國小兒童口腔治療需求及肥胖對口腔狀態之影響

Treatment needs and the relationship between obesity and oral health of elementary school children

何曜廷(Yao-Ting Ho)

指導教授 ： 黃純德 教授

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2003年)

摘要

齲齒一直是我國盛行的一種流行病，雖然政府、學校、牙醫師一直在呼籲口腔保健的重要，但我國齲齒的盛行率仍是居高不下。而在邁入已開發國家的過程中，物資取得容易，加上父母親的縱容，導致兒童過度攝食。而兒童的偏食經常導致產生營養過剩。
我們希望能瞭解國小學童的口腔狀況以及其治療需求，並且探討肥胖兒童的口腔情況是否和一般正常的兒童口腔情況有所不同，在其危險因子之中是否有其相關性。對全國所有國小學童作分層多段隨機集束抽樣法調查，共檢查了2324名國小6~12歲兒童。
乳牙齲齒的盛行率自6歲到12歲為84.04 %到13.19 %。(deft index = 2.94±3.53)。因換牙的關係使乳牙齲齒隨著年齡的增加逐漸減少。恆牙齲齒的盛行率自6歲到12歲為15.86 %到69.32 %。(DMFT index=1.45±2.13)。隨著年齡的增加，恆牙齲齒的問題是日益的擴散及嚴重。就以肥胖程度來看，乳牙齲齒的盛行率和嚴重程度在過輕和正常的兒童(盛行率=64.95%、d=1.65、f=1.38)明顯的超過肥胖的兒童(盛行率=45.56%、d=0.93、f=0.91)。在恆牙齲齒上肥胖兒的盛行率(盛行率=49.92%)並不會明顯的多於一般正常的兒童(盛行率=49.35%)，但是在齲齒的嚴重程度上肥胖的兒童(D=0.71、F=1.22)都比正常的兒童(D=0.36、F=0.98)要嚴重。
治療需求的盛行率的部分，在乳牙需一面填補、兩面以上填補、需作根管治療和需拔牙分別為8.58 %、27.31 %、11.65 %、11.91 %。在恆牙需一面填補、兩面以上填補、需作根管治療和需拔牙分別為10.50 %、5.67 %、4.00 %、1.60 %。依肥胖程度分，在乳牙上需兩面以上填補、需作根管治療和需拔牙在肥胖兒都比正常兒童及過輕兒童來的少，而在需一面填補上並未達統計上的顯著。所以整體而言，肥胖兒在乳牙上的治療需求是低於一般正常兒童及過輕的兒童的。在恆牙上需兩面以上填補、需作根管治療的在肥胖兒都比正常兒童及過輕兒童來的多，而在需一面填補和需拔牙上並未達統計上的顯著。所以整體而言，肥胖兒在恆牙上的治療需求是高於一般正常兒童及過輕的兒童。
刷牙次數而言，最多的是一天兩次，佔40.82 %。其次才是一天一次(18.07 %) 和三次(13.28 %)。不刷牙的佔23.76 %。肥胖兒和正常兒童在潔牙習慣上並沒有顯著的差異。在本研究中發現輕微齲齒的族群每日平均刷牙次數高於中度齲齒族群，可見潔牙之重要。但刷牙次數高於3次，齲齒指數卻相對較高，可見潔牙不但要注重次數，還要注意刷牙的品質。
經逐步回歸分析調整過後可以得到：和乳牙齲齒相關的有年齡層、肥胖程度、油炸類、高油零食、餅乾和水果。和恆牙齲齒相關的有性別、年齡層、糖或巧克力、餅乾、冰淇淋、冰棒冰沙剉冰和速食麵。
由以上我們可知由於國人飲食習慣的多樣化後，肥胖逐漸成為國人的一種流行病。肥胖兒的口腔狀況和一般正常的兒童有所差異。但是真正學理方面的解釋仍需更進一步的研究，包括營養的攝取量及頻次、食物含在口內的時間、唾液的分泌等差異性，才能真正針對肥胖兒作較佳的口腔健康建議。

關鍵字

齲齒指數 ； 治療需求 ； 肥胖

並列摘要

Though our government, teachers and dentists always emphasize the importance of oral health, caries is still a common problem in Taiwan. While becoming a more developed country, we can get food easier than before. But this might lead to unbalanced eating habits in children. Because of these habits, diseases such as obesity may result.
We want to know what the oral health conditions and treatment needs are in elementary school students. Is there any difference between obese children and normal children? What is the relationship between the risk factors of obese children and normal children? We took an oral examination of selected children from all elementary schools in Taiwan using WHO criteria. We examined 2324 children from 6 to 12 years old.
The prevalence of caries in primary teeth from 6 to 12 years old is 84.04% to 13.19%. (deft index = 2.94 ±3.53). Because of the change to permanent teeth, caries in primary teeth decline as age increases. The prevalence of caries in permanent teeth from 6 to 12 years old is 15.86% to 69.32%. (DMFT index = 1.45 ±2.13). The prevalence and severity of caries in permanent teeth increases with age. The prevalence and severity of caries in primary teeth in the underweight and normal groups (caries prevalence = 64.95%、d = 1.65、f = 1.38) are higher than in the obese group (cavities prevalence = 45.56%、d = 0.93、f = 0.91). But the prevalence of caries in permanent teeth in the obese group (49.92%) is similar to the normal group (49.35%). Otherwise, the severity of caries in permanent teeth in the obese group (D = 0.71、F = 1.22) is more than in the normal group (D = 0.36、F = 0.98).
The prevalence of treatment needs in primary teeth for one surface filling, two or more surfaces filling, endodontic treatment and extraction are 8.58 %、27.31 %、11.65 %、11.91 %, respectively. The prevalence of treatment needs in permanent teeth for one surface filling, two or more surfaces filling, endodontic treatment and extraction are 10.50 %、5.67 %、4.00 %、1.60 %, respectively. The treatment needs for two or more surfaces filling, endodontic treatment, and extraction of primary teeth in the underweight group is higher than in the obese group, but the one surface filling category didn’t reach a difference of statistical significance. In conclusion, the treatment needs for primary teeth in the obese group are lower than in the normal and underweight groups. The treatment needs for two or more surfaces filling and endodontic treatment in permanent teeth in the obese group are higher than in the normal and underweight groups, but the one surface filling and extraction categories didn’t reach a difference of statistical significance. The treatment needs for permanent teeth in the obese group are higher than in the normal and underweight groups.
Most students brush their teeth twice per day (40.8 %). About 23.76% students don’t brush their teeth at all. Brushing habits account for no differences between the obese and normal groups. In our research, we found that people with fewer caries brush their teeth more frequent than people with more caries. But people who brush their teeth more than three times a day still have high DMFT index. So we should not only focus on the brushing times but also brushing quality.
We put all of the dietary and brushing habits into a linear regression, and we found that the deft index is related to sex, age, obesity, diet of fried things, diet of potato chips, diet of cookies, and diet of fruits. The DMFT index is related to sex, age, diet of sugar and chocolate, diet of cookies, diet of ice cream, diet of ice, and diet of instant noodles.
After a variety of eating habits, we could see that obesity gradually becomes a common disease. Meanwhile, the oral condition of obesity child is different from the normal one. But for the further academic explanation, we need more researches to give the best suggestion on obesity children, including the quantity of nutrition intake、the time that food in the oral cavity、and saliva secretion.

並列關鍵字

DMFT index ； deft index ； Treatment needs ； Obesity

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