%。龋齿预测能力随着氟暴露增加而降低。敏感度和特异度之和从低氟组的151%（65% + 86%）降至最佳氟组的131%（40% + 91%）。低氟组的阳性预测值最高（62%）。基线时重复唾液采样并未提高龋齿预测能力。结果表明，在制定和实施学龄前儿童龋齿风险评估策略时应考虑总体氟暴露情况。
