目的 调查石家庄市3~14岁儿童错牙合畸形的发生率,并构建错牙合畸形的预测模型。方法 采取整群抽样法,于2023年5—10月抽取石家庄市8个区幼儿园、小学及初中共6 591名3~14岁儿童作为调查对象,对其开展牙牙合发育情况的检查,并分成错牙合组和正常组。收集儿童一般资料、喂养情况、饮食情况、是否存在口腔不良行为等信息开展单因素分析,通过多因素分析确定错牙合畸形的影响因素,并据此构建预测模型,然后通过ROC曲线下面积(AUC)、校准曲线及决策曲线检验模型的预测效能。结果 6 591名儿童中,检出错牙合畸形4 342名,错牙合畸形发生率为65.88%;错牙合畸形主要类型为深覆牙合、深覆盖、牙列拥挤,发生率分别为26.61%、19.60%、15.73%。Logistic回归分析显示,3~14岁儿童错牙合畸形发生的危险因素包括有家族遗传史、奶瓶喂养时间＞12个月、食物精细度高、吮唇、咬物、单侧咀嚼、口呼吸、患有龋齿(P<0.05)。内部验证显示,AUC为0.818(95%CI:0.763~0.873),校准曲线的拟合较佳,拟合优度HL检验χ2=9.904,P=0.275,阈值概率处于3%~81%时预测模型净获益率较理想。结论 基于有无家族遗传史、奶瓶喂养时间、食物精细度、是否存在口腔不良习惯(吮唇、咬物、单侧咀嚼、口呼吸)、有无龋齿构建的列线图可对石家庄市3~14岁儿童错牙合畸形发生风险进行较好地预测。
Abstract
Objective To investigate the prevalence of malocclusion among children aged 3 - 14 years in Shijiazhuang City, and to construct a predictive model for malocclusion. Methods Using cluster sampling, a total of 6 591 children aged 3 - 14 years from kindergartens, primary schools, and junior high schools in eight districts of Shijiazhuang City were selected as subjects for examination of dental development from May to October 2023. Children were divided into malocclusion and normal groups. Univariate analysis were conducted on information collected regarding children's demographic data, feeding practices, dietary habits, and presence of oral maladaptive behaviors. Multivariate analysis identified factors influencing malocclusion, based on which a predictive model was developed. The model's predictive performance was evaluated using the area under the ROC curve (AUC), calibration curves, and decision curves. Results Among the 6 591 children surveyed, 4 342 cases of malocclusion were identified, yielding a prevalence rate of 65.88%. The primary types of malocclusion were deep overbite, deep overjet, and crowded teeth, with rates of 26.61%, 19.60%, and 15.73%, respectively. Logistic regression analysis revealed that risk factors for malocclusion in children aged 3 - 14 years included a family history of malocclusion, bottle-feeding duration >12 months, high food fineness, lip-sucking, object-biting, unilateral chewing, mouth breathing, and presence of dental caries(P<0.05). Internal validation showed an AUC of 0.818 (95%CI: 0.763 - 0.873), good calibration curve fit, and a Hosmer-Lemeshow goodness-of-fit test (χ2=9.904, P=0.275). The prediction model demonstrated satisfactory net benefit rates when the threshold probability ranged from 3% to 81%. Conclusion A nomogram constructed based on the presence or absence of a family history of malocclusion, bottle-feeding duration, food fineness, and oral maladaptive behaviors (lip-sucking, object-biting, unilateral chewing, mouth breathing), as well as the presence or absence of dental caries, can predict the risk of malocclusion occurrence reasonably well among children aged 3 - 14 years in Shijiazhuang City.
关键词
错牙合畸形 /
流行病学调查 /
3~14岁儿童 /
预测模型
Key words
malocclusion /
epidemiological investigation /
children aged 3-14 /
prediction model
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参考文献
[1] 董原,李娜. 喂养方式与儿童错牙合畸形发病风险相关性的研究进展[J]. 口腔医学研究,2022,38(7):601-604.
Dong Y, Li N.Research progress on the correlation between feeding methods and the risk of childhood malocclusion[J].Journal of Oral Science Research, 2022, 38 (7): 601-604.(in Chinese)
[2] Lombardo G, Vena F, Negri P, et al. Worldwide prevalence of malocclusion in the different stages of dentition: A systematic review and meta-analysis[J]. Eur J Paediatr Dent,2020,21(2):115-122.
[3] Qi W, Yin Z, Sun Y, et al. Nomogram for predicting the 12-year risk of ADL disability among older adults[J]. Aging Clin Exp Res,2022,34(7):1583-1591.
[4] Wu J, Zhang H, Li L, et al. A nomogram for predicting overall survival in patients with low-grade endometrial stromal sarcoma: A population-based analysis[J]. Cancer Commun (Lond),2020,40(7):301-312.
