兒童利用牙齒塗氟之相關因素探討
--以南部某醫學大學兒童牙科門診為例

摘要背景：據估計全民健保一年在齲齒的花費約有新台幣150多億元，而氟化防齲是目前認為最直接且積極、有效的方法；為改善兒童口腔狀況以及推廣氟化物的使用，中央健保局於2004年7月開辦『兒童牙齒預防保健服務』，提供未滿5歲兒童每年2次氟化防齲處理口腔項目。許多國內、外研究認為父、母親對於口腔預防保健的了解、支持與參與，將會影響兒童能否接受適當的醫療照護，故為了解影響兒童利用牙齒塗氟之相關因素，特別進行此次調查。目的：調查兒童接受牙齒塗氟經驗的實際情形，藉此探討兒童因素、家長因素與其對牙齒塗氟的認知、接受程度對兒童接受牙齒塗氟應用之相關性。方法：針對南部某醫學大學兒童牙科門診部就醫兒童患者之家長，立意取樣共計316位，以結構式問卷進行面訪調查。所得資料以JMP5.1.2版統計軟體進行建檔、分析。結果：參與本研究的兒童個案數共有316人，研究中有80.06％的兒童從未接受過牙齒塗氟；其次是曾經自費接受過的有11.39％；接受健保給付塗氟的有8.54％。根據兒童自身因素與其接受牙齒塗氟經驗做比較，分析結果在兒童基本資料方面不具統計上顯著差異，但是有接受塗氟經驗的兒童使用氟化物習慣的比例高於從未接受過的。家長因素方面，有接受塗氟經驗兒童的家長在教育程度、社經地位的表現較佳；接受過牙齒塗氟、塗氟知識得分較高的家長其兒童接受塗氟經驗比例亦較高，且具統計上顯著性差異（p<0.05）。知道牙醫師有塗氟的家長會帶小孩去接受的是不知道者的17.78倍；曾接受牙齒塗氟的家長會帶小孩接受塗氟是不曾接受者的8.12倍；贊成健保給付牙齒塗氟的家長會帶小孩接受塗氟是不贊成者的3.33倍；家長牙齒塗氟知識達40分以上會帶小孩接受塗氟是未滿40分者的4.89倍。結論與建議；本研究調查結果顯示影響兒童利用牙齒塗氟之相關因素，就兒童自身因素對其接受牙齒塗氟的使用率影響不大；但在家長因素方面，知道牙齒塗氟、曾接受過牙齒塗氟、贊成健保給付牙齒塗氟、牙齒塗氟知識得分較高的家長，其小孩接受過牙齒塗氟的比例較高。是故，在牙科醫療院所或是報章雜誌、網路媒體等針對家長大力宣導並在宣導時加強牙齒塗氟預防齲齒的安全性與重要性，必可提高兒童牙齒塗氟的接受率，以收改善兒童口腔齲齒狀況、推廣氟化物使用及避免醫療資源浪費之效。關鍵字：牙齒塗氟、牙齒預防保健

關鍵字

牙齒塗氟；牙齒預防保健

並列摘要

Abstract Background: The cost of caries treatment was about 15 billion a year, according to the Bureau of National Health Insurance (BNHI). Because fluoride gels application was proven to be the most effective and direct way to prevent dental caries. A service of dental fluoride application for children under 5 years old twice a year in the “Preventive Dental Health Service for Children” by the BNHI began in July 2004. Many studies pointed out that the attitude and awareness of parents on preventive oral health may prevent the children from receiving appropriate medical care, the study was performed to understand the associated factors affecting fluoride gels application in children. Purpose: The aim of this study was to evaluate the fluoride gel experience of children, and its` association between knowledge and acceptance of fluoride gels application contributed to children or parents. Methods: The study was performed at the department of pedodontics at a medical university hospital in southern Taiwan. With a total of 316 visiting children, were interviewed with a structured questionnaire. All of the data were coded and analyzed with compact software JMP version 5.1.2. Results: Among the 316 samples, 80.06% of them had never received fluoride application; 11.39% of the children received self-paid fluoride application; and 8.54% of them received fluoride application under insurance payment. There was no significant difference between children itself and the acceptance of fluoride application, but more proportion of them who had ever received fluoride application were used to fluoride than those never received. As for parental factors, the parents of those children who ever received fluoride application had better performance in educational level and socioeconomic status; more proportion of the children received fluoride application if their parents had ever received fluoride application or had high scores of fluoride application knowledge, which was statistically significant (p<0.05). It was 17.78 times for parents who know the fluoride application from their dentist had their children receive the procedure than those unaware of it; it was 8.12 times of parents who had ever received fluoride application would bring their children to receive the procedure than those not receiving the procedure; parents who agree with the fluoride application, would bring their children to receive the procedure was 3.33 times than those that did not; parents with fluoride knowledge scores over 40 would bring their children to receive the fluoride application was 4.89 times than those with scores under 40. Conclusion and suggestions: The result of this study showed that the children themselves has no prominent effect on the utilization of fluoride application; as for their parents, who were aware of dental fluoride application, and who had ever received fluoride application, or agreed with insurance payment for fluoride application, and those with high scores of fluoride application knowledge had a higher proportion of their children received fluoride application. We suggested that a promotion program of preventive dental health at clinics, TV and radio broadcasts, and websites with accentuation on the safety and importance of fluoride application towards parents may enhance the utilization rate of fluoride application by children, with the effect of improving caries status of children, reduce the expenditure of insurance payment for caries management. Key words: Fluoride gel application, Preventive dental health