全身麻醉与单纯强制束缚下儿童牙齿治疗效果的对比研究

Comparison of long-term dental treatment effects of children treated under general anesthesia and passive restraint

目的对比研究全身麻醉（全麻）与单纯强制束缚下儿童牙齿治疗术后患者口腔健康习惯、口腔健康相关生活质量及长期治疗效果，为临床提供参考。方法选择2012年1月至2013年3月于北京大学口腔医学院·口腔医院儿童口腔科接受全麻下牙齿治疗的2～4岁患者27例（全麻组）及束缚下治疗的患者34例（束缚组），随访2～3年，收集患者基本信息、口腔卫生状况及观察期内患者的治疗情况，由家长填写口腔健康习惯调查问卷和幼儿口腔健康相关生活质量量表。分别以患者及患牙为单位绘制生存曲线，用Cox比例风险模型分析影响计划外再治疗的因素。结果两组各失访2例，最终纳入全麻组25例（474颗牙），束缚组32例（624颗牙），共1098颗牙齿，复查时间平均955d。全麻组和束缚组口腔卫生状况均较治疗前显著改善（P=0．019，P〈0．001），口腔健康习惯束缚组改善得更明显。全麻组发生计划外再治疗牙齿128颗（27．0％），束缚组232颗（37．2％）。束缚组新发龋率26．6％（97／364）和再发龋率17．3％（45／260）均显著高于全麻组[分别为5．1％（9／176）和10．1％（30／298）]（P〈0．001，P=0．012）；两组发生充填体缺陷、牙髓根尖周病及继发龋差异均无统计学意义（P〉0．05）。全麻组牙髓根尖周病和继发龋的发生时间显著长于束缚组（P〈0．01）。全麻组治疗牙齿的平均生存时间1018d，束缚组944d，两组差异有统计学意义（P〈0．05）。龋失补牙数、牙位、进食频率、刷牙习惯及两种行为管理方式是牙齿治疗后长期效果的影响因素。结论全麻下儿童牙齿治疗的长期效果明显好于束缚下治疗，但口腔健康习惯的改善不如后者明显；术后应持续加强对患者的口腔卫生宣教，维护良好的长期治疗效果。

Objective To compare the long-term dental treatment effects, oral health habits and oral-health-related qualities of life of children treated under general anesthesia （GA） and passive restraint （PR）, respectively. Methods Twenty seven 2 to 4-year-old children treated under GA and thirty four children treated under PR were recruited in the Department of Pediatric Dentistry, Peking University School and Hospital of Stomatology. Up to 2 years after the treatment, a follow up assessment was conducted. The data of general information, dental plaque level and the unplanned treatments were recorded and analyzed. The questionnaire of oral health habits and early childhood oral health impact scale （ECOHIS） for each child was also completed and analyzed. The survival rate and median survival time of the deciduous teeth were calculated. Multivariate analysis was performed by using Cox proportional hazard model. Results Twenty-five children under GA and 32 under PR were finally included, with a total of 1 098 deciduous teeth. The postoperative dental plaque indicesin both GA and PR groups had significantly improved than that of before the treatments （P=0.019, P〈0.001）. The oral health habits had also improved, and the improvement in PR group was more obvious than that in GA group. Totally 128 teeth （27.0%） appeared unplanned treatments in GA group and 232 teeth （37.2%） in PR group during the follow-ups. The new caries and recurrent caries in PR group were significantly more than that in GA group （P〈0.001, P=0.012）. No significant differences were found between the two groups in restoration failure, secondary caries and endodontic diseases （P=0.129, P=0.822, P=0.642）. However, the time of occurrence of endodontic disease and secondary caries in GA group were significantly longer than that in PR group （P〈0.01, P〈0.001）. The median survival time of teeth in GA group was 1 018 days comparing to 944 days in PR group. The difference was statistically significant （P〈0.05）. The survival rate was associated with such factors as decayed-missing-filled tooth （dmft）, anterior or posterior teeth, feeding frequency, brushing habits and behavior management techniques. Conclusions The long-term dental treatment effects of children treated under GA was significantly better than that of PR group. Continuous reinforcement of proper dietary and oral hygiene habits might help in maintaining the long-term treatment effect.