牙周狀況與唾液性質因素對局部無牙患者贋復治療滿意度之影響

Effects of Periodontal Condition and Saliva Quality on the Partially Edentulous Patients’Satisfactions with Prosthetic Treatments

林佩寰(Pei-Huan Lin)

指導教授 ： 林哲堂

臺北醫學大學/口腔醫學院/牙醫學系碩博士班/碩士(2013年)

摘要

隨著人口老化比例逐年上升，中老年人口因缺牙而產生口腔贋復需求的比例亦隨之增加。對局部或全部無牙的患者而言，口腔贋復治療如固定式或活動式義齒可改善其咀嚼功能、整體美觀以及增進其心理舒適度。過往研究顯示口腔贋復物治療（包含固定式與活動式義齒）之預後，皆與患者本身的口腔衛生習慣緊密相關，然而目前尚無研究針對患者的口腔衛生習慣和牙周狀況、唾液性質及贋復治療滿意度之間三方探討關聯性和影響程度。

本研究的目的為分析贋復需求患者接受口腔贋復物治療（特別是局部活動義齒）前後之口腔衛生情形和牙周狀況（含牙菌斑指數、牙齦發炎指數、牙周囊袋深度、牙齒動搖度）、其唾液性質（包括酸鹼度、流速、緩衝能力、總抗氧化能力、超氧歧化酵素濃度）是否影響患者對贋復治療之滿意度。研究於臺北醫學大學附設醫院贋復牙科診間進行，由贋復專科訓練醫師評估患者狀況符合研究設定後納入個案，自西元2011年十一月起，至2012年十月已累計有三十九位局部無牙患者。個案接受三個階段之牙周狀況量測及唾液採集，此三階段分別為：初診就診前、贋復治療完成後、以及治療結束後三個月回診期間。在患者口腔衛生之評估上採用牙菌斑指數計量，牙周狀態之評估則採用牙周囊袋深度、牙齒動搖度、以及牙齦發炎指數計量。各治療階段採集之唾液樣本經檢測唾液酸鹼值、流速及緩衝能力後，離心處理而以酵素免疫分析測讀儀測得其總抗氧化能力（total antioxidant status，TAS）與所含之超氧歧化酵素（superoxide dismutase，SOD）濃度。對贋復物之滿意度及治療成效則以口腔健康影響指標（oral health impact profile，OHIP）分數評估。所得之資料數據以SAS 9.3版進行統計分析。

研究結果顯示口內局部無牙狀態及贋復物部位之不同與治療後滿意度無顯著相關。然而，牙菌斑指數與口腔健康影響指標之心理失能領域相關（p<0.05）且與社交失能領域相關（p<0.01）;牙齦發炎指數與口腔健康影響指標之生理不適領域、生理失能領域和心理失能領域相關（p<0.05）;唾液緩衝能力與口腔健康影響指標之功能限制領域及心理失能領域相關（p<0.05）;超氧歧化酵素濃度則與口腔健康影響指標之心理困擾領域及身心障礙領域相關（p<0.05）。

本研究結論為局部無牙患者的牙周狀況及唾液性質可作為後續局部活動義齒贋復治療後患者滿意度評估之一參考指標，後續研究仍須增加個案收集量以減少統計上之誤差。

關鍵字

局部活動義齒 ； 牙菌斑指數 ； 牙齦發炎指數 ； 唾液 ； 總抗氧化能力 ； 超氧歧化酵素 ； 口腔健康影響指標

並列摘要

Proportion of the aging population in the developing countries is increasing year by year, along with the increased demand of oral prosthetic treatment. In partially or fully edentulous patients, the treatment of oral prostheses can improve their masticatory efficiencies, aesthetics and what is more, the psychological benefits. Early studies have indicated that the prognoses of oral prostheses, inclusive of fixed or removable dentures, are closely related to the oral hygiene and oral status of the patients. However, there is no research make mention of the association among the periodontal condition, oral hygiene, saliva quality and the prosthetic prognosis.

The purpose of this study was to conduct an analysis of the relationship among the oral hygiene, the periodontal condition, the quality of saliva (i.e. the pH value, the flow rate, the buffer capacity, the antioxidant status and the amount of superoxide dismutase) and patients’ satisfactions with fixed or removable prostheses. In this prospective follow-up study, a total of thirty-nine partially edentulous patients in TMUH were recruited from November 2011 to October 2012. The oral hygiene of patients was assessed based on the plaque index (PI) scale. The periodontal condition was examined using the measurements of the pocket depth, the mobility scale and the gingival index (GI) scale. The pH value, flow rate and buffer capacity of saliva were estimated through the collected saliva of patients by chewing a block of paraffin wax for five minutes. Specimens of saliva were assessed in measuring glass for flow rate determination and examined on test strips for pH value and buffer capacity assessment. Besides, the saliva was centrifuged and extracted for total antioxidant status (TAS) and superoxide dismutase (SOD) measurement with commercial kit and ELISA reader. The patients’ satisfactions with prosthetic treatments were estimated via the oral health impact profile (OHIP). Data analysis was carried out with SAS software (version 9.3).

The results showed that the edentulous condition was not significantly associated with the OHIP, however the PI status of patients was significantly associated with the domain of psychological disability (p <0.05) and the domain of social disability (p<0.01) in OHIP. The GI status of patients was significantly associated with the domains of physical pain, physical disability, and psychological disability in OHIP (p <0.05). The buffer capacity of saliva was significantly associated with the domains of functional limitation and psychological disability in OHIP (p <0.05). The SOD of saliva was significantly associated with the domains of psychological discomfort and handicap in OHIP (p <0.05).

The results of this study suggested that if the less value of PI/GI/SOD or the more buffer capacity the partially edentulous patients had the better patients’ satisfactions and prognosis of prosthetic treatment the dentists could expect. Further research should collect more subjects to increase the reliability of the study.

並列關鍵字

removable partial denture ； plaque index ； gingival index ； saliva ； total antioxidant status ； superoxide dismutase ； oral health impact profile

參考文獻

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