이 연구의 목적은 서울시 학생치과주치의 사업이 구강 건강과 관련된 삶의 질에 미치는 영향을 확인하는 것이다. 2018년 사업의 전체 대상자인 20,802명 중 무작위로 선정된 110명의 10세 초등학생들을 대상으로 하였으며, 사업 시행 전과 후에 Child Oral Health Impact Profile (COHIP) 설문 문항을 작성하도록 하였다. 사업 전후 설문을 모두 작성한 107명의 어린이들을 대상으로, COHIP 점수와 우식 치아의 수, 결손 치아의 수, 부정교합, 구강위생상태와 같은 임상검사 결과들이 분석되었으며, 응답의 신뢰도와 타당도가 확인되었다. COHIP 점수는 사업 시행 후 증가되었으며(p < 0.001, effect size 1.05), 우식 치아와 결손 치아가 있는 어린이들은 낮은 COHIP 점수를 보였다. 결론적으로, 서울시 학생치과주치의 사업은 10세 초등학생들의 구강 건강과 관련된 삶의 질에 긍정적으로 기여할 수 있다.
이 연구의 목적은 서울시 학생치과주치의 사업이 구강 건강과 관련된 삶의 질에 미치는 영향을 확인하는 것이다. 2018년 사업의 전체 대상자인 20,802명 중 무작위로 선정된 110명의 10세 초등학생들을 대상으로 하였으며, 사업 시행 전과 후에 Child Oral Health Impact Profile (COHIP) 설문 문항을 작성하도록 하였다. 사업 전후 설문을 모두 작성한 107명의 어린이들을 대상으로, COHIP 점수와 우식 치아의 수, 결손 치아의 수, 부정교합, 구강위생상태와 같은 임상검사 결과들이 분석되었으며, 응답의 신뢰도와 타당도가 확인되었다. COHIP 점수는 사업 시행 후 증가되었으며(p < 0.001, effect size 1.05), 우식 치아와 결손 치아가 있는 어린이들은 낮은 COHIP 점수를 보였다. 결론적으로, 서울시 학생치과주치의 사업은 10세 초등학생들의 구강 건강과 관련된 삶의 질에 긍정적으로 기여할 수 있다.
The purpose of this study was to investigate the effects of public preventive dental healthcare services named the "Dental Preventive Health Services for Children" (DPHSC) on oral health-related quality of life (OHRQoL) in Korean children. Of the total 20,802 beneficiaries in 2018, 110 10-year-old e...
The purpose of this study was to investigate the effects of public preventive dental healthcare services named the "Dental Preventive Health Services for Children" (DPHSC) on oral health-related quality of life (OHRQoL) in Korean children. Of the total 20,802 beneficiaries in 2018, 110 10-year-old elementary school students were randomly selected and were requested to complete a survey using the Korean version of Child Oral Health Impact Profile (COHIP) questionnaire before and after participating in DPHSC. Overall, 107 participants completed the pre- and post-survey. COHIP scores and clinical results such as numbers of decayed and missing teeth, malocclusion, and oral hygiene status from dental examination were statistically analyzed and the reliability and the validity of the responses were verified. There was a significant clinical increase in mean overall COHIP scores following DPHSC (p < 0.001, effect size 1.05). Children with decayed and missing teeth demonstrated poor OHRQoL. In conclusion, DPHSC can improve the OHRQoL of 10-year-old children.
The purpose of this study was to investigate the effects of public preventive dental healthcare services named the "Dental Preventive Health Services for Children" (DPHSC) on oral health-related quality of life (OHRQoL) in Korean children. Of the total 20,802 beneficiaries in 2018, 110 10-year-old elementary school students were randomly selected and were requested to complete a survey using the Korean version of Child Oral Health Impact Profile (COHIP) questionnaire before and after participating in DPHSC. Overall, 107 participants completed the pre- and post-survey. COHIP scores and clinical results such as numbers of decayed and missing teeth, malocclusion, and oral hygiene status from dental examination were statistically analyzed and the reliability and the validity of the responses were verified. There was a significant clinical increase in mean overall COHIP scores following DPHSC (p < 0.001, effect size 1.05). Children with decayed and missing teeth demonstrated poor OHRQoL. In conclusion, DPHSC can improve the OHRQoL of 10-year-old children.
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문제 정의
Among these, the Child Oral Health Impact Profile (COHIP) questionnaire is the only instrument confirmed through validity and reliability testing for elementary school students in Korea[9]. Therefore, this study aims to examine the effects of DPHSC on the OHRQoL using COHIP.
제안 방법
Spearman’s rank correlation coefficient was used for all correlation tests. A Wilcoxon ranksum test was used to compare findings based on the dental examination results such as number of decayed teeth, number of missing teeth, malocclusion and PHP scores.
After the surveys were completed manually, DPHSC including dental examination, oral hygiene education, and preventive dental treatment was conducted on the same day. Prior to the implementation of DPHSC, all participating dentists have completed a national education program for oral examination.
Prior to the implementation of DPHSC, all participating dentists have completed a national education program for oral examination. Dental examination in DPHSC yielded clinical results such as numbers of decayed and missing permanent teeth, malocclusion, and oral hygiene status, based on the contents of the program. Extent of dental caries was evaluated using the International Caries Detection and Assessment System (ICDAS) [11], and when a permanent tooth showed caries greater than ICDAS code 4, it was recorded as “decayed.
Assessing OHRQoL is vital for multidisciplinary assessment of chronic diseases such as dental caries and can be used for public health policies[25,26]. In this study, we used COHIP, one of the questionnaires utilized for OHRQoL for children, to evaluate the effectiveness of DPHSC.
