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82 J Dent Assoc Thai Vol. 60 No. 2 April-June 2010

∫ ∑ «‘ ∑ ¬ “ ° “ √ Original Article

ª√– ‘∑∏‘º≈¢Õß°“√ Õπ„À⺟⪰§√Õß·ª√ßøíπ‡¥Á°Õ“¬ÿ 9-18 ‡¥◊Õπ µàÕÕ—µ√“ºÿ ∂Õπ Õÿ¥ ∑’ˇæ‘Ë¡¢÷Èπ„π 1 ªï «ÿ≤‘°ÿ≈ ∏π“°“≠®π¿—°¥’ Õ“®“√¬å ¿“§«‘™“∑—πµ°√√¡ªÑÕß°—π §≥–∑—πµ·æ∑¬»“ µ√å ¡À“«‘∑¬“≈—¬π‡√»«√ ™ÿµ‘¡“ ‰µ√√—µπå«√°ÿ≈ √Õß»“ µ√“®“√¬å ¿“§«‘™“∑—πµ°√√¡ ”À√—∫‡¥Á° §≥–∑—πµ·æ∑¬»“ µ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬

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«.∑—πµ. ªï∑’Ë 60 ©∫—∫∑’Ë 2 ‡¡.¬.-¡‘.¬. 2553

∫∑π” ‚√§øíπºÿ„π°≈ÿࡇ¥Á°ª∞¡«—¬ ‡ªìπªí≠À“∑—πµ “∏“√≥ ÿ¢ ∑’Ë ”§—≠‡√◊ËÕßÀπ÷ËߢÕߪ√–‡∑»‰∑¬ ®“°√“¬ß“π°“√ ”√«® ¿“«–  ÿ¢¿“æ™àÕߪ“°√–¥—∫ª√–‡∑» §√—Èß∑’Ë 6 æ.».2549-2550 ‚¥¬°Õß ∑—πµ “∏“√≥ ÿ¢ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢ æ∫«à“„π °≈ÿ¡à ‡¥Á°Õ“¬ÿ 3 ªï ¡’Õµ— √“°“√‡°‘¥‚√§øíπºÿ„πøíππÈ”π¡ Ÿß∂÷ß√âÕ¬≈– 61.37 ‚¥¬‡°◊Õ∫∑—ÈßÀ¡¥µ√«®æ∫«à“¬—߉¡à√—∫°“√√—°…“„¥ Ê ·≈– §à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ ‡ªìπ 3.21 ´’Ë/§π1 ·≈–°“√„Àâ°“√√—°…“øíπ∑’˺ÿ „π°≈ÿ¡à ‡¥Á°π’‡È Õß∑”‰¥â¬“° ‡π◊ÕË ß®“°ªí≠À“„π°“√„À⧫“¡√à«¡¡◊Õ ¢Õ߇¥Á° ‚√§øíπºÿ„πª∞¡«—¬ àߺ≈°√–∑∫À≈“¬ª√–°“√µàÕ‡¥Á° ‡™à𠇥Á°¡’Õ“°“√ª«¥ √—∫ª√–∑“πÕ“À“√‰¥âπâÕ¬≈ß ¡’ªí≠À“„π‡√◊ËÕß °“√πÕπÀ≈—∫2 ·≈–¬—߇ªì𠓇Àµÿ¢Õß°“√µ‘¥‡™◊ÈÕ„π™àÕߪ“°∑’Ëπ” ‰ª Ÿà ° “√µ‘ ¥ ‡™◊È Õ ∑“ß√–∫∫ ´÷Ë ß º≈∑—È ß À¡¥®–°√–∑∫µà Õ  ÿ ¢ ¿“æ ‚¥¬√«¡ ∑”„À⇥Á°¡’°“√‡®√‘≠‡µ‘∫‚µ™â“°«à“‡¥Á°∑’Ëøíπ‰¡àºÿ3 ·≈– æ∫«à“¡’§«“¡ —¡æ—π∏å°∫— °“√ºÿ„πøíππÈ”π¡´’ÕË πË◊ Ê „π™àÕߪ“°·≈– „πøí π ∂“«√4 πÕ°®“°π’È ¬— ß ¡’ § «“¡ — ¡ æ— π ∏å ‡ °’Ë ¬ «¢â Õ ß°— ∫ §«“¡ ∫°æ√àÕß„π°“√ÕÕ°‡ ’¬ß·≈–ªí≠À“∑“ß —ߧ¡¢Õ߇¥Á° ∑”„À⇥Á° ‡°‘¥§«“¡√Ÿ â °÷ ¥âÕ¬§à“·≈–¢“¥§«“¡¡—πË „®„πµπ‡ÕßÕ’°¥â«¬ ªí≠À“ ‡À≈à“π’È∑”„Àâ»—°¬¿“æ„π°“√æ—≤π“¢Õ߇¥Á°π—Èπ≈¥≈ß·≈–µâÕß  Ÿ≠‡ ’¬§à“„™â®“à ¬„π°“√√—°…“ Ÿß¢÷πÈ 5  “‡Àµÿ°“√‡°‘¥‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬¡’ªí®®—¬∑’Ë ”§—≠ 3 ª√–°“√6,7 ‰¥â·°à ‡™◊ÈÕ∑’ˇªì𠓇Àµÿ¢Õß‚√§øíπºÿ„π™àÕߪ“° ·ªÑß ·≈–πÈ”µ“≈∑’ˇ™◊ÈÕ®ÿ≈‘π∑√’¬å “¡“√∂‡ª≈’ˬπ‡ªìπ°√¥‰¥â ·≈–§«“¡ µâ “ π∑“π°“√≈–≈“¬¢Õߺ‘ « øí π ´÷Ë ß ªí ® ®— ¬ ∑—È ß  “¡ª√–°“√µâ Õ ß  —¡æ—π∏å°∫— √–¬–‡«≈“∑’‡Ë À¡“– ¡ §«“¡∂’„Ë π°“√∫√‘‚¿§ πÕ°®“°π’È ¬—ßæ∫«à“¡’§«“¡ —¡æ—π∏å°—∫ “‡ÀµÿÕ◊Ëπ Ê ‰¡à«à“®–‡ªìπ惵‘°√√¡ °“√‡≈’Ȭßπ¡À√◊Õ¢Õ߇À≈«Õ◊ËπÕ¬à“߉¡à‡À¡“– ¡8 À√◊Õ°“√‡≈’È¬ß ¥â«¬π¡·¡àÕ¬à“߉¡à∂Ÿ°«‘∏’ °“√¢“¥°“√∑”§«“¡ –Õ“¥™àÕߪ“° ‡¥Á°∑’ˇÀ¡“– ¡‡ªìπªí®®—¬‡ √‘¡ªí®®—¬Àπ÷Ëß∑’Ë∑”„À⇰‘¥øíπºÿ‰¥âßà“¬ ‡™àπ°—π9 ·µà∫“ß°“√»÷°…“‰¡àæ∫§«“¡·µ°µà“ß°—π√–À«à“ß°≈ÿ¡à ∑’¡Ë ’ øí π ºÿ · ≈–‰¡à ¡’ øí π ºÿ „ π‡¥Á ° ∑’Ë ¡’ æ ƒµ‘ ° √√¡°“√‡≈’È ¬ ßπ¡¢«¥∑’Ë ‰ ¡à ‡À¡“– ¡10 ®–‡ÀÁπ‰¥â«“à 惵‘°√√¡°“√‡≈’¬È ßπ¡‰¡à„™à “‡Àµÿ„π°“√ ‡°‘¥‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬·µà‡æ’¬ßÕ¬à“߇¥’¬« ·µà‡°‘¥®“°À≈“¬ ªí®®—¬√à«¡°—π °“√·ª√ßøíπ‡ªìπªí®®—¬ ”§—≠ªí®®—¬Àπ÷ßË ∑’™Ë «à ¬„π°“√°”®—¥ ‡™◊ÈÕ∑’ˇªì𠓇Àµÿ¢Õß°“√‡°‘¥‚√§øíπºÿ °“√„Àâ∑—πµ ÿ¢»÷°…“ (oral health education) ‡ªìπ·π«∑“ßÀπ÷Ëß„π°“√ªØ‘∫—µ‘‡æ◊ËÕÀ«—ߺ≈„π

