牙本質知覺敏感症之盛行率、相關危險因子調查及與口腔相關生活品質之關聯

Prevalence and Risk Factors of Dentin Hypersensitivity and Association with Oral Health Related Quality of Life

林伯彥(Po-Yen Lin)

指導教授 ： 簡國龍 ； 林俊彬

國立臺灣大學/公共衛生學院/公共衛生碩士學位學程/碩士(2011年)

https://doi.org/10.6342/NTU.2011.00456

摘要

背景與目標：牙本質知覺敏感症（敏感性牙齒）為牙科臨床上常遭遇的問題，是牙科病友眾多求診的主訴之一，嚴重時常會影響患者的飲食與日常生活起居習慣，研究報告顯示牙本質知覺過敏症的流行率佔總人口的2.8%到84.0%，差異頗大。本試驗之目的是希望能推估牙本質知覺敏感症之盛行率，並藉由問卷瞭解牙本質知覺敏感症與口腔衛生之相關性；影響因素包括是否有使用去敏感牙膏、是否有找醫師求診等，以及飲食習慣及與口腔健康相關生活品質之關聯性。

方法：本研究為一橫斷式研究，分為兩部分進行。第一部分以一般民眾為研究族群，請民眾填寫與牙本質知覺敏感症有關的問卷。問卷內容包括：基本人口學資料、口腔衛生習慣、飲食習慣、口腔健康相關生活品質之量表。第二部分以台大醫院牙科部的民眾為研究族群，使用問卷方式及臨床檢查同步施行，臨床檢查則由吹氣、溫度及刮觸測試確診牙本質知覺敏感症。

結果：自2010年11月至2011年4月止，共收集了1070筆完整資料。其中單純完成問卷調查的有743人，另外有327人完成問卷及臨床檢查。在第一部分的問卷中，有269位民眾認為自己有牙本質知覺敏感症，盛行率為36.2%；有牙本質知覺敏感症的病人，其口腔健康相關生活品質平均分數為48.0±6.3，顯著低於沒有牙本質知覺敏感症的52.8±5.5 （p value < 0.0001）。在經過年齡、性別、教育程度、抽菸、口腔衛生習慣調整之後，有牙本質知覺敏感症的病人之口腔健康相關生活品質平均分數依然顯著較低，而其中影響最大的是疼痛不適面向（p value < 0.0001）。在第二部分的結合問卷及臨床檢查中，被檢查出有牙本質知覺敏感症的有278位，盛行率為85.0%；認為自己有牙本質知覺敏感症的平均有8.8±6.0顆敏感牙齒，認為沒有的則有3.7±4.3顆。其中最容易被測得敏感性牙齒的為第一大臼齒及小臼齒。隨著年齡的增加，罹患牙本質知覺敏感症的相對危險性也隨之升高。牙周病之患者、牙周病治療、以及攜帶活動假牙、牙齒磨耗、牙齦萎縮等也都會顯著提高罹患牙本質知覺敏感症的危險性，而定期檢查牙齒則會降低其危險性（p value < 0.05）。問卷與臨床檢查之一致性為0.283。另外，敏感性牙齒的顆數與口腔健康相關生活品質分數呈現線性關聯性，平均多一顆敏感性牙齒，生活品質分數會下降0.21分（p value < 0.05）。

結論：本研究發現，年齡、牙周病、牙周病治療、攜帶活動假牙、牙齒磨耗、牙齦萎縮等會顯著提高罹患牙本質知覺敏感症的危險性，而定期檢查牙齒則會降低其危險性。另外，有牙本質知覺敏感症的病人其口腔健康相關生活品質平均分數顯著較低。因此建議未來需進一步研究有效治療牙本質知覺敏感症的方法，以提升病患之口腔健康相關生活品質。

關鍵字

牙本質知覺敏感症 ； 橫斷式研究 ； 口腔健康相關生活品質

並列摘要

Background: Dentin hypersensitivity is a common complaint in dental clinics. Some studies have reported that dentin hypersensitivity was found in adult populations with a prevalence ranging from 2.8%-84.0%. The aim of this study is to investigate the prevalence and possible causal factors including oral hygiene status and diet. The relationships between dentin hypersensitivity and oral health related quality of life will also be evaluated.

Methods: The study was cross-sectional designed and divided into 2 parts. The participates in the 1st part were invited from general population. Each participate completed a structured questionnaire which includes demographic data, oral hygiene status, diet, and oral health-related quality of life assessment. The 2nd part would be performed at Department of Dentistry of National Taiwan University Hospital. Each subject completed the questionnaire and further intra-oral examination. The examination would be performed by administering a blast of air, cold water and tactile test to confirm the diagnosis of dentin hypersensitivity.

Results: We obtained a total number of 1070 data during Nov. 2010 to Apr. 2011. In the 1st part, the prevalence of dentin hypersensitivity from questionnaire was 36.2% (269/743). The mean score indicated that patients with dentin hypersensitivity reported considerably more impaired oral health related quality of life (48.0±6.3 vs 52.8±5.5, p value < 0.0001) than subjects without dentin hypersensitivity. In multiple regression analyses considering gender, age, education level, and oral hygiene habits, the score was significantly lower in patients with dentin hypersensitivity (p value < 0.0001), especially the pain/discomfort domain. In the 2nd part, 85.0% (278/327) was diagnosed dentin hypersensitivity from intra-oral examination. The patients who thought they got dentin hypersensitivity had 8.8±6.0 sensitized teeth, compared to those who did not think they had dentin hypersensitivity, who had 3.7±4.3 sensitized teeth. The most frequent sensitized teeth were 1st molars and premolars. The risk ratio of dentin hypersensitivity was increased by age, periodontitis, periodontal treatment, removable partial dentures wearing, cervical abrasion and gingival recession, and decreased by periodical oral exams (p value < 0.05). The consistency between the result from the questionnaire and the diagnosis in clinical exam was 0.283. Furthermore, the total numbers of sensitized teeth was correlated to the oral health related quality of life score. In multiple regression analyses, the more sensitized tooth was diagnosed, the lower score would be recorded in questionnaire (p value < 0.05).

Conclusion: We clearly demonstrated that the dentin hypersensitivity was associated with a poor oral health related quality of life scores among adult Taiwanese. Patients who were older, had periodontitis, periodontal treatment, removable partial denture wearing, cervical abrasion or gingival recession would have higher risk to get dentin hypersensitivity. Further studies on the improvement of quality of life scores by treating dental hypersensitivity are warranted.

並列關鍵字

Dentin hypersensitivity ； cross-sectional study ； oral health related quality of life

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