加強式口腔衛生課程對精神疾病病人潔牙方式及牙周健康的影響

The Effect of Enhanced Oral Hygiene Program on Oral Care and Periodontal Health among Patients with Mental Disorders

姚宜吟(Yi-Ying Yao) ； 邱芃云(Peng-Yun Chiu) ； 莊智堯(Chih-Yao Chuang)

《醫學與健康期刊》 9卷3期 (2020/11) Pp. 75-84

摘要

目的：精神疾病等弱勢族群口腔衛生健康，因疾病及就醫不便利性，較一般民眾差，同時也是容易被忽視的族群。本實驗在研究一個針對精神疾病病人設計的加強式口腔衛生課程介入，以改善精神疾病病人的刷牙習慣方式、口腔衛生及口內牙周健康狀況。方法：本實驗從精神病房以立意取樣選取40位精神疾病病人做口腔健康衛生課程介入，包含口腔清潔影片同步學習操作干預治療。這些病人將隨機分配成實驗組20人（接受定時加強式口腔衛生課程及刷牙）和對照組20人（維持原來刷牙習慣方式）。實驗過程中將實驗組及對照組潔牙方式各自紀錄。口腔衛生及口內牙周健康狀況以牙菌斑指數（plaque index）的改變來評估。經4周完成研究後，統計分析實驗前及實驗後牙菌斑指數的差異。結果：經過4周加強式口腔衛生課程介入後，牙菌斑指數差異分析顯示，加強式口腔衛生課程介入具顯著效益。實驗前：（牙菌斑指數）實驗組91%及對照組88%；兩組沒有顯著差異p值：0.718；實驗後：（牙菌斑指數）實驗組47%及對照組73%；兩組有顯著差異p值：0.003。由此可見實驗組在牙菌斑指數（plaque index）降低較多，表示牙菌斑減少得比對照組多。結論：加強式口腔衛生課程介入，經由影片示範同步學習操作正確口腔清潔方式，可以使精神疾病病人達到牙菌斑減少的效果。

關鍵字

精神疾病 ； 加強式口腔衛生課程 ； 牙周健康 ； 牙菌斑指數 ； 潔牙方式

並列摘要

Objectives. The patients with mental disorders generally tend to have poor oral hygiene and oral health due to a lack of self control, inadequate cooperation and greater barriers to dental care. Therefore, a specifically designed oral hygiene program targeting this group to enhance their oral health is essential. This study evaluated the effect of the enhanced oral hygiene program on oral care and periodontal health in patients with mental disorders. Methods. Forty patients were enrolled from the psychiatric department under the conditions that they had more than 16 teeth and they could physically clean teeth independently. The participants were divided randomly into two groups: a study group assigned to take part in an enhanced oral hygiene program and a control group which did not. This intervention was an oral hygiene program, which made use demonstration videos and models, was conducted by dental professionals for 4 weeks. The oral care methods and plaque index scores of both groups were recorded individually. Oral hygiene and periodontal health were assessed based on individual changes of plaque index. At the end of the intervention, plaque index scores were collected and analyzed to compare the difference before and after the intervention between study and control group. Chi-square test and t-test were used for analysis. A p-value＜0.05 considered significant. Results. The study group, consisted of, 10 males and 10 females (mean age 46 years old), and the control group consisted of, 7 males and 13 (mean age 44 years old). At baseline, study and control group plague index score were 91% and 88% respectively. There was no significant difference mean age, gender, and plaque index scores between the two groups (p＞0.05.) After 4 weeks of intervention, we found a significant difference plaque index scores, study group 47% and control group 73% (p＜0.05). Conclusion. The enhanced oral hygiene program improved patients-performance of oral care tasks and reduced the plaque index scores. It not only improved oral hygiene and prevented periodontitis in patients with mental disorders, it prevented caries and tooth loss as well.

並列關鍵字

Mental disorders ； Enhanced oral hygiene program ； Periodontal health ； Plaque index score ； Oral care methods

參考文獻

Kebede B, Kemal T, Abera S: Oral health status of patients with mental disorders in southwest Ethiopia. 2012;7:e39142. doi:10.1371/journal.pone.0039142.

台灣行政院健保署發布資料。NHIA Ministry of Health and Welfare. https://www.nhi.gov.tw/.

行政院經濟建設委員會：人口推計。台北：行政院經濟建設委員會，2012。NDC: Population projection for Taipei, 2012. https://popproj.ndc.gov.tw/main_en/dataSearch.aspx?uid=78&pid=78&upn=8D038F3F06D3982D.

溫靖宇、柯明中、陳楚杰：台灣老人精神醫療利用之醫療申報資料分析研究。台灣老年醫學暨老年學雜誌2015；10：28-41。Jing-Yu Wen, Ming-Chung Ko, Chu-Chieh Chen: Utilization of Psychiatric Services for the Elderly in Taiwan: A Health Claims Data Analysis. Taiwan Geriatr Gerontol 2015;10: 28-41.

Fu TS, Lee CS, Gunnell D, Lee WC, Cheng AT: Changing trends in the prevalence of common mental disorders in Taiwan: a 20-year repeated cross-sectional survey Lancet 2013;381:235-41.