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°“√≈¥øíπºÿ®“°°“√∑∫∑«π«√√≥°√√¡Õ¬à“߇ªìπ√–∫∫¢Õß Kay11 æ∫«à“§«“¡√Ÿâ¢Õß°≈ÿࡵ—«Õ¬à“ßÀ≈—ß®“°‰¥â√—∫°“√„Àâ∑—πµ ÿ¢»÷°…“ ®–¥’¢÷Èπ ·µà¬—ß¡’À≈—°∞“π‰¡à‡æ’¬ßæÕ∑’Ë®– π—∫ πÿπ∂÷ߺ≈„π°“√ ≈¥Õÿ∫—µ‘°“√≥å‚√§øíπºÿ π◊ËÕß®“°∫“ß°“√»÷°…“¬—߉¡àæ∫§«“¡  —¡æ—π∏å¢Õß°“√„Àâ∑—πµ ÿ¢»÷°…“·≈–°“√≈¥Õ—µ√“øíπºÿ12 Kowash ·≈–§≥–13 · ¥ß„Àâ‡ÀÁπ«à“°“√„Àâ∑π— µ ÿ¢»÷°…“·°à¡“√¥“¢Õ߇¥Á° ‡≈Á°√à«¡°—∫°“√‰ª‡¬’ˬ¡∑’Ë∫â“πÕ¬à“ß ¡Ë”‡ ¡Õ  “¡“√∂ªÑÕß°—π °“√‡°‘¥øíπºÿ„π‡¥Á°ª∞¡«—¬‰¥â ·π«∑“ß∑’‡Ë À¡“– ¡„π°“√®—¥°“√‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬π—πÈ §«√‡πâπ‰ª∑’Ë°“√ à߇ √‘¡ ÿ¢¿“æ ·≈–ªÑÕß°—πøíπºÿµ—Èß·µàøíπ‡√‘Ë¡ ¢÷πÈ ¡“°°«à“°“√√—°…“‡¡◊ÕË ‡°‘¥‚√§·≈â« «—µ∂ÿª√– ß§å¢Õß°“√»÷°…“π’È ‡æ◊ËÕª√–‡¡‘πº≈¢Õß‚§√ß°“√„Àâ∑—πµ ÿ¢»÷°…“‚¥¬°“√·ª√ßøíπ·°à ºŸâª°§√Õß ‚¥¬‰¡à¡’°“√„À⧔·π–π”‡æ◊ËÕ‡ª≈’ˬπ·ª≈ß惵‘°√√¡ Õ◊πË Ê ∑’‡Ë ªì𠓇Àµÿ√«à ¡¢Õß‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬ ·≈–°“√µ‘¥µ“¡ º≈∑ÿ° 4 ‡¥◊Õπ „π°≈ÿࡇ¥Á°Õ“¬ÿ 9-18 ‡¥◊Õπ ‡æ◊ËÕ¥Ÿº≈¢ÕßÕ—µ√“ °“√‡°‘¥øíπºÿ∑‡Ë’ ª≈’¬Ë π·ª≈߉ª„π√–¬–‡«≈“ 1 ªï °“√¥”‡π‘π°“√«‘®¬— °“√«‘®—¬π’ȇªìπ°“√«‘®—¬‡™‘ß∑¥≈Õß ‰¥â¡’°“√§”π«≥À“§à“ ¢π“¥°≈ÿà ¡ µ— « Õ¬à “ ß∑’Ë ® –∑”°“√»÷ ° …“ æ∫«à “ ®”π«π∑’Ë µâ Õ ß°“√ „π·µà≈–°≈ÿࡧ◊Õ 45 §π ∑’Ë√–¥—∫π—¬ ”§—≠ ·Õ≈øÉ“‡∑à“°—∫ 0.05 ·≈–§“¥«à“Õ“®®–¡’°“√‰¡à°≈—∫¡“µ‘¥µ“¡º≈‡ªìπ®”π«π¡“° ‡π◊ÕË ß®“°ª√–™“°√∑’»Ë °÷ …“‡ªìπ∑“√°·≈–‡¥Á°‡≈Á°´÷ßË ‡¥‘π∑“ß≈”∫“° ®÷߉¥â‡æ‘Ë¡¢π“¥°≈ÿࡵ—«Õ¬à“߇ªìπ 290 ®“°Õ”‡¿ÕπÈ”æÕß ®—ßÀ«—¥ ¢Õπ·°àπ ‚¥¬¡’‡°≥±å„π°“√§—¥‡¢â“¥—ßπ’ȧ◊Õ‡¥Á°∑’Ë¡’Õ“¬ÿ√–À«à“ß 9-18 ‡¥◊Õπ ºŸâª°§√Õß„À⧫“¡¬‘π¬Õ¡„π°“√‡¢â“√à«¡‚§√ß°“√ «‘®—¬∑’Ë¡’°“√‡®√‘≠‡µ‘∫‚µµ“¡‡°≥±åª°µ‘ ‰¡à¡’‚√§ª√–®”µ—«„¥ Ê ‚¥¬»÷°…“®“° ¡ÿ¥∫—π∑÷° ÿ¢¿“æ¢Õß°√–∑√«ß “∏“√≥ ÿ¢ Õ¬Ÿ„à π ‡¢µ√—∫º‘¥™Õ∫„π°“√„Àâ«—§´’π¢Õß ∂“π’Õπ“¡—¬µà“ß Ê „πÕ”‡¿Õ πÈ”æÕß ®—ßÀ«—¥¢Õπ·°àπ ‰¡à¡’°“√ √â“ßøíπ∑’˺‘¥ª°µ‘·≈–¡’‡°≥±å „π°“√§—¥ÕÕ°¥—ßπ’È ºŸâª°§√Õß∑’ˉ¡à„À⧫“¡√à«¡¡◊Õ„π°“√∑”«‘®—¬ À√◊Õ¢ÕÕÕ°®“°°“√«‘®—¬ ‡¥Á°À√◊ÕºŸâª°§√Õß¡’§«“¡º‘¥ª°µ‘∑“ß °“¬À√◊Õ®‘µ „π°“√»÷°…“π’È¡’°“√∑”·∫∫ Õ∫∂“¡°àÕπ°“√»÷°…“ ‚¥¬ ‡π◊ÈÕÀ“„π·∫∫ Õ∫∂“¡ª√–°Õ∫¥â«¬¢âÕ¡Ÿ≈∑—Ë«‰ª 惵‘°√√¡∑—πµ ÿ¢¿“æ¢Õ߇¥Á° 惵‘°√√¡°“√√—∫ª√–∑“πÕ“À“√ √«¡∑—Èß∑”°“√ µ√«®øíπ ·≈â«À“§à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ ∑—ÈßÀ¡¥ 8 µ”∫≈„πÕ”‡¿Õ πÈ”æÕß ‡°≥±å°“√«‘π®‘ ©—¬øíπºÿ ¥—¥·ª≈ß¡“®“°‡°≥±å¢Õß Warren ·≈–§≥–15 ‚¥¬°”À𥇪ìπ 2 ·∫∫ §◊Õ °“√ºÿ·∫∫¡’√Ÿ (cavitated


