營養/口腔衛生習慣因子與嚴重早發性幼兒齲齒相關性之研究

A study to investigate relationship between nutrition/oral hygiene related factors and risk of severe early childhood caries.

唐如青(Ru-Shing Tang)

指導教授 ： 黃純德

共同指導教授 ： 黃孟娟(Meng-Chuan Huang)

高雄醫學大學/口腔醫學院/牙醫學研究所/博士(2013年)

摘要

背景
根據調查，在台灣有52.90%的學齡前孩童有嚴重早發性幼兒齲齒(Severe-Early Childhood Caries， S-ECC)問題，台灣學齡前孩童口腔健康狀況距離WHO所制定的目標仍有一小段距離。文獻指出，有嚴重齲齒的孩童，由於牙齒疼痛，發炎或缺牙等問題，進而限制食物種類攝取，甚至影響睡眠､生活品質及健康的生長發育。但是營養與嚴重早發性幼兒齲齒之間的關係很少被討論。為了暸解嚴重早發性幼兒齲齒對孩童健康的影響，並且預防齲齒危害孩童健康，降低孩童齲齒率，本研究將針對2-5歲孩童依序探討有嚴重早發性齲齒孩童之營養狀況，以及嚴重早發性齲齒的口腔衛生危險因子作研究探討。
研究目的
第一部分研究，探討嚴重早發性幼兒齲齒對孩童營養狀況的影響，營養狀況內容包含生長發育(身體質量指數)、貧血相關臨床生化值(紅血球、血紅素、血容比、鐵等)、礦物質相關臨床生化值(如鈣、鎂等)、營養不良相關臨床生化值（如白蛋白等）。
第二部分研究，分析比較嚴重早發性幼兒齲齒(病例組)與對照組的照護者口腔衛生習慣與照護知識、孩童飲食習慣及生長發育(身體質量指數)的差異性，並探討影響孩童有嚴重早發性幼兒齲齒的相關因子。
材料與方法
1.嚴重早發性幼兒齲齒對孩童營養狀況影響分析
研究設計為橫斷面研究，收集同意參加本研究具有嚴重早發性幼兒齲齒的2-5歲孩童總共101人，其中38%為女生，62%為男生，取樣於高雄醫學大學附設醫院兒童牙科門診，孩童臨床生化值送至高醫檢驗科做檢驗，生長法育測量值與臨床生化值結果由病歷中取得。進一步，將生長發育測量結果根據台灣行政院衛生署國民健康局做標準分類，貧血與缺鐵性貧血診斷是根據WHO定義做標準，進而分析齲齒與各種營養臨床狀況之間關係。
2. 探討影響孩童有嚴重早發性幼兒齲齒的相關因子
病例組取樣於高雄醫學大學附設醫院兒童牙科門診，採隨機抽樣調查收集對照組(孩童診斷為沒有嚴重早發性幼兒齲齒)， 同意收案與總共320人，病例組收案為105人，對照組為215人。病例組的生長發育狀況在病歷中取得，對照組的測量值是由學校健康檢查記錄表取得。進一步，將孩童生長發育測量結果根據台灣衛生福利部健康署做標準分類，口腔衛生習慣與飲食問卷由標準化的問卷所取得，由家長或主照護者所填寫，進而分析齲齒狀況與其他因子之間相關性。
結果：
一、 營養狀況：
嚴重早發性幼兒齲齒的孩童具有一些營養不良狀況包含過輕(30%)，缺鐵(46%)與貧血(9%)。調整控制干擾因子孩童年齡、性別、身體質量指數與母親教育程度之後，邏輯迴歸分析結果顯示孩童有嚴重早發性幼兒齲齒且defs index > 34的會有7.25倍貧血的風險(p < 0.05）。
二、 探討嚴重早發性幼兒齲齒與飲食/口腔衛生相關因子之相關性：
1. 口腔衛生習慣與知識 ：嚴重早發性幼兒齲齒組的照護者之口腔衛生平均知識分數較對照組低 (p < 0.05）， 口腔衛生知識分數會受到母親之年齡，父親教育程與社經地位，有統計上顯著的相關性(p < 0.05)。母親年齡小於30歲(OR:8.83)、主照顧者的不正確口腔衛生習慣(OR:3.66)及只有在疼痛時帶孩童看牙科的習慣(OR:7.4)，會讓孩童有嚴重早發性幼兒齲齒的危險 (p < 0.05)。
2. 飲食習慣 : 攝食習慣上，孩童將食物含在嘴裡沒有馬上吞下去有4.39倍風險以及沒有咀嚼就會吞下食物有3.47倍風險，會發生嚴重早發性幼兒齲齒危險，在統計上有顯著性的差異性(p < 0.05)。選擇食物的種類上，攝取流質或半流質食物方式會有4.33倍風險會發生嚴重早發性幼兒齲齒(p < 0.05)。甜食習慣上，愛吃甜食與果汁的孩童其發生嚴重早發性幼兒齲齒機率分別為2.23 、2.36倍風險(p < 0.05)。正餐的攝取頻率上，有嚴重早發性齲齒的孩童比沒有嚴重早發性幼兒齲齒的控制組，較少攝取五穀飯類(OR:2.94)、豬肉(OR:2.33)，及營養食品(OR:2.32) (p < 0.05)
結論
貧血與嚴重早發性幼兒齲齒(S-ECC)且defs＞34有相關性，臨床醫師及牙醫師需要兼顧孩童的營養狀況與口腔衛生習慣。照顧者不正確的口腔衛生習慣與知識、不正確的飲食習慣，皆與孩童羅患嚴重早發性幼兒齲齒有相關性的。正確的口腔衛生教育與口腔預防政策的實施必須在懷孕期開始做起，可以納入孕婦與幼兒手冊中。

