270名5岁自闭症儿童龋病及其影响因素调查分析

doi:10.13591/j.cnki.kqyx.2023.12.005

摘要/Abstract

摘要：

目的了解学龄前自闭症儿童龋病的患病情况及其影响因素,为自闭症儿童的龋病防治提供参考依据。方法参照第4次全国口腔健康流行病学调查标准和方法,对青岛市1所自闭症特殊教育学校270名5岁儿童进行龋病检查,并对其家长进行现场问卷调查,对所得数据进行统计分析。结果 5岁自闭症儿童的乳牙患龋率为64.81%,龋均为3.09±3.41,龋补充填比为27.42%。单因素方差分析显示,调查问卷中的所有因素对患龋率(dmft)均无明显影响(P>0.05);进一步分析各影响因素与有龋率(dt)的关系,每日刷牙总时间越短、晚上刷牙后/睡觉前吃零食喝饮料次数越多,有龋率越高(P<0.05);因龋补牙率(ft)与每日刷牙次数、每日刷牙总时长、家长是否协助刷牙、饭后漱口或刷牙情况相关(P<0.05)。以有龋率为因变量进行多因素 Logistic 回归分析显示每日刷牙总时间<1 min、经常在晚上刷牙后/睡觉前吃零食喝饮料是自闭症儿童乳牙患龋的危险因素(P<0.05)。结论 5岁自闭症儿童的乳牙患龋率较高,应进一步重视每天的刷牙时长和纠正睡前吃零食习惯;因龋补牙可能是改善自闭症儿童口腔卫生习惯的重要原因,在口腔诊疗过程中应加强口腔健康指导。

关键词: 自闭症, 儿童, 龋病, 乳牙, 危险因素, 流行病学调查

Abstract:

Objective To investigate the prevalence of dental caries in preschool children with autism and its influencing factors, so as to provide reference for the prevention and treatment of dental caries in children. Methods According to the standards and methods of the 4th National Oral Health Epidemiological Survey, a total of 270 5-year-old children with autism in a special education school in Qingdao were investigated for dental caries. A questionnaire survey was also conducted among the parents, and the obtained data were statistically analyzed. Results The caries prevalence rate of primary teeth in 5-year-old autistic children was 64.81%. The mean DMFT was 3.09±3.41, and the caries filling ratio was 27.42%. Single-factor analysis showed that all factors in the questionnaire had no significant effect on the caries prevalence(dmft)(P>0.05). Furthermore, the relationship between the influencing factors and the caries rate(dt)was analyzed. In children who had shorter brushing time and more frequency of eating snacks and drinking beverages at night, the caries rate(dt)was higher(P<0.05). Factors related to dental filling rate(ft)due to caries were(P<0.05):daily brushing times, the total time of brushing teeth, whether parents assisted in brushing teeth, gargling or brushing teeth after meals. Multivariate Logistic regression analysis with caries prevalence(dt)as the dependent variable showed that the total time of daily tooth brushing less than 1 minute and frequently eating snacks and drinking beverages at night after tooth brushing/before bedtime were the risk factors for primary teeth caries in children with autism(P<0.05). Conclusion The caries rate of primary teeth in 5-year-old autistic children is high, so more attention should be paid to enough brushing time every day and correcting the habit of eating snacks before bedtime. Dental caries may be an important reason to improve the oral health habits of children with autism, and oral health guidance should be strengthened in the dental visit process.

Key words: autism, children, caries, primary tooth, risk factor, epidemiological investigation

中图分类号:

R788.1

侯丽媛,刘梦佳,公文,王佳英,辛秉昌,滕娜娜,张进,孙德刚. 270名5岁自闭症儿童龋病及其影响因素调查分析[J]. 口腔医学, 2023, 43(12): 1081-1085.

HOU Liyuan,LIU Mengjia,GONG Wen,WANG Jiaying,XIN Bingchang,TENG Nana,ZHANG Jin,SUN Degang. Investigation and analysis of dental caries and its influencing factors in 270 5-year-old children with autism[J]. Stomatology, 2023, 43(12): 1081-1085.

图/表 3

表1

表2

270名5岁自闭症儿童患龋情况的单因素分析"