84 J Dent Assoc Thai Vol. 60 No. 2 April-June 2010

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º ¡ø≈ŸÕÕ‰√¥å À“°‰¡à·ª√ßøíπ√Õ¬ºÿ®–≈ÿ°≈“¡µàÕ‰ª‡ªìπ√Ÿºÿ‚¥¬ ¡’°“√· ¥ß¿“æ ®“°π—Èπ®–≈ÿ°≈“¡µàÕ‰ª®π‡À≈◊Õ·µà√“°„π∑’Ë ÿ¥ ‚¥¬¡’°“√· ¥ß¿“æ ·≈–∑—πµ·æ∑¬å„À⺟⪰§√Õ߇≈◊Õ°«à“Õ¬“° ‡≈’¬È ß≈Ÿ°À≈“π„Àâ¡ø’ πí ‡À¡◊Õπ√Ÿª„¥ À≈—ß°“√ Õπ·ª√ßøíπ®“°Àÿπà ®”≈Õß®–¡’°“√≈ß¡◊Õ·ª√ßøíπ ®√‘ß ‚¥¬„™â¬“ ’øíπ∑’Ë¡’ à«πº ¡¢Õßø≈ŸÕÕ‰√¥å 500 ppm ∑”°“√ ∫’∫¬“ ’øíπ≈ß∫π·ª√ß„À⇪ìπ®ÿ¥¢π“¥‡≈Á° 1 ®ÿ¥ °àÕπ·ª√ßøíπ ºŸâ Õπ‡µ◊ÕπºŸâª°§√Õß«à“„π‡¥Á°∑’ˉ¡à‡§¬·ª√ßøíπ¡“°àÕπ‡≈¬«à“ ‡¥Á°Õ“®√âÕ߉Àâ‡æ√“–‡¥Á°«—¬π’ȉ¡à™Õ∫Õ¬Ÿàπ‘Ëß Ê ·≈–™àÕߪ“°‡ªìπ ∫√‘‡«≥ à«πµ—«∑’‰Ë ¡àÕ¬“°„À℧√¡“√ÿ°≈È” ¥—ßπ—πÈ ºŸªâ °§√ÕßµâÕß¡—πË §ß „π°“√·ª√ß ºŸâª°§√Õßπ—Ëß∑’Ëæ◊Èπ‡À¬’¬¥¢“µ√ßÕÕ°‰ª¢â“ßÀπâ“„Àâ ‡¥Á°πÕπ∑’Ë¢“ À—π»’√…–‰ª∑“߇¥’¬«°—π°—∫ºŸâª°§√Õß´÷ËßÀ—πÀ≈—ß„Àâ · ß∏√√¡™“µ‘ »’√…–¢Õ߇¥Á°®–ÀπÿπÕ¬Ÿà∫√‘‡«≥µ—° À“°‡¥Á°¥‘Èπ „Àℙ⢓„π°“√§«∫§ÿ¡·¢π·≈–¢“¢Õ߇¥Á°‰«â„Àâπ‘Ëß·≈â«®÷ß∑”°“√ ·ª√ßøíπ‚¥¬„™âπ«‘È ·À«°°√–æÿßâ ·°â¡ÕÕ° ¢¬—∫·ª√߉ª¡“√–¬– —πÈ Ê „π·π«µ—ßÈ ©“°°—∫µ—«øíπ∫√‘‡«≥≈–ª√–¡“≥ 10 §√—ßÈ ·≈â«®÷߇ª≈’¬Ë π ∑’Ë„À¡à‚¥¬„Àâ´âÕπ∑—∫°—∫∫√‘‡«≥‡¥‘¡‡≈Á°πâÕ¬ ®–‡√‘Ë¡·ª√ß∑’Ë∫√‘‡«≥ øíπ∫π¥â“π·°â¡∑“ߢ«“´’Ë„π ÿ¥ µàÕ¡“∫√‘‡«≥¥â“π·°â¡∑“ߴ⓬ ·≈â«®÷߉ª·ª√ßøíπ≈à“ߥâ“π·°â¡∑“ߴ⓬µàÕ¡“∑“ߥâ“π¢«“ ‡¡◊ËÕ ·ª√ߥâ“π·°â¡‡ √Á®„Àâ·ª√ߥâ“π≈‘Èπ ‚¥¬¡’≈—°…≥–«π°≈—∫®“° °“√·ª√ߥâ“π·°â¡À≈—ß®“°·ª√ßøíπ§√∫∑ÿ°´’·Ë ≈â« ®÷ßπ”ºâ“ –Õ“¥ ™ÿ∫πÈ”¡“‡™Á¥¬“ ’øπí ∫√‘‡«≥µ—«øíπ·≈–≈‘πÈ ÕÕ°„ÀâÀ¡¥ ‚¥¬·ª√ßøíπ «—π≈– 2 §√—ßÈ ™à«ßÕ“∫πÈ”‡™â“·≈–‡¬Áπ À“°æ∫«à“¡’øπí πÈ”π¡™‘¥°—π °≈ÿ¡à µ—«Õ¬à“ß®–‰¥â√∫— °“√ Õπ ‡æ‘Ë¡‡µ‘¡‡°’ˬ«°—∫°“√„™â‰À¡¢—¥øíπ‚¥¬∑—πµ·æ∑¬åºŸâ∑”«‘®—¬ ‰À¡ ¢—¥øíπ∑’Ë„™â‡ªìπ™π‘¥∑’Ë¡’¢’Ⱥ÷Èß ¥÷ßÕÕ°¡“¬“«ª√–¡“≥ 8 π‘È« ºŸ°ª¡  Õߧ√—Èß„À⇪ìπ«ß°≈¡ „À⇥Á°πÕπ„π≈—°…≥–‡™àπ‡¥’¬«°—π°—∫°“√ ·ª√ßøíπ „™âπ‘È«À—«·¡à¡◊Õ·≈–π‘È«™’È„π°“√§«∫§ÿ¡‰À¡¢—¥øíπ ‚¥¬ ∑”∑ÿ°´’‡Ë √‘¡Ë ®“°°“√¢¬—∫‰À¡¢—¥øíπ‡∫“ Ê ºà“π®ÿ¥ —¡º— ≈߉ª ·≈â« ‚Õ∫øíπ´’Ë„¥´’ËÀπ÷Ëß §àÕ¬ Ê ¢¬—∫¢÷Èπ‡∫“ Ê ∑”‡™àπ‡¥‘¡Õ’°§√—Èß„π®ÿ¥  —¡º— ‡¥‘¡ ·µà„™â‰À¡¢—¥øíπ‚Õ∫øíπÕ’°´’Ë ∑”„Àâ§√∫∑ÿ°´’Ë À≈—ß°“√ ·ª√ßøíπ™à«ß‡¬Áπ∑ÿ°«—π À≈—ß®“°°“√∑”«‘®—¬„π§√—Èß·√°®–¡’°“√µ‘¥µ“¡º≈∑ÿ° 4 ‡¥◊Õπ ‚¥¬„π·µà≈–§√—Èß®–¡’°“√‡√’¬°ª√–™ÿ¡°≈ÿࡵ—«Õ¬à“ß·≈– Õ“ “ ¡—§√ “∏“√≥ ÿ¢ ‡æ◊ËÕ Õ∫∂“¡∂÷ߪí≠À“„π°“√·ª√ßøíπ ·≈–™à«¬À“∑“ß·°â‰¢ªí≠À“∑’ˇ°‘¥¢÷Èπ√–À«à“ß°≈ÿà¡ ·≈–„Àâ¡’°“√ µ‘¥µ“¡º≈°“√·ª√ßøíπ‚¥¬°≈ÿà¡Õ“ “ ¡—§√ “∏“√≥ ÿ¢„πæ◊Èπ∑’Ë∑’Ë √—∫º‘¥™Õ∫ À“°‡°‘¥ªí≠À“®–‰¥â “¡“√∂·°â‰¢‰¥â„π‡∫◊ÈÕßµâπ À“° ‡°‘𧫓¡ “¡“√∂®–∑”°“√µ‘¥µàÕºŸâ∑”«‘®—¬‡æ◊ËÕÀ“·π«∑“ß°“√


