The importance of preventive dental visits from a young age: systematic review and current perspectives.
The importance of preventive dental visits from a young age: systematic review and current perspectives.
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DOI：
10.2147/ccide.s41499
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Divaris K
中科院分区：
文献类型：
--
作者：
Bhaskar V;McGraw KA;Divaris K
龋齿是最常见的儿童慢性疾病，对人口中的弱势群体影响尤为严重，并对儿童、家庭和卫生系统造成重大影响。由于针对口腔健康促进和疾病预防的努力从根本上优于疾病发展后的牙科康复，因此早期预防性牙科就诊（EPDV）受到专业和学术利益相关者的广泛倡导。本次全面审查的目的是严格审查和总结有关 EPDV 在改善儿童口腔健康结果方面的有效性的现有证据。我们对 PubMed 和 Embase 电子数据库进行了系统性文献检索，以确定截至 2013 年 10 月 30 日调查 EPDV 对口腔健康结果（包括临床、行为和成本终点）有效性的同行评审出版物。所确定研究的结果由两名研究人员独立提取和总结。 4篇稿件符合纳入标准并纳入评审。所有研究均在美国进行，并采用公共保险索赔数据的回顾性队列研究设计，而一项研究将索赔文件与幼儿园州牙科监测数据进行匹配。该研究发现 EPDV 对于未来临床确定的幼儿园龋齿水平没有任何益处。其他三项研究发现，对于 EPDV 与随后更多的预防性就诊、更少的非预防性就诊以及更低的非预防性服务相关支出之间的关联，人们的支持程度参差不齐。选择偏见和问题驱动的牙科护理寻求模式是审查研究中经常阐述的主题。目前支持 EPDV 有效性和第一年首次牙科就诊建议的证据基础薄弱，需要进行更多研究。对于高危儿童或患有现有牙科疾病的儿童来说，3 岁之前使用 EPDV 的益处是显而易见的。然而，EPDV 可能与生命最初几年恢复性牙科护理就诊和相关支出的减少有关。
Dental caries, the most common childhood chronic disease, disproportionately affects vulnerable parts of the population and confers substantial impacts to children, families, and health systems. Because efforts directed toward oral health promotion and disease prevention are fundamentally superior to dental rehabilitation secondary to disease development, early preventive dental visits (EPDVs) are widely advocated by professional and academic stakeholders. The aim of this comprehensive review was to critically review and summarize available evidence regarding the effectiveness of EPDVs in improving children’s oral health outcomes. A systematic literature search of the PubMed and Embase electronic databases was undertaken to identify peer-reviewed publications investigating the effectiveness of EPDVs on oral health outcomes, including clinical, behavioral, and cost end points up to October 30, 2013. Outcomes of the identified studies were abstracted and summarized independently by two investigators. Four manuscripts met the inclusion criteria and were included in the review. All studies were conducted in the US and employed a retrospective cohort study design using public insurance-claims data, whereas one study matched claims files with kindergarten state dental surveillance data. That study found no benefit of EPDVs in future clinically determined dental caries levels in kindergarten. The other three studies found mixed support for an association of EPDVs with subsequent more preventive and fewer nonpreventive visits and lower nonpreventive service-related expenditures. Selection bias and a problem-driven dental care-seeking pattern were frequently articulated themes in the reviewed studies. The currently available evidence base supporting the effectiveness of EPDVs and the year 1 first dental visit recommendation is weak, and more research is warranted. The benefits of EPDVs before the age of 3 years are evident among children at high risk or with existing dental disease. However, EPDVs may be associated with reduced restorative dental care visits and related expenditures during the first years of life.