高原地区居民龋病现况调查及其影响因素分析:一项日喀则与重庆的对比横断面研究OA

Objective The unique environment of plateau regions(low oxygen,low temperatures,dryness,and intense ultraviolet radiation)may affect the oral microbiome and oral health of residents.However,there remains a lack of systematic comparative studies on the prevalence of dental caries and oral health knowledge,attitude,and practice(KAP)between residents in the plateau and plain regions.This study aims to investigate the prevalence of dental caries and the levels of oral health KAP among residents in the urban area of Rikaze,Xizang,to compare these findings with residents in a plain area(Chongqing),and to analyze the association between dental caries and KAP levels,providing a scientific basis for the formulation of oral disease prevention and control strategies in plateau regions.Methods A cross-sectional study design was adopted.Permanent residents aged 3 years and above were selected from the urban area of Rikaze,Xizang(high-altitude group,n=1 196)and from Chongqing(plain group,n=1 297)by stratified cluster sampling.Oral examinations were conducted by investigators trained in accordance with the World Health Organization's oral health survey guidelines who had passed a standardization test(Kappa=0.82).The investigators recorded the prevalence of dental caries,mean number of decayed,missing,and filled teeth(DMFT),and types of restorations for caries-related tooth loss.Additionally,a self-designed KAP questionnaire was used to collect data on residents'oral health knowledge,attitudes,and behaviors.Statistical analysis was performed to examine the association between KAP scores and dental caries.Results The caries prevalence in the plateau group ranged from 93.0%to 99.5%(increasing with age),and the mean DMFT number increased from 6.9±3.9 to 14.5±6.8 with age,both significantly higher than those of the same age groups reported in the Fourth National Oral Health Epidemiological Survey.The actual restoration rate for teeth lost due to caries in the plateau group was only 6.4%,far lower than the average rate in plain areas and the national average,and no implant restoration was detected.Residents in the plateau group scored significantly lower than those in the plain group across all oral health KAP dimensions:knowledge(awareness of correct brushing techniques:48.7%vs 84.7%),attitude(agreement that"oral diseases should be taken seriously":4.8%vs 90.7%),and behavior(proportion brushing teeth≥2 times daily:24.8%vs 76.9%)(all P<0.05).Multivariate logistic regression analysis showed that after adjusting for age,gender,ethnicity,and education level,and other factors,every 1-point increase in the knowledge score(OR=0.10,95%CI:0.07 to 0.13),attitude score(OR=0.21,95%CI:0.18 to 0.26),and practice score(OR=0.13,95%CI:0.10 to 0.17)was associated with a 90%,79%,and 87%reduction in caries risk,respectively(all P<0.05).Multivariate linear regression analysis indicated that altitude,age,ethnicity,and education level were all independent influencing factors for KAP scores(all P<0.05).Conclusion Residents in plateau regions face the dual dilemma of high caries prevalence(93.0%to 99.5%)and an extremely low restoration rate(2.1%).Their oral health KAP levels lag significantly behind those in plain area residents in all dimensions,and KAP levels serve as an independent protective factor against dental caries.The natural environment of the plateau,low levels of knowledge,negative attitudes,and non-compliant behaviors jointly constitute the composite risk factors for the high incidence of dental caries.Countermeasures It is recommended to build upon the national"Five Health"Promotion Action Plan for Children and Adolescents(2026 to 2030),implementing in Xizang a target of over 80%coverage of oral health care guidance for children and 10 000 pit-and-fissure sealants per year,and incorporating oral health knowledge into school curricula and community health education;to expand the"Healthy Teeth"care mechanism in Xizang to cover all age groups,providing regular dental examinations and oral health education;utilize the assistance mechanism provided by tertiary hospitals supporting Xizang to train local dental professionals and improve primary oral health care capacity in Xizang areas;and to accelerate the development of caries prevention products to reduce the incidence of dental caries in plateau regions.