«.∑—πµ. ªï∑’Ë 60 ©∫—∫∑’Ë 2 ‡¡.¬.-¡‘.¬. 2553

·°â‰¢ªí≠À“ ·≈–Õ’°«—µ∂ÿª√– ß§å§◊Õ‡ªìπ°“√°√–µÿâπ„π°“√„Àâ ·ª√ßøíπÕ¬à“ß ¡Ë”‡ ¡Õ„π°≈ÿà¡∑¥≈Õß Õ“ “ ¡—§√ “∏“√≥ ÿ¢ ª√–®”À¡Ÿà∫â“π·≈–µ”∫≈¡’®”π«π∑’Ë·µ°µà“ß°—πÕÕ°‰ª „π°“√∑” «‘®—¬‰¥â·§à¢Õ§«“¡√à«¡¡◊Õ„π°“√ªØ‘∫—µ‘ ‚¥¬ª≈àÕ¬„À⇪ìπ‰ªµ“¡ ≈—°…≥–«‘∂°’ “√¥”‡π‘πß“π‡¥‘¡¢Õß·µà≈–æ◊πÈ ∑’Ë ‡¡◊ËÕ§√∫√–¬–‡«≈“ 1 ªï ∑—Èß°≈ÿà¡∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡ ®–‰¥â√—∫°“√µ√«®øíπ‚¥¬∑—πµ·æ∑¬åºŸâµ√«®‰¡à∑√“∫«à“‡¥Á°∑’˵√«® Õ¬Ÿà„π°≈ÿà¡„¥ ‚¥¬¡’§«“¡πà“‡™◊ËÕ∂◊Õ¿“¬„πºŸâµ√«®§π‡¥’¬«®“°  ∂‘µ‘·§ªª“ (Kappa) ‡∑à“°—∫ 0.85 ·≈–∑”·∫∫ Õ∫∂“¡Õ’°§√—Èß ‡æ◊ËÕπ”¡“À“§«“¡ —¡æ—π∏å∑“ß ∂‘µ‘°“√∑¥ Õ∫‰§ ·§«√å (Chisquare)  ∂‘µ°‘ “√∑¥ Õ∫øÕ√å‡ÕÁ°·´°µå (Fisher exact test)  ∂‘µ‘ °“√∑¥ Õ∫∑’ (t-test) ·≈–§à“§«“¡‡ ’ˬߠ—¡æ—π∏å (Relative risk) µàÕ‰ª

85

º≈ ‡¡◊Ë Õ ‡√‘Ë ¡ µâ π °“√»÷ ° …“¡’ ° ≈ÿà ¡ §«∫§ÿ ¡ 147 §π ·≈–°≈ÿà¡ ∑¥≈Õß 143 §π ‡¡◊ËÕ ‘Èπ ÿ¥°“√»÷°…“‡À≈◊Õ®”π«π 102 §π ·∫àß ‡ªìπ°≈ÿ¡à §«∫§ÿ¡ 46 §π ¡’‡æ»™“¬ 24 §π ‡æ»À≠‘ß 22 §π °≈ÿ¡à ∑¥≈Õß 56 §π ¡’‡æ»™“¬ 23 §π ‡æ»À≠‘ß 33 §π ‡¡◊Ë Õ‡ª√’ ¬∫‡∑’ ¬∫§à “ ‡©≈’ˬºÿ ∂Õπ Õÿ ¥ °àÕπ·≈–À≈—ß°“√ »÷°…“„π°≈ÿࡧ«∫§ÿ¡À√◊Õ„π°≈ÿà¡∑¥≈Õß (µ“√“ß∑’Ë 1) æ∫«à“°≈ÿà¡ §«∫§ÿ¡®–¡’§à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ (‡ªìπ´’ËÀ√◊Õ¥â“π) ∑—Èß™π‘¥π—∫·≈– ‰¡àπ—∫√Õ¬‚√§®ÿ¥¢“«À≈—ß°“√»÷°…“ Ÿß°«à“°àÕπ°“√»÷°…“Õ¬à“ß¡’ π— ¬  ”§— ≠ (p < .05)  à«π°≈ÿà¡∑¥≈Õß§à“‡©≈’ˬºÿ ∂Õπ Õÿ ¥ ‡ªìπ ®”π«π´’ËÀ√◊Õ¥â“π‚¥¬‰¡àπ—∫√Õ¬‚√§®ÿ¥¢“«‡ªìπ√Õ¬ºÿ À≈—ß°“√ »÷°…“®–¡’§à“ Ÿß°«à“°àÕπ°“√»÷°…“Õ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·µà

µ“√“ß∑’Ë 1 §à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ °àÕπ·≈–À≈—ß°“√ Õπ·ª√ßøíπ Table 1 mean dmf/dmfs before and after tooth brushing instruction (n = 102) White spot

Control (n = 46) dfmt Before

After

Test (n = 56) dmfs

p-value

Before

dmft

dmfs

After

p-value

Before

After

p-value

Before

After

p-value

excluded

0.7

8.1

< .001*

1.85

20.8

< .001*

0.21

1.55

< .001*

0.34

3.64

0.01*

included

2.3

9.46

< .001*

4.02

22.24

< .001*

1.64

2.7

0.138

2.09

5.00

0.055

* Significant p < .05

§à“¥—ß°≈à“«∑—Èß™π‘¥´’ËÀ√◊Õ¥â“π∑’Ëπ—∫√Õ¬‚√§®ÿ¥¢“«‡ªìπ√Õ¬ºÿ°≈—∫ ‰¡à·µ°µà“ß°—πÕ¬à“ß¡’π¬—  ”§—≠∑“ß ∂‘µ°‘ Õà π·≈–À≈—ß°“√»÷°…“ ‡¡◊Ë Õ π”¡“À“§«“¡ — ¡ æ— π ∏å ∑ “ß ∂‘ µ‘ ® “°·∫∫ Õ∫∂“¡ æ∫«à“惵‘°√√¡„π°“√∑”§«“¡ –Õ“¥øíπ¢Õ߇¥Á° °àÕπ·≈–À≈—ß °“√«‘®—¬¡’§«“¡·µ°µà“ß°—π ‚¥¬°àÕπ°“√»÷°…“ °≈ÿࡧ«∫§ÿ¡·≈– °≈ÿà¡∑¥≈Õß ‰¡à¡’§«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ ·µà À≈—ß°“√»÷°…“ °≈ÿà¡∑¥≈Õß·ª√ßøíπ∂’Ë°«à“°≈ÿࡧ«∫§ÿ¡ ‚¥¬¡’ §«“¡·µ°µà“ßÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p = .004) ¥—ßµ“√“ß∑’Ë 2  à « π惵‘ ° √√¡Õ◊Ë π Ê ∑’Ë ¡’ º ≈µà Õ °“√‡°‘ ¥ ‚√§øí π ºÿ ª ∞¡«— ¬ ‡™à π 惵‘°√√¡À≈—∫§“¢«¥π¡ °“√°‘ππ¡¢«¥µÕπ°≈“ߧ◊π °“√‡µ‘¡ πÈ”µ“≈≈ß„π¢«¥π¡ °“√°‘π¢π¡ °“√¥◊Ë¡πÈ”µ“¡À≈—ß®“°°‘ππ¡ °àÕπ·≈–À≈—ß°“√«‘®—¬ ‰¡à¡’§«“¡·µ°µà“ß°—π¢Õß°≈ÿà¡∑¥≈Õß·≈– °≈ÿ¡à §«∫§ÿ¡°àÕπ·≈–À≈—ß°“√»÷°…“ ‡¡◊ÕË ‡ª√’¬∫‡∑’¬∫§à“‡©≈’¬Ë ºÿ ∂Õπ Õÿ¥ ‡ªìπ´’ÀË √◊Õ¥â“π∑’‡Ë æ‘¡Ë ¢÷πÈ (incremental rate = º≈µà“ߢÕß§à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ °àÕπ°“√ »÷°…“·≈–À≈—ß°“√»÷°…“) ¢Õß°≈ÿà¡∑¥≈Õ߇ª√’¬∫‡∑’¬∫°—∫°≈ÿà¡ §«∫§ÿ¡∑—ßÈ ™π‘¥π—∫À√◊Õ‰¡àπ∫— √Õ¬‚√§®ÿ¥¢“« æ∫«à“§à“‡©≈’¬Ë ºÿ ∂Õπ

