瓶装水是幼儿龋齿的风险因素


  【24drs.com】November 18, 2009 (宾州费城) — 加州大学旧金山分校家庭与社区医学科助理教授Rosalia A. Mendoza医师在美国公共卫生协会第137届年会中发表的回溯研究指出,饮用瓶装水是幼儿龋齿(early childhood caries,ECC)唯一可调整的风险因素。
  
  基于旧金山地区2岁前孩童因为龋齿转诊到口腔健康诊所的比率达62%这项事实而促成本研究,其中有超过半数有饮用不含氯的瓶装水,这是因为以逆渗透和杂质一起去除了。
  
  根据疾病控制预防中心的资料,目前有69%的美国人居住在有氯化自来水的社区。
  
  Mendoza医师报告指出,饮用氯化自来水显然比饮用瓶装水有保护力(胜算比[OR]为0.59;P= .07)。
  
  Mendoza医师等人的回溯分析中,是针对位于都会区、每年服务超过8000名5岁以下孩童的旧金山家庭健康中心,区别与未经治疗之幼儿龋齿有关的风险和保护因素;幼儿龋齿在旧金山区域的非裔美国人和拉丁裔孩童中尤其盛行。
  
  【居住在有氯化自来水的社区不等于有接触到氯】
  在2006年6月至2009年4月间,239名孩童(114名女孩与125名男孩),其中70%是拉丁裔,由家庭医学科医师转诊到旧金山家庭健康中心的口腔健康门诊。医师们分辨有蛀洞和无蛀洞的龋齿,他们也询问家长有关孩童的口腔健康状态与孩童的行为。研究者探究幼儿龋齿风险因素,例如每天食用超过3次的含糖点心或饮料,也探讨幼儿龋齿的保护因素,例如家长定期看牙医、孩童使用含氯的牙膏刷牙、孩童饮用自来水。
  
  研究者发现,饮用瓶装水是唯一有关且可调整的风险因素。
  
  Mendoza 医师在Medscape Public Health & Prevention的访问中表示,家庭医学科医师在初步筛检与转诊给牙医师扮演重要角色。在1-2岁时经常就诊、遵守预防照护的疫苗时程,都可以用来与早期定期口腔照护整合。
  
  Mendoza 医师表示,我们在找出一些可调整的风险行为和保护因素上相当成功。例如,目前无法进行州调查之瓶装水与自来水的偏好与实际情况。
  
  Mendoza 医师观察发现,有趣的是,牙科诊所和该社区的龋齿盛行率似乎也有关联。
  
  【建议在家中过滤水】
  Mendoza 医师等人试图评估这些移民家庭对于氯的重要性的了解有多少。她表示,他们知道市府供应的自来水中所含的氯是免费的吗?她的团队希望厘清促进社区饮用自来水之健康观念的障碍,并加以克服。
  
  她表示,多数家庭相信牛奶或水比果汁健康,但是,他们选择以瓶装水加入配方奶或不含气的饮料,而不是使用自来水。
  
  让孩童使用瓶装水似乎是因为担心美国的水不安全。Mendoza 医师问道,如果你租屋而居,如果你知道自来水中有沉积物,如果你不喜欢那个味道,你如何处理?Mendoza的建议是「使用过滤器」。
  
  【需监测自来水饮用习惯】
  Mendoza 医师表示,接著,研究者将推动把偏好瓶装水的重要性与实务纳入全国与各州的调查。
  
  她指出,在我们当地社区中,对于这些相信瓶装水的移民家庭区域,我们将寻找可以成功促进这些移民家庭的公卫方法。
  
  与会的医疗资源和服务管理局执行处公卫分析师Jeffrey Johnston表示,看到家庭医师如何传递氯化水有助于预防龋齿的讯息是相当有趣的,他结论表示,希望我们目前可以改变一些提供服务的方式。
  
  Mendoza医师和 Johnston先生皆宣告没有相关财务关系。
  
  美国公共卫生协会(APHA)第137届年会:摘要204297。发表于2009年11月8日。
  

Bottled Water a Risk Factor for Early Childhood Caries

By Crina Frincu-Mallos, PhD
Medscape Medical News

November 18, 2009 (Philadelphia, Pennsylvania) — Drinking bottled water was the only modifiable risk factor related to early childhood caries (ECC) in a retrospective investigation presented here at the American Public Health Association 137th Annual Meeting by Rosalia A. Mendoza, MD, MPH, assistant professor in the Department of Family and Community Medicine at the University of California at San Francisco.