In the pre-survey, split-half reliability for Cronbach’s alpha was used to validate the internal consistency. The construct validity of the questionnaire was examined with a correlation test between each subscale, and the discriminant validity was explored with a correlation test between the pre-survey and the results of the dental examination. Spearman’s rank correlation coefficient was used for all correlation tests.
The beneficiaries of the DPHSC were 10-year-old elementary school students living in Seoul, and DPHSC was conducted from July to December in 2018. The inclusion criteria for this study were healthy students with age-appropriate literacy. The exclusion criteria were as follows: students with intellectual and cognitive disabilities and students who underwent orthodontic treatment.
The researchers approached the selected participants individually by phone and fully explained the study design to the students and their legal guardians on the day they visited the designated dental clinics to participate in the DPHSC. The participants with written informed consent were included in this study.
The scores to each items in the survey utilized the 5-point Likert scale, which ranged from 0, being “almost all the time,” to 4, being “never” in OH, FL, SES, and SCE subscales asking negative symptoms of OHRQoL.
In contrast, the scores of the items in the SI subscale asking positive perceptions about OHRQoL were “Strongly disagree” (0), “somewhat disagree” (1), “Don’t agree or disagree” (2), “Somewhat agree” (3), and “Strongly agree” (4). The subscale scores were calculated by summing up the items scores included and the overall COHIP score by summing up the subscale scores. The overall COHIP score ranged from 0 to 136, of which a higher COHIP score indicated a better OHRQoL.
대상 데이터
Five missing teeth were observed in two students, one had one, and another had four. Malocclusion was observed in 18 students. The average PHP score of students was 2.
All 107 participants were given dental examination, oral hygiene education, professional oral prophylaxis, and topical fluoride application. Sealant was applied on 85 teeth from 36 students. Sixty students got their teeth scaled.
Sealant was applied on 85 teeth from 36 students. Sixty students got their teeth scaled.
The beneficiaries of the DPHSC were 10-year-old elementary school students living in Seoul, and DPHSC was conducted from July to December in 2018. The inclusion criteria for this study were healthy students with age-appropriate literacy.
3%). The data from these 107 cases were analyzed (49 males and 58 females). Compared with the whole population of beneficiaries of DPHSC, the enrolled samples did not show any significant differences in gender ratio, the number of decayed permanent teeth, the number of missing permanent teeth, malocclusion, or oral hygiene status.
The exclusion criteria were as follows: students with intellectual and cognitive disabilities and students who underwent orthodontic treatment. The participants of this study were randomly selected from all 20,802 beneficiaries from 11 districts of urban areas in Seoul where DPHSC data could be collected using computerized system. The number of samples was targeted to 110 with an effect size of 0.
The survey used COHIP, which contains 5 subscales and 34 items[7]. The Oral Health (OH) subscale contains ten items: “Pain/toothache,” “Breathing through the mouth,” “Discoloration of teeth,” “Crooked teeth or spaces,” “Sores or sore spots,” “Bad breath,” “Bleeding gums,” “Food sticking,” “Sensitivity with hot/ cold,” and “Dry mouth.
데이터처리
A Wilcoxon signed rank test was used to compare the COHIP scores between the pre- and post-surveys. Cohen’s d was used to identify the effect size, which was calculated by dividing the average difference between the pre- and post-survey by pooled standard deviation.
However, the correlations between SI subscale and other subscales were not significant, and this may be related to the finding that the responses on the SI subscale showed a relatively even distribution compared with the responses on the other subscales (Table 4). Likewise, discriminant validity was also verified in that carious or missing tooth reduced COHIP score, and similar results are shown in the comparison of COHIP scores by Wilcoxon rank sum test (Figs 1 and 2). This is consistent with previous studies[27-31].
Spearman’s rank correlation coefficient was used for all correlation tests.
성능/효과
3. It was found that the average overall COHIP score was significantly increased after DPHSC (p < 0.001), as well as OH, FL, SES, and SI subscales; however, SCE subscale did not show any significant difference.
4. The majority of respondents reported “Almost never” or “Never” at the negative items (OH 58.0%, FL 82.2%, SES 86.0%, SCE 98.1%) while “strongly disagree” or “somewhat disagree” at the positive items (SI 42.0%).
In terms of construct validity, the correlations between each subscales were less than 0.5 and significant (p < 0.05) except for the SI subscale, and all correlations between each subscales and overall COHIP were significant (p < 0.01).
Among the participants with decayed teeth, the overall COHIP score and subscale scores did not change significantly after the implementation of DPHSC. In those with missing teeth, the overall COHIP, OH subscale and SES subscale scores increased significantly after the implementation of DPHSC (p = 0.009, 0.007 and 0.015, respectively).
On the discriminant validity, the participants with missing teeth showed lower overall COHIP score, OH score, SES score, and SI score than those without missing teeth (p < 0.05).
Seoul and Gyeonggi province are close to each other, with similar living standards and environment. So OHRQoL of students in these two regions was expected to be similar, and the result confirmed this, which enables us to conclude that the randomization process used in this study was valid.
In addition, this study confirmed that DPHSC improves the OHRQoL of children. The overall score of COHIP increased statistically after DPHSC and the effect size was very high (1.05). In the subscales, all but the SCE subscale showed a statistically significant improvement.
With Cronbach’s alpha above 0.75 (p < 0.01), high reliability was confirmed for the overall COHIP and the subscale scores.
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