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.
* AI 자동 식별 결과로 적합하지 않은 문장이 있을 수 있으니, 이용에 유의하시기 바랍니다.
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
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.
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.
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.
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.
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.
대상 데이터
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 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.
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.
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.
데이터처리
Spearman’s rank correlation coefficient was used for all correlation tests.
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].
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.
성능/효과
With Cronbach’s alpha above 0.75 (p < 0.01), high reliability was confirmed for the overall COHIP and the subscale scores.
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).
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).
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%).
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).
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.
참고문헌 (35)
Hurlbutt M, Young DA : A best practices approach to caries management. J Evid Based Dent Pract, 14:77-86, 2014.
Mejare I, Axelsson S, Twetman S, et al. : Caries risk assessment. A systematic review. Acta Odontol Scand, 72:81-91, 2014.
Ministry of Health and Welfare : The report of Korea National Children's Oral Health Survey in 2018. Available from URL: http://www.mohw.go.kr/react/al/sal0301vw.jsp?PAR_MENU_ID04&MENU_ID0403&CONT_SEQ349638 (Accessed on July 2, 2020).
Jung SH, Shin BM, Park DY, Ma DS : One-year outcomes and reasons for dropout in participants of the continuous dental care program of the Community Child Center in Gangnueng city. J Korean Acad Oral Health, 37:110-116, 2013.
Amalia R, Schaub RM, Groothoff JW, et al. : Impact of school-based dental program performance on the oral health-related quality of life in children. J Invest Clin Dent, 8:12179, 2017.
Broder HL, Wilson-Genderson M : Reliability and convergent and discriminant validity of the Child Oral Health Impact Profile (COHIP Child's version). Community Dent Oral Epidemiol, 35:20-31, 2007.
Hebling E, Pereira AC : Oral health-related quality of life: a critical appraisal of assessment tools used in elderly people. Gerodontology, 24:151-161, 2007.
Ahn YS, Kim HY, Noh HJ, et al. : Validation of a Korean version of the Child Oral Health Impact Profile (COHIP) among 8- to 15-year-old school children. Int J Paediatr Dent, 22:292-301, 2012.
Tsakos G, Allen PF, Steele JG, Locker D : Interpreting oral heal-related quality of life data. Community Dent Oral Epidemiol, 40:193-200, 2011.
Ismail AI, Sohn W, Pitts NB, et al. : The International Caries Detection and Assessment System (ICDAS): an integrated system for measuring dental caries. Community Dent Oral Epidemiol, 35:170-178, 2007.
Brook PH, Shaw WC : The development of an index of orthodontic treatment priority. Eur J Orthod, 11:309-320, 1989.
Shaw WC, Richmond S, Stephens CD, et al. : Quality control in orthodontics: indices of treatment need and treatment standards. Br Dent J, 170:107-112, 1991.
Alhabdan YA, Albeshr AG, Yenugadhati N, Jradi H : Prevalence of dental caries and associated factors among primary school children: a population-based cross-sectional study in Riyadh, Saudi Arabia. Environ Health Prev Med, 23:60, 2018.
Nishide R, Mizutani M, Hatashita H, et al. : Homecare protective and risk factors for early childhood caries in Japan. Environ Health Prev Med, 23:57, 2018.
Ha DH, Do LG, Roberts-Thomson K, Jamieson L : Risk indicators for untreated dental decay among Indigenous Australian children. Community Dent Oral Epidemiol, 47:316-323, 2019.
Macpherson LMD, Anopa Y, Conway DI, McMahon AD : National supervised tooth brushing program and dental decay in Scotland. J Dent Res, 92:109-113, 2018.
Mbawalla H, Masalu JR, Masatu M, Astrom AN : Changes in adolescents' oral health status following oral health promotion activities in Tanzania. Acta Odontol Scand, 71:333-342, 2013.
Antunes LA, Andrade MR, Luiz RR, et al. : Change in the quality of life of children and adolescents younger than 14 years old after oral health interventions: a systematic review. Pediatr Dent, 35:37-42, 2013.
Abanto J, Paiva SM, Bonecker M, et al. : The impact of dental caries and trauma in children on family quality of life. Community Dent Oral Epidemiol, 40:323-331, 2012.
de Paula JS, Sarracini KL, Mialhe FL, et al. : Longitudinal evaluation of the impact of dental caries treatment on oral health-related quality of life among schoolchildren. Eur J Oral Sci, 123:173-178, 2015.
Pakpour AH, Lin CY, Jansson H, et al. : Predictors of oral health-related quality of life in Iranian adolescents: A prospective study. J Invest Clin Dent, 9:12264, 2018.
Schuch HS, Costa Fdos S, Goettems ML, et al. : Oral health-related quality of life of schoolchildren: impact of clinical and psychosocial variables. Int J Paediatr Dent, 25:358-365, 2015.
Severo Alves L, Dam-Teixeira N, Susin C, Maltz M : Association among quality of life, dental caries treatment and intraoral distribution in 12-year-old South Brazilian schoolchildren. Community Dent Oral Epidemiol, 41:22-29, 2013.
Knapp R, Gilchrist F, Rodd HD, Marshman Z : Change in children's oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review. Int J Paediatr Dent, 27:302-312, 2017.
Slade GD, Bailie RS, Morris P, et al. : Effect of health promotion and fluoride varnish on dental caries among Australian Aboriginal children: results from a community-randomized controlled trial. Community Dent Oral Epidemiol, 39:29-43, 2011.
Wennhall I, Matsson L, Schroder U, Twetman S : Outcome of an oral health outreach programme for preschool children in a low socioeconomic multicultural area. Int J Paediatr Dent, 18:84-90, 2008.
Jaime RA, Carvalho TS, Mendes FM, et al. : Oral health education program on dental caries incidence for school children. J Clin Pediatr Dent, 39:277-283, 2015.
※ AI-Helper는 부적절한 답변을 할 수 있습니다.