以臨床隨機分派試驗評估口腔衛生教育介入對於高血糖個案牙周病之成效

Effectiveness of Oral Hygiene Instruction (OHI) in Improving Periodontal Disease among Subjects with Diabetes Mellitus (DM): A Randomized Controlled Trial

駱明德(Ming-Te Lo)

指導教授 ： 陳秀熙

國立臺灣大學/公共衛生學院/流行病學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.01872

摘要

中文摘要
研究背景：根據目前相關研究指出牙周病核心治療對於早期牙周病治療具有成效，但除牙周病核心治療外，加上口腔衛生指導(OHI)介入是否具有加成效果，目前尚未明朗，尤其對於高血糖及糖尿病個案之介入成效亦未相當明確。
研究目的：本研究利用隨機分派試驗模式，進行除了臨床牙周病核心治療外，評估口腔衛生指導介入對於高血糖及糖尿病個案是否具有成效。
研究方法：本研究利用基隆社區闔家歡健康篩檢平台，針對2006-2007年35-54歲參加篩檢民眾，其禁食8小時血漿血糖篩檢結果為大於110mg/dL或及問卷自述具有糖尿病之高血糖或糖尿病個案進行邀請。總計138位牙周社區牙周治療需求指數（CPITN）初測CPI指數為2或3者進入本研究，並利用隨機分派為介入組及控制兩組，包括69名口腔衛生教育指導介入組為牙周病核心治療另外加衛生教育指導，另69名無口腔衛生教育指導控制組為單一接受牙周病核心治療。口腔衛生指導介入內容包括牙菌斑成因及其影響說明、貝氏正確刷牙法及牙線使用方法等。並利用社區牙周治療需求指數（CPITN）的(CPI)部份及指標牙齒平均出血點數(BOP)作為兩種評估指標。該研究經介入後分別採取一個月及三個月追蹤時間進行後測CPI及指標牙齒出血點數(BOP)評估。利用Wilcoxon Rank Sum test進行初步介入組與控制組之比較，並進一步利用線性混合模式分別針對CPI及BOP兩種指標結果，進行一個月及三個月口腔衛生指導介入成效評估。
研究結果：本研究分析結果顯示，口腔衛生教育指導介入組相對於無口腔衛生教育指導控制組，並無顯著介入成效。基於兩觀察時間獨立假設下，不論於一個月或三個月追蹤結果分析，皆呈現兩組未達統計顯著差異。本研究利用線性混合模式考量其相依性(correlation)，一個月追蹤結果呈現介入組CPI指標比控制組低(difference=-0.04881)，但未達統計顯著意義，(p-value=0.6869)，其BOP指標(difference=-0.2075)亦未達統計顯著意義(p-value=0.1917)；另三個月追蹤結果亦顯示不論於CPI或BOP測量指標皆未達統計顯著意義。
結論：口腔衛生教育指導介入對於既有牙周病核心治療並無顯著加成成效。

關鍵字：口腔衛生指導、探測出血、社區牙周指數、臨床隨機試驗、社區族群模式、牙周病、糖尿病

關鍵字

口腔衛生指導 ； 探測出血 ； 社區牙周指數 ； 臨床隨機試驗 ； 社區族群模式 ； 牙周病 ； 糖尿病

並列摘要

Abstract
Background While dental scaling and root planing is effective in treating early periodontal disease (PD), little is known about the additional benefit of appliying oral hygiene instruction (OHI) in patients with PD, particularly co-existing with impaired fasting glucose (IFG) or diabetes mellitus (DM).
Aim A randomized controlled trial was conducted to assess the efficacy of OHI in treating PD in subjects with hyperglycemia.
Method The population is targeted at Keelung residents aged 35-54 years with fasting plasma glucose (FPG) greater than 110mg/dL or DM history from the participants enrolled in the Keelung Community-based Integrated Screening (KCIS) program between 2006 and 2007. A total 138 subjects with baseline CPI equal to 2 or 3 were randomly assigned to two arms, 69 subjects in the study group with core treatment together with OHI and the other 69 subjects in the control group with core treatment only. OHI consist of how to apply disclosing agent and the illustration of dental plaque, Bass tooth brushing method, and the procedure of dental floss. The primary outcomes consist of Community Periodontal Index (CPI) and Bleeding on Probing (BOP). After intervention, each participant was followed at one month and three months to keep record of CPI and BOP. Wilcoxon rank sum test was first adopted to assess the difference of CPI and BOP in the two groups. The multiple linear mixed model was further applied to assess the difference of CPI and BOP between the study group and the control group at both one-month and three-month follow-up times.
Results No statistically significant differences in baseline characteristics and CPI or BOP were found between the study group and the control group. There were lacking of statistically significant difference in CPI or BOP at both one-month and three-month follow-up with consideration of independence assumption. By using a linear mixed models that take correlation with compound symmetry into account, the study group yielded lower CPI than the control group, but the difference of CPI was not statistically significant (difference=-0.04881, p-value=0.6869) at one-month follow-up. Nor was that of BOP (difference=-0.2075, p-value=0.1917) with respect to CPI or BOP. No significant difference was also found at three-month follow-up.
Conclusion The OHI is not effective in ameliorating PD while it was combined with dental scaling and root planing.

Key word: Bleeding on Probing (BOP), Community-based, Community Periodontal Index (CPI), Diabetes, Peridontal Disease, Oral Hygiene Instruction (OHI), Randomized Control Trial (RCT).

並列關鍵字

Bleeding on Probing (BOP) ； Community-based ； Community Periodontal Index (CPI) ； Diabetes ； Peridontal Disease ； Oral Hygiene Instruction (OHI) ； Randomized Control Trial (RCT)

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