第二型糖尿病患者之血糖、口腔衛生知識、態度和行為與牙周疾病之相關性探討

糖尿病患者之血糖、口腔衛生知識、態度和行為與牙周疾病之相關性探討口腔衛生科學研究所研究生吳玲琨 9158502 指導教授謝天渝林英助研究背景糖尿病(Diabetes Mellitus，簡稱DM)是民國90年國人十大死亡原因中的第四位，同時健保花費在糖尿病及其相關合併症上的費用，每年超過新台幣350億元(約佔全部醫療費用的八分之一)；糖尿病可說是國家醫療衛生政策中幾項重大挑戰之一。糖尿病其所引發或伴隨的慢性併發症，如慢性腎衰竭、心血管疾病、視網膜病變、神經性病變及截肢等，是造成上述死亡、殘疾、個人或社會經濟負擔的主因。近年來國外許多研究顯示，牙周病在糖尿病患者中有較高之盛行率及嚴重程度，因此牙周病可視為糖尿病的第六個慢性併發症，但是國內對這方面的資料十分缺乏，不同國家間的研究也不是很充分。研究目的探討是否糖尿病患者血糖控制不好，有較差的口腔現況及口腔衛生知識、態度、行為。研究方法本研究以高雄市某市立醫院之糖尿病門診患者為研究對象，總共有70位個案參與研究，將其分成HbA1c>8者一組41人、及HbA1c≦8者一組29人，分別進行問卷調查及口腔檢查，將所得資料以JMP統計軟體分析。研究結果 HbA1c>8者其牙菌斑指數、牙結石指數、牙周附連喪失指數及牙周囊袋指數皆不良於HbA1c≦8。HbA1c≦8者其每天刷牙兩次以上及清潔牙縫習慣比HbA1c>8來得好，而HbA1c≦8者知識分數較高，刷牙兩次以上的行為較好，進而牙菌斑、牙齦炎及牙結石指數較低；態度分數好者其牙菌斑情形較好，每天刷牙兩次以上者牙菌斑情形亦較好。多變量迴歸模式中發現，血糖控制不良者有較高得牙菌斑指數>2、牙結石指數≧2、牙周附連指數≧2及牙周囊袋指數≧4之機率。尤其是牙周囊袋指數≧4（OR＝4.96, 95%CI =[1.14,34.92]）的部分。結論：第二型糖尿病血糖控制HbA1c>8者有較差的口腔知識、潔牙行為和刷牙習慣，而多變量迴歸分析中發現，糖尿病患者之口腔衛生知識、態度及行為會影響其口腔牙菌斑之嚴重程度，進而影響其口腔健康狀況，因此我們認為增加糖尿病患者尤其是血糖控制不佳者的口腔衛生知識、行為和態度，進而改善口腔健康，是一未來可加以推廣促進糖尿病患者健康的方向之一。關鍵字：第二型糖尿病，牙周疾病，血糖控制，口腔衛生知識態度行為。

關鍵字

第二型糖尿病；口腔衛生知識態度行為；血糖控制；牙周疾病

並列摘要

The Relationship between Oral Health Knowledge, Attitude, Practices, and Periodontal Disease in Type 2 Diabetic Patients with Poor Glycemic Control Lin Kun Wu, Tien Yu Shieh, Ying Chu Lin Graduate Institute of Oral Health Sciences, Kaohsiung Medical University, Taiwan, R.O.C. Abstract Background Diabetes mellitus is one of the most importance chronic diseases, which has been the forth-leading cause of death in Taiwan. The complications of diabetes can be prevented, halted or delayed by means of good glycemic control. Many authors have emphasized that diabetes increases the risk of oral manifestations and many different biological aspects behind this association have been studied. Health-related behavior might also be an important factor to assess in regard to that relationship. Study objective The study was carried out in one of Kaohsiung municipal hospitals with the aim of comparing periodontal disease and oral health knowledge, attitude and practices in 70 sampled type 2 diabetic patients with Poor glycemic control. Methods Questionnaires were used to collect data on oral self-care, oral health knowledge and attitude. Periodontal Index were examined and recorded by dentist. Results The results of this study did not show strong evidence for the relationship between periodontal disease and type 2 diabetes. But the results demonstrated that good glycemic control was significantly related to good oral health knowledge. Those with higher periodontal risk knowledge also practiced more oral health behaviors. Most of our diabetic subjects (67%) have never been informed about the risk factor of oral health. Conclusion We conclude that the oral health education is important for diabetic patients. Efforts should be made to provide information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff. Key words: type 2 diabetes mellitus, periodontal disease, glycemic control, oral health knowledge, attitude and practice

並列關鍵字

attitude and practice ； oral health knowledge ； glycemic control ； periodontal disease ； type 2 diabetes mellitus

參考文獻

Google Scholar

1. 吳崇榮。從大型臨床試驗看第2型糖尿病的預防方式。台灣醫界2003；46(1)：13-7。

Google Scholar

2. Lin T, Chou P, Lai MS, Tsai ST, Tai TY. Direct costs-of-illness of patients with diabetes melliyus in Taiwan. Diabetes Research and Clinical Practice 2001; 54Suppl: 43-6.