- 學位論文
人格特質、醫病溝通與義齒品質對台灣老人全口義齒滿意度的影響
The Influence of Patient Personality, Dentist-Patient Communication and Denture Quality on Denture Satisfaction among Taiwanese Old Complete Denture Wearers
摘要
目的: 許多文獻指出老年人的義齒滿意度與其口腔健康相關生活品質可能有關。但從以往的滿意度調查中顯示超過30％以上的老人不滿意他們的義齒，因此了解影響義齒滿意度的因素，將有助於改善老人配戴義齒後口腔健康相關生活品質。但到目前為止，仍然少有研究針對患者的人格特質、牙醫師與病人間的溝通狀況、義齒品質與義齒滿意度之間的關係加以探討。本研究之目的即是為了探究個人因素（即社會人口學變項、人格特質）及臨床因素（即牙醫師與病人間的溝通、義齒品質）與台灣老年人口的全口義齒整體滿意度間之相關性。關於老年人全口義齒整體滿意度和口腔健康相關生活品質之間的關係也將被探討。 材料與方法: 本研究針對高雄市65歲以上裝置公費全口義齒之老人進行多階段隨機取樣之橫斷性研究，並對抽樣樣本進行問卷調查以及人格特質與義齒品質評估，共得到387位研究樣本。本研究以百分比、平均數及標準差呈現研究樣本各變因之分佈情形，並以多元邏輯斯迴歸模型探討病人全口義齒整體滿意度與基本人口學變項、人格特質、牙醫師-病人間溝通狀況以及義齒品質間的相關性，以此探討全口義齒整體滿意度影響因素中與不滿意有關之重要變項。 結果: 本研究樣本之「全口義齒整體滿意度」中不滿意者佔36.7%、尚可者佔27.6%、滿意者佔35.6%；其年齡分佈為65-74歲佔59.7%、75歲以上佔40.3%；其性別分佈為男性佔64.1%、女性佔35.9％。「教育程度」中不識字佔17.1%，國小佔47.3%，國中佔13.4%，高中及以上佔22.2%。｢居住型態｣中獨居者佔16.8%；｢人格特質｣中非理性者佔7.8%；「牙醫師與病人間的溝通狀況」中未感受到充分溝通者佔39.3%；「義齒品質」 (FAD)的得分中位數為8，小於8的低分組佔40.6%。單變項分析顯示「全口義齒整體滿意度」與｢居住型態｣(COR=2.04，95% CI=1.06-3.95)。｢人格特質｣(COR=4.86，95% CI=1.60-14.77)、「牙醫師與病人間的溝通狀況」(COR=7.46，95% CI=4.34-12.80)及「義齒品質」(COR=5.02，95% CI=3.02-8.37)有顯著相關。控制個人因素及臨床因素後進行多變項分析後發現：「全口義齒整體滿意度」之顯著變項僅為「牙醫師與病人間的溝通狀況」(AOR=6.41，95% CI=2.63-15.61)及「義齒品質」(AOR=4.40，95% CI=1.76-11.06)，此二變項稀釋｢居住型態｣及｢人格特質｣對「全口義齒滿意度」的效應，且此二變項之間無交互作用。「全口義齒整體滿意度」與「口腔健康相關生活品質狀況」之各分項得分以及總分均有顯著相關。 結論: ｢義齒品質｣及｢牙醫師與病人間的溝通｣是老人全口義齒整體滿意度顯著的影響因子。義齒品質各分項中對全口義齒整體滿意度的影響因子包含靜態咬合、動態咬合、上顎義齒固著度、上顎義齒穩定度與下顎義齒穩定度。本研究結果可提供牙醫師及其他口腔照護工作者在擬定全口義齒治療策略時之參考，亦即加強牙醫師與病人間溝通之訓練並提升影響義齒品質各分項的臨床技巧與技工室技術，方能提升全口義齒治療的整體滿意度，進而提升其口腔健康相關生活品質。
並列摘要
Objective: Denture satisfaction is associated with oral-health-related quality of life in elderly denture wearers. Investigation of the patient’s satisfaction in the denture wearer often indicated that more than 30% of wearers have reported dissatisfaction with their dentures. Until now, only few little research has addressed the relationship between patient personality, dentist-patient communication, denture quality, and denture satisfaction. Aim of this study was to investigate individual (ie, sociodemographic characteristics, patient personality) and clinical factors (ie, dentist-patient communication, denture quality) associated with complete denture satisfaction among the Taiwanese elderly population. The relationship between denture satisfaction and quality of life among those elderly was also identified. Methods: A multistage sampling and cross-sectional design was used to collect data. A total of 387 full edentulous citizens from Kaohsiung, Taiwan, aged 65 years and above, who received a new set of complete dentures were included. The participants were personally interviewed using a structured questionnaire, personality classification, and denture quality evaluation. We conducted descriptive analyses to estimate the distribution of demographic characteristics, dentist-patient communication, FAD scores, and complete denture satisfaction. The association between general satisfaction and potential factors were simultaneously examined using polytomous logistic regression analysis. Results: Among the participants, 36.7% were dissatisfied with their dentures. They ranged in age from 65 to 99 years old, with 59.7% participants aged from 65 to 74 years, and 40.3% aged 75 or older. Of the participant, 64.1% were male, and 35.9％ were female. There were 17.1% illiterate, 47.3% having completed elementary school, 13.4% junior high and 22.2% senior high or above. The minority (16.8%) of the sample lived alone. Few (7.8%) of the participants were not philosophical, and approximately 39.3% did not perceive sufficient communication from the dentist. The median FAD score was 8, and 40.6% of participant had low score. Living status (crude odds ratio [COR] = 2.04), personality (COR = 4.86), dentist-patient communication (COR = 7.46), and denture quality (COR = 5.02) were associated with patients’ complete denture satisfaction. Multivariate regression model showed dentist-patient communication (adjusted odds ratio [AOR] = 6.41), and denture quality (AOR = 4.40) were important factors of complete denture satisfaction, which minimized the effect of the living status and personality factor. Dentist-patient communication and denture quality independently influence the denture satisfaction among elderly denture wearers. The perception of no dentist-patient communication and low denture quality was highly associated with the dissatisfaction of patients with dentures. Participants who dissatisfied with their denture had significantly higher scores of functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, handicap and OHIP-14 total scores than those who satisfied with their denture. Conclusion:The findings of this study emphasize that dentist-patient communication and denture quality independently and strongly influence the denture satisfaction of elderly adults who wear complete dentures. The importance of training programs for dentists and oral healthcare providers aimed at enhancing dentist-patient communication should be emphasized. Additional efforts should be made to improve denture quality through the development of clinical skills as well as technical procedures for enhancing denture occlusion, articulation, retention, and stability to increase the denture satisfaction and the oral health related quality of life in those elderly adults.