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  • 學位論文

台灣某機構慢性精神病患者口腔健康狀況之探討

Oral Health Status of Institutionalized Chronic Psychiatric Patients in Taiwan

指導教授 : 黃純德

摘要


研究背景: 由於精神病患者口腔衛生較常人差,且隨著年齡的增加惡化的速度也較常人快,若不注意其口腔衛生保健或無法協助其潔牙,常造成精神病患者不同程度的齲齒及牙周疾病等問題。國內目前有關精神病患者之口腔流行病學研究資料不多,且缺乏具有系統性的口腔保健資料。為使慢性精神病患者能實際受惠,提升其生命及生活品質,首先需要瞭解慢性精神病患者之口腔健康狀況及其醫療需求。 研究目的: 探討機構內慢性精神病患者:1.口腔健康狀況及其醫療需求。2.飲食及生活習慣、潔牙習慣、就醫行為等之相關性。3.口腔健康狀況與飲食及生活習慣、潔牙習慣、就醫行為及其相關性。 研究方法: 研究對象取自財團法人私立高雄仁愛之家附設慈惠醫院共294位住院之慢性精神病患者。研究內容包括口腔檢查及由主要照顧者填寫問卷,口腔檢查表係參考世界衛生組織(WHO)所頒布之口腔健康檢查診斷方法與標準,透過牙醫師之一致性訓練後,對慢性精神病患者做口腔健康狀況檢查並評估醫療需求。再以JMP6.0來進行統計分析。 結果: 本研究分析結果DMFT指數為13.39顆,齲齒數為6.14顆,缺牙數為5.56顆,填補數為2.18顆,齲齒盛行率為98.30%,填補率為50.00%。慢性病房病患DMFT指數為14.59顆,其他病房為12.89顆。慢性病房病患的齲齒數、缺牙數及缺牙率皆顯著高於其他病房病患(P<0.05),而填補數及填補率則是顯著低於居住在其他病房病患(P<0.0001)。半數以上的病患(53.74%)有主動要求甜食的習慣,每週吃甜食1-2次者最多,佔(39.12%),其次為每週吃3-6次以上者(25.17%) 。大部分個案能自行刷牙(97.62%),及一天刷牙二次(41.16%)。有136人(46.26%)三年內曾看過牙醫,且是牙痛時才去就診(91.91%)。88.34%的人有碎屑堆積,94.35%的人有牙結石堆積,96.11%的人有牙齦炎,43.54%的人需要製作上顎假牙,43.54%的人需要製作下顎假牙。74.49%的人有上顎補綴復形需求,57.82%的人有下顎補綴復形需求。 結論: 機構內慢性精神病患者的口腔狀況比國內一般同年齡及國外的研究來的差,隨著年齡增加而齲齒與牙周狀況變差,缺牙數明顯增加,但填補率反而減少。影響DMFT指數及缺牙數的重要因素是因慢性精神病患者合併其他障礙、選擇的刷牙方式、沒有定期做口腔檢查、吃甜食次數及將食物含口中很久才吞下的習慣等,而產生更嚴重的口腔健康問題。36歲以上的慢性精神病患者有94.81%有牙結石情形,若沒有適時加以治療或注意口腔衛生,將造成缺牙數的增加,進而影響口腔正常功能、身體健康與生活品質,更也會增加醫療支出。 建議: 一、應即早訂定身心障礙者口腔保健計畫. 二、加速相關專業人員的培訓:基層醫療院所牙醫師及專業口腔衛教師. 三、持續定期進行口腔檢查與建檔,連續追蹤其口腔健康狀況與口腔衛生情形,提出具體改善計畫。

並列摘要


Background: The oral-health condition of psychiatric patients is worse than the general public, and gets worse with age, if they or their caregivers do not pay enough attention to clean their teeth. There are few studies related to the oral health and prevention programs of psychiatric patients in Taiwan. It is necessary to explore and understand their oral health status and treatment needs in order to improve their oral function and quality of life. Study objective: The purpose of this study was to investigate the following items of chronic psychiatric patients:1;oral health condition and treatment needs. 2;the related factors such as dietary habits, teeth cleaning habits, status of daily activities and the experience of dental visit. 3;the relationship between the oral health status and its related factors. Methods: The samples in this study were 294 chronic psychiatric patients from Kaohsiung Tsyr-Huey Mental Hospital. The research content included an oral health examination and a questionnaire that was completed by the staff of the nursing homes or care centers. The oral health examination form and rules followed the methods and standard of oral health examination and diagnosis proclaimed by the WHO. The oral examination was performed by dentists who have received special training to achieve the inter-examiner, intra-examiner reliability during the examination for the oral health status and treatment needs of chronic psychiatric patients. JMP 6.0 was used to compile statistics and analyze the data. Results: The DMFT index number of the total sample was 13.39. The number of caries teeth, missing teeth and filled teeth were 6.14, 5.56 and 2.18 respectively. The caries prevalence rate and filling rate were 98.30%, and 50.00% respectively. The DMFT index of the patients in the chronic ward was 14.59. The DMFT index of the other wards was 12.89. The caries rate, missing teeth and missing rate of the patients in the chronic ward were higher than the patients in other wards (P<0.05); however, the number of filled teeth and the filling rate of chronic patients was lower than other patients (P<0.0001). More than half of the patients (53.74%) are used to asking for sweets. The patients who take sweets 1-2 times a week is the most common (39.12%), then 3-6 times a week. Most patients can brush their own teeth (97.62%) and brush 2 times a day (41.16%). There were 136 patients who visited a dentist in the past three years (46.26%), and only when toothache occurred (91.91%). 88.34% had dental debris, 96.11% had gingivitis, 94.35% had dental calculus, and 43.54% and 43.54% of the patients required maxilla and mandible denture respectively. The prosthetic need was 74.49% in the maxilla and 57.82% in the mandible. Conclusion: The oral health condition of the institutionalized psychiatric patients is worse than that of the general public in Taiwan. They have poor oral health status including a high number of dental caries, missing teeth and poor periodontal status. Related factors causing a high DMFT index and missing teeth are severity of disability, method of brushing, the interval of dental visits, frequency of eating sweets, maintaining food in mouth and swallowing it slowly. Especially calculus showed 94.81% in the psychiatric patients more than 36 years old. If we do not provide sufficient oral treatment and improve their oral hygiene, if will cause an increase in periodontitis, raise the number of missing-teeth, and affect the normal oral function and quality of life. Most of all increasing our oral and medical treatment expenses. Suggestions: 1. Improve the oral hygiene and promote the oral prevention plan for psychiatric patients as soon as possible. 2.Reinforce the training for oral hygiene and health professionals, such as nurses, caregivers and social workers in the institutions, hospital wards and nursing care institutions. 3.Continuously provide oral examinations, establish and periodically maintain a data bank of oral health and hygiene condition. Key words:chronic psychiatric patients、oral health status、DMFT index、missing teeth。

參考文獻


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