The study was prompted by the fact that 62% of children referred to an oral health clinic in the San Francisco area had caries by the age of 2 years. More than half of them drank bottled water, from which fluoride is usually removed, together with impurities, by reverse osmosis.

Currently, 69% of the American population lives in communities served by fluoridated public water supply systems, according to the Centers for Disease Control and Prevention.

"There appears to be a protective effect of drinking the fluoridated tap water over drinking bottled water" (odds ratio [OR], 0.59; P?= .07), Dr. Mendoza reported.

In their retrospective analysis, Dr. Mendoza and colleagues aimed to identify risks and protective factors associated with untreated ECC at an urban San Francisco Family Health Center, which serves more than 8000 children 5 years and younger annually. ECC seem to be more prevalent among African American and Latino children in the San Francisco area.

Living in Fluoridated Communities Does Not Translate Into Fluoride Exposure

Between June 2006 and April 2009, 239 children (114 girls and 125 boys), 70% of whom were Latino, were referred to the oral health screening clinic at a San Francisco Family Health Center by family medicine physicians. The physicians had identified cavitated and noncavitated caries. They also interviewed parents about the oral health status of the child and the child's behavior. The investigators looked for ECC risk factors, such as more than 3 sugary snacks or drinks consumed per day, and ECC protective factors, such as whether the parent sees a dentist regularly, the child's teeth are brushed with fluoride toothpaste, and the child drinks tap water.

Drinking bottled water was "the only associated and modifiable risk factor" that the investigators found.

Family medicine physicians have an "important role during the early screening and referral to dentists," said Dr. Mendoza in an interview with Medscape Public Health & Prevention. "Frequent visits in the first and second year of life, following the vaccine schedule for preventive care," can be used to incorporate early regular oral care.

"We are very successful [in] detecting some of the modifiable risk behaviors and protective behaviors," said Dr. Mendoza. For instance, bottled water vs tap water preferences and practices are currently not part of state surveys.

Interestingly, "there also appears to be an association between a dental home and caries prevalence in this community," Dr. Mendoza observed.

At-Home Water Filtration Recommended

Dr. Mendoza and colleagues are trying to assess how well immigrant families understand the importance of fluoride. "Do they know that fluoride is part of their tap water, the municipal water, which is free?" she said. Her team wants to find out what the barriers are "that we need to overcome in our health promotion to facilitate greater tap water consumption in this community."

Most families believed that milk or water is a healthier choice than juice, she said, but "they chose to use bottled water, not water from the tap, to add to formula milk or to aguas frescas."

At the core of the practice of giving bottled water to children seems to be the perception that "the water [in the United States] is not safe. If you do live in a rental property, if you know there is sediment in the tap water or if you don't like the taste, how do you address that?" asked Dr. Mendoza: "You use a filter!"

Need for Monitoring of Tap Water Drinking Habits

Next, the researchers are going to "push the importance of bottled water preferences and practice into our national and state surveys," said Dr. Mendoza.

"In our local community, we are going to be looking at ways that we can do successful public health promotion around these identified areas in immigrant practices and beliefs around bottled water," she added.

"It was interesting to see how family physicians can deliver the message that fluoridated water can help protect teeth from caries," said Jeffrey Johnston, public health analyst in the Office of Operations, Health Resources and Services Administration in Rockville, Maryland, who attended the meeting. "Hopefully, now we can implement some service-delivery changes," he concluded.

Dr. Mendoza and Mr. Johnston have disclosed no relevant financial relationships.

American Public Health Association (APHA) 137th Annual Meeting: Abstract 204297. Presented November?8, 2009.

    
相关报导
龋齿与头颈部癌症风险较低有关
2013/9/18 上午 10:59:54
无家可归孩童的过重与龋齿
2012/11/26 下午 05:25:38

上一页
   1  
下一页




回上一页