湖北省宜昌市6～7岁儿童口腔健康状况、行为及其影响因素的分析
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摘要
本研究旨在：(1)调查湖北省宜昌市6～7岁儿童口腔健康状况和行为；(2)探讨儿童患龋情况、口腔健康行为与社会行为危险因素之间的关系；(3)评价学生母亲和学校教师的口腔健康态度、知识和行为，为制定和评价学校口腔健康教育计划提供基线资料。
调查对象为湖北省宜昌市15所小学1898名6～7岁儿童及其母亲、215名学校教师。采用WHO龋病诊断标准调查儿童患龋情况。采用母亲问卷和教师问卷的调查方法收集儿童、母亲和学校教师的口腔健康态度、行为以及相关影响因素。共下发问卷1898份，收到有效母亲问卷1356份，回答率71.4％。
宜昌市1898名儿童乳牙患龋率为72.1％，龋均为3.78，龋面均为8.42；恒牙患龋率为5.2％，龋均为0.07，龋面均为0.08。
40％的儿童每天刷牙两次以上，60％的儿童每天刷牙一次。78％的儿童使用氟化牙膏。大约50％的儿童在过去一年拜访过牙医，34％的儿童从来就没有拜访过牙医。儿童的饮食以淀粉和纤维素为主，含糖类食品相对较少。最常食用的含糖食品依次为：蛋糕饼干、加糖牛奶、面包和甜早点。影响儿童刷牙行为的因素依次为母亲的刷牙行为、儿童的牙科就诊行为和母亲的文化程度，其中母亲的刷牙行为是影响儿童刷牙行为最主要的因素(RR=10.50)。儿童的就诊行为和母亲的就诊行为、母亲刷牙行为、母亲对龋病预防知识的了解程度和母亲的文化程度密切相关。
甜早点、蛋糕饼干与儿童患龋情况关系密切，影响儿童龋齿发生的因素是餐间吃甜食、含糖食品的消费和和儿童使用氟化牙膏，其中餐间吃甜食是影响龋病最危险的因素。
学校教师的口腔知识水平高于学生母亲。母亲主要通过电视(62.4％)
和书本(51.5%)获得口腔健康知识，而学校教师可以通过各种途径其中包
括牙医(75.3%)获得口腔健康知识。几乎所有的母亲(94.0%)没有每天帮
助儿童刷牙。仅有18.9%的母亲过去一年内去医院检查或治疗过牙齿。
小学生口腔卫生状况较差，学校应该开展口腔健康教育和口腔健康促进
项目。开展口腔健康项目必须有母亲和学校教师的参与，以帮助学生建立良
好的口腔健康行为，阻止口腔疾病的进一步发展。
Objectives: The objectives of the study were: (1) to describe oral health status of 6-7-year old schoolchildren, (2) to evaluate the pattern of oral health behaviour, (3) to assess the relative effect of socio-behavioural risk factors on oral health behaviour and dental caries experience, and (4) to assess dental knowledge and behavior among school teachers and the mothers of the children. Methods: Dental caries of 1898 6-7-year-old children in Yichang City was recorded according to WHO criteria. Collected data from 1365 (response rate, 71.4%) mothers with first grade student and 215 school teacher in Yichang city by highly structured questionnaires were analyzed.
Results: The caries prevalence was 72.1 per cent for primary teeth and 5.2% for the permanent teeth in 6-7-year-old children in Yichang City. The mean dmft was 3.78 for primary teeth and 0.07 for permanent teeth. About 40 per cent of the children brushed their teeth twice a day or more often and 57.6 per cent once a day. Fluoridated toothpaste was used by 78.5% of the children. Nearly half of the children had seen a dentist during the last year while 34.2 per cent had never visited a dentist. The children' diet were mainly starch and cellulose, with consumption of a little sugary foods and drinks. The results of logistic regression
analyses indicated that children' brushing behaviour was mainly affected by mothers' brushing behaviour, children' dental visiting behaviour was mainly affected by mothers' dental visiting behaviour. Caries experience of the children was related to frequency of siiacks between meals, consumption of sugary foods and use of fluoride toothpaste. Level of dental knowledge was higher among teachers than among mothers; the mothers were mostly informed through television/book (62.4%/51.5%), while teachers received information from various sources, including the dentists (75.3%). Almost all children (94.0%) didn't have practical support from then- parents in daily toothcleaning. Only 18.9 percent of mothers had visited the dentist within a year.