Õÿ¥ ∑’ˇæ‘Ë¡¢÷Èπ¢Õß°≈ÿࡧ«∫§ÿ¡®– Ÿß°«à“°≈ÿà¡∑¥≈ÕßÕ¬à“ß¡’π—¬  ”§—≠∑“ß ∂‘µ∑‘ ßÈ— 4 §à“ (p < .001) (µ“√“ß∑’Ë 3) µ“√“ß∑’Ë 4 ‡ª√’¬∫‡∑’¬∫§à“√âÕ¬≈–¢Õ߇¥Á°∑’ªË √“»®“°øíπºÿ „π°≈ÿࡧ«∫§ÿ¡°àÕπ·≈–À≈—ß°“√»÷°…“∑—Èßπ—∫·≈–‰¡àπ—∫√Õ¬‚√§ ®ÿ¥¢“« §à“¥—ß°≈à“«®–‡æ‘¡Ë ¢÷πÈ Õ¬à“ß¡’π¬—  ”§—≠∑“ß ∂‘µ‘ (p < .001) ·µà„π°≈ÿ¡à ∑¥≈Õß§à“¥—ß°≈à“«®–‡æ‘¡Ë ¢÷πÈ Õ¬à“ß¡’π¬—  ”§—≠‡©æ“–„π °√≥’∑’ˉ¡àπ—∫√Õ¬‚√§®ÿ¥¢“« ‡¡◊ËÕπ—∫√Õ¬‚√§®ÿ¥¢“«§à“√âÕ¬≈–¢Õß ‡¥Á°∑’˪√“»®“°øíπºÿ°àÕπ·≈–À≈—ß°“√»÷°…“‰¡à·µ°µà“ßÕ¬à“ß¡’ π— ¬  ”§— ≠ ∑“ß ∂‘ µ‘ (p = .045) ‡¡◊ËÕ‡ª√’¬∫‡∑’¬∫§à“√âÕ¬≈–¢Õß ‡¥Á ° ∑’Ë ª √“»®“°øí π ºÿ ∑—È ß ™π‘ ¥ π— ∫ ·≈–‰¡à π— ∫ √Õ¬‚√§®ÿ ¥ ¢“«¢Õß °≈ÿࡧ«∫§ÿ¡·≈–°≈ÿà¡∑¥≈Õß°àÕπ°“√»÷°…“¥â«¬æ∫«à“‰¡à¡’§«“¡ ·µ°µà“ß°—πÕ¬à“ß¡’π—¬ ”§—≠∑“ß ∂‘µ‘ (p = .144 ·≈– p = .152) À≈—ß°“√»÷°…“æ∫«à“§à“√âÕ¬≈–¢Õ߇¥Á°∑’˪√“»®“°øíπºÿ„π°≈ÿà¡ §«∫§ÿ¡ Ÿß°«à“°≈ÿ¡à ∑¥≈ÕßÕ¬à“ß¡’π¬—  ”§—≠∑“ß ∂‘µ‘ (p < .001) ‡¡◊ËÕπ”°≈ÿࡵ—«Õ¬à“ß¡“§”π«≥À“§à“§«“¡‡ ’ˬߠ—¡æ—π∏å (Relative risk) ‚¥¬π”º≈µà“ߧà“√âÕ¬≈–¢ÕߺŸ∑â ¡Ë’ ø’ πí ºÿ°Õà π·≈–À≈—ß „π°≈ÿ¡à ∑’‰Ë ¥â√∫— °“√ Õπ·ª√ßøíπ À“√¥â«¬º≈µà“ߥ—ß°≈à“«¢Õß°≈ÿ¡à


86 J Dent Assoc Thai Vol. 60 No. 2 April-June 2010

 –¥«° √«¡∑—Èߪؑ°‘√‘¬“∑’ˇ¥Á°®–µÕ∫ πÕß„π°√≥’∑’˺Ÿâª°§√Õ߉¡à ‡§¬∑”§«“¡ –Õ“¥™àÕߪ“°‡¥Á°¡“°àÕπ·≈–‰¡à‡§¬™‘π°—∫°“√¡’  ‘Ë ß ·ª≈°ª≈Õ¡‡¢â “ ‰ª„π™à Õ ßª“° Õ“®®–√â Õ ß‰Àâ µà Õ µâ “ π‚¥¬

‡©æ“–„π‡¥Á°Õ“¬ÿ 1-2 ¢«∫ Tiberia ·≈–§≥–15 æ∫«à“Àπ÷Ëß„πªí®®—¬‡ ’ˬß∑’Ë∑”„À⇰‘¥‚√§øíπºÿ

µ“√“ß∑’Ë 2 惵‘°√√¡∑’Ë¡’º≈µàÕ∑—πµ ÿ¢¿“æ¢Õ߇¥Á°°àÕπ·≈–À≈—ß°“√ Õπ·ª√ßøíπ·°àºŸâª°§√Õß Table 2 Dental health behaviors of children before and after teaching the parents to brush Before (n = 290) Frequency of brushing • none • <1/week • 1-2/week • 3-5/week • Every day Sleep with bottle in the mouth • no • yes Bottle or breast feeding at night • no • yes Adding sugar in bottle • no • yes Frequency of snacking • none •1 •2 •3 • >3 Sucking water after milk feeding • no • yes

* Significant p < .05

control

test

9 (19.6%) 1 (2.2%) 4 (8.7%) 5 (10.9%) 27 (58.7%)

17 (30.4%) 2 (3.6%) 10 (17.9%) 7 (12.5%) 20 (35.7%)

27 (58.7%) 19 (41.3%)

34 (63.0%) 20 (37.0%)

9 (19.6%) 37 (80.4%)

6 (10.9%) 49 (89.1%)

42 (97.7%) 1 (2.3%)

55 (100%) 0

10 (21.7%) 12 (26.1%) 10 (21.7%) 7 (15.2%) 7 (15.2%)

14 (25.5%) 19 (34.5%) 10 (18.2%) 2 (3.6%) 10 (18.2%)

9 (19.6%) 37 (80.4%)

17 (30.4%) 39 (69.6%)

After (n = 102) p-value 0.202

control

After

10 (21.7%) 4 (8.7%) 9 (19.6%) 1 (2.2%) 22 (47.8%)

10 (17.9%) 2 (3.6%) 8 (14.3%) 16 (28..6%) 20 (35.7%) 0.571 33 (61.1%) 21 (38.9%) 0.174 6 (10.9%) 49 (89.1%)

