運用台灣全民健保資料庫分析牙科樹脂充填材與兒童注意力不足過動症關係的研究

Association between dental composite resin restoration and attention deficit hyperactivity disorder in children from Taiwan National Health Insurance Database.

胡潔仁(Chieh-Jen Hu)

指導教授 ： 張育超

中山醫學大學/口腔醫學院/牙醫學系碩士班/碩士(2018年)

摘要

注意力不足過動症(attention deficit hyperactivity disorder; ADHD)是兒童最常見的精神疾患。一般認為最主要的病因是遺傳，但近年來環境毒素對於過動症的影響也受到注目。例如環境賀爾蒙甲醛、雙酚A (bisphenol A)，這幾年來陸續有研究指出過度的雙酚A暴露可能與兒童注意力不足過動症有關。而齲齒是台灣兒童口腔內最常見的疾病，近年來治療以使用複合樹脂材料填補為主。而複合樹脂材料已證實會釋放出雙酚A，填補後會使唾液和尿液中雙酚A可偵測濃度變高。但目前仍鮮少有研究討論牙科樹脂和兒童過動症之間的關係，因此設計此研究來釐清兩者之間是否有關係。本研究使用台灣健保資料庫，選出1998-2005年出生，並在2000-2008年有接受過齲齒填補治療後一年以上被診斷出ADHD的兒童做分析，以1:2比例選出同樣條件、未被診斷出ADHD的兒童做對照組，持續追蹤到2013年。結果顯示接受樹脂填補治療的患者被診斷出ADHD的風險顯著較高odds ratio=1.183 (95%CI=1.092-1.282)。進一步分析樹脂填補次數中位數為8次，填補8次以下被診斷出ADHD的odds ratio為1.166 (95%CI=1.068-1.273); 填補8次以上被診斷出ADHD的odds ratio為1.206(95%CI=1.099-1.324)。結果中顯示接受樹脂填補治療後得到ADHD之風險比未填補樹脂高，其中帶有劑量效應，填補次數越多被診斷出ADHD風險越高。

關鍵字

注意力不足過動症 ； 雙酚A ； 複合樹脂填補材 ； 齲齒填補

並列摘要

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood psychiatric conditions. The exact etiology of ADHD is still unclear, but many studies have confirmed that perinatal or neonatal exposure to low-dose (bisphenol A) BPA will contribute to ADHD. BPA has recently received increased attention. BPA is used widely to make polycarbonate plastics such as those in hard plastic baby and water bottles and epoxy resins such as those in dental sealants and resin-based composites. Resin-based composites are becoming most popular filling material for prepared cavity nowadays, especially in children. We designed this nationwide population-based nested case-control study to figure out the relationship between composite resin treatment and ADHD in Taiwanese children. Our study used the Longitudinal Health Insurance Databases (LHID 2010) from the National Health Insurance Research Database of Taiwan (NHIRD-TW). Subjects of the study was included children birth years are between 1998 and 2005, and patients who received operative dentistry (OD) treatment between January 2000 and December 2008 from the NHIRD-TW. OD treatment. In conclusion, we found that patients who had received dental composite resin OD treatment had higher risk for ADHD diagnosis than patients who never received composite resin OD treatment (adjusted Odds ratio; OR=1.246 ; 95% CI=0.68–0.93), and ADHD risk is higher in male then female. (male OR=1.278; 95% CI=1.142-1.431; female OR=1.139; 95% CI=0.919-1.411). Moreover, in the frequency of resin OD treatment above 8 times group had higher odds ratio to ADHD diagnosis (OR=1.206; 95% CI=1.099-1.324) compared with group who had resin OD treatment below 8 times (OR=1.166; 95% CI=1.068-1.273). Otherwise, the duration from first composite resin OD treatment to ADHD diagnosis over 1 year had greater effect to odds ratio of ADHD diagnosis compared with under 1 year (OR=1.246 vs OR=1.185).

並列關鍵字

ADHD ； composite resin ； Bisphenol A ； BPA ； OD

參考文獻

American Academy of Pediatrics. (1987). Medication for Children With an Attention Deficit Disorder. Pediatrics, Nov. 80 (5), 758-760.

Anastopoulos AD, DuPaul GJ, Barkley RA. (1991 ). Stimulant medication and parent training therapies for attention deficit-hyperactivity disorder. J Learn Disabil., Apr 24(4), 210-218.

Arcia, E., Conners,C. (1998). Gender difference in ADHD ? J.Dev.Behav.Pediatr., 19(2), 77-83.

Barkley, R.A., McMurray, M.B., Edelbrock, C.S., & Robbins, K. (1989). The side effects of Ritalin: A systematic placebo controlled evaluation of two doses. . Manuscript submitted for publication.

Bowen RL, Marjenhoff WA. . (1992). Dental composites/glass ionomers: the materials. . Adv Dent Res., Sep(6), 44-49.