- 學位論文
台灣照護機構內19-44歲身心障礙者 口腔健康狀況之探討
Oral Health Status of Institutionalized 19-44 Years Old People with Disabilities in Taiwan
摘要
研究背景：19-44歲的身心障礙者，家人不再協助潔牙行為、成人的體型較大，在抑制的行為下進行牙科治療困難，致使齲齒與牙周狀況在此年齡層，有日漸嚴重的趨勢。 研究目的：探討機構內19-44歲身心障礙者：1.口腔健康狀況及醫療需求；2.飲食及生活習慣、潔牙習慣、就醫行為與日常生活活動能力等之相關性。3.口腔健康狀況與飲食及生活習慣、潔牙習慣、就醫行為與日常生活活動能力及其相關性。 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所執行的「台灣身心障礙者之口腔健康狀況調查計劃」，且領有身心障礙手冊者之19-44歲身心障礙者。口腔檢查表依據世界衛生組織(WHO)所頒布之標準，透過牙醫師之一致性訓練後，對身心障礙者做口腔健康狀況檢查並評估醫療需求。其中自北部機構有592人，中部機構有576人，南部機構有646人，東部機構有187人，總樣本數共為2‚001人。主要研究內容是對機構內19-44歲身心障礙者做口腔檢查，並針對其主要照護者填寫身心障礙者有關飲食、潔牙行為與生活習慣的問卷調查。抽樣方法為分層集束抽樣調查法，抽樣機率以等比隨機抽樣、機構為單位來進行抽樣。台灣19-44歲共9,843,714人，而居住在機構內領有身心障礙手冊者共14,540人，來抽樣共2,422人，其中完成口腔檢查並已由照護者填寫問卷資料者，共有2,001人，完成率為82.61％。以Microsoft Access軟體設計資料庫，採JMP統計軟體來進行分析。 結果：機構內19-44歲身心障礙者，平均年齡為29.67歲；平均DMFT指數為10.47，以40-44歲13.32最高、35-39歲11.68次之（P＜.0001）；平均齲齒數為4.76，以19歲5.04最高、25-29歲5.04次之；平均缺牙數為3.48，以40-44歲7.34最高、35-39歲5.62次之（P＜.0001）；平均填補數為2.23，以25-29歲2.68最高、20-24歲2.53次之（P＝0.0001）；平均齲齒盛行率為93.45％，以40-44歲95.44％最高、25-29歲95.04％次之(P＝0.0247)；平均填補率為31.23％，以25-29歲36.21％最高、20-24歲35.86％次之；有牙菌斑為89.33％與牙齦炎者為87.25％，以40-44歲牙菌斑為95.31％與牙齦炎者為94.53％最高、35-39歲牙菌斑為91.76％與牙齦炎者為93.19％次之（P＜.0001）；有牙結石者平均為67.47％，以35-39歲82.01％最高、40-44歲81.10％次之（P＜.0001）。需要製作上顎或下顎假牙者平均為57.07％。 結論：19-44歲身心障礙者，隨著年齡增加而齲齒與牙周狀況變差，缺牙數明顯增加，但填補率反而減少，牙結石在35歲以上的機構內身心障礙者有80％都有牙結石，若沒有加以治療或注意口腔衛生，會造成缺牙數增加，進而影響口腔功能與健康。教導口腔保健知識、培養良好口腔衛生態度、養成正確潔牙行為，並可透過口腔健康照護網路、當地衛生機構及牙科團隊等多元化的宣導方式，來提供家長、照護者、老師等相關人員，有關口腔衛生保健的資訊，那麼擁有良好口腔健康與80歲時仍保有20顆有功能性的牙齒，將是可以達成的目標。
並列摘要
Background：The oral condition of people with disability deteriorates more rapidly than that of the general public. Those aged 19-44 years old people with disabilities had high prevalence rate of dental caries and periodontal diseases because of difficulty to get the help from their family to clean their teeth. Adults with disabilities are more difficult to treat than children and general people, because of their size, behavior and recognition. So the oral health status is getting worser. We were interested in surveying the status of oral health and the relationship with its related factors. Purpose：The purpose of this study was to investigate the following ilems of people with disabilities aged from 19-44 years old: 1.oral health condition and treatment needs. 2.the related factors such as dietary habits, teeth cleaning habits, status of daily activities and the experience of dental visit. 3.the relationship between the oral health status and its related factors. Methods：The samples were taken from the study of “Oral Health Status and Related Factors of Institutionalized People with Disabilities in Taiwan” by the graduate institute of oral health sciences, Kaohsiung Medical University. The number of people with disabilities aged 19-44 years old staying in institutions in Taiwan were 14,540. A total number of 2,422 people who were extracted by Stratified cluster sampling design and Probability Proportional to Size (PPS) were used. There were 2,001 persons had completed the oral examination from the people with disabilities aged 19-44 years old and the standardized questionnaire in the study. The response rate was 82.61％. There were 592 persons from north Taiwan, 576 from center, 646 from south and 187 from the east area. The study was conducted according to the protocol criteria set by the WHO. The oral examination was performed by dentists who have received special training in the oral health status and treatment needs of disabled people with disabilities. database was designed by MS Access and data were analyzed by using JMP. Results：The average age of the 19-44 year old people with disabilities included in this study was 29.67 years old. The DMFT index was 10.47 and the group aged 40-44 years old had a significantly higher DMFT index than other age groups (P<.0001). Decayed teeth number were 4.76 and the group aged 19 years old was the highest at 5.04. Missing teeth number were 3.48 and the group aged 40-44 was the highest at 7.34(P<.0001). Filled teeth number were 2.23 and the group aged 25-29 was the highest at 2.68(P=0.0001). Caries prevalence was 93.45% and the group aged 40-44 was the highest at 95.44% (P=0.0247). The filling rate was 31.23% and the group aged 25-29 was the highest at 36.21%. There were 89.33％ of individuals who had plaque index and 87.25％ had gingivitis index and the group aged 40-44 showed the highest plaque index at 95.31% and 94.53％ at gingivitis index(P<.0001). There were 67.47% of individuals who had calculus index and the group aged 35-39 had the highest index at 82.01% (P<.0001). There were 57.07% of individuals who needed prosthesis on the maxilla or mandible. Conclusion：The people with disabilites aged from 19-44 years old have poor oral health status included of large number of dental caries, missing teeth and poor periodontal status, especially calculus showed 80％ in over 35 years old people. The older they are, the worse the situation will be. If the people with disabilites do not receive proper care, the number of missing teeth will be increased and then affect the oral function and health. We have to provide householders, minders and teachers about oral health knowledge to develop the oral health attitude and habits, to brush their teeth, and overall oral health care. Thus, it is no inconceiveable to have 20 fully functional teeth when they are 80 years old.