肌萎縮性脊髓側索硬化症口腔照護特殊醫療服務－病例報告

Special Oral Care and Medical Service of Amyotrophic Lateral Sclerosis : A Case Report

高永信(Yung-Hsin Ko) ； 劉宏文(Hung-Wen Liu)

《北市醫學雜誌》 15卷1期 (2018/03) Pp. 96-104

https://doi.org/10.6200/TCMJ.201803_15(1).0010

摘要

肌萎縮性脊髓側索硬化症患者隨病程變化，身體功能日漸低落，日常生活已無法自行打理，加上外出就診非常不便，而肌萎縮性脊髓側索硬化症患者又無法如正常人一般接受牙科治療，所以口腔維護上變成了一個困難的課題。牙周狀況或口腔衛生不良的臥床病患因口腔清潔困難、口腔沉積過多牙結石，成為細菌的溫床，病菌會由上呼吸道進入，加上宿主本身免疫功能低下，容易導致吸入性肺炎發生。根據研究指出，吸入性肺炎是住院及臥床病人死亡的主要因素之一，因此家人或者看護應每天幫病友刷牙、使用牙線或清潔口腔黏膜，病患也應定期接受牙醫師洗牙、去除牙菌斑、牙結石等。本院設有身心障礙者牙科特別門診，能為無法正常在一般牙科就醫的病患提供服務；此病患為一位50歲男性的初期肌萎縮性脊髓側索硬化症病患因為上顎無牙、下顎缺牙嚴重需要製作假牙與一系列治療，在本院得到完善的牙科照護成果。

關鍵字

肌萎縮性脊髓側索硬化症 ； 漸凍人 ； 口腔照護

並列摘要

Along with the progress of disease course, patients suffering from amyotrophic lateral sclerosis (ALS) gradually loss the ability to move and have to rely on others for daily life activity. Leaving house would need to drag in people to help and the transportation is even more difficult. Some tortures are physical, and some are mental, but the one that is both, is dental. Can't the ALS patients visit the dentists like the average persons? The problem for ALS patients to receive dental treatment reveals the level of social environment friendliness. Because of the difficulty to clean oral cavity, it is common that bed sickness patients have cumulated calculous deposits which form a bacterium advantageous environment that allows the germs to enter the upper respiratory tract. This causes aspirated pneumonia especially among those with low immunity function. Aspirated pneumonia is the main reason of death among hospital and bed sickness patients. For this reason, family and nursing workers should help the ALS patients to brush tooth, use dental floss or clean oral mucosa every day. Patients must be regularly arranged for dental scaling to eliminate plaques and calculous deposits. Our hospital provides disability dental specialty clinic services to take care of the disable patients. A 50-year-old patient with initial period of ALS had an edentulous upper arch and severe loss of teeth at lower arch. Denture fabrication and treatment were required. The Taipei City Hospital Zhongxiao Branch Division of Rehabilitation Medicine have developed an oral and facial massage technique and have been teaching the nursing workers to learn this skill so that they can care the patients at home. Dental health of this patient was improved after the massage treatment.

並列關鍵字

Amyotrophic lateral sclerosis ； Oral care