An investigation of risk factors in deciduous teeth caries and planning for dental health strategy

本研究旨在比较乳牙龋病的区域特征，找出乳牙龋病的发病因素，并以先验模型为乳牙龋病的诊断框架，对乳牙龋病进行区域诊断。在这些研究的基础上，进行了健康策略规划。结果表明，虽然城市的患龋率为1.33，但两个地区的患龋率分别为2.27和2.59，两者之间的差异正在缩小。它仍然显示了近两倍的DMFT。然而，分析累积DMFT的比例，在所有三个地区，只有10%的儿童拥有整个DMFT的50%或更多，而儿童之间的DMFT不平等是未来的一个重要问题。前一模型中的每个因素都不同于各地区提供的口腔保健服务和健康教育，而“喂奶时间”、“奶瓶使用”和“刷牙习惯”对乳牙患龋率有较大的影响，各地区对这些因素都表现出了适宜的行为。在前一模型中，以DMFT为因变量，以健康行为因素为解释变量的Logistic回归分析结果显示，“等张饮料摄入频率”是一个较强的危险因素，其优势比为2.406。虽然“零食”和“等张饮料”是神奈川地区的龋病发病因素，但在DMFT较高的两个地区，平泉的“抛光”和奥沙曼部的“皱纹检查”分别是显著的危险因素。在本次调查中，对氟化物作为“易感因素”之一的认识也不够。因此，考虑到儿童之间的DMFT差异越来越大，建议将公共卫生中的氟化物应用作为人口策略。此外，不同地区的龋病因素结构也不同，这一研究表明，前向模型也是一种有用的局部诊断工具。

This study was conducted to compare regional characteristic and identify the factors of deciduous caries and to make a regional diagnosis of deciduous teeth caries using PRECEDE model as a framework of deciduous teeth caries. Then, based on those researches, planning for health strategy was performed. As a result, although caries prevalence (dmft) was 1.33 in urban areas, those were 2.27 and 2.59 respectively in the tow local areas despite the difference were decreasing. It still showed almost twice dmft. However, analyzing the ratio of accumulated dmft, in all three areas only 10% of all children had 50% or more of the whole dmft, and an inequality of dmft among children is an important future problem. Each factor in PRECEDE model differ from dental health service and health education offered in each area While "period of feeding", "use of feeding bottle" and "tooth brushing habit", which have been indicated that they had a strong influence on deciduous teeth caries incidence so far, appropriate behavior to those factors was shown in all the areas. As a result of analysis using logistic regression analysis in which dependent variable was dmft and explanatory variable was health behavior factor in PRECEDE model, "frequency of ingestion of isotonic drink" was a strong risk factor being the odds ratio 2.406. Although "between-meal snack" and "isotonic drink" were caries incidence factors in the area in Kanagawa, in two areas with higher dmft, "the finish polish" in Hiraizumi and "rugular checkups" in Oshamanbe was a significant risk factor respectively. Understanding to fluoride application as one of "Predisposing factors" was not sufficient in this survey as well. Therefore, fluoride application in public health is suggested as population strategy considering that the difference of dmft is increasing among children. Moreover, the structure of caries factors by areas differ and it was shown by this study that PRECEDE model is also useful as a tool of local diagnosis.