0.409 28 (60.8%) 18 (39.1%) 0.174 9 (19.6%) 37 (80.4%) 0.439

p-value 0.004*

0.433 41 (95.35%) 2 (4.65%)

0.329

55 (100%) 0

9 (19.6%) 12 (26.1%) 14 (30.4%) 4 (8.7%) 7 (15.2%)

0.319 14 (25.5%) 21 (38.2%) 9 (16.4%) 2 (3.6%) 9 (16.4%)

10 (21.7%) 36 (78.3%)

16 (28.6%) 40 (71.4%)

0.155

0.289


«.∑—πµ. ªï∑’Ë 60 ©∫—∫∑’Ë 2 ‡¡.¬.-¡‘.¬. 2553

µ“√“ß∑’Ë 3 §à“‡©≈’ˬºÿ ∂Õπ Õÿ¥ ∑’ˇæ‘Ë¡¢÷Èπ„π°≈ÿࡧ«∫§ÿ¡·≈–°≈ÿà¡∑¥≈ÕßÀ≈—ß °“√ Õπ Table 3 Incremental dmft/dmfs of both control and test group after tooth

brushing instruction Incremental rate dmft excluding white spot lesion

Type

N

Mean

Control

46

7.4

p-value

87

§«∫§ÿ¡ æ∫«à“À“°‰¡àπ∫— √Õ¬‚√§®ÿ¥¢“« ®–‰¥â§“à ‡∑à“°—∫ 0.34 À“° π—∫√Õ¬‚√§®ÿ¥¢“«®–‰¥â§à“‡∑à“°—∫ 0.39 ´÷ËßÀ¡“¬§«“¡«à“ °≈ÿà¡ §«∫§ÿ¡¡’‚Õ°“ ‡°‘¥øíπºÿ‡ªìπ (1/0.34) 2.9 ‡∑à“¢Õß°≈ÿà¡∑¥≈Õß À“°‰¡àπ∫— √Õ¬‚√§®ÿ¥¢“« À√◊Õ‡ªìπ (1/0.39) 2.5 ‡∑à“¢Õß°≈ÿ¡à ∑¥≈Õß À“°π—∫√Õ¬‚√§®ÿ¥¢“« (µ“√“ß∑’Ë 5)

< .001*

dmft including white spot lesion

Test

56

1.3

Control

46

7.1

Test

56

1.0

Control

46

18.9

∫∑«‘®“√≥å < .001*

dmfs excluding white spot lesion

< .001*

dmfs including white spot lesion

Test

56

3.3

Control

46

18.2

Test

56

2.9

< .001*

* Significant p < .05

µ“√“ß∑’Ë 4 §à“√âÕ¬≈–¢Õ߇¥Á°∑’˪√“»®“°øíπºÿ Table 4 Percentage of caries free children % caries free

p-value

Control

Test

(n = 46)

(n = 56)

47.8

64.29

0.152

White spot include

Before After

6.52

48.21

< .001*

White spot exclude

Before

80.43

89.29

0.144

After

6.5

64.29

< .001*

* Significant p < .05

µ“√“ß∑’Ë 5 §à“√âÕ¬≈–¢Õ߇¥Á°∑’Ë¡’øíπºÿ·≈–§à“§«“¡‡ ’ˬߠ—¡æ—π∏å Table 5 Percentage of children with caries and relative risk White spot

Before

After

Difference in Percentage

Control (n =46)

Test (n = 56)

exclude

19.57

93.48

73.91 (A)

include

52.2

93.5

41.3 (Y)

exclude

10.71

35.71

25 (B)

include

35.71

51.79

16.08 (X)

Relative risk (excluding white spot) = B/A = 25/73.91 = 0.34 Relative risk (including white spot) = X/Y = 16.08/41.3 = 0.39

‡π◊ÕË ß®“°ª√–™“°√∑’∑Ë ”°“√»÷°…“π’‡È ªìπ‡¥Á°∑“√°∂÷߇¥Á°‡≈Á° °“√‡¥‘π∑“ߢÕߺŸâª°§√Õß´÷ËßµâÕß擇¥Á°¡“∑’Ë ∂“π’Õπ“¡—¬¥â«¬ √∂®—°√¬“π¬πµåÕ“®‰¡à –¥«° ‚¥¬‡©æ“–„πƒ¥Ÿ∑’ËÕ“°“»√âÕπ®—¥ À√◊ÕΩπµ° À√◊Õ‡ªìπ™à«ß∑”π“ √«¡∑—ßÈ °“√»÷°…“π’‰È ¡à¡∑’ πÿ  π—∫ πÿπ §à“‡¥‘π∑“ß ®÷ß¡’Õµ— √“¢Õ߇¥Á°∑’‰Ë ¡à‰¥â¡“µ‘¥µ“¡º≈§√∫µ“¡‡°≥±å ∑’°Ë ”À𥉫â§Õà π¢â“ß Ÿß´÷ßË ‡ªìπ ‘ßË ∑’§Ë “¥‰«â ®÷߉¥â ¡ÿà ª√–™“°√ª√‘¡“≥  Ÿß°«à“∑’µË Õâ ß°“√ ¢âÕ¡Ÿ≈‡∫◊ÕÈ ßµâπæ∫«à“°≈ÿ¡à §«∫§ÿ¡·≈–°≈ÿ¡à ∑¥≈Õß ‰¡à¡’§«“¡·µ°µà“ß°—π¢ÕßÕ—µ√“ºÿ ∂Õπ Õÿ¥ ™π‘¥´’ËÀ√◊Õ¥â“π ‰¡à«à“ ®–π—∫À√◊Õ‰¡àπ—∫√Õ¬‚√§®ÿ¥¢“« ·≈–§à“√âÕ¬≈–¢Õ߇¥Á°∑’Ë¡’øíπºÿ‰¡à ·µ°µà“ß°—π 惵‘°√√¡∑’Ë —¡æ—π∏å°—∫∑—πµ ÿ¢¿“扡෵°µà“ß°—π ∑“ß ∂‘µ„‘ π°≈ÿ¡à ∑—ßÈ  Õß ¥—ß®–‡ÀÁπ‰¥â®“°µ“√“ß∑’Ë 2 «à“À≈—ß°“√»÷°…“ ªí®®—¬æƒµ‘°√√¡µà“ß Ê ∑’Ë —¡æ—π∏å°—∫°“√‡°‘¥‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬¢Õß°≈ÿà¡ ∑¥≈Õß·≈–°≈ÿࡧ«∫§ÿ¡‰¡à·µ°µà“ß°—π ¬°‡«âπªí®®—¬‡¥’¬«‡∑à“π—Èπ §◊Õªí®®—¬°“√·ª√ßøíπ °≈ÿà¡∑¥≈Õß¡’ºŸâ∑’Ë·ª√ßøíπ„Àâ≈Ÿ°À≈“π‡æ‘Ë¡ ¢÷πÈ ·≈–¡’°≈ÿ¡à ∑’·Ë ª√ß 3-5 §√—ßÈ µàÕ —ª¥“Àå‡æ‘¡Ë ¢÷πÈ „π¢≥–∑’„Ë π°≈ÿ¡à §«∫§ÿ¡ºŸâ∑’Ë·ª√ßøíπ„Àâ≈Ÿ°∑ÿ°«—π·≈– 3-5 §√—ÈßµàÕ —ª¥“ÀåπâÕ¬≈ß ®“°°àÕπ∑”°“√»÷°…“ ´÷ËßÕ“®‡π◊ËÕß¡“®“°‡¥Á°‚µ¢÷È𧫓¡¬“° ≈”∫“°„π°“√·ª√ßøí π ‡æ‘Ë ¡ ¢÷È π °“√»÷ ° …“π’È ‰ ¡à ¡’ «— µ ∂ÿ ª √– ß§å ®–‡ª≈’ˬπ·ª≈ßªí®®—¬æƒµ‘°√√¡Õ◊Ëπ Ê ‡π◊ËÕß®“°ªí®®—¬‡À≈à“π’È¡’ §«“¡ —¡æ—π∏å°—∫‡™◊ÈÕ™“µ‘ «—≤π∏√√¡ ·≈–«‘∂’°“√¥”√ß™’«‘µ¢Õß ·µà≈–™ÿ¡™π ´÷ßË ®–·µ°µà“ß°—π‰ª„π·π«ªØ‘∫µ— ‘ ºŸ«â ®‘ ¬— ‡≈◊Õ°¡ÿßà ‡πâπ ªí®®—¬°“√·ª√ßøíπ‡π◊ÕË ß®“°°“√·ª√ßøíπ®—¥‡ªìπ°“√¥Ÿ·≈ ÿ¢Õπ“¡—¬ ¢—È π æ◊È π ∞“π¢Õߪ√–™“°√„π — ß §¡ªí ® ®ÿ ∫—π √âÕ¬≈– 81.10 ¢Õß ª√–™“™π°≈ÿà¡«—¬∑”ß“π ·≈–√âÕ¬≈– 73.86 ¢Õß°≈ÿࡺŸâ ŸßÕ“¬ÿ ∑”§«“¡ –Õ“¥™à Õ ßª“°¥â « ¬«‘ ∏’ · ª√ßøí π1 ¥— ß π—È π ®–‡ÀÁ π ‰¥â «à “ ª√–™“™π∑—«Ë ‰ª·ª√ßøíπ‡ªìπ°‘®«—µ√ª√–®”«—π °“√ Õπ„À⺪Ÿâ °§√Õß ·ª√ßøíπ„Àâ≈Ÿ°À≈“π ®÷߉¡à„™à‡√◊ËÕß∑’ËÀà“߉°≈®“°™’«‘µª√–®”«—π À“°·µà«à“ºŸâª°§√Õß∑’ˇ¢â“√à«¡°“√»÷°…“‰¡à∑√“∫«à“§«√®–‡√‘Ë¡ ·ª√ßøíπ„Àâ≈Ÿ°À≈“π‡¡◊ËÕ‰√ ‰¡à∑√“∫µ”·Àπàß∑’Ë∑”„Àâ°“√·ª√ßøíπ


