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  • 學位論文

口腔醫療資源缺乏地區學童齲齒狀況與其影響因素之探討

Study of Dental Caries Status and Influencing Factors in Primary School Children Residing in Areas Deficient in Oral Medical Resources

指導教授 : 陳弘森

摘要


研究背景: 民眾就醫的公平性是評量健保優劣的首要因素,在台灣實施健保十餘年來已被評為世界第二的水準,但我們長期存在著醫療資源分配不均的問題,仍有些偏遠地區的居民不容易得到完善的醫療照顧。 研究目的: 在許多願意付出社會關懷的牙醫團體經營下,目前已有許多偏遠地區的學校有牙醫介入照護,而本研究特選在牙醫尚未介入學校服務前所做的調查,希望可以真正深入瞭解由中央健康保險局評定為口腔醫療資源缺乏且醫療需求遠大於供給的地區,其學童原始口腔健康狀況及學童參與學校牙醫治療計畫的意願。 研究方法與對象: 此研究為橫斷面研究,以同一時間調查對象之齲齒發生率及學童家庭基本資料、學童口腔照護習慣為探討題目。對象為平地口腔醫療資源不足區,至調查之日尚未有牙醫介入照護的高雄縣內門鄉內門國小,95學年度全校1-6年級學生,共計275位。研究方法為檢查其口腔狀況及實施問卷調查,回收的有效問卷有263份(95.64%)。 結果: 研究結果此區學童混合齒列的齲齒指數為5.61顆,齲齒盛行率為93.54%,齲齒填補率卻只有13.08%。母親是否為外籍及父親的職業也會影響學童的恆牙齲齒狀況。研究中發現,”弱勢學童”的父母親有較低的教育程度,父親職業為農、工者較多,而這些學童有齲齒卻沒有填補的人數比例比一般學童高,有很低的平均填補顆數,這些結果都有呈現統計上的顯著差異。性別差異方面,女生比男生更重視口腔衛生,因為女生在使用牙線情形及刷牙次數都比男生多,尤其以睡前刷牙之比率差異最大,有82.96%的女生有睡前刷牙的習慣,男生只有69.53%。因地處偏遠地區,醫療需求遠大於供給,會定期檢查牙齒的學童僅有37人(14.23%)。至於未能定期檢查牙齒的原因,主要為父母工作忙沒有時間佔最多,有129人(57.85%),其次為害怕看牙醫,有91人(40.81%)。 263名學生中,願意參與學校牙醫治療計畫的有193人(73.38%),不願意參與學校治療計畫的學生有70人(26.62%)。影響學生不願意參與學校治療計畫的複選結果,主要原因為已在他處接受治療,有33人(38.37%);其次為父母不同意學童參加治療,有21人(24.42%)。 結論: 此口腔醫療資源缺地區學童齲齒盛行率及齲齒指數高於其他參考文獻調查結果,但是齲齒填補率卻低於其他參考文獻調查結果,特別是弱勢學童有較低的填補顆數及填補率。學童的齲齒情形與醫療資源的供給息息相關,所以為了縮小醫療上的城鄉差距,提供牙醫巡迴醫療照護對彌補就醫的不公平是刻不容緩的事。

並列摘要


Background: The fairness of the public seeking medical advice is the first factor to evaluate the quality of health insurance. Taiwan has brought health insurance into force for more than ten years now, it got the second best standard in the world; however, Taiwan has the problem of unbalanced distribution of medical resources over a long period of time, there are still some residents who live in remote districts cannot get the faultless medical care easily. Objective: Under the operations of many dentist groups who are willing to devote social care, dentists have already stepped into the dental care for primary school children in many remote districts’ schools. This study especially chooses the investigation that was undertaken before the dentists participated in the school services, hoping to truly understand in the areas that Bureau of National Health Insurance assessed as lacking the resources of dental care and the demand of medical treatment is way higher that supply, what the primary school children’s original oral hygiene statuses are and their willingness to participate in school’s dental treatment plan. Methods: This is a cross-sectional research, targeting pupils in Nei-Meng Primary School, Nei-Meng Village, Kaohsiung County, a school without dental care provider in its neighborhood. The study approaches utilize oral examinations and accompany questionnaires. Investigations were conducted on all 275 school children that were enrolled in 2006, and 263 valid questionnaires were retrieved and evaluated. Results: The study results indicate that the caries index is 5.61, caries prevalence is 93.54%, while the rate for caries filling is only 13.03%. Nationality of mother or profession of father affects the caries existence in the permanent teeth in these school children. This study finds out that, the parents of “disadvantaged primary school children” have lower levels of education, most of their fathers’ occupations are farmers and workers; and the proportion of these school children having dental caries but without filling is higher that general school children, they have very low average number of filled teeth. These results have all shown the significant difference statistically. Differences also exist between sexes in self-care of oral hygiene, in that female pupils demonstrate higher frequencies in using dental floss as well as brushing teeth. The difference is more pronounced between sexes in the brushing rate before going to bed at night, as 82.96% of the female pupils are having the brushing habits, while only 69.53% of male pupils conduct such practices. Owing to the distant location of the neighborhood, only 37 school children (14.23%) are experiencing dental examinations periodically. As for the reasons contributing to the lack of periodical dental examinations, 129 pupils (57.85%) answered “parents are too busy at work”, and 91 pupils (40.81%) claimed “fear of seeing dentist”. Among the 263 school children, 193 (73.38%) of them are willing to participate in the school’s dental treatment plan, while 70 (26.62%) of them are unwilling to participate in the school’s dental treatment plan. From the result that influences the school children who are unwilling to participate in the school’s dental treatment plan, it shows that the main reason is that they have already received the treatment from somewhere else, which has 33 children in total (38.37%); the second main reason is that their parents disagreed to allow their children to participate in the treatment, which has 21 children in total (24.42%). Conclusion: The school children live in areas deficient in dental causing had high caries index and high caries prevalence than other references’s results, but the filling rate was the lowest than them. Especially the minority school children had the lower number of filled teeth and the lowest filling rate. For narrowing the margin of the city and country on medical treatment, provide the dentist with the care of the circuit medical treatment is an urgent matter.

參考文獻


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醫學大學口腔衛生科學研究所碩士論文;2001
2.張怡民。2001-2002台灣地區國小學童口腔狀況與甜食攝取之相關
性探討。高雄醫學大學口腔衛生科學研究所碩士論文;2002
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