Conclusions: (1) the children of 6-7-year-old have high caries levels for primary teeth and substantial proportions of children have poor oral health behaviour; (2) regular oral health behaviour and high education of mothers have positive influence upon children's oral health habits; (3) children's oral health status was affected by their dietary habits; (4) there is an urgent need for implementation of systematic oral health education and promotion programmes for children in Yichang City; and (4) we should emphasize oral heath education among mother and schoolteachers in order to promote oral health education and promotion programmes.
调查对象为湖北省宜昌市15所小学1898名6～7岁儿童及其母亲、215名学校教师。采用WHO龋病诊断标准调查儿童患龋情况。采用母亲问卷和教师问卷的调查方法收集儿童、母亲和学校教师的口腔健康态度、行为以及相关影响因素。共下发问卷1898份，收到有效母亲问卷1356份，回答率71.4％。
宜昌市1898名儿童乳牙患龋率为72.1％，龋均为3.78，龋面均为8.42；恒牙患龋率为5.2％，龋均为0.07，龋面均为0.08。
40％的儿童每天刷牙两次以上，60％的儿童每天刷牙一次。78％的儿童使用氟化牙膏。大约50％的儿童在过去一年拜访过牙医，34％的儿童从来就没有拜访过牙医。儿童的饮食以淀粉和纤维素为主，含糖类食品相对较少。最常食用的含糖食品依次为：蛋糕饼干、加糖牛奶、面包和甜早点。影响儿童刷牙行为的因素依次为母亲的刷牙行为、儿童的牙科就诊行为和母亲的文化程度，其中母亲的刷牙行为是影响儿童刷牙行为最主要的因素(RR=10.50)。儿童的就诊行为和母亲的就诊行为、母亲刷牙行为、母亲对龋病预防知识的了解程度和母亲的文化程度密切相关。
甜早点、蛋糕饼干与儿童患龋情况关系密切，影响儿童龋齿发生的因素是餐间吃甜食、含糖食品的消费和和儿童使用氟化牙膏，其中餐间吃甜食是影响龋病最危险的因素。
学校教师的口腔知识水平高于学生母亲。母亲主要通过电视(62.4％)
和书本(51.5%)获得口腔健康知识，而学校教师可以通过各种途径其中包
括牙医(75.3%)获得口腔健康知识。几乎所有的母亲(94.0%)没有每天帮
助儿童刷牙。仅有18.9%的母亲过去一年内去医院检查或治疗过牙齿。
小学生口腔卫生状况较差，学校应该开展口腔健康教育和口腔健康促进
项目。开展口腔健康项目必须有母亲和学校教师的参与，以帮助学生建立良
好的口腔健康行为，阻止口腔疾病的进一步发展。
Objectives: The objectives of the study were: (1) to describe oral health status of 6-7-year old schoolchildren, (2) to evaluate the pattern of oral health behaviour, (3) to assess the relative effect of socio-behavioural risk factors on oral health behaviour and dental caries experience, and (4) to assess dental knowledge and behavior among school teachers and the mothers of the children. Methods: Dental caries of 1898 6-7-year-old children in Yichang City was recorded according to WHO criteria. Collected data from 1365 (response rate, 71.4%) mothers with first grade student and 215 school teacher in Yichang city by highly structured questionnaires were analyzed.
Results: The caries prevalence was 72.1 per cent for primary teeth and 5.2% for the permanent teeth in 6-7-year-old children in Yichang City. The mean dmft was 3.78 for primary teeth and 0.07 for permanent teeth. About 40 per cent of the children brushed their teeth twice a day or more often and 57.6 per cent once a day. Fluoridated toothpaste was used by 78.5% of the children. Nearly half of the children had seen a dentist during the last year while 34.2 per cent had never visited a dentist. The children' diet were mainly starch and cellulose, with consumption of a little sugary foods and drinks. The results of logistic regression
analyses indicated that children' brushing behaviour was mainly affected by mothers' brushing behaviour, children' dental visiting behaviour was mainly affected by mothers' dental visiting behaviour. Caries experience of the children was related to frequency of siiacks between meals, consumption of sugary foods and use of fluoride toothpaste. Level of dental knowledge was higher among teachers than among mothers; the mothers were mostly informed through television/book (62.4%/51.5%), while teachers received information from various sources, including the dentists (75.3%). Almost all children (94.0%) didn't have practical support from then- parents in daily toothcleaning. Only 18.9 percent of mothers had visited the dentist within a year.