因素	受检人数	患龋人数	χ²	P	有龋人数	χ²	P	因龋补牙人数	χ²	P
性别
男	235	149(63.40)	1.582	0.209	136(57.87)	0.312	0.577	46(19.57)	0.708	0.400
女	35	26(74.29)			22(62.85)			9(25.71)
每日刷牙次数
早晚各刷1次	117	78(66.67)	2.713	0.438	64(54.70)	2.397	0.494	29(24.79)	12.632	0.006
晚上刷1次	83	57(68.67)			54(65.06)			22(26.51)
早晨刷1次	40	22(55.00)			22(55.00)			2(5.00)
不是每天都刷牙	30	18(60.00)			18(60.00)			2(6.67)
每日刷牙总时长
<1 min	37	29(78.38)	3.480	0.175	29(78.38)	11.209	0.004	3(8.11)	12.430	0.002
1~3 min	170	107(62.94)			101(59.41)			30(17.65)
>3 min	63	39(61.90)			28(44.44)			22(34.92)
家长是否协助刷牙
家长每天帮孩子刷	93	67(72.04)	3.694	0.296	59(63.44)	2.030	0.566	29(31.18)	13.016	0.005
家长有时帮孩子刷	115	72(62.61)			66(57.39)			16(13.91)
孩子自己刷	54	31(57.41)			28(51.85)			10(18.52)
不能配合或还没开始刷	8	5(62.50)			5(62.50)			0(0.00)
晚上刷牙后睡觉前吃零食/喝饮料
经常吃+每天吃	22	19(86.36)	5.946	0.051	18(81.82)	9.292	0.010	6(27.27)	4.250	0.119
偶尔吃	121	80(66.12)			76(62.81)			18(14.88)
从不吃	127	76(59.84)			64(50.39)			31(24.41)
饭后漱口或刷牙
饭后从不漱口	94	55(58.51)	2.934	0.231	55(58.51)	0.401	0.818	11(11.70)	9.714	0.008
饭后偶尔漱口	146	98(67.12)			87(59.59)			33(22.60)
每次饭后漱口	30	22(73.33)			16(53.33)			11(36.67)
平时进食饮料、饼干等零食的次数
每天1次或更少	103	63(61.17)	4.072	0.131	57(55.34)	2.488	0.288	19(18.45)	1.371	0.504
每天2~3次	122	77(63.11)			70(57.38)			24(19.67)
太多次数,数不清楚	45	35(77.78)			31(68.89)			12(26.67)
出生时的分娩方式
顺产	127	83(65.35)	0.031	0.861	74(58.27)	0.006	0.937	27(21.26)	0.117	0.732
剖宫产	143	92(64.34)			84(58.74)			28(19.58)
出生时的体重/kg
≤2.5	12	8(66.67)	1.022	0.6	6(50.00)	0.386	0.825	3(25.00)	12.071	0.002^*
2.5~4.0	238	152(63.87)			140(58.82)			42(17.65)
>4.0	20	15(75.00)			12(60.00)			10(50.00)
出生后6个月内的喂养方式
母乳为主	164	111(67.68)	1.531	0.465	99(60.37)	1.322	0.516	37(22.56)	1.236	0.539
母乳奶粉各半	59	36(61.02)			35(59.32)			10(16.95)
奶粉为主	47	28(59.57)			24(51.06)			8(17.02)
父母最高学历
高中、中专及以下	40	28(70.00)	7.803	0.050	27(67.50)	5.522	0.137	4(10.00)	5.932	0.115
大专	43	29(67.44)			28(65.12)			9(20.93)
本科	146	85(58.22)			76(52.05)			29(19.86)
硕士及以上	41	33(80.49)			27(65.85)			13(31.71)

