母亲患龋风险对儿童龋易感性的影响

doi:10.19439/j.sjos.2023.01.012

摘要/Abstract

摘要： 目的: 评价母亲孕期患龋风险对婴幼儿龋易感性的影响,为有效控制和预防低龄儿童龋的发生和发展提供依据。方法: 从北京市西城和密云区妇幼保健院选择140名妊娠4~9个月的孕妇及婴幼儿作为研究对象,采用WHO 2013年龋病诊断标准,进行口腔检查、问卷调查并收集母亲刺激性唾液样本,应用Dentocult SM、Dentocule LB和Dentobuff Strip标准试剂盒进行龋活性检测。在婴儿出生后6个月、1岁和2岁时,采用ICDAS II龋齿诊断为标准记录儿童患龋情况。收集婴幼儿静息唾液样本,应用巢式PCR检查6个月、1岁和2岁婴儿变异链球菌（S.mutans）的定植情况。采用SPSS 21.0软件包对数据进行统计学分析。结果: 经过2年观察,失访率 11.43% ,共有124对母子（女）完成随访观察。根据母亲开放龋洞（即未经治疗龋洞）数、Dentocult SM法检测变异链球菌、Dentocule LB法检测乳酸杆菌、Dentbuff Strip法检测唾液缓冲能力及问卷调查结果,将母亲分为中、低龋风险（LCR）组和高龋风险（HCR）组。HCR组1岁儿童非洞龋患龋率（18.33%）和龋均（0.3±0.087）显著高于LCR组患龋率（3.13%）和龋均（0.06±0.044）（P<0.05）,HCR组2岁儿童成非洞龋患龋率（21.67%）和龋均（0.33±0.088）显著高于LCR组患龋率（6.25%）和龋均（0.09±0.048）（P<0.05）,HCR组2岁儿童成洞龋患龋率（20.00%）和龋均（0.33±0.10）显著高于LCR组患龋率（6.25%）和龋均（0.11±0.055）（P<0.05）。HCR组儿童6个月、1岁、2岁时S.mutans检出率显著高于LCR组（P<0.05）。6个月检出S.mutans的儿童,2岁时患龋率（29.62%）和龋均（0.67±0.22）显著高于未检出儿童的患龋率（13.40%）和龋均（0.30±0.082）（P<0.05）。结论: 经2年观察,高龋风险的母亲,其儿童龋易感性相应升高。母亲高龋风险在一定程度上影响儿童口腔内S.mutans定植;S.mutans定植时间越早的婴幼儿,2岁时患龋风险相应增加。建议通过对高龋风险母亲进行孕期早期口腔健康行为干预,阻断或延缓S.mutans垂直传播,有效预防和减少ECC发生、发展。

关键词: 低龄儿童龋, 龋风险评估, 变异链球菌, 垂直传播

Abstract: PURPOSE: To evaluate the impact of caries risk of pregnant mothers on caries susceptibility of infants in order to provide a basis for effective control and prevention of the occurrence and development of early childhood caries. METHODS: A total of 140 pregnant women and infants from 4 to 9 months of gestation in Xicheng and Miyun Maternal and Child Health Hospital were selected as the study subjects. According to WHO 2013 caries diagnosis standard, oral examination, questionnaire survey and stimulating saliva samples of pregnant mothers were collected. Caries activity was determined using the Dentocult SM, Dentocule LB and Dentobuff Strip standard kit. At 6 months, 1 year, and 2 years, caries was recorded and resting saliva samples were collected. Nested PCR was used to detect the colonization of S.mutans in infants at 6 months, 1 year, and 2 years of age. Statistical analysis was concluded with SPSS 21.0 software package. RESULTS: After 2 years of observation, the rate of lost follow-up was 11.43%, 124 pairs of mother-child were followed up. The study was divided into moderate and low caries risk (LCR) group and high caries risk (HCR) group based on the number of open caries (untreated cavities) in mothers, detection of Streptococcus mutans by Dentocult SM, Lactobacillus by Dentocule LB, saliva buffering capacity by Dentbuff Strip, and questionnaire results. The results showed that the prevalence of white spot(18.33%) and dmft (0.3±0.087) in HCR group were significantly higher than those in LCR group (3.13%, 0.06±0.044) (P<0.05) at one-year old children. The prevalence of white spot (21.67%) and dmft (0.33±0.088) in HCR group were significantly higher than those in LCR group (6.25%, 0.09±0.048) (P<0.05) at two-year old children. The prevalence of caries (20.00%) and dmft (0.33±0.10) in HCR group were significantly higher than those in LCR group (6.25%, 0.11±0.055)(P<0.05) at two-year old children. The detection rate of S.mutans in HCR group was significantly higher than that in LCR group at 6 months, 1-year old and 2-year old children(P<0.05). The prevalence of dental caries (29.62%) and dmft (0.67±0.22) in children with S.mutans detected at 6 months were significantly higher than those in children without S.mutans detected (13.40%) and dmft (0.30±0.082) (P<0.05). CONCLUSIONS: After 2 years of observation, mothers with high caries risk also had higher caries susceptibility in their children. At the same time, the high risk of dental caries in mothers affected the colonization of S.mutans in children's oral cavity to a certain extent; and the earlier colonization of S.mutans, the higher risk of dental caries at 2-year old children. Therefore, intervention of oral health behaviors of mothers with high caries risk in early pregnancy can effectively prevent or reduce the occurrence and development of ECC to some extent by blocking or delaying the vertical transmission of S.mutans.

Key words: Early childhood caries, Caries risk assessment, Streptococcus mutans, Vertical transmission

中图分类号:

R788

周琼, 刘敏, 王霄, 陈薇. 母亲患龋风险对儿童龋易感性的影响[J]. 上海口腔医学, 2023, 32(1): 63-68.

ZHOU Qiong, LIU Min, WANG Xiao, CHEN Wei. Impact of maternal caries risk on children’s caries susceptibility[J]. Shanghai Journal of Stomatology, 2023, 32(1): 63-68.

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