- 學位論文
高雄市老人全口活動假牙調查研究 1. 現況及需求評估 2. 全口活動假牙功能品質(FAD)評估及與口腔健康 相關生活品質相關性之探討
Investigation of the complete denture among the elderly in Kaohsiung city 1. The status and needs of the complete denture among the elderly 2. The impact of complete denture’s quality (FAD) on the oral health-related quality of life among the elderly
摘要
中文摘要 緣起 老人人口增加是全世界的趨勢，我國亦然，目前65歲以上老人人口比例已達到10.4％，預估2026年老人人口將高達20.6％。此外，根據2009年調查報告，我國65歲以上老人有12.6％為全口無牙，而11.9％有配戴全口活動假牙。高雄市政府由1999年起首創我國『免費裝置老人全口活動假牙』福利政策之先例，至今施惠無數全口無牙之高雄市老人。本研究將深入探討，以進一步瞭解免費全口活動假牙品質及其對口腔健康相關生活品質的影響。 目的 本研究計畫主要評估高雄巿老人其免費全口活動假牙功能品質(FAD)以及口腔健康相關生活品質(Oral Health Impact Profile-14，OHIP-14)。並探討其全口活動假牙功能品質(FAD)與口腔健康相關生活品質(OHIP-14)之相關性。 方法 研究對象由高雄市政府公費裝置全口活動假牙的高雄市老人名冊隨機抽樣。每人均接受全口活動假牙功能品質評估(Functional Assessment of Dentures, FAD)的10項口腔內臨床檢查以及14題口腔健康相關生活品質（OHIP-14）的問卷調查。 在資料統計上， 類別變項採用卡方檢定（Chi-squared）進行分析(p＜0.05)。而複迴歸分析（multiple regression analysis）則用來探討全口活動假牙功能品質(FAD)與口腔健康相關生活品質(OHIP-14)之間的相關性。 結果 400位配戴免費全口活動假牙老人(男性65.75%、女姓34.25％) ；平均年齡77.18歲，最高96歲。年齡層以76-80歲人數最多(33.7％)，65-70歲的年齡層人數最少(14.5％)。以教育程度區分，小學教育(或以下)者62.2%為最多，大專教育程度者僅有10.3% 為最少。全口活動假牙使用年數均為9年以下。整體口腔健康相關生活品質 (OHIP-14)的平均指數為11.73±10.12；男性之生活品質指數11.35略低於女性12.45；最年輕的65-70歲群其相關生活品質指數為8.88為最低，其餘依年齡層的增加OHIP-14指數有依序增高的傾向。教育程度由低而高之OHIP-14指數依序降低，大專教育程度者指數為最低8.20 (p＜0.05)。 全口活動假牙的功能品質(FAD) 10項評估， 9項假牙功品質適合者高達71.00％-87.75%。有148位受檢者10項FAD假牙品質評估全部適合(37.00%)。FAD假牙品質的動態咬合功能(articulation, 2ii)、上顎假牙固著力(vertical pull, 3i)、上顎假牙穩定度(lateral displacement ,4i)、上顎假牙穩定度(pronounced rocking ,4ii)這四項皆與OHIP-14有顯著相關性(p < 0.0001)。再採複迴歸分析，只假牙動態咬合(2ii) 以及上顎假牙穩定度(4i) 此2項與OHIP-14有顯著性差異。 結論 高雄市配戴免費全口活動假牙老人之 整體口腔健康相關生活品質 (OHIP-14)介於日本和韓國之間。整體免費全口活動假牙之假牙功能品質(FAD) 堪稱良好，且可受公評 。 而FAD假牙功能品質評估與口腔健康相關生活品質(OHIP-14)最有相關的為假牙動態咬合(2ii) 以及上顎假牙穩定度(4i)這2項 。 本研究結果可提供牙醫師臨床全口活動假牙製作以及政府福利政策實施的參考。
並列摘要
Introduction The elderly portion of the general population is increasing around the world, the same as Taiwan. In Taiwan, the elderly population has increased to 10.4% in 2008, and is expected to be as high as 20.6% by 2026. In addition, in 2008, 12.6% of the population in Taiwan (2.74 million) was edentulous and 11.9% of the population who were 65 years or older wore complete dentures. In 1999, a new welfare and public health policy was initiated in Kaohsiung City, Taiwan, that provided a new set of complete dentures, free-charge, for edentulous citizens, 65 years of age and older. Over a period of the following eight years, more than twenty-five thousand elderly citizens received new dentures as beneficiaries of this program. Objectives: The objective of this study was to assess the denture qualityof FAD and the relationship between the essential functional qualities of the complete dentures and the participants’ oral health-related well-being among an elderly edentulous population. Methods: Four hundred elderly subjects from Taiwan, ages 65 and older, with diverse levels of formal education, received intra-oral examinations in accordance with the 10 criteria embedded in the Functional Assessment of Dentures (FAD) and personal interviews in accordance with the Oral Health Impact Profile-14 (OHIP-14). The mean OHIP-14 sum scores were compared among categories using t-test or ANOVA. Multiple regression analysis was used to identify the significant FAD criteria related to specific OHIP-14 domains while adjusting for gender, age, and education. Results: The subject were 400 elderly, ages 65 and older with free complete denture from city government, male 65.75％、female 34.25％, mean age 77.18 years, the oldest was 96 years; Mean score of OHIP-14 was 11.73±10.12, males’ score was 11.35 less than female 12.45, Maxillary stability and retention, and denture articulation demonstrated significant relationships with the mean OHIP-14 sum score and individual mean OHIP-14 sum domain scores. Maxillary denture stability and denture articulation were the two most significant denture related variables. Conclusions: Generally, the FAD quality of complete denture of the warefair policy in Kaohsiung city are good .The OHIP-14 life quality of the Free denture Kaohsiung elderly were between the Japan and Korea. Maxillary denture stability and denture articulation were the two most significant denture related with the highest level of patient oral health related well-being in this elderly population.