- 學位論文
台灣機構內腦性麻痺者口腔健康狀況之探討
Oral Health Status of Institutionalized People with Cerebral Palsy in Taiwan
摘要
研究背景：國外研究資料顯示，腦性麻痺者口腔健康狀況普遍不良，預防保健措施的介入，能有效改善各類型身心障礙者口腔健康狀況。國內目前並無腦性麻痺者口腔健康狀況相關研究，爰此，需探討瞭解其口腔健康現況，據為改善腦性麻痺者口腔健康狀況之參考依據。 研究目的：分為二大部分探討：1.腦性麻痺者口腔健康狀況及不同障礙程度、性別、年齡之影響。2.口腔健康狀況與飲食、生活習慣、口腔衛生習慣與日常生活活動能力的相關性。 研究方法：研究對象取自高雄醫學大學口腔衛生科學研究所執行的「台灣身心障礙者口腔健康狀況調查」計畫中，居住在機構內領有身心障礙手冊之腦性麻痺者，共有632人完成問卷與口腔檢查。口腔檢查表係遵循世界衛生組織（WHO）所頒佈的標準，並針對參與檢查的牙醫師，進行檢查者的一致性訓練及相關研習後，執行口腔健康檢查及對個案之主要照護者進行口腔健康狀況與飲食、潔牙生活習慣之問卷調查。抽樣採用分層集束抽樣調查法（PPS）、以等比隨機抽樣、機構為基本抽樣單位。以MS Access設計資料庫，JMP作統計分析。 結果：平均年齡19.25歲，平均日常生活活動能力為77.08分，平均DMFT指數為7.80±7.27，隨著年齡（P<0.0001）及障礙程度嚴重性增加而升高；平均齲齒數(DT)為4.01±4.99，以25-34歲最高（P<0.0001）；平均缺牙數(MT)為2.06±4.72，以35歲以上9.04±9.16最高（P<0.0001），隨著年齡及障礙程度嚴重性增加而升高（P < 0.05）；平均填補數(FT)為1.72±3.20，以19-24歲2.64±4.19最高（P<0.0001）；平均齲齒盛行率為84.17％，以35歲以上98.68％最高（P<0.0001）；平均填補率為31.05％，以19-24歲34.82％最高。牙菌斑指數方面，男性優於女性，男性有79.05％，女性有82.42％；牙齦狀況，男性優於女性，男性74.04％有牙齦炎或牙結石，女性76.17％有牙齦炎或牙結石；牙結石狀況，女性優於男性，女性44.5％有牙結石，男性48.4％有牙結石。 結論：女性口腔健康狀況較男性差。DMFT指數、缺牙數隨著年齡增加而升高。缺牙數亦隨著障礙程度嚴重性增加而升高。全部自己清潔口腔、極重度障礙及在養護機構接受照護，其口腔健康狀況較差。伴有智障者口腔健康狀況與沒伴有智障礙者，沒有顯著不同，但伴有智障者其填補數及填補率較高；在肢體障礙部分，右上肢為一般人慣用肢，口腔健康狀況最差，可知上肢障礙影響腦性麻痺者之潔牙及口腔健康行為。腦性麻痺者常見的口腔健康問題，為醫療補綴較少及潔牙行為不足，可能導因於本身障礙程度、行為特質差異、福利機構類型、運動障礙及特殊口腔特徵。
並列摘要
Background: Due to many researches that show people with cerebral palsy have poor oral health status. Improving the oral health status by the intervention of the oral health education has proved in many countries and the effect is prominent especially for people with disabilies. There are no studies about oral health status in people with cerebral palsy in Taiwan. We must know the current oral health condition, and then improve it . Purpose: The purpose of this study was to investigate the current oral health condition and the related factors of people with cerebral palsy. The items of related factors included dietary and teeth cleaning habits, the experience of dental visits and the status of daily activities. Methods: The samples were extracted from the study of 〝Oral Health Status and Related Factor of Institutionalized People with Disabilities in Taiwan〞. Which was conducted by the Graduate Institute of Oral Health Sciences, Kaohsing Medical University. A total of 632 people with cerebral palsy participated in this study. The oral examinations were carried out by dentists. The dietary habits, teeth cleaning habits and status of daily activities were collected in a questionnaire. Stratified cluster sampling design and Probability Proportional to Size (PPS) were used, a database was designed by using MS Access and data were analyzed by using JMP. Results: The average age of the sample was 19.25 years old. The average score of daily activities was 77.08. The people with cerebral palsy had a DMFT index of 7.80, which increased with age and severity of disability. Decayed teeth number were 4.01 and the group aged 25-34 was the highest at 5.76（P<0.0001）. Missing teeth number were 2.06 and the group aged over 35 was the highest at 9.04 (P<0.0001). Missing teeth number increased with severity of disability. Caries prevalence was 84.17% and the group aged over 35 was the highest at 98.68（P<0.0001）. The filling rate was 31.05% and the group aged 19-24 was the highest at 34.82%. For the plaque index, male (79.05%) had a better condition than female 82.42﹪. For the gingival status, male (74.04﹪) had a better condition than female 76.17﹪. For the calculus index, female (44.5%) had a better condition than male 48.4﹪. Conclusion: Female had worse oral health status than male. DMFT index and Missing teeth number increased with age. Missing teeth number increased with degree of disability. Cleaning teeth by themselves, profound disabled degree, and those people staying in nursing home institutions had worse oral health status.There were no significant difference of oral health status between people with cerebral palsy who had or had not mentally retardation, but mentally retardated people with cerebral palsy had more filled teeth and higher filling rate. Right upper hand is commonly used for brushing teeth, so those people with the palsy of the right hand had the worst oral health status. People with cerebral palsy had common problems of poor oral health condition, poor oral hygience and lacking prosthesis which were caused by their characteristics of behavior, high sensitivity in the oral cavity, degree of motor disability, and institution types they stayed.