- 學位論文
學齡前兒童乳牙齲齒與母親特質差異之相關研究
The association between primary dental caries and maternal characteristic differences among preschool children
摘要
背景： 齲齒是兒童最常見的口腔疾病，台灣兒童齲齒早在學齡前期發生。母親與孩童口腔健康習慣與狀態相關，並且母親特質例如：移民背景、口腔健康相關知識、態度與行為都影響孩童齲齒。目前學齡前兒童乳牙顯著齲齒與母親特質之相關研究有限，因此探討兒童顯著齲齒與母親特質之相關研究。 目的： 探討學齡前兒童乳牙齲齒與母親特質差異之相關性。 方法： 採用橫斷面研究設計，樣本為設籍高雄之母親與學齡前兒童。總計590對（495對來自幼稚園，95對來自社區）母親及其四歲至六歲兒童參與研究，母親填寫問卷與兒童接受口腔健康檢查。使用multiple logistics regression models 分析學齡前兒童decay teeth (dt)、missing teeth (mt)、filled teeth (ft)、齲齒經驗指數(dmft)等與母親特質差異之相關因素，學齡前兒童顯著齲齒指數(Significant Caries index, SiC)與其主要影響因素採用polytomous logistics regression models依乘法模式探討交互作用。 結果： 顯著齲齒(齲齒顆數6至19顆)的兒童下顎臼齒齲齒率為64.5% 至84.9%，且將近半數兒童正中門齒皆為齲齒,。兒童顯著齲齒的相關因素為母親口腔保健自我效能 (aOR = 0.64; 95% CI 0.53 - 0.96)、沒有使用含氟牙膏 (aOR = 2.39; 95% CI 1.56 - 3.98)、兒童每天至少一次攝取含糖飲料(aOR = 2.27; 95% CI 1.15 - 4.48)、以及兒童沒有定期牙科拜訪 (aOR = 2.32; 95% CI 1.20 - 3.98)。顯著齲齒組兒童沒有定時牙科拜訪同時與每天喝含糖飲料一次以上者、母親有較低的口腔保健相關自我效能等變項呈現顯著交互作用(P for interaction term is 0.034 and 0.004)。 新住民兒童dmft為6.5顆，上顎前牙唇側齲齒率為14.7%至22%。兒童dmft相關因素為母親刷牙頻率 (aOR = 8.95, 95% CI 1.95 - 41.05)；母親沒有要求孩子吃完甜食後刷牙，她們的孩子容易有齲齒 (aOR = 3.54, 95% CI 1.04 - 12.03)；兒童因齲齒而填補的牙齒與定期牙科檢查相關 (aOR = 2.28, 95% CI 1.26 - 4.10)。 結論： 兒童齲齒預防計畫應該要增進母親口腔保健自我效能，同時強調兒童飲食控制與定期牙科檢查的重要性，讓母親在嬰幼兒時期預防早期齲齒發生。新住民兒童有口腔健康不均等現象，應該實施多國語言口腔衛生宣導，提供新住民母親獲得口腔保健知識的管道、增進正向態度、鼓勵口腔保健行為，以解決口腔健康不均等現象。
並列摘要
Background: Caries is the most common oral diseases for children, and Taiwanese children caries development in preschool. The role of mother has been emphasized in relation to a child's oral health habits and status. The correlations between the risk indicators of preschoolers developing caries, include maternal socio-economic status, immigrant background, oral health knowledge and attitudes; the oral self-care behavior. A lack of caries preventive program on preschoolers and their mothers has been conducted by the Taiwan Ministry of Health and Welfare. Therefore, this study investigated the association between children with severe caries and maternal characteristics. Objectives: This study identified the high caries prevalence group expressed by the Significant Caries Index (SiC) on preschoolers aged 4-6 years and associated maternal characteristics; and to explore the disparities and factors associated with oral health among immigrant children. Methods: A cross-sectional community-based study was conducted to collect data from mothers and their preschool children in Kaohsiung. A total of 590 (495 from kindergartens, 95 from communities) children aged 4–6 years and their mothers completed the questionnaire and oral examination. Multiple logistics regression models were used to analyze the association between children’s oral health【decay teeth (dt)、missing teeth (mt)、filled teeth (ft)、dmft】and maternal characteristics. Main effect variables were incorporated into the polytomous logistics regression for the testing of interaction based on a multiplicative model. Results: Among the SiC children, caries experience was most frequently in the mandibular molars (range 64.5% to 84.9%), and almost 50% of these children had central incisor caries. The factors associated with SiC children were the maternal self-efficacy toward oral hygiene (aOR = 0.64; 95% CI 0.53 - 0.96), no use of fluoride toothpaste (aOR = 2.39; 95% CI 1.56 - 3.98), children sugary beverage consumed more than once per day (aOR = 2.27; 95% CI 1.15 - 4.48), and child's irregularly dental visits (aOR = 2.32; 95% CI 1.20 - 3.98). Significant interaction effects were detected among irregular dental checkup children whose SSB intake was 1+ times per day and mothers had lower level of efficacy toward oral hygiene (P for interaction term is 0.034 and 0.004, respectively). The caries index was 6.05 in immigrant children. The caries prevalence of maxillary anterior teeth in the labial surfaces was higher among immigrants, ranging from 14.7 to 22%. The factor associated with children’s caries index was maternal tooth brushing fre quency (adjusted odds ratio [aOR] = 8.95, 95% confidence interval [CI] 1.95–41.05). When the mothers did not direct children to brush teeth after eating sweets, their children were more likely to have decayed teeth (aOR = 3.54, 95% CI 1.04–12.03). Children’s filled teeth were related to their dental regular check-ups (aOR = 2.28, 95% CI 1.26–4.10). Conclusion: The caries prevention program should enhance the maternal self-efficacy toward oral hygiene, as well as emphasis on messages for child's dietary management and regular dental checkups for mothers to prevent severe caries at the very early age. Disparities in oral health among immigrant and native children were observed. The findings suggest that multilingual oral health intervention programs, and provide immigrants receive the oral health knowledge, attitudes, and encourage oral health behavior, and to solve the problem of oral health disparities.