Uspešnost minimalno invazivnih tehnik zdravljenja kavitiranih dentinskih karioznih lezij mlečnih kočnikov in njihov vpliv na z oralnim zdravjem povezano kakovost življenja

Likar Ostrc, Lenka (author), Pavlič, Alenka (mentor)

Namen Prevesti in validirati prvi slovenski vprašalnik za ocenjevanje kakovosti življenja, povezane z oralnim zdravjem (angl. oral health-related quality of life,) predšolskih otrok, ter primerjati uspešnost obravnave mlečnih kočnikov s kavitiranimi karioznimi lezijami v dentinu, obravnavanih z neinvazivno tehniko zdravljenja karioznih lezij brez preparacije in brez izdelave zalivke ali s konvencionalno tehniko. Metode V prvem delu raziskave smo s prevodom vprašalnika ECOHIS pridobili slovensko različico vprašalnika - ECOHIS-SVN. Analizirane so bile psihometrične lastnosti: notranja konsistentnost (koeficient Cronbach alfa), test-retestna zanesljivost (koeficientom intraklasne korelacije (ICC)), konvergentna veljavnost (Spearmanov koeficientom korelacije rangov (r)) in kriterijska veljavnost (Mann-Whitneyjevim U testom). V drugem delu raziskave smo primerjali konvencionalno zdravljenje (KT) s tehniko zdravljenja karioznih lezij brez preparacije (NRCT). Primerjali smo klinično učinkovitost, ocenili smo prisotnost zobnih oblog, otrokovo sodelovanje, zaznavanje bolečine in mnenje staršev o zdravljenju, in vpliv na otrokovo kakovost življenja, povezano z oralnim zdravjem, po obravnavi mlečnih kočnikov s KT ali NRCT. V sklopu statistične analize so bili opravljeni: Fisherjev eksaktni test za klinično učinkovitost, Mann-Whitney U test za razliko med skupinami glede prisotnosti zobnega plaka, kep in oceni ECOHIS-SVN, ter sodelovanja in zaznavanja bolečine in oceno staršev. Multipla linearna regresija je bila izvedena za oceno povezanosti sodelovanja otrok, zaznavanja bolečine, oceno staršev in tehniko zdravljenja. Rezultati V prvem delu raziskav je sodelovalo 255 otrok (4,8 leta ± 0,8). Koeficient Cronbach alfa je znašal 0,85, ICC 0,85, r pa 0,6-0,75. V drugem delu raziskave je bilo po 12 mesecih vključenih 53 otrok (30 v KT skupini, 23 v NRCT skupini). Pri 15 (14,4 %; KT=5, NRCT=10) od 104 obravnavanih zob je prišlo do vsaj enega zapleta. V NRCT skupini se je prisotnost zobnega plaka statistično značilno zmanjšala v primerjavi s KT skupino (p=0.013). Otrokovo sodelovanje, zaznavanje bolečine in mnenje staršev o zdravljenju se med skupinama ni statistično značilno razlikovalo. Z multiplo linearno regresijo smo potrdili statistično pomembno povezavo med otrokovim sodelovanjem in zaznavanjem bolečine (p=0.027) ter oceno staršev (p=0,038). Primerjava z izbrano vrsto zdravljenja (KT/NRCT) ni bila statistično povezana (p=0,104). Kakovost življenja, povezana z oralnim zdravjem se ob koncu študije med skupinami ni razlikovala (p=0.422). Zaključek ECOHIS-SVN je zanesljiv in veljaven instrument za oceno kakovosti življenja, povezane z oralnim zdravjem pri predšolskih otrocih. Medtem ko je zdravljenje s KT klinično učinkovitejše, se je NRCT izkazala za učinkovitejšo pri zmanjšanju prisotnosti zobnega plaka. Zato bi lahko NRCT obravnavali kot otroku prijazen pristop, ki potencialno odloži potrebo po bolj invazivnem zdravljenju kavitiranih karioznih lezij.

• Language: Slovenian
• Keywords: zobozdravstvo, oralno zdravje, zobni karies, mlečni kočniki, kakovost življenja, povezana z oralnim zdravjem, predšolski otroci, veljavnost, zanesljivost, randomizirana klinična študija, neinvazivno zdravljenje kariesa, zapleti, sodelovanje, zaznava
• Work type: Doctoral dissertation
• Organization: MF - Faculty of Medicine
• Year: 2024
• PID: 20.500.12556/RUL-155391
• Publication date in RUL: 29.03.2024

Secondary language

• Language: English
• Title: The effectiveness of minimally invasive techniques for treating cavitated dentinal carious lesions of primary molars and their impact on the oral health-related quality of life

Abstract

Aims Firstly, to translate and validate the Early Childhood Oral Health Impact Scale- Slovenian version (ECOHIS-SVN), the first Slovenian instrument assessing Oral Health-Related Quality of Life (OHRQoL) in preschool children. Secondly, to compare the effectiveness of treating cavitated carious lesions in primary molars using a non-invasive restorative technique (NRCT) or a conventional technique (CT). Methods The ECOHIS-SVN was developed through forward-backwards translations and its psychometric properties were analysed: internal consistency (Cronbach’s alpha), test-retest reliability (intra-class correlation coefficients - ICC), convergent validity (Spearman’s rank correlation - r) and criterion validity (Mann-Whitney U test). Subsequently, a randomised controlled trial was conducted to compare conventional treatment (CT) and non-restorative caries treatment (NRCT). Clinical efficacy, plaque presence, child’s cooperation, pain perception, parents’ treatment opinion and children’s OHRQoL were assessed. Statistical analyses included Fisher’s exact test for clinical efficacy, Mann-Whitney U test for differences between groups in dental plaque, dmft and ECOHIS-SVN scores and for children’s cooperation, pain perception and parents’ opinion. Multiple linear regression was used to examine the association between children’s cooperation, study groups, pain perception and parents’ opinion. Results In the first study, 255 children (4.8 years± 0.8) participated. Cronbach’s alpha was 0.85, ICC was 0.85, and r was 0.6-0.75. In the second study, 53 children (30 in the CT and 23 in the NRCT group) were included. Of 104 teeth, 15 (14.4%; CT=5, NRCT=10) have had at least one complication. NRCT showed greater efficiency in reducing dental plaque compared to CT (p=0.013). There were no statistically significant differences between groups in children’s cooperation (p=0.169), child’s pain perception (p=0.515) and parent’s responses - treatment acceptability (p=0.324), child’s comfort (p=0.563), while child’s cooperation was rated better in CT group (p=0.011). Multiple linear regression confirmed a statistically significant association between the child’s cooperation and pain perception (p=0.027) or the parents’ responses (p=0.038), while the selected type of treatment (CT/NRCT) had no impact (p=0.104). Comparison between the groups in OHRQoL did not differ statistically significantly (p=0.422). Conclusions The ECOHIS-SVN is a reliable and valid instrument to assess the OHRQoL in preschool children. While CT is clinically more efficient for cavitated lesions in primary teeth, NRCT demonstrates advantages in plaque control, presenting itself as a child-friendly approach enabling that potentially delays the necessity for more invasive treatments.

• Keywords: Dentistry, Oral health, Dental caries, Primary molars, Oral Health-Related Quality of Life, Preschool children, validity, reliability, Randomised Clinical Trial (RCT), Non-Invasive Caries Treatment (NRCT), Complications, Cooperation, Pain perception