摘要
窝沟封闭作为预防龋病的专业方法目前应用广泛,作为口腔公共卫生项目全覆盖大规模应用也在各地逐步展开,项目评价是项目实施的一个重要环节。如何对社区窝沟封闭项目的效果效益进行评价,特别是对社区全覆盖窝沟封闭项目进行评价,需要研究和实施。广州市儿童窝沟封闭项目开展有序、管理规范。项目评价采用了回顾性队列研究的方法,抽样调查分析,样本分为"有适应证已封闭组"和"有适应证未封闭组"2组,按照第一恒磨牙患龋情况和封闭剂保留情况,评价封闭剂保留率、龋齿发病率、降低发病率、纯收益率,以及项目成本效果、成本效益,取得了可以推广的经验。本文回顾分析了窝沟封闭项目评价理论和相关报告,探讨了以往研究存在的缺陷,重点介绍广州市儿童窝沟封闭项目评价方法和结果,针对项目评价,特别是样本分组、评价指标提出建议,以期对今后窝沟封闭项目的评价有参考价值。
As a professional method to prevent decayed teeth and an oral public health project,pit and fissure sealant is widely used domestically.How to evaluate the effect and benefit of the community pit and fissure closure project,especially the community full coverage pit and fissure closure project,requires investigation.The Guangzhou Children′s Pit and Fissure Sealing Project was carried out in an orderly manner and was administered normatively.A retrospective cohort study with use of a sample survey was used in this program.According to cavity occurrence and reservations of sealant in the first permanent molar,the samples were divided into the following two groups:the sealing group with indication and the sealing group without indication.Reservations of sealant,cavity incidence,reduced incidence,net profit,cost-effectiveness and cost-benefits of the program were evaluated.Some promotable experiences were summarized during this project.Various relevant theories and reports of the pit and fissure sealant project evaluation were reviewed and previous studies were discussed in this article.By analyzing the methods and results of the pit and fissure sealant project in Guangzhou,suggestions are made for project evaluation,especially sample grouping and evaluation indicators,which was refer to a further study for the pit and fissure sealing project.
引文
[1] WHO Expert Committee on Recent Advances in Oral Health&World Health Organization.(1992). Recent advances in oral health:report of a WHO expert committee[meeting held in Geneva from 3 to 9 December 1991][R]. Geneva:World Health Organization. 1992. http://www.who.int/iris/handle/10665/39644.
[2]杨是.窝沟封闭的效果评价[J].牙病防治杂志, 1994, 2(4):41-42.
[3]司燕,郑树国.窝沟封闭防龋[J].中国实用口腔科杂志, 2012, 5(10):582-587.
[4]刘惠荣摘译.窝沟封闭两年临床实验[J].国外医学参考资料口腔医学分册, 1978, 5(1):34.
[5]魏怡摘译.窝沟封闭剂防龋的三年临床效果报告[J].国外医学参考资料口腔医学分册, 1980, 7(5):300-301.
[6]方震,吕学敏,瞿岩霞,等.含氟与无氟光固窝沟封闭的探讨[J].口腔医学, 1982, 2(1):33-35.
[7]杨星民,张晓丹,王晓斐,等. 7~9岁儿童第一恒磨牙窝沟封闭剂脱落的多因素分析[J].牙体牙髓牙周病学杂志, 2017, 27(12):721-724.
[8]高雪彬,张琦,李晶,等.低龄儿童行窝沟封闭术时酸蚀剂选择的临床研究[J].国际口腔医学杂志, 2017, 44(4):433-436.
[9]段君兰,刘宗响,张洪永,等.氟保护漆联合窝沟封闭对第一恒磨牙防龋的效果评估[J].口腔医学, 2017, 37(7):629-631.
[10]广州市疾病预防控制中心.广州市儿童六龄齿免费窝沟封闭项目评估报告[M].广州:广东教育出版社, 2016:13-35.
[11]广州市疾病预防控制中心.广州市儿童六龄齿免费窝沟封闭项目评估报告[M].广州:广东教育出版社, 2016:2.
[12]齐小秋.第三次全国口腔健康流行病学调查报告[M].北京:人民卫生出版社, 2008:16.
[13] Dye BA, Thornton-Evans G, Li X, et al. Dental caries and sealant prevalence in children and adolescents in the United States, 2011-2012[J]. NCHS Data Brief, 2015, 191:1-8.
[14] Mertz-Fairhurst EJ, Fairhurst CW, Williams JE, et al. A comparative clinical study of two pit and fissure sealants:7-year results in Augusta,GA[J]. JADA, 1984, 109(2):252-255.
[15] Pereira AC, Pardi V, Mialhe FL, et al. A 3-year clinical evaluation of glass-ionomer cements used as fissure sealants[J]. Am J Dent,2003, 16(1):23-27.
[16] Tagliaferro EP, Pardi V, Ambrosano GM, et al. Occlusal caries prevention in high and low risk school children a clinical trial[J].Am J Dent, 2011, 24(2):109-114.
[17] Bravo M, Llodra JC, Baca P, et al. Effectiveness of visible light fissure sealant(delton)versus fluoride varnish(duraphat):24-month clinical trial[J]. Community Dent Oral Epidemiol, 1996, 24(1):42-46.
[18] Liu BY, Lo EC, Chu CH, et al. Randomized trial on fluorides and sealants for fissure caries prevention[J]. J Dent Res, 2012, 91(8):753-758.
[19] Richardson AS, Gibson GB, Waldman R. Chemically polymerized sealant in preventing occlusal caries[J]. J Can Dent Assoc, 1980,46(4):259-260.
[20] John T, Malavika P, Laurel G, et al. Sealants for preventing andarresting pit-and-fissure occlusal caries in primary and permanent molars[J]. JADA, 2016, 147(8):631-643.
[21] Zero D, Fontana M, Lennon AM. Clinical applications and outcomes of using indicators of risk in caries management[J]. J Dent Educ, 2001, 65(10):1126-1132.
[22] Leskinen K, Salo S, Suni J, et al. Practice-based study of the cost effectiveness of fissure sealants in Finland[J]. J Dent, 2008, 36(12):1074-1079.
[23] Akinlotan M, Chen B, Fontanilla TM, et al. Economic evaluation of dental sealants:a systematic literature review[J]. Community Dent Oral Epidemiol, 2018, 46(1):38-46.
[24] Khouja T, Smith KJ. Cost-effectiveness analysis of two caries prevention methods in the first permanent molar in children[J]. J Public Health Dent, 2018, 78(2):118-126.
