瓶裝水是幼兒齲齒的風險因素


  【24drs.com】November 18, 2009 (賓州費城) — 加州大學舊金山分校家庭與社區醫學科助理教授Rosalia A. Mendoza醫師在美國公共衛生協會第137屆年會中發表的回溯研究指出,飲用瓶裝水是幼兒齲齒(early childhood caries,ECC)唯一可調整的風險因素。
  
  基於舊金山地區2歲前孩童因為齲齒轉診到口腔健康診所的比率達62%這項事實而促成本研究,其中有超過半數有飲用不含氯的瓶裝水,這是因為以逆滲透和雜質一起去除了。
  
  根據疾病控制預防中心的資料,目前有69%的美國人居住在有氯化自來水的社區。
  
  Mendoza醫師報告指出,飲用氯化自來水顯然比飲用瓶裝水有保護力(勝算比[OR]為0.59;P= .07)。
  
  Mendoza醫師等人的回溯分析中,是針對位於都會區、每年服務超過8000名5歲以下孩童的舊金山家庭健康中心,區別與未經治療之幼兒齲齒有關的風險和保護因素;幼兒齲齒在舊金山區域的非裔美國人和拉丁裔孩童中尤其盛行。
  
  【居住在有氯化自來水的社區不等於有接觸到氯】
  在2006年6月至2009年4月間,239名孩童(114名女孩與125名男孩),其中70%是拉丁裔,由家庭醫學科醫師轉診到舊金山家庭健康中心的口腔健康門診。醫師們分辨有蛀洞和無蛀洞的齲齒,他們也詢問家長有關孩童的口腔健康狀態與孩童的行為。研究者探究幼兒齲齒風險因素,例如每天食用超過3次的含糖點心或飲料,也探討幼兒齲齒的保護因素,例如家長定期看牙醫、孩童使用含氯的牙膏刷牙、孩童飲用自來水。
  
  研究者發現,飲用瓶裝水是唯一有關且可調整的風險因素。
  
  Mendoza 醫師在Medscape Public Health & Prevention的訪問中表示,家庭醫學科醫師在初步篩檢與轉診給牙醫師扮演重要角色。在1-2歲時經常就診、遵守預防照護的疫苗時程,都可以用來與早期定期口腔照護整合。
  
  Mendoza 醫師表示,我們在找出一些可調整的風險行為和保護因素上相當成功。例如,目前無法進行州調查之瓶裝水與自來水的偏好與實際情況。
  
  Mendoza 醫師觀察發現,有趣的是,牙科診所和該社區的齲齒盛行率似乎也有關聯。
  
  【建議在家中過濾水】
  Mendoza 醫師等人試圖評估這些移民家庭對於氯的重要性的瞭解有多少。她表示,他們知道市府供應的自來水中所含的氯是免費的嗎?她的團隊希望釐清促進社區飲用自來水之健康觀念的障礙,並加以克服。
  
  她表示,多數家庭相信牛奶或水比果汁健康,但是,他們選擇以瓶裝水加入配方奶或不含氣的飲料,而不是使用自來水。
  
  讓孩童使用瓶裝水似乎是因為擔心美國的水不安全。Mendoza 醫師問道,如果你租屋而居,如果你知道自來水中有沉積物,如果你不喜歡那個味道,你如何處理?Mendoza的建議是「使用過濾器」。
  
  【需監測自來水飲用習慣】
  Mendoza 醫師表示,接著,研究者將推動把偏好瓶裝水的重要性與實務納入全國與各州的調查。
  
  她指出,在我們當地社區中,對於這些相信瓶裝水的移民家庭區域,我們將尋找可以成功促進這些移民家庭的公衛方法。
  
  與會的醫療資源和服務管理局執行處公衛分析師Jeffrey Johnston表示,看到家庭醫師如何傳遞氯化水有助於預防齲齒的訊息是相當有趣的,他結論表示,希望我們目前可以改變一些提供服務的方式。
  
  Mendoza醫師和 Johnston先生皆宣告沒有相關財務關係。
  
  美國公共衛生協會(APHA)第137屆年會:摘要204297。發表於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.

    
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