矯正機關內男性毒癮愛滋病毒感染者與非感染者口腔健康狀況之探討

目的: 本研究目的在探討男性收容人毒癮愛滋病毒感染者與非感染者的藥物濫用、口腔衛生知識、態度、行為及口腔健康狀況。方法: 本研究採橫斷性研究，共分成兩組收集個案，以結構式問卷調查及口腔檢查等方式，研究對象為法務部矯正署高雄第二監獄之在監服刑之男性毒癮收容人，區分愛滋病毒感染者與非感染者，徵詢意願參加有效樣本共302人(愛滋感染者150人、非愛滋感染者152人)，研究變項包括：感染愛滋病毒與否、年齡、教育程度、婚姻狀況、藥物濫用種類、使用年份、開始使用年齡、口腔衛生知識、正確刷牙法、牙刷更換率、刷牙次數、刷牙習慣、刷牙動機、看牙醫時機、攝取甜食習慣、牙周附連喪失、CPI、齲齒盛行率、填補率、口腔黏膜狀況等，施測結果進行描述性統計分析、卡方檢定、t -test、ANOVA等，並且利用邏輯斯迴歸分析評估各種因素對口腔健康狀況之影響。結果: 年齡層主要分佈25-40歲間，愛滋病毒感染者佔56.67%，非愛滋病毒感染者佔63.82%，學歷以國中(含)以下居多，婚姻狀態則是以未婚，職業均以工人為主。愛滋病毒感染者毒品使用以注射海洛因居多佔96.67%，次之為安非他命，而非愛滋病毒感染者毒品使用以安非他命為主佔75.66%，次之為海洛因。證實經由靜脈毒癮者與他人共用針具、稀釋液及容器是為感染愛滋病毒的高危險行為。影響口腔健康狀況的因素包括:愛滋病毒感染、年齡、教育程度、婚姻、檳榔、安非他命、海洛因、知識、態度以及行為等。缺牙顆數(MT) 愛滋病毒感染者為8.62(±7.32)顆及非愛滋病毒感染者為5.8(±5.51)顆，P值為0.0002。齲齒經驗指數(DMFT) 愛滋病毒感染者為12.95(±7.05)顆及非愛滋病毒感染者為11.05(±5.77)顆，P值0.011，亦有顯著差異。且服用雞尾酒療法者其齲齒數為3.26(±2.70)顆，未服用雞尾酒療法者其齲齒數為2.08(±2.47)顆，而有服用雞尾酒療法者其缺牙顆數為10.64(±9.15)顆，而未服用雞尾酒療法者其缺牙顆數為7.83(±6.73)顆，研究顯示有服用雞尾酒療法者其缺牙顆數較偏高。邏輯斯迴歸中分析得知，經過各項因素調整過後，邏輯斯迴歸分析，並且經過調整各個因素後顯示，年齡層41-50歲組上其缺牙顆數達6顆以上者比上25-40歲組的人3.24倍。在51-62歲組上其缺牙顆數達6顆以上者比上25-40歲組的人8.74倍。在CPI指數方面，並經由邏輯斯回歸中分析得知，41-50歲此年齡層的牙周囊袋大於4mm比上25-40歲間其牙周囊袋大於4mm的危險值是0.42倍。但是是否為愛滋病毒感染者與CPI指數異常方面則較無相關。由此研究可知缺牙顆數不單單是單純因疾病影響，還有隨著年齡增加及毒品濫用之使用種類均有影響其口腔健康狀況。口腔黏膜方面，並經由邏輯斯回歸中分析得知，愛滋感染者其口腔黏膜異常比非愛滋感染者口腔黏膜異常危險值大於1.7倍。顯示在監獄中仍為數不少的愛滋特殊牙科門診治療需求。結論：本研究顯示愛滋病毒感染者缺牙因素與使用海洛因及年齡有關，與免疫方面影響較無明顯差異。但愛滋病毒感染者其口腔黏膜異常比非愛滋感染者口腔黏膜異常危險值大於1.7倍。表示在監獄中還是有為數不少的愛滋特殊牙科門診治療需求，影響其口腔健康狀況有待更進一步的探討。而且缺牙顆數不單單是單純因疾病影響，還有隨著年齡增加及毒品濫用之使用種類均有影響其口腔健康狀況。許多患者口腔病變出現於發病初期，如能早期發現這些口腔疾病，可幫助個案早期治療，以幫助未來能提供收容人相關衛生教育、疾病防治及後續牙科醫療處遇之參考。