關鍵字

嚴重早發性幼兒齲齒 ； 營養 ； 貧血 ； 口腔衛生習慣 ； 飲食習慣

並列摘要

Background:
According to previous research, the oral health status of Taiwanese elementary school children remains below the standards set by the World Health Organization (WHO). To decrease caries rates, we must be vigilant regarding children’s oral health before they reach 6 years of age. The prevalence rate of severe early childhood caries (S-ECC) in Taiwan was reported as 73.19%. Children with extensive caries experience toothache, inflammation, tooth loss, and other problems. Furthermore, these problems restrict the intake of certain foods, reduce sleep quality, and impair life quality and healthy development. To prevent dental caries from damaging children’s health and to decrease the caries rate in children, this study analyzed the complex relationship between the nutrition, oral hygiene related factors and S-ECC.
Objective
1. Analyze the nutritional status among preschool children with S-ECC by obtaining anthropometric measurements (body mass index: BMI) and conducting biochemical tests (anemia-related parameters, levels of mineral micronutrients and nutrition-related parameters).
2. Analyze the difference between the oral hygiene habits and knowledge、dietary habits and anthropometric results between the S-ECC group and healthy group, and evaluated the risk factor of S-ECC among children.
Material and Methods
1. Analyze the relationship between nutrition and severe early childhood caries
We used cross-setional approach to recruited 2-5 years old children (n=101) who visited the pediatric department of an academic hospital for treatment of S-ECC. We recorded the data of growth status and biochemical measures from the chart completed on the day of children’s dental surgery. The body weight and height of each child were recorded, and their BMI were calculated. The children were classified as obese, overweight, normal or underweight based on the standards established by the Centers of Disease Control, Department of Health of Taiwan. The laboratory medicine department staff of the academic hospital analyzed the blood samples. Cases of anemia and iron deficiency were identified according to the criteria established by the WHO.
2. To investigate relationships between oral hygiene related factors and risk of severe early childhood caries: case-control study
Preschool children with S-ECC were recruited who visited the pediatric department of an academic hospital for denral treament, while control group (without S-ECC) were recruited from the community. A total of 320 children were recruited; 105 with S-ECC and 215 controls. The oral hygiene habits and knowledge and the dietary habits of the children were obtained using a standardized questionnaire completed by the primary caregivers of the children.
The data were analyzed using Microsoft Access database management software and JMP statistical software.
Results
1. Nutritional status of children with S-ECC：
The children with S-ECC showed 30% were underweight, 46% had iron deficiencies and 9% had anemia. Performing logistic regression analyses revealed that the children with S-ECC (defs index > 34) were 7.25 times more more likely to have anemia while adjusting for confounding factors（p<.05）.
2. The relationships between oral hygiene related factors /dietary and risk of severe early childhood caries
Oral hygiene related habits and knowledge:
The healthy control group had higher oral hygiene knowledge scores than the S-ECC group did（p<.05）. The education level and socio-economic status of the parents (the caregivers) were correlated with the oral health knowledge scores (p < .05). Performing logistic regression analyses reveled that mother whe aged younger than 30 years are 8.33 times and main caregiver with poor oral hygiene habits were 3.66 times more likely to have children with S-ECC. The children who went to dental clinics because of tooth pain were 7.4 times more likely to have S-ECC (p< .05).
Dietary habtits:
Of children had dietary habits of pouched their food in mouth (4.39 odds) and swallowed without chewing (3.47 odds) and intake semi or full fluid food type (4.33 odds) were more likely to have S-ECC than S-ECC-free controls (p < .0001). Higher frequencies of snack/sweet and juice intake were nearly twice more likely to have S-ECC risk than S-ECC-free controls (P<0.05). The children with S-ECC consumed less rice and pork than those in the S-ECC-free controls (P<0.05).
Conclusion
The results revealed that S-ECC is strongly associated with anemia, indicating that clinicians and dentists must provide treatment that improves both the oral hygiene and the nutritional status of children with S-ECC.
The poor oral hygiene habits / knowledge of caregivers and poor dietary habits are associated with children with S-ECC. Thus, oral hygiene related education must have been starting with pregnancy program, implanted to pregnancy manual and infant manual.

並列關鍵字

severe early childhood caries ； nutrition ； anemia ； oral hygiene habits ； dietary habits

參考文獻

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