| Summary: | 博士 === 高雄醫學大學 === 牙醫學研究所 === 100 === Oral disease is often neglected as it is not life threatening. Daily oral activities may severely influence the oral health of children with disabilities. The dental health of children with disabilities is worse than that of ordinary children the same age. As a result, the disadvantages lead to poor oral health and more untreated decayed teeth. Numerous studies have proven that fluoride is effective in preventing dental caries. Urine is the most commonly utilized biomarker for fluoride excretion in public health and epidemiological studies. Approximately 30 - 50% of fluoride is excreted from urine in children. Moreover, urinary fluoride excretion reflects the total fluoride intake from multiple sources. After administering fluoride tablets to children with disabilities, investigating urinary fluctuation patterns is important. Establishing an oral health prevention program for children in special schools at an early stage is crucial. School-based fluoride programs have been proven in many studies to be effective in preventing dental caries. Fluoride tablet is regarded as a suitable means to control dental caries in children with disabilities. Therefore, we evaluated the effect of caries prevention by the application of fluoride tablets.
Before evaluating the effectiveness of fluoride, we must realize the oral health status of children with disabilities and monitor fluctuating patterns of urinary fluoride concentration after fluoride tablets are ingested. The three purposes of this thesis were: First, to analyze the impact of dietary and tooth-brushing habits to dental caries in special school children with disabilities. The second aim was to monitor the short and long term fluctuating patterns of urinary fluoride concentration after fluoride tablets were ingested by children with disabilities. The third aim was to evaluate the anti-caries effect of long term application of fluoride tablets on children with disabilities.
Study 1 was a cross-sectional survey which investigated 535 special school children , 60.93% male and 39.07% female, with disabilities aged 6-12 years from 10 special schools in Taiwan. Oral examinations were carried out by dentists with a Kappa score of their inter-examiner agreement exceeding 0.8. Data on demographics, diet, and tooth-brushing habits of children with disabilities were collected using a standardized questionnaire completed by the parents/caregivers. The study results showed that more than three quarters of the participants had severe or profound disability. The children with profound disability were more likely to have their teeth brushed by a parent/caregiver (67.37%). The children with mild/moderate disability brushed their teeth by themselves (81.60%). Children whose teeth were brushed by parents/caregivers had better dental health, and lower caries prevalence than those who brushed themselves. The main risk factors related to decayed teeth of children with disabilities are frequency of sweets intake, ability to brush teeth and with/without plaque.
In Study 2, 535 children with disabilities aged 6 - 12 years old were selected randomly and divided into three groups: Group A, 1.0 mg fluoride tablet, Group B, 0.5 mg fluoride tablet, and Group C, control group. Seventy-five children with disabilities were randomly selected from three special education primary schools to participate in this survey. Urine was collected on the day prior to fluoride intake (baseline), the first, third, fifth and the eighth day of fluoride ingestion for short term observation, and once every six months for a total of 18 months for long-term observation. The urine samples were collected in the morning (MU) and 2 hrs after fluoride tablets were ingested (AU). The AU sample showed statistically significantly higher concentrations of urine fluoride than those of the MU samples, and no statistically significant difference was noted in the MU samples among the three groups. Group A showed the highest urinary fluoride concentration (UFC) among the three groups. UFC increased as ingested fluoride tablet dosage increased, and it returned to the baseline level on the following day and persisted throughout the study period.
In Study 3, 217 school children with disabilities were divided into two groups: the intervention group ingested 1.0 mg fluoride tablet while the control group ingested a placebo. The oral examinations were conducted in the daytime prior to fluoride intake (baseline) and once every six months to trace the effectiveness of fluoride tablet ingestion. The results of this study indicated significant reductions of 0.63 DMFT index inceratment as well as 1.25 DMFS index inceratment than in the control group. Observations of dental caries found that the anti-cariogenic benefit of fluoride tablet ingestion was statistically significantly effective with 30.42% of new DMFT index and 36.84% of new DMFS index examined after 24 months follow-up. Reductions of inceratmental DMFS index on the surface types occurred in mesio-distal, occlusal, and bucco-linqual surfaces with 53.27%, 31.72% and 52.57%, respectively. Through a 24-month period of tracing the effectiveness of fluoride tablet ingestion, there is clear evidence of a caries-inhibiting effect of fluoride tablets.
In conclusion, the dental health education, prevention program and periodical oral check-up of children with disabilities and their parents/caregivers should be reinforced. Brushing skills should be taught to children according to their type, severity and individual characteristics of disability. Fluoride tablets should be regarded as a caries preventive means in school-based caries prevention programs for children with disabilities in fluoride deficient countries and for individuals with high caries risk.
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