煙毒犯口腔健康狀況及相關因素探討

煙毒犯在日常生活上無法如一般常人般能完善的照顧自己，往往需要仰賴他人如家人或醫護人員的協助照料，此類病患或因吸食毒品所產生的睡眠少或睡眠習慣改變、食慾不振、飲食習慣改變、多話、情緒不安等症狀，或因服用毒品所導致的副作用，例如：唾液分泌減少、意識模糊不集中或精神恍惚症狀致使部份生活自我照顧功能退化的關係，種種原因常使得此類患者無法確實做到口腔清潔的工作。然而國內對煙毒使用者口腔健康危害之相關研究卻非常缺乏，因此以口腔健康觀念調查問卷及口腔檢查表為工具，調查了解煙毒犯的物質濫用情形、口腔健康狀況及其相關之飲食習慣，以期了解現況並建立資料，作為提供未來研擬改善對策的參考。研究中共收集了422位男性煙毒犯，其中其中平均齲齒指數（DMFT）為9.56顆，而填補率僅22.36%，顯示仍有將近80﹪的未治療牙，牙周疾病的盛行率為97.63%。物質濫用方面菸及檳榔居多數分別為93.37﹪、86.97﹪，毒品則以海洛因、安非他命及搖頭丸為主分別為41.94﹪、39.81﹪、39.57﹪。物質濫用對口腔的影響，在平均齲齒指數方面（DMFT）有檳榔的影響大於菸大於酒，及安非他命大於海洛因大於K他命大於搖頭丸的趨勢，在社區牙周指數方面（CPITN）有菸的影響大於檳榔大於酒，及K他命大於搖頭丸大於安非他命大於海洛因的趨勢，在口腔黏膜病變方面，整體而言不同物質使用者之口腔黏膜病變以白斑症（9.91﹪）＞口腔黏膜下纖維化（3.77﹪）＞潰瘍（0.94﹪）＞膿瘍（0.47﹪）＞口腔癌（0.24﹪）。相關影響因素方面以吃零食、每天吸食安非他命或海洛因一次到數次及海洛因使用途徑為吸食者，這都是導致煙毒犯口腔健康惡化的相關影響因素。

關鍵字

煙毒犯；口腔健康狀況

並列摘要

The drug offenders are generally considered that those who can not fully take care of their own daily living activities, and most of time can not be responsible for their own behaviors. In many cases, the drug offenders have to rely on medical professionals or family. offender patients usually cannot perform their oral hygiene habits etc. This is because part of their self-caring function is deteriorated by such symptoms of drug use as a change in sleeping habit, loss of appetite, a change in eating habit, talkativeness and emotional instability, or by the direct side effects of drugs, such as decreased saliva secretion, weak consciousness, or absentmindedness. Nevertheless, there are very scarce studies concerning drug offenders’ oral health crisis in Taiwan. Hence, a questionnaire for oral health knowledge and an oral examination table were adopted as instrumentations to investigate drug offenders’ substance abuse condition, oral health condition and pertinent eating and drinking habits. This study was conducted to understand the status quo and create a database, which will serve as reference for lying down strategies for improvement in the future. A total of 422 male drug offenders participated in this study. The mean DMFT of the subjects is 9.56 and the filling rate is merely 22.36%, which indicates that nearly 80% of the subjects leave their decayed teeth untreated. The prevalence rate of periodontal disease among the subjects is 97.63%. In the aspect of substance abuse, the two most commonly consumed substances among the subjects are cigarettes (93.37%) and betel nuts (86.97%); in the aspect of drug abuse, the three more commonly used narcotics among the subjects are heroin (41.94%), amphetamine (39.81%), and MDMA (39.57%). As for the effects of substance abuse on oral health, the following substances are ranked by the greatness of their effect on the DMFT: betel nut, cigarette and alcohol; amphetamine, heroin, ketamine and MDMA. The following substances are ranked by the greatness of their effect on the CPITN: cigarette, betel nut and alcohol; Ketamine, MDMA, amphetamine and heroin. In the aspect of oral mucosa disease, the most prevailing disease overall among the users of different substances is leukoplakia (approximately 9.91% of the subjects), followed by oral submucosa fibrosis (OSF)(3.77%), ulceration (0.94%), abscess (0.47%), and oral cancer (0.24%). Related factors that can worsen drug offenders’ oral health include eating junk food, using amphetamine one to several times a day, and consuming heroin by inhaling or smoking.