牙科患者齲齒治療對健康生活品質改善之探討

研究背景: 齲齒會造成牙齒敏感酸痛，美觀及咀嚼功能喪失等影響生活品質的問題，而牙科的治療應有全人醫療的概念，不只是解決病患口腔疾病的表徵，也應該提升病患的口腔健康相關生活品質，並能夠照顧到病患的生理、心理與社會等層面，繼而影響其整體性健康相關生活品質。研究目的: 本研究針對16歲到40歲牙科門診之齲齒病患，驗証其口腔健康相關生活品質（OHRQoL），包括口腔健康相關生活品質量表（OHIP）及口腔健康日常生活影響指數（OIDP）與整體性健康相關生活品質（HRQoL）（世界衛生組織生活品質量表簡明版，WHOQOL-BREF）三種量表的信效度，並探討此三種量表在接受齲齒填補治療前後的改善成效及影響因素。研究方法: 對象為100年2月至9月之國軍高雄總醫院及其屏東分院牙科部齲齒填補治療病患，共135位完成前測問卷，治療兩週後有126位完成後測問卷。其中包括口腔檢查記錄，問卷調查內容包括：社會人口學基本資料、個人健康、習慣、潔牙狀況、口腔健康狀況與OHIP、OIDP、WHOQOL-BREF等量表。統計分析以內在一致性法（Cronbach's alpha）評估信度，並以單因子變異數分析（One-way ANOVA）分析社會人口學基本資料、個人健康習慣、潔牙狀況、口腔狀況與各量表之相關性，再以配對t檢定（paired t-test）檢定各變項在各量表治療前後的改變量，並檢定其治療效應值（effect size, ES），同時以迴歸分析方法，探討齲齒填補治療患者，OHRQoL改善成效之影響因素。研究結果: 本研究OHIP量表總分Cronbach's alpha值為0.95，其下七個面向為0.72-0.88；OIDP量表總分Cronbach's alpha值為0.94；WHOQOL-BREF量表總分Cronbach's alpha值為0.92，其下四個面向為0.64-0.80。在ES值方面，OHIP量表總分ES值為0.54，其下七個面向的ES值為0.33-0.78；OIDP量表總分ES值為0.39；WHOQOL-BREF量表總分ES值為0.13，其下四個面向的ES值為0.04-0.11。迴歸分析顯示影響OHIP總分改變量之重要因素是性別、齲齒狀況與治療狀況分組、最大值牙菌斑數、經濟來源、平均多久換一把牙刷與治療齲齒顆數；影響OIDP總分改變量是性別、齲齒狀況與治療狀況分組及平均牙菌斑指數；影響WHOQOL-BREF總分改變量為性別、齲齒狀況與治療狀況分組及門齒擁擠狀況。結論: 本研究三種量表應用在齲齒填補治療的患者具有良好的信效度，且治療後顯示在OHIP量表的改善有達中等程度的改變，其中在身體疼痛及心理痛苦面向改善最多；在OIDP量表則有少量程度的改變；在WHOQOL-BREF量表則是未達少量程度的改變。齲齒填補治療能改善口腔健康相關生活品質，但對於整體性健康相關生活品質則改善有限。女性相較於男性及DMFT index≤8與齲齒治療完成者相較於DMFT index>8與齲齒尚未治療完成者在齲齒填補治療後，OHRQoL及HRQoL皆有較明顯的改善。

關鍵字

齲齒填補治療；口腔健康相關生活品質量表；口腔健康日常生活影響指數；世界衛生組織生活品質量表簡明版；口腔健康相關生活品質；整體性健康相關生活品質

並列摘要

Background: Dental caries often lead to toothache, unesthetic and functional limitations, therefore resulting in patients’ health-related quality of life problems. In terms of dental treatments,dentists need to have a broader concept of total patient care, in which, not only the resolving of oral symptoms, but also the oral health-related quality of life (OHRQoL) can be improved, with coverage of all domains in patient’s physiology, psychology and social relationships. Study objective: The purpose of this study is to investigate the responsiveness and related factors in OHRQoL (oral health impact profile, OHIP, and oral impacts on daily performances, OIDP) and HRQoL (WHOQOL-BREF) for dental caries restoration treatments. Study methods: One hundred and thirty-five subjects (aged 16-40 years）received dental caries restoration treatment consecutively from the Department of Dentistry in Kaohsiung Armed Forces General Hospital and in the Pingtung branch from February to September, 2011. Each participant received questionnaire interviews before and after treatment. Collected information included the OHIP, OIDP, and WHOQOL-BREF. One hundred and twenty-six subjects finished both questionnaires before and after the 2-week treatment. The reliability was evaluated by Cronbach’s α, and the differences in demographics characteristics, oral health behaviors, and oral health status of the three measurements were analyzed by using one-way ANOVA. The changes in OHIP, OIDP, WHOQOL-BREF scores between baseline and after 2 weeks were analyzed by using multiple linear regression and paired t-test. The effect size (ES) was used to investigate the responsiveness of QoL measurements. Study results: The Cronbach’s α for OHIP total score and the seven domains were 0.95 and 0.72-0.88, and for OIDP total score, it was 0.94. The WHOQOL-BREF total score and the four domains were 0.92 and 0.64-0.80. In terms of ES, OHIP total scores were 0.54 and 0.33-0.78, and OIDP total score was 0.39. The WHOQOL-BREF total scores were 0.13 and 0.04-0.11. The stepwise multiple regression analysis showed that the changes in OHIP were significantly associated with sex, DMFT index groups and dental caries status, maximum of plaque index, economic resource, frequency of changing toothbrush,and number of treated caries. The changes in OIDP were significantly associated with sex, DMFT index groups, dental caries status, and mean of plaque index. The changes in WHOQOL-BREF were significantly associated with sex, DMFT index groups, dental caries status, and having crowded incisor teeth. Conclusion: The OHRQoL scale of OHIP and OIDP, and HRQoL scale of WHOQOL-BREF had satisfactory validity and reliability in patients receiving dental caries treatment. The OHRQoL scale, especially in domains of physical pain and psychological discomfort of OHIP, showed significant responsiveness in patients receiving dental caries restoration treatment. However, using the HRQoL scale, these patients only showed a slight improvement.