Conclusions: (1) the children of 6-7-year-old have high caries levels for primary teeth and substantial proportions of children have poor oral health behaviour; (2) regular oral health behaviour and high education of mothers have positive influence upon children's oral health habits; (3) children's oral health status was affected by their dietary habits; (4) there is an urgent need for implementation of systematic oral health education and promotion programmes for children in Yichang City; and (4) we should emphasize oral heath education among mother and schoolteachers in order to promote oral health education and promotion programmes.
引文
1. National Committee For Oral Health. The second national survey of oral health in China (1995). Beijing: People Health Press, 1999
2．卞金有主编．口腔预防医学．人民卫生出版社(第三版)，2001
3. Marthaler TM, O'Mullance D, Vrbie V. The prevalence of dental caries in Europe 1990-95. Caries Research, 1996, 30:237-255
4. Burt B. Trends in caries prevalence in North American children. Int Dent J, 1994, 44:403-413
5. Sheiham A. Changing trends in dental caries. Int J Epidemiol, 1984, 13: 142-147
6. Petersen PE, Razanamihaja N. Oral health status of children and adults in Madagascar. Int Dent J, 1996, 46:41-47
7. Wang HY, Poul EP, Jin-You B, et al. The second national survey of oral health status of children and adults in China. Int Dent J, 2002, 52(4): 283-90
8．郭颖，黄薇，台保军．学龄儿童(6-7)岁恒牙萌出情况及分析．临床口腔医学杂志，1997，13(2)：123-124
9．郭养涵，赖红昌，谢方德．恒牙萌出次序变化的调查报告．临床口腔医学杂志，1992，8(4)：196-197
10．刘寿桃，杨虹，王金东．深圳市小学生牙科遵医行为影响因素调查分析．口腔医学纵横杂志，2000，5(2)：33-34
11．胡碧．窝沟封闭剂保留情况的追踪观察．临床口腔医学杂志，2001，5(2)：156
12. Petersen PE. Guttman scale analysis of dental health knowledge and attitudes. Community Dent Oral Epidemio, 1989,17:170-172
13．江汉，台保军，许仙枝等．母亲文化程度对儿童饮食习惯的影响．武汉大
学学报(医学版)，2002，23(3)：60．
14．罗泊．吃糖频率与龋齿病变进展的关系．牙体牙髓牙周病学杂志，1996，6(3)：148-149．
15．刘淑杰，贾萍，张丽．学龄前儿童乳牙龋病危险因素的逐步回归分析．现代口腔医学杂志，1996，10(2)：94-96．
16. Dawson H. Market outlook. Crunch time. Beverage World Int, 1994, 2:16-22
17. Ismail AI, Tanzer JM, Dingle JL. Current trends of sugar consumption in developing societies. Community Dent Oral Epidemiol, 1997, 25:438-43
18. Petersen PE. Oral health behaviour of 6-year-old Danish children. Acta Odontol Stand, 1992, 50:57-64
19. Habibian M, Roberts G, Lawson M, et al. Dietary habits and dental health over the first 18 months of life. Community Dent Oral Epidemiol, 2001, 29(4): 239
20. Petersen PE, Zhong ES. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China. Int Dent J 1998,48:210-216
21. Du M, Bian Z, Guo L. Caries patterns and its association with infant feeding in 2-4 year old Chinese children. International Dental Journal, 2001, 50(6): 385-9
22. Burt BA. Relative consumption of sucrose and other sugars: has it been a factor in reduced caries experience? Caries Res, 1993,27(1):56-63
23. Butt BA, Eklund S, A.Morgan LO, et al. The effects of sugar intake and frequency of ingestion on dental caries increment in a three-year longitudinal study. J Dent Res, 1988,67:1422-1429
24. Marthaler TM. Changes in the prevalence of dental caries: how much can be
attributed to changes in diet? Caries Res, 1990, 24(1): 3-15
25. Chestnutt IG, Schafer F, Jacobson APM, et al. The influence of toothbrushing frequency and post-brushing rising on caries experience in a caries clinical trial. Community Dent Oral Epidemiol, 1998, 26; 406-411
26. Peng B, Petersen PE, Fan MW, et al. Oral health status and oral health behaviour of 12-year-old urban schoolchildren in the People's Republic of China. Community Dental Health, 1997, 14; 238-244
27. Tai BJ, Du M, Peng B, et al. Experiences from a school-based oral health promotion programme in Wuhan City, PR China. Int J Paediatr Dent, 2001, 11(4): 286-91.
