Holst A, Mårtensson I, Laurin M
Department of Paediatric Dentistry, Blekinge County Council, Karlskrona, Sweden.
Swed Dent J. 1997;21(5):185-91.
A special model for dental care in pre-school children was used in a small clinic in the county of Blekinge in southern Sweden. The model is based on screening of caries risk performed by a dental assistant before the caries attack. Any single risk factor or risk behavior in pre-school children was considered. The aim was to 1) evaluate the dental assistant's selection of caries risk children up to the age of three years, 2) compare dental health variables in 4 yr olds in the test clinic with those for the whole county in 1994 and 3) compare time spent by the dentist and the dental assistant in the test clinic and in the whole county per child up to the age of four. 102 children participated. One specially trained dental assistant screened all children using background factors combined with clinical examinations at ages 1, 2 and 3. Eighty-two children participated each year from one year. A systematized form for questioning the parents was used. Individual caries prevention was given including fluoride and antimicrobial treatments as well as fissure sealants in primary molars at caries risk. The proportion of children with caries lesions at four years and a caries risk assessment up to the age of two was 1.0 (sensitivity). The proportion of children with no caries lesions at four years and no caries risk assessment at year two was 0.7 (specificity). The most frequent risk factors found at 2 yrs were frequency order: lack of oral hygiene (visible plaque), deep fissures in molars and frequent intakes of sweet drinks. The proportion of children with no caries lesions at 4 yrs of age in the test clinic was 92.9% compared to a county mean of 76.4%. In the group of children where a risk assessment was made each year from one year the proportion of caries free children was 96.3%. The total time spent per child in the test clinic was 22 minutes more than the county mean. However, dentist's time, excluding assistance, was 28 minutes less in the test clinic. The results suggest that the model used for caries prevention in pre-school children is cost-effective, and that dental health can be remarkably improved.
瑞典南部布莱金厄郡的一家小诊所采用了一种针对学龄前儿童的特殊牙科护理模式。该模式基于牙科助理在龋齿发作前对龋齿风险进行的筛查。考虑了学龄前儿童的任何单一风险因素或风险行为。目的是：1）评估牙科助理对三岁以下龋齿风险儿童的筛选情况；2）将测试诊所中4岁儿童的牙齿健康变量与1994年全县儿童的牙齿健康变量进行比较；3）比较牙医和牙科助理在测试诊所和全县为四岁以下每个儿童花费的时间。102名儿童参与其中。一名经过专门培训的牙科助理在儿童1岁、2岁和3岁时，结合背景因素和临床检查对所有儿童进行了筛查。每年有82名儿童参与。使用了一份系统化的家长询问表格。针对个体进行了龋齿预防，包括氟化物和抗菌治疗，以及对有龋齿风险的乳磨牙进行窝沟封闭。四岁时有龋齿病变且两岁前有龋齿风险评估的儿童比例为1.0（敏感性）。四岁时无龋齿病变且两岁时无龋齿风险评估的儿童比例为0.7（特异性）。在2岁时发现的最常见风险因素按频率顺序为：口腔卫生不良（可见牙菌斑）、磨牙深沟和频繁饮用甜饮料。测试诊所中4岁时无龋齿病变的儿童比例为92.9%，而全县平均水平为76.4%。在从一岁起每年进行风险评估的儿童组中，无龋齿儿童的比例为96.3%。测试诊所中每个儿童的总花费时间比全县平均水平多22分钟。然而，不包括协助时间，测试诊所中牙医的时间比全县少28分钟。结果表明，用于学龄前儿童龋齿预防的模式具有成本效益，并且牙齿健康可以得到显著改善。
