广东省汕头市地方性氟中毒病区改水后儿童龋齿患病情况调查分析

Prevalence of dental caries in Shantou City Guangdong Province fluorosis areas after water improvement

目的分析广东省汕头市地方性氟中毒病区改水后，不同改水时间、不同尿氟含量与儿童龋齿检出率的关系。方法2009年，在广东省汕头市地方性氟中毒病区选择4个已改水村（井陈店镇溪北村、峡山镇义英村、陈店镇范溪村、司马镇仙港村）作为病区村，在非氟中毒病区选择都镇上南村作为对照村，共5个村作为调查点。每个调查点按东、西、南、北、中5个方位各选择1个采样点，每个采样点各采集末梢水1份，进行水氟测定。在村小学抽取6～14岁小学生，男女各半，进行龋齿患病情况调查，同时采集6～14岁小学生50ml课间尿样，进行尿氟测定。水氟和尿氟含量采用氟离子电极法进行检测，龋齿检查按《口腔预防医学》（第3版）中推荐的标准进行。结果4个病区村居民饮用水氟含量均低于1．0mg／L（国家标准）。病区村小学生尿氟含量与对照村相比。其中改水6年的仙港村儿童尿氟中位数（四分位间距）为0．620（0．380）mg／L，与对照村[0．480（0．290）mg／L]比较，差异有统计学意义（P〈0．05）。4个病区村儿童龋齿检出率[45．26％（355／785）、43．65％（509／1166）、34．98％（99／283）、31．97％（332／1037）]与对照村[49．73％（651／1309）]比较，差异均有统计学意义（P均〈0．05）。尿氟为0．2-〈0．4mg,／L组与0．00．〈0．20mg／L组的儿童龋齿检出率比较，差异有统计学意义（OR=0．222，X2=3．910，P〈0．05）。结论尿氟水平低是龋齿发生的主要因素之一，为了降低龋齿检出率有必要设定我国水氟含量卫生标准的下限。

Objective To analyse the relationship between children urine fluoride level, time of water supply improvement and detection rate of dental caries in fluorosis areas after water supply improvement. Methods The following five villages were selected as survey spots： four of the water quality improved viUages（Xibei Village of Jingchen Town, Yiying Village of Xiashan Town, Fanxi Village of Chendian Town and Xiangang Village of Sima Town） as diseased villages in Shantou City, Guangdong province, and Shangnan Village of Du Town in non- fluorosis areas as a control village in 2009. Five sampling points were selected in each survey point according to five directions of east, west, south, north and center, and one tap water sample was collected in each sampling point to do water fluoride determination. In the primary school of the village, 6 to 14-year-old pupils were randomly selected, half male and half female, to carry out the prevalence of dental caries survey. At the same time, after- class urine samples were collected to determine urinary fluoride. Water and urine fluoride were determine by fluoride selective ion electron and caries were checked according to the standards recommended by ＂The Oral Preventive Medicine ＂ （ 3rd edition ）. Results The fluoride in drinking water was all less than 1.0 mg/L（the nationalstandard）. Compared with the control village [0.480（0.290）mg/L], the median（range interquartile） of urinary fluoride in Xiangang village[0.620（0.380）mg/L] was higher, and the difference was statistically significant （P 〈 0.05 ）. Prevalence of caries in the four endemic villages [ 45.26% （ 355/785 ）, 43.65% （509/1166 ）, 34.98% （99/283）, 31.97% （332/1037） ] were lower than that of the control village[49.73%（651/1309）], and the differences were statistically significant（P 〈 0.05）. Compared children dental caries detection rate of urinary fluoride 0.2 - 〈 0.4 mg/L group with 0.00 - 〈 0.20 mg/L group, the differences were statistically significant（OR = 0.222, X2 = 3.910,P 〈 0.05）. Conclusions Low concentration of urinary fluorine is one of the factors influencing prevalence of children＇ dental caries. It is necessary to establish lower limit of hygienic standard on fluoride in drinking water for reducing the prevalence of caries.