口腔衛生教育介入對南部地區發展遲緩兒童
口腔衛生狀況之成效評估

研究背景：國內有許多關於口腔健康狀況的調查，其研究對象大多是以正常人為主，而對於弱勢族群，如發展遲緩者，並沒有受到重視，根據國內、外研究指出，齲齒仍為威脅發展遲緩兒童口腔健康最嚴重的問題，因此口腔衛生之照護，對發展遲緩者而言，比一般人還要來得重要。而研究更發現在發展遲緩者的父母親和照護者的口腔衛生知識方面，有40%的人沒有接受過任何口腔衛生的指導，反映出父母親和照護者對於口腔保健資訊和訓練的課程有實際上的需求。然而，口腔衛生教育介入對提升口腔健康狀況是最直接有效的方法。研究目的：探討發展遲緩兒童及其主要照顧者口腔衛生教育介入前後口腔衛生習慣、知識、態度的成效，及發展遲緩兒童牙菌斑殘留率之成效。研究方法：研究對象為本研究對象以立意取樣方式。以南部地區早療機構的學齡前兒童為對象，共計301人。針對受試兒童、父母或照顧者提供口腔衛生教育課程等潔牙技巧教導及口腔保健宣導，及採一對一個別潔牙技巧指導，間隔2週後執行二次團體衛教介入，分析比較兩階段間的差異。以描述性統計進行各變項初步分析，再使用McNemar’s test及paired t- test進行推論性統計。研究結果：研究發現兒童在口腔衛生教育介入後不論是全口或是不同側面的牙菌斑殘留率皆低於介入前，其中頰側面牙菌斑殘留率改善最多，其次依序為為近心頰側、遠心頰側、舌側面、近心舌側，而改善效果最小為遠心舌側；口腔衛生教育介入後，照護者平均知識得分高於介入前；而在照護者態度部份，在介入後平均態度分數較介入前高，表示在口腔衛生教育介入後，照護者知識有顯著提升，且態度較正向。結論與建議：本研究發現口腔衛生教育課程介入後，兒童不管在口腔衛生行為或是潔牙後牙菌斑殘留率都有改善，可推論發展遲緩兒童經由口腔潔牙技巧教導後，可讓兒童在口腔清潔上具有改善效果。而主要照顧者的潔牙行為介入前後差異不大，但在照護者知識有顯著提升，而且照護者態度較正向。整體而言，口腔衛生教育課程的介入對發展遲緩兒童的口腔衛生具有改善的效果。

關鍵字

發展遲緩兒童；口腔衛生教育；牙菌斑殘留率

並列摘要

Background There have been nunerous domestic surveys on the oral health status of normal people, For few disadvantaged groups, such as the developmentally delayed. According to domestic and foreign researches, dental caries is the most serious problem of oral health that threatens children with developmental delay. Oral health care is more important in children with development delay than in normal people. While researchers also found that 40% of parents and caregivers of children with developmental delay have not received any oral health guidance, which reflects the parents and caregivers need for oral health information and training courses. Actually, oral health education intervention is the most direct and effective way to enhance the oral health status. Purpose Objectives To investigate the effectiveness of oral hygiene habits, knowledge, attitude, and the plaque residual rate, before and after the intervention of oral health education for children with developmental delay and their primary caregivers. Methods The research subjects were obtained with purposive sampling and a total of 301 pre-school children from early intervention agencies in the southern region of Taiwan were recruited. To the tested children, parents and caregivers, oral health education courses, such as teeth cleaning skills and oral health advocacy were provided. One-to-one individual teeth cleaning techniques were employed and secondary group education intervention guidance was performed to compare the difference between two phases after an interval of two weeks. Descriptive statistics were used for preliminary analysis of each variable and McNemar’s test.and paired t- test for inferential statistics. Results The study found that children's plaque residual rate was lower after the intervention of oral health education, either whole mouth or different areas of the mouth. Plaque residual rate on the buccal side improved most, followed by the mesial buccal side, telecentric buccal side, lateral sides of the tongue and proximal side of the tongue. There was less improvement in the telecentric tongue. After oral health education intervention, the caregiver’s average knowledge scores were higher than before intervention. As to the attitude of caregivers, the average scores were also higher after intervention. Oral health education intervention significantly enhanced the caregiver’s knowledge and a more positive attitude. Conclusion and Suggestion This study proposes that after the intervention of oral health education programs, regardless of whether the acts of oral hygiene or plaque residual rate after cleaning teeth, oral health improve in children. It can be inferred that via oral cleaning techniques instriction, children with developmental delay show improvement in oral hygiene. There is no significant difference before and after behavior intervention by the primary caregivers, whereas their knowledge significantly improves and attitude is positive. Overall, oral health education intervention for children with developmental delay presents an improved effect.