台灣0-6歲兒童之早發性幼兒齲齒 (ECC) 與嚴重型早發性幼兒齲齒 (SECC)之探討及齲齒型態之演變

研究背景：幼兒早發性齲齒在開發中國家一直是威脅著兒童口腔健康的疾病，也是兒童牙醫方面重要的防治課題。經由此次調查研究，探討台灣幼兒口腔健康狀態並分析早發性幼兒齲齒、嚴重型早發性幼兒齲齒及齲齒型態之演變。研究目的：探討並分析台灣早發性幼兒齲齒及嚴重型早發性幼兒齲齒的盛行率、齲齒經驗指數、齲齒型態和發展過程之演變。研究方法：研究母群體為全台灣0~6歲幼兒，採用分層多段隨機集束抽樣調查法(stratified multi-stage cluster sampling)，抽樣對象5804名，經兒童父母親或主要照顧者知情同意，參與此調查共3,121人。口檢方式為醫師經一致性訓練後，登記各牙面齲齒狀態，紀錄在口檢表上。數據收集用MS Access，結果統計分析用SPSS 14.0版。研究結果： 5~6歲的兒童ECC盛行率為71.23%，SECC盛行率為53.73%，填補率為30.06%，5~6歲的平均齲齒經驗指數deft為5.62。幼兒早發性齲齒最早被觀察到的年齡為17個月大，即上顎前牙平滑面齲齒開始的年齡。後牙溝隙齲齒開始於19~24個月大，後牙鄰接面齲齒開始於25~30個月大。5歲以前的前牙平滑面齲齒發生面數一直最高。在5~6歲時後牙溝隙齲齒發生面數明顯高於前牙平滑面齲齒。結論：幼兒奶瓶性齲齒通常最早發生在嬰幼兒1.5歲前，與此次所調查的幼兒齲齒型態有所不同。表示幼兒奶瓶性齲齒的現象有改善。但1.5歲以後幼兒早發性齲齒的進展就變得很快。與2006年5~6歲的齲齒盛行率、填補率和deft index數據做比較(73.62%、30.20%和5.58)，雖然盛行率和填補率稍低，但deft index稍高，尤其在dt部分，表示齲齒率有增加趨勢。其轉捩點為3~4歲。所以幼兒早發性齲齒在3歲以前即要加強防治。齲齒型態之發生順序為：上顎前牙平滑面齲齒、下顎後牙溝隙齲齒、上顎後牙溝隙齲齒、上顎和下顎後牙鄰接面齲齒，下顎前牙平滑面齲齒最少數。2~4歲時防治重點為上顎前牙平滑面齲齒，3歲以後防治重點應轉為後牙溝隙齲齒。

關鍵字

幼兒早發性齲齒(ECC) ；嚴重型幼兒早發性齲齒(SECC) ；學齡前兒童；口腔健康狀態

並列摘要

Background: Early childhood caries (ECC) has become a significant pediatric problem in many developing countries. In Taiwan, ECC influences children on their physical and mental health obviously. Via dental survey, we investigated the preschool children’s oral health status and evolutional pattern of carious lesions. Objectives: The purpose of this study was to investigate the prevalence, patterns, and transitional changes of ECC & SECC in Taiwan. Methods: This study object is aimed at children less than 6 years of age in Taiwan. Our survey sampling was using stratified multi-stage cluster sampling. Anticipated sample was5,804 and 3,121 children who were examined was recorded in check table. Data collection with MS Access and statistics analyzed with SPSS 14.0 versions. Result: Dental caries was detected delayed occurring after 17 months old. Maxillary anterior caries was seen as late as 17 months. Pit and fissure caries was seen as late as 19-24 months. Posterior proximal caries was seen as late as 25-30 months. The ECC prevalence of 5- to 6-year-old was 71.23%, SECC prevalence was53.73%, and filling rate was 30.06%. In addition, the mean deft index of 5- to 6-year-old children was 5.62. Conclusion: Nursing bottle decay usually occurs at children under 1.5 years old. The result data indicated that the phenomenon of nursing bottle decay was improved obviously. However, SECC was widespread in children after 17 months old. Compared with the mean caries prevalence (73.65%), mean filling rate (30.20%) and deft index (5.58) of 5- to 6- year-old children in 2006, the toddler caries wasn’t improved in last four years. The time of turning interval was 3-4 years old. So ECC was also a significant health issue for the children above 3 years old. To sum up, the process of ECC modes was as following: smooth surface caries of upper anterior teeth, pit and fissure caries of lower posterior teeth, pit and fissure caries of upper posterior teeth, and upper & lower proximal caries. The final appearance was smooth surface caries of lower anterior teeth. The preventive intervention of anterior smooth surface caries should be focusing on 2-4 years old. The preventive intervention of posterior pit and fissure caries should be focusing on more than 3 years old .