88 J Dent Assoc Thai Vol. 60 No. 2 April-June 2010

„π‡¥Á°ª∞¡«—¬§◊ÕºŸªâ °§√Õß¡’ª≠ í À“„π°“√·ª√ßøíπ‡¥Á°‡™àπ‡¥’¬«°—∫ °“√»÷°…“¢Õß Mohebbi ·≈–§≥–16 ∑’Ëæ∫«à“¡“√¥“√âÕ¬≈– 59.0 „Àâ¢âÕ¡Ÿ≈«à“¢“¥∑—°…–„π°“√∑”§«“¡ –Õ“¥øíπ≈Ÿ°„π‡¥Á°Õ“¬ÿµË” °«à“ 3 ªï Õ—µ√“°“√·ª√ßøíπ«—π≈– 1 §√—ßÈ „π‡¥Á°Õ“¬ÿπÕâ ¬°«à“ 2 ¢«∫ ®–µË”§◊Õ√âÕ¬≈– 19.0 „π‡¥Á° 12-15 ‡¥◊Õπ ·≈–√âÕ¬≈– 18.0 „π‡¥Á° 16-23 ‡¥◊Õπ ´÷Ëß„π™à«ß¥—ß°≈à“«À“°‡¥Á°¬—߉¡à‡ª≈’Ë¬π‰ª¥◊Ë¡π¡®“° ·°â « ·≈–¬—ß¡’惵‘°√√¡¥Ÿ¥¢Õ߇À≈«®“°¢«¥π¡‰¡à‡À¡“– ¡ ‚Õ°“ „π°“√‡°‘¥øíπºÿ®– Ÿß  ”À√—∫ª√–‡∑»‰∑¬‡¥Á°Õ“¬ÿ 3 ªï ®–·ª√ßøíπ‡Õß√âÕ¬≈– 55.0-96.0 „π¢≥–∑’˺Ÿâª°§√Õß/·¡à ·ª√ß„Àâ‡æ’¬ß√âÕ¬≈– 36.35 „𠇥Á° 5 ªï §à“√âÕ¬≈–¢Õ߇¥Á°∑’Ë·ª√߇Õߧ◊Õ 87.10 ·¡à/ºŸâª°§√Õß ·ª√ß„Àâ√Õâ ¬≈– 9.85 ‚¥¬∑—«Ë ‰ª∑—πµ·æ∑¬å¡°— ®–·π–π”ºŸªâ °§√Õß „Àâ·ª√ßøíπ„À⇥Á°®π°«à“‡¥Á°®–√–∫“¬ ’Õ¬Ÿà„π¢Õ∫À√◊Õ “¡“√∂ ºŸ°‡™◊Õ°√Õ߇∑Ⓣ¥â∑’ËÕ“¬ÿª√–¡“≥ 7-8 ªï17 ·µà‡¥Á°‰∑¬ à«π„À≠à ®–·ª√ßøíπ‡Õß‚¥¬ºŸâª°§√Õß¡’ à«π√à«¡πâÕ¬1 ´÷Ëß Õ¥§≈âÕß°—∫ §«“¡™ÿ°¢Õß‚√§øíπºÿ„π‡¥Á°Õ“¬ÿ 3 ªï ´÷Ë ß  Ÿ ß ∂÷ ß √â Õ ¬≈– 61.371 · ¥ß„Àâ‡ÀÁπ«à“°“√¥Ÿ·≈ ÿ¢Õπ“¡—¬„π™àÕߪ“°¢Õ߇¥Á°Õ“®∑”‰¡à∂°Ÿ «‘∏À’ √◊Õ “¬‡°‘π‰ª „π°“√»÷°…“π’æÈ ∫«à“ºŸªâ °§√Õß√âÕ¬≈– 30.0 ‡ªìπ §ÿ≥¬à“ §ÿ≥¬“¬  “¡“√∂‡√’¬π√Ÿ«â ∏‘ °’ “√·ª√ßøíπ„À⇥Á°‰¥â‡ªìπÕ¬à“ߥ’ ´÷Ëß «π∑“ß°—∫§«“¡§‘¥‡ÀÁπ∑’Ë«à“ ‡¥Á°∑’ËÕ¬Ÿà™π∫∑∑’ˇ≈’ȬߥŸ‚¥¬ªŸÉ ¬à“ µ“ ¬“¬¡—°¡’ ¢ÿ ¿“æ™àÕߪ“°‰¡à¥‡’ æ√“–‰¡à¡∫’ ¥‘ “ ¡“√¥“‡ªìπºŸ¥â ·Ÿ ≈ ∑”§«“¡ –Õ“¥„Àâ Õπ“¡—¬™àÕߪ“°¡’§«“¡ —¡æ—π∏å°—∫°“√‡°‘¥øíπºÿ Wendt ·≈–§≥–18 æ∫«à“‡¥Á°∑’˵√«®æ∫§√“∫®ÿ≈‘π∑√¬å∫πº‘«øíπ„π™à«ß Õ“¬ÿ 1-2 ªï ®–¡’‚Õ°“ ‡°‘¥øíπºÿ„πÕ’° 1-2 ªïµÕà ¡“‰¥â ßŸ Alaluusua ·≈– Malmivirta19 æ∫«à“§√“∫®ÿ≈‘π∑√’¬å∫πøíπµ—¥πÈ”π¡∫π„π‡¥Á° Õ“¬ÿ 18 ‡¥◊Õπ  “¡“√∂∑”𓬰“√‡°‘¥øíπºÿ‡¡◊ÕË ‡¥Á°Õ“¬ÿ 36 ‡¥◊Õ𠉥âÕ¬à“ß·¡àπ¬”∂÷ß√âÕ¬≈– 91.0 ®÷ß®”‡ªìπÕ¬à“߬‘Ëß∑’˺Ÿâª°§√Õß®–  —߇°µ·≈–∫Õ°‰¥â«à“§√“∫®ÿ≈‘π∑√’¬å∑’Ëøíπµ—¥πÈ”π¡∫π¡’≈—°…≥– Õ¬à“߉√·≈–‡√’¬π√Ÿâ«‘∏’°”®—¥Õ¬à“ß∂Ÿ°µâÕß ‚¥¬‡©æ“–Õ¬à“߬‘ËßµâÕß ‡√‘¡Ë ªØ‘∫µ— „‘ π‡¥Á°Õ“¬ÿ‰¡à‡°‘πªï§√÷ßË ‡æ◊ÕË °”®—¥§«“¡‡ ’¬Ë ߢÕß°“√‡°‘¥ ‚√§øíπºÿ„π‡¥Á°ª∞¡«—¬ ™ÿµ¡‘ “ ‰µ√√—µπå«√°ÿ≈ ·≈–√æ’æ√√≥ ‚™§ ¡∫—µ™‘ ¬— 20 æ∫«à“ ‡¥Á°°≈ÿà¡∑’Ë∑”§«“¡ –Õ“¥™àÕߪ“°∑ÿ°«—π¡’Õ—µ√“ºÿ ∂Õπ Õÿ¥ ‡ªìπ ¥â“πµË”°«à“‡¥Á°°≈ÿ¡à ∑’∑Ë ”§«“¡ –Õ“¥™àÕߪ“°∫“ß«—πÀ√◊Õ‰¡à∑”‡≈¬ °“√·ª√ßøí π ∫à Õ ¬§√—È ß ·≈–°“√∑’Ë ∫‘ ¥ “¡“√¥“¡’  à « π™à « ¬„π°“√ ·ª√ßøíπ®– “¡“√∂≈¥°“√‡°‘¥øíπºÿ∫√‘‡«≥º‘«‡√’¬∫¢Õßøíπ‰¥â9,18,21,22 Douglass ·≈–§≥–23 Nurko ·≈–§≥–24 „Àâ°“√»÷°…“„π°“√¥Ÿ·≈  ÿ¢¿“æ™àÕߪ“°∑“√° æ∫«à“‡¥Á°∑’˺Ÿâª°§√Õß„Àâ¢âÕ¡Ÿ≈«à“·ª√ßøíπ

