【摘要】 目的 探讨窝沟封闭项目预防低龄小学生第一恒磨牙龋病的效果，为开展群体性儿童龋病防治工作提供参考。方法 采用前瞻性队列研究方法，于2017-2018年以整群抽样方法先在陕西省西安市7个项目区中抽取16所小学，再以班为单位抽取二年级学生为研究对象。2017年基线调查2 672名学生做口腔检查并对其家长进行问卷调查，1年后随访调查到2 373名学生及其家长。以接受了窝沟封闭服务的学生作为封闭组(n=1 387),未接受过窝沟封闭的学生作为非封闭组(n=986)。比较两组学生干预前后第一恒磨牙新发龋病率、龋均增量，倍差法评价窝沟封闭干预效果。结果 封闭组新发龋病率(11.0%)低于非封闭组(15.4%),差异有统计学意义(χ~2=10.249,P=0.001)。封闭组第一恒磨牙龋均增量为(0.17±0.59),低于非封闭组的(0.30±0.78),差异有统计学意义(Z=-3.930,P<0.001)。上颌牙面新发龋病率(6.2%)高于下颌牙面(3.6%),差异有统计学意义(χ~2=39.544,P<0.001)。倍差法控制其他影响因素，封闭组龋均数和患龋率均呈下降趋势(P<0.05)。随基线期学生的软垢指数水平和乳牙龋齿数增加，龋均数和患龋率均有增加(P<0.05)。结论 开展窝沟封闭项目能减少低龄小学生第一恒磨牙龋病的发生，窝沟封闭保留率、基线期软垢指数、基线期乳牙龋齿数对防龋效果均有影响，需要采取综合措施预防第一恒磨牙龋病发生。更多还原

【Abstract】 Objective To evaluate the effect of pit and fissure sealant program(PFSM) in the first permanent molars(FPMs) for young elementary students, so as to provide a reference for the development of population-based child caries prevention and treatment. Methods Using a prospective cohort study method, 16 elementary school were first selected in 7 project areas in Xi’an city, Shaanxi province by cluster sampling method in 2017-2018,then second-grade students(7-to 8-years old) were selected by class-cluster.A total of 2 672 students were surveyed at baseline in 2017 for oral examinations and questionnaires to their parents, and 2 373 students and their parents were surveyed 1 year later at follow-up.Students who attended PFSM were designated as the PFSM group(n=1,387) and those who did not attended PFSM were designated as the no PFSM group(n=986).The new-onset caries rate and D1MFT increment of the first permanent molar before and after intervention were compared between the 2 groups, and the effect of PFSM was evaluated by difference-in-differences(DID). Results The caries incidence of FPMs in PFSM group was lower than that in no PFSM group(11.0% vs 15.4%,χ~2=10.249,P=0.001).The mean D1MFT increment of FPMs in PFSM group(0.17±0.59) was lower than that in no PFSM group(0.30±0.78).The difference was statistically significant(Z=-3.930,P<0.001).The caries incidence of FPMs in maxilla was higher than that in mandible(6.2% vs 3.6%,χ~2=39.544,P<0.001).DID showed that the D1MFT and caries incidence of FPMs in PFSM group had a downward trend by controlling confounding factors(P<0.05).With the increase of the debris index(DI) and decayed, missing, and filled tooth(dmft) in baseline survey, the caries incidence and D1MFT were increased(P<0.05). Conclusion PFSM had reduced the caries incidence of FPMs of young elementary students.The retention rate of pit and fissure sealant, DI and dmfs in baseline all affect the effect of caries prevention.Comprehensive measures should be taken to prevent the caries incidence of FPMs.更多还原