心血管疾病與牙周疾病及缺牙相關因素之探討
—以台北縣的社區健檢為例

中文摘要研究背景：牙周疾病是成人常見的慢性口腔疾病，在近期的許多研究中更發現口腔疾病與重大慢性疾病的相關性。相較目前國內對牙周疾病與全身系統性疾病之相關性研究有限，且在全身系統性疾病中的心血管疾病更佔據全國人民十大死因的第四位，希望藉此研究能了解牙周疾病的相關影響因素與心血管疾病的關係。研究目的：暸解台北縣成年人現存牙周疾病與心血管疾病之相關性，並探討牙周病與心血管疾病的共同危險因子與兩者之關係。研究方法：本研究以立意取樣調查台北縣地區之國小教職員工、校工級人員，年齡在三十五歲以上，自願接受口腔檢查及完成問卷調查者為研究對象，以橫斷式研究自民國九十三年九月至九十四年二月期間共收集有效樣本297人。所收集之資料則採用MS Access軟體完成資料建檔，再以SAS JMP統計套裝軟體，進行比較口腔健康狀況及身體疾病是否有差異。研究結果：結果發現平均男、女牙周疾病的盛行率為69%，社區牙周指數嚴重者容易發生在年紀較大、教育程度較低者。隨著年齡的增加，牙齦附連喪失的問題也隨之嚴重。低教育程度與高年齡層者其牙齒剩餘顆數也相對下降。本研究針對吸菸與不吸菸者進一步以迴歸分析來看心血管疾病、牙周疾病、牙齦附連疾病及剩餘牙齒的關係，發現不吸菸者中教育程度在專科以上者及罹患心血管疾病者各有0.55倍及2.24倍的機率會得到牙周疾病。且不吸菸者中年齡在50-64歲者及專科教育程度以上者罹患牙齦附連疾病的機率較35-49歲及專科以下者高出1.81倍及0.36倍。女性且有心血管疾病者其社區牙周指數與牙周附連喪失皆高於女性無罹患心血管疾病者（P 值＝0.0013；P 值＝0.0126）。嚼食檳榔、吸菸或喝酒再加上罹患心血管疾病者，其社區牙周指數及牙周附連喪失情形與那些未嚼食檳榔、吸菸、喝酒者則無顯著差異（P值皆＞0.05）。若和男性比較起來，女性且罹患心血管疾病者及嚼食檳榔者的牙周指數與牙周附連喪失較差。結論與建議：影響口腔健康的相關因素有性別、高年齡層、低教育程度、罹患心血管疾病及嚼食檳榔。應針對此族群進行定期口腔檢查，以了解口腔狀況並加強口腔保健與行為，進而能提高此族群的警覺性。許多文獻都提到抽菸是許多系統性疾病與牙周疾病的危險因子，然而，在本研究中並未發現抽菸會增加牙周疾病及心血管疾病的危險性，抽菸和其他的相關因素對牙周疾病而言都有各自不同的影響，但在本研究因受限於樣本數及經過分層分析後，無法推論吸菸與牙周病的關係。台灣地區近年來醫療發達、資訊快速、教育普及；但民眾在口腔衛生的保健及觀念卻顯薄弱；面對牙周疾病與心血管疾病有多種共同的危險因子，針對這些危險因子，建議在規劃國人健康計劃的同時，口腔健康照護團隊有責任也有義務推廣口腔衛生知識，如此才能提供個案更完整的全人健康醫療照護。關鍵字：牙周病、心血管疾病、吸菸

關鍵字

牙周病；心血管疾病；吸菸

並列摘要

Abstract Background: Periodontal disease (PD) is a very common oral disease among adults. Epidemiological studies have reported a strong association between PD and chronic systemic disease. However, studies relating PD to chronic systemic disease were limited. Study Objective: The purpose of this cross-sectional study was to evaluate the relationship of PD and CVD. Participants comprised 297 adults aged above 35 years from Taipei County in 2004. The statistical analyses were conducted by SAS JMP to determine the relationship between oral disease and chronic systemic disease. Results: The results showed the prevalence rate of PD among men and women was 69%. The community periodontal index of treatment needs (CPITN) increased with older age and (lower) education level. Serious periodontal attachment loss was related to increasing in age. Furthermore, decrease of the remaining number of teeth also correlated with lower education level and the elderly age group. For smokers and non-smokers, logistic regression analysis illustrated the relationship between CVD with PD, periodontal attachment loss and remaining teeth. Non-smoking subjects with higher education levels or with CVD had a 0.55-times and 2.24-times of risk for having PD respectively, than non-smoking subjects with lower education levels or without CVD. Non-smoking subjects aged 50-64 or with higher education levels had a 1.81-times and 0.36-times of risk for having periodontal attachment loss than non-smoking subjects aged 35-49 or with lower education levels. CPTIN and periodontal attachment loss in women with cardiovascular disease (CVD) were higher than women without CVD (p-value = 0.0013；p-value = 0.0126). CPTIN and periodontal attachment loss in areca quid, cigarette smoking and alcohol drinking user groups showed no significant difference with those groups who had never used areca quid, cigarette or alcohol. In comparison with women, the CPTIN and periodontal attachment loss were poor in men with CVD and having used areca quid. Conculsions: Oral health is a part of general health condition. It also reflects on good chewing function and balances nutrition in the human body. When CVD is a threat, the cost of treatment is very high. As the group of elderly is growing rapidly, oral health and periodontal disease prevention needs to be emphasized. Key Word: periodontal disease, cardiovascular disease, smoking