表2

表3

参考文献 28

[1]	Lord C, Elsabbagh M, Baird G, et al. Autism spectrum disorder[J]. Lancet, 2018, 392(10146):508-520. doi: S0140-6736(18)31129-2 pmid: 30078460
[2]	Lord C, Brugha TS, Charman T, et al. Autism spectrum disorder[J]. Nat Rev Dis Primers, 2020, 6(1):5. doi: 10.1038/s41572-019-0138-4 pmid: 31949163
[3]	Willsey HR, Willsey AJ, Wang B, et al. Genomics, convergent neuroscience and progress in understanding autism spectrum disorder[J]. Nat Rev Neurosci, 2022, 23(6):323-341. doi: 10.1038/s41583-022-00576-7 pmid: 35440779
[4]	Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and characteristics of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2018[J]. MMWR Surveill Summ, 2021, 70(11):1-16.
[5]	Baio J, Wiggins L, Christensen DL, et al. Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States, 2014[J]. MMWR Surveill Summ, 2018, 67(6):1-23. doi: 10.15585/mmwr.ss6706a1 pmid: 29701730
[6]	Clark MB, Braun PA. Promotion of oral health and prevention of dental caries among children in primary care[J]. JAMA, 2021, 326(21):2139-2140. doi: 10.1001/jama.2021.20396 pmid: 34874439
[7]	Suhaib F, Saeed A, Gul H, et al. Oral assessment of children with autism spectrum disorder in Rawalpindi, Pakistan[J]. Autism, 2019, 23(1):81-86. doi: 10.1177/1362361317730299 pmid: 29076744
[8]	El Khatib AA, El Tekeya MM, El Tantawi MA, et al. Oral health status and behaviours of children with Autism Spectrum Disorder: A case-control study[J]. Int J Paediatr Dent, 2014, 24(4):314-323. doi: 10.1111/ipd.12067 pmid: 24750459
[9]	Zerman N, Zotti F, Chirumbolo S, et al. Insights on dental care management and prevention in children with autism spectrum disorder(ASD). What is new?[J]. Front Oral Health, 2022, 3: 998831. doi: 10.3389/froh.2022.998831
[10]	Drummond BK, Meldrum AM, Boyd D. Influence of dental care on children’s oral health and wellbeing[J]. Br Dent J, 2013, 214(11):E27. doi: 10.1038/sj.bdj.2013.533
[11]	王兴. 第四次全国口腔健康流行病学调查报告[M]. 北京: 人民卫生出版社, 2018: 12-17.
[12]	Leiva-García B, Planells E, Planells Del Pozo P, et al. Association between feeding problems and oral health status in children with autism spectrum disorder[J]. J Autism Dev Disord, 2019, 49(12):4997-5008. doi: 10.1007/s10803-019-04211-w pmid: 31489541
[13]	Zhang YJ, Lin L, Liu JB, et al. Dental caries status in autistic children: A meta-analysis[J]. J Autism Dev Disord, 2020, 50(4):1249-1257. doi: 10.1007/s10803-019-04256-x pmid: 32008179
[14]	胡秋斌, 林锦萍, 孙守娟. 广东省中山市3-5岁学龄前儿童乳牙患龋率的调查分析[J]. 广东医科大学学报, 2022, 40(4):452-454.
[15]	Lam PPY, Chua H, Ekambaram M, et al. Risk predictors of early childhood caries increment-a systematic review and meta-analysis[J]. J Evid Based Dent Pract, 2022, 22(3):101732. doi: 10.1016/j.jebdp.2022.101732
[16]	Anwar DS, Mohd Yusof MYP, Ahmad MS, et al. Family influences on the dental caries status of children with special health care needs: A systematic review[J]. Children, 2022, 9(12):1855. doi: 10.3390/children9121855
[17]	王沪宁, 王艳, 张皓, 等. 上海市1 296名3-5岁儿童龋病及其相关危险因素分析[J]. 上海口腔医学, 2020, 29(2):174-178.
[18]	刘怡然, 沈红, 仇颖莹, 等. 江苏省3-5岁儿童龋病相关因素调查分析[J]. 口腔医学, 2020, 40(4):342-347.
[19]	郑晓丹, 刘义兰, 杨霞, 等. 口腔门诊开展儿童龋齿关怀课堂教育的效果评价[J]. 护理学杂志, 2019, 34(17):66-68.
[20]	李睿敏, 林茜文, 龙哲, 等. 银川市重度低龄儿童龋患病率及相关影响因素分析[J]. 中国妇幼保健, 2022, 37(18):3402-3406.
[21]	王密, 陈菁菁, 刘芳, 等. 中国学龄前儿童乳牙龋病影响因素的Meta分析[J]. 医学研究与教育, 2022, 39(2):41-47. doi: 10.3969/j.issn.1674-490X.2022.02.006
[22]	仇颖莹, 沈红, 刘怡然, 等. 江苏省5岁、12岁青少年儿童龋病流行现状及影响因素分析[J]. 口腔医学, 2018, 38(4):352-357.
[23]	Sheiham A. A new understanding of the relationship between sugars, dental caries and fluoride use: Implications for limits on sugars consumption[J]. Public Health Nutr, 2014, 17(10):2176-2184. doi: 10.1017/S136898001400113X pmid: 24892213
[24]	Hajishafiee M, Kapellas K, Listl S, et al. Effect of sugar-sweetened beverage taxation on sugars intake and dental caries: An umbrella review of a global perspective[J]. BMC Public Health, 2023, 23(1):986. doi: 10.1186/s12889-023-15884-5 pmid: 37237341
[25]	World Health Organization. Guideline on sugars intake for adults and children[M]. Geneva: World Health Organization, 2015.
[26]	尧丽, 杨海帆, 吴美霖, 等. 正强化和负强化: 概念、争议与神经机制[J]. 心理科学, 2017, 40(5):1091-1097.
[27]	寇娟, 杨梦圆, 魏子杰, 等. 自闭症谱系障碍社交动机理论:机制及干预探索[J]. 心理科学进展, 2023, 31(1):20-32. doi: 10.3724/SP.J.1042.2023.00020
[28]	顾智玉, 孙雪芹, 陈忆洁, 等. 遵义市小学教师口腔健康知识和对口腔健康教育态度的调查[J]. 华西口腔医学杂志, 2023, 41(1):52-57.

性别	人数/牙数	有龋坏的人数/牙数	因龋缺失的人数/牙数	已充填无龋的人数/牙数	患龋的人数/牙数	患龋率/%	龋均	龋补充填比/%
男	235/4 700	136/498	4/4	46/190	149/692	63.40(149/235)	2.94±3.27	27.62(190/688)
女	35/700	22/103	1/2	9/37	26/142	74.29(26/35)	4.06±4.14	26.43(37/140)
合计	270/5 400	158/601	5/6	55/227	175/834	64.81(175/270)	3.09±3.41	27.42(227/828)
χ²/F						1.582	3.278	0.082
P						0.209	0.071	0.774

影响因素	β	S.E	Wald χ²	P	Exp(B)	95%CI
每日刷牙总时长	-0.984	0.278	12.509	<0.001	0.374	0.217~0.645
晚上刷牙后睡觉前吃零食/喝饮料	-0.593	0.218	7.419	0.06	0.553	0.361~0.847