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89

‡∑’ ¬ ∫°— ∫ ∫√‘ ‡ «≥Õ◊Ë π Ê „π™àÕߪ“° À“°ºŸâ ª °§√Õ߉¥â ‡ √’ ¬ π√Ÿâ «‘ ∏’ ·ª√ßøíπ„Àâ≈Ÿ°À≈“π‰¥â∂Ÿ°µâÕß®–∑”„Àâ°“√ªÑÕß°—πøíπºÿ„π‡¥Á° ª∞¡«—¬ —¡ƒ∑∏‘Ϻ≈ «‘∏’·ª√ßøíπ®–‡ªìπ«‘∏’∑’˪√–À¬—¥§à“„™â®à“¬·≈– ‡ªìπ«‘∏¥’ ·Ÿ ≈∑—πµ ÿ¢¿“æ∑’ªË Ø‘∫µ— „‘ π™’«µ‘ ª√–®”«—π¢Õߪ√–™“°√∑—«Ë ‰ª ®÷ߧ«√®–¡’°“√ªØ‘∫—µ‘Õ¬à“߬—Ë߬◊π¡“°°«à“«‘∏’°“√Õ◊Ëπ Ê ∑’˵âÕß„™â ∫ÿ § ≈“°√∑— π µ·æ∑¬å · ≈–„™â «—   ¥ÿ ∑’Ë ¡’ §à “ „™â ®à “ ¬ Ÿ ß ‡™à π °“√„™â ø≈ŸÕÕ‰√¥å«“√åπ‘™ ‡ªìπµâπ ¥—ßπ—ÈπÀ“°¡’°“√√≥√ߧå„À⺟⪰§√Õß ·ª√ßøíπ‡¥Á°„Àâ∂Ÿ°«‘∏’µ—Èß·µàøíπÀπⓇ√‘Ë¡¢÷Èπ ‚¥¬„™â¬“ ’øíπº ¡ ø≈ŸÕÕ‰√¥åÕ¬à“ß°«â“ߢ«“ß §“¥«à“Õ—µ√“ºÿ·≈–§«“¡™ÿ°¢Õß‚√§ øíπºÿ„π‡¥Á°ª∞¡«—¬¢Õߪ√–‡∑»‰∑¬®–≈¥≈ßÕ¬à“߇¥àπ™—¥

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Original Article

Effectiveness of Parental Toothbrushing Instruction toward The 1-Year Incremental DMF Rate of 9-18 Month Old Children Wuttikul Thanakanjanaphakdee Lecturer Department of Preventive Dentistry Faculty of Dentistry, Naresuan University Chutima Trairatvorakul Associate Professor Department of Pediatric Dentistry Faculty of Dentistry, Chulalongkorn University Correspondence to: Associate Professor Chutima Trairatvorakul Department of Pediatric Dentistry Faculty of Dentistry Chulalongkorn University Henri-Dunant Rd., Patumwan Bangkok 10330 Tel: 02-2188532-3 Fax: 02-2188534 E-mail: ctrairat@yahoo.com

Abstract The purpose of this study was to assess the 1 year incremental dmf rate of 9-18 months old children after teaching their parents to brush their children’s teeth. The study was conducted in Nampong district, Khonkaen province. The samples that fitted the criteria consisted of 46 and 56 children in control and test group respectively. The parents were interviewed regarding the oral health behavior relating to Early Childhood Caries, then they practiced brushing their children’s teeth with fluoride dentifrice. Two, four-month follow ups at the health station were conducted by the investigator. After 1 year, the parents were interviewed again and the children’s teeth were examined. At the end of the study, the control group had mean caries free percentage of 6.52 (not including white spot lesion) and 6.50 (including white spot lesion). The test group’s percentage of caries free was 64.30 (not including white spot lesion) and 48.21 (including white spot lesion). The 1-year interview showed that the only behavior that had been changed was increased brushing by the parent in the test group while other behaviors ie, bottle feeding, night feeding, frequency of sweet and snack, adding sugar in the liquid fed by bottle did not change statistically significantly (p < .05). The dmft rate (including white spot lesion) in the test group receiving brushing instruction was not significantly different between before and after the study, while this rate in the control group who did not receiving the instruction was statistically different (p < .05). The incremental dmft and dmfs (not including white spot), respectively in the control group were 7.4 and 18.9 respectively, and 7.1 and 18.2 (including white spot). In the test group the incremental dmft and dmfs (excluding white spot) were 1.3 and 3.3, respectively, and were 1 and 2.9 (including white spot), respectively. All these incremental rates in the test group were significantly lower than those in the control group (p < .001). The control group’s chance of having caries is 2.9 or 2.5 tines of the test group, excluding or including while spot lesion. In summary parental tooth brushing instruction is statistically significantly effective to prevent early childhood caries. Key words: early childhood caries; dental health education; fluoride tooth paste; tooth brushing


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