屏東縣某國中之學生牙科就醫行為相關阻礙因素探討

背景：研究者服務的學校地處醫療缺乏地區，新生健康檢查齲齒率很高（60.4％），矯治率卻很低（11.8％），於是引進校牙醫進行齲齒治療，調查學生治療意願後卻發現，不同意者將近四成（37.9％），對於不同意治療學生是否有阻礙因素存在，有其探討之必要。研究目的：探討校牙醫介入對改善國中生口腔健康狀況之成效及國中生牙科就醫阻礙因素。研究方法：以屏東縣醫療缺乏地區某國中，九十九學年七至九年級學生為研究對象，計675人。研究分二部分，第一部分採準實驗設計（quasi-experimental design），對學生進行前測與後測兩次口腔檢查，比較兩組學生在介入前後口腔狀況之差異。第二部分採橫斷式研究（cross-sectional study）方法，進行團體施測自填式問卷，以瞭解阻礙牙科就醫之相關因素。研究結果：介入組與對照組比較，在校牙醫介入後，DT由3.02顆減少為0.97顆，FT由0.94顆增加為2.99顆，口腔健康狀況有明顯的改善，對照組則顯示沒有改善且微幅惡化。齲齒率高（71.6％），但自覺需要治療者只有三成（29.6％），且只有一成自覺牙齒狀況不好（10.5％），大多數學生（91.9％）在感覺不舒服時才會去看牙醫。中文版牙科焦慮量表(Chinese version Dental Anxiety Scale; C-DAS)得分的顯著預測因素為看牙齒沒有不愉快經驗、害怕看牙齒時會痛、自覺口腔狀況良好、就讀八年級、害怕會鑽牙齒、牙齒或牙齦不舒服時不管它。同不同意在校接受治療的預測因素為牙齒狀況沒有影響外觀及牙科焦慮（C-DAS）程度。結論：校牙醫的介入治療對青少年口腔健康狀況有顯著的改善。齲齒率高，但自覺需要治療者比例少，認為牙齒或牙齦沒有不舒服就不需要看牙醫，顯示口腔衛生觀念及保健知識顯然不足。牙科焦慮（C-DAS）得分越高，同意在校接受治療的機率越低，顯示疼痛、焦慮會影響就醫的意願。

關鍵字

牙科害怕/焦慮； C-DAS ；阻礙因素；青少年；齲齒；校牙醫

並列摘要

Background: There were high caries and low treatment rate among new students in junior high school, but no studies investigated the barriers of seeking dental treatment among junior high school students in Taiwan. This study aims to explore the barriers of accepting dental treatment in school. Methods: The participants were 675 junior high school students. The students were divided into two groups (treatment vs. control) according to their agreement (agree or disagree) on accepting dental treatment in school. Quasi-experimental design was adopted to estimate the effectiveness of dental treatment. The students were asked to complete a structured questionnaire; the content included the barriers related to dental treatment. Results: After the treatment, the DT of treatment group decreased from 3.02 to 0.97, and the FT increased from 0.94 to 2.99; comparing to the control group, there was no improvement in FT and slight increase in DT. There was high caries rate (71.6%), but only 29.6% self-reported that they aware of treatment need, only 10.5% reported awareness of bad oral health, most of them (91.9%) reported seeking dentist only when they feel uncomfortable in the oral cavity. The multiple regression analysis revealed that the significant predictors of dental anxiety were previous unpleasant experience, fear of pain, lack of oral health awareness, 8th grade, fear of dentist drilling and neglect of oral discomfort. Logistic regression analysis revealed that the significant predictors of accepting dental treatment in school were appearance and dental anxiety. Conclusions: Introduction of school dentist and dental treatment into junior high school significantly improved the students’ oral health. The high caries rate and low self-aware of treatment needed showed that there is an urgent need to improve the oral health attitude and knowledge in students. Finally, dental anxiety is an important barrier to seeking dental treatment.