[5] 傅民魁.口腔正畸学[M].6版. 北京:人民卫生出版社,2012:6-7.
Fu MK. Orthodontics[M]. 6th edition.Beijing: People's Health Publishing House, 2012:6-7.(in Chinese)
[6] 常蕊,吴丽更,穆颖,等.ICDAS-Ⅱ与WHO两种龋病评估系统在儿童龋病检查中的应用比较[J].牙体牙髓牙周病学杂志, 2011,21(10):555-597.
Chang R, Wu LJ, Mu Y, et al.Comparison of the application of ICDAS-Ⅱ and WHO caries assessment systems in pediatric caries examination[J].Chinese Journal of Conservative Dentistry, 2011, 21 (10): 555-597.(in Chinese)
[7] 郑汝君,李玥晓,杨雅岚,等.昆明市3～5岁儿童乳牙列错牙合畸形患病率及相关因素[J].昆明医科大学学报,2021,42(1):94-98.
Zheng RJ, Li YX, Yang YL, et al. The prevalence and related factors of primary malocclusion in children aged 3 - 5 in Kunming[J]. Journal of Kunming Medical University, 2021, 42 (1): 94-98.(in Chinese)
[8] 林丽,傅传,傅忠.湖州市安吉县儿童错牙合畸形发生情况调查及影响因素分析[J].中国公共卫生管理,2022,38(3):400-403.
Lin L, Fu C, Fu Z. Investigation on the occurrence of childhood malocclusion and analysis of influencing factors in Anji County, Huzhou City[J].Chinese Journal of Public Health Management 2022, 38 (3): 400-403.(in Chinese)
[9] 张利明,宋鹏,赵悦,等.石家庄市儿童乳牙列错牙合畸形与正畸治疗意识的流行病学调查[J].中国医药导报,2022,19(21):62-65.
Zhang LM, Song P, Zhao Y, et al. Epidemiological investigation on malocclusion of primary teeth and awareness of orthodontic treatment in children in Shijiazhuang[J]. China Medical Herald, 2022, 19 (21): 62-65.(in Chinese)
[10] Góngora-León I, Alarcón-Calle CS, Aliaga-Del Castillo A, et al. Association of breastfeeding duration with the development of non-nutritive habits, and transversal and vertical occlusal alterations in preschool children: A cross-sectional study[J]. Dent Med Probl,2023,60(1):47-53.
[11] 姜玲玲,曹玉慧,刘占帅,等.哈尔滨市12 087名学龄儿童错牙合畸形患病率及影响因素研究[J].口腔医学,2019,39(10):931-935.
Jiang LL, Cao YH, Liu ZS, et al. A study on the prevalence and influencing factors of malocclusion in 12 087 school-age children in Harbin[J]. Stomatology, 2019,39 (10): 931-935.(in Chinese)
[12] Saghiri MA, Eid J, Tang CK, et al. Factors influencing different types of malocclusion and arch form-A review[J]. J Stomatol Oral Maxillofac Surg,2021,122(2):185-191.
[13] 徐舒豪,黄诗言,饶南荃,等.成都地区混合牙列期及恒牙列初期儿童错牙合畸形患病率的调查研究[J].中国实用口腔科杂志,2022,15(1):87-92.
Xu SH, Huang SY, Rao NQ, et al. A survey on the prevalence of malocclusion in children with mixed dentition and early permanent dentition in Chengdu[J]. Chinese Journal of Practical Stomatology, 2022, 15 (1): 87-92.(in Chinese)
[14] 丁敏林,张海亮,徐亮,等.学龄前儿童乳牙列错颌畸形与口腔不良习惯的关系及预防对策[J].现代实用医学,2022,34(9):1185-1187.
Ding ML, Zhang HL, Xu L, et al. The relationship and preventive measures between malocclusion of primary teeth and oral habits in preschool children[J]. Modern Practical Medicine, 2022, 34 (9): 1185-1187.(in Chinese)
[15] Currò G, Bilello G, Messina P, et al. Transverse Asymmetries of the Maxilla Even in Healthy and Apparently Symmetrical Subjects[J]. Int J Environ Res Public Health,2021,18(2):446-459.
[16] Mota-Veloso I, Ramos-Jorge J, Freitas LRP,et al. The prevalence of malocclusion is higher in schoolchildren with signs of hyperactivity[J]. Am J Orthod Dentofacial Orthop,2021,159(5):653-659.
[17] Granja GL, Bernardino VMM, Lima LCM, et al. Orofacial dysfunction, nonnutritive sucking habits, and dental caries influence malocclusion in children aged 8-10 years[J]. Am J Orthod Dentofacial Orthop,2022,162(4):502-509.
基金
河北省医学科学研究课题计划(20211769)
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