28．杜民权，Petersen PE，台保军等．牙医医生对口腔卫生服务体系的评价．口腔医学纵横杂志，2002，18(1)：49
29．台保军，黄薇．湖北省牙防组十年工作回顾．口腔医学纵横，1998，14(4)：241
2．卞金有主编．口腔预防医学．人民卫生出版社(第三版)，2001
3. Marthaler TM, O'Mullance D, Vrbie V. The prevalence of dental caries in Europe 1990-95. Caries Research, 1996, 30:237-255
4. Burt B. Trends in caries prevalence in North American children. Int Dent J, 1994, 44:403-413
5. Sheiham A. Changing trends in dental caries. Int J Epidemiol, 1984, 13: 142-147
6. Petersen PE, Razanamihaja N. Oral health status of children and adults in Madagascar. Int Dent J, 1996, 46:41-47
7. Wang HY, Poul EP, Jin-You B, et al. The second national survey of oral health status of children and adults in China. Int Dent J, 2002, 52(4): 283-90
8．郭颖，黄薇，台保军．学龄儿童(6-7)岁恒牙萌出情况及分析．临床口腔医学杂志，1997，13(2)：123-124
9．郭养涵，赖红昌，谢方德．恒牙萌出次序变化的调查报告．临床口腔医学杂志，1992，8(4)：196-197
10．刘寿桃，杨虹，王金东．深圳市小学生牙科遵医行为影响因素调查分析．口腔医学纵横杂志，2000，5(2)：33-34
11．胡碧．窝沟封闭剂保留情况的追踪观察．临床口腔医学杂志，2001，5(2)：156
12. Petersen PE. Guttman scale analysis of dental health knowledge and attitudes. Community Dent Oral Epidemio, 1989,17:170-172
13．江汉，台保军，许仙枝等．母亲文化程度对儿童饮食习惯的影响．武汉大
学学报(医学版)，2002，23(3)：60．
14．罗泊．吃糖频率与龋齿病变进展的关系．牙体牙髓牙周病学杂志，1996，6(3)：148-149．
15．刘淑杰，贾萍，张丽．学龄前儿童乳牙龋病危险因素的逐步回归分析．现代口腔医学杂志，1996，10(2)：94-96．
16. Dawson H. Market outlook. Crunch time. Beverage World Int, 1994, 2:16-22
17. Ismail AI, Tanzer JM, Dingle JL. Current trends of sugar consumption in developing societies. Community Dent Oral Epidemiol, 1997, 25:438-43
18. Petersen PE. Oral health behaviour of 6-year-old Danish children. Acta Odontol Stand, 1992, 50:57-64
19. Habibian M, Roberts G, Lawson M, et al. Dietary habits and dental health over the first 18 months of life. Community Dent Oral Epidemiol, 2001, 29(4): 239
20. Petersen PE, Zhong ES. Dental caries and oral health behaviour situation of children, mothers and schoolteachers in Wuhan, People's Republic of China. Int Dent J 1998,48:210-216
21. Du M, Bian Z, Guo L. Caries patterns and its association with infant feeding in 2-4 year old Chinese children. International Dental Journal, 2001, 50(6): 385-9
22. Burt BA. Relative consumption of sucrose and other sugars: has it been a factor in reduced caries experience? Caries Res, 1993,27(1):56-63
23. Butt BA, Eklund S, A.Morgan LO, et al. The effects of sugar intake and frequency of ingestion on dental caries increment in a three-year longitudinal study. J Dent Res, 1988,67:1422-1429
24. Marthaler TM. Changes in the prevalence of dental caries: how much can be
attributed to changes in diet? Caries Res, 1990, 24(1): 3-15
25. Chestnutt IG, Schafer F, Jacobson APM, et al. The influence of toothbrushing frequency and post-brushing rising on caries experience in a caries clinical trial. Community Dent Oral Epidemiol, 1998, 26; 406-411
26. Peng B, Petersen PE, Fan MW, et al. Oral health status and oral health behaviour of 12-year-old urban schoolchildren in the People's Republic of China. Community Dental Health, 1997, 14; 238-244
27. Tai BJ, Du M, Peng B, et al. Experiences from a school-based oral health promotion programme in Wuhan City, PR China. Int J Paediatr Dent, 2001, 11(4): 286-91.
28．杜民权，Petersen PE，台保军等．牙医医生对口腔卫生服务体系的评价．口腔医学纵横杂志，2002，18(1)：49
29．台保军，黄薇．湖北省牙防组十年工作回顾．口腔医学纵横，1998，14(4)：241