關鍵字

愛滋病毒感染；藥物濫用；口腔健康狀況

並列摘要

Abstract Objectives: This study aims to understand the oral health knowledge, attitudes, behaviors and oral health status of male HIV and non-HIV-infected drug abusers. Methods: This study is a cross-sectional study which was done in the Ministry of Justice Correction Department Kaohsiung Second Prison. The subjects were male inmates, serving sentences of drug addiction, who were willing to answer a structured questionnaire and oral examination. A total of 302 of inmates were included in the study. There were 150 HIV-infected and 152, non-HIV-infected individuals. The variables studied included:, the age of the subject, education level, marital status, the type of drug abuse, the use of year to start using age, oral health knowledge, correct toothbrushing method, toothbrush replacement rate, brushing times, brushing habits, brushing motive, the opportunity to see the dentist, the intake of sweets habit, periodontal attachment loss, CPI, caries prevalence, fill rate, and oral mucosal status. The results were analyzed using, chi-square test, t-test, ANOVA, and logistic regression analysis to assess the impact of various factors on the oral health status. Results: The age of subject ranged from 25 to 40 years old. HIV-infected individuals accounted for 56.67% and non-infected individuals account or 63.82%. The subjects were mostly less-educated (not higher than junior high school) and single laborers. Heroin accounted for 96.67% of injection drug used among HIV-infected drug users. This was followed by amphetamine usage. However, amphetamine accounted for 75.66% of durg used by non-HIV drug users, which was followed by heroin. This confirms that sharing needles, diluent and container with others is a high-risk source of HIV infection. The possible risk factors influencing oral health include HIV infection, age, education level, marital status, betel nut chewing, amphetamines, heroin, knowledge, attitudes, and behavior. The number of missing teeth (MT) in HIV-infected and non-HIV-infected subjects was 8.62 (± 7.32) and 5.8 (± 5.51), respectively (P value= 0.0002). Caries Experience Index (DMFT) in HIV-infected and non-HIV-infected subjects was 12.95(±7.05) and 11.05(±5.77), respectively (P value= 0.011). Both showed significant difference. The number of caries teeth in subjucts taking HAART and not taking HAART was 3.26 (± 2.70) and 2.08 (± 2.47), respectively, while the number of MT in those taking HAART and not taking HAART were 10.64 (± 9.15) and 7.83 (± 6.73), respectively. The study showed subjects taking HAART had more missing teeth compared with subjects not taking HAART. After adjusing for each factor, logistic regression analysis showed that the number of people with more than six missing teeth in the 41-50-years-old group is 3.24 times in the 25-40-year-old group. The number of people with more than six missing teeth in the 51-62-years-old group is 8.74 times in the 25-40-year-old group. In the CPI index, logistic regression analysis showed that the risk of people with more than 4mm periodontal pocket in the 41-50-years-old group is 0.42 times in the 25-40-years-old group. There was no correlation between existence of HIV infection and abnormality of CPI index. Our research shows that the number of missing teeth and oral health status are not only affected by disease, but also increasing age and the type of drug abuse. In the aspect of oral mucosa, logistic regression analysis showed that the risk of having abnormal oral mucosa in HIV-infected persons was 1.7 times in non-HIV-infected persons. It showed that there was a large number of special dental treatment needs for AIDS in prison. Conclusion: This study shows that the missing teeth in HIV-infected persons were related to heroin use and age, but not related to immunization significantly. However, the risk of having abnormal oral mucosa in HIV-infected persons was 1.7 times in non-HIV-infected persons. It showed that there was still a large number of special dental treatment needs for AIDS in prison. The impact to oral health needs further investigation. Furthermore, missing teeth and oral health status are affected by disease itself, as well as increasing age and the type of drug abuse. Oral lesions appeared in the early stage in many patients, hence, early detection of oral diseases can help the patient receive early treatment. Our study can help provide a reference in case of inmate-related health education, disease prevention and follow-up of dental office in the future.

並列關鍵字

HIV Infection ； Drug Abusers ； Oral Health Status

參考文獻

文獻參考

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