護理之家住民不同口腔清潔工具對於口腔衛生與菌量影響的比較

背景：近年來老年人口增加，目前台灣人口結構也轉型成為高齡社會，全國各地增設許多長期照護機構，提供照護老年人或特殊需求者的生活，在長照機構的老年人常有之口腔疾病問題為牙周疾病和齲齒，高達九成以上，與牙菌斑堆積有很大的相關性，而國內長照機構對於口腔清潔工具的使用上有差異。目的：對於護理之家長期臥床住民的口腔照護上，比較牙刷及口腔棉棒在移除牙菌斑與菌量的平均數差異影響，提供照護者在選擇最佳口腔清潔工具的參考依據。方法：以同一機構為單位，進行準實驗設計（Quasi-experimental designs）之研究，使同一住民單組前後測（one-group pretest-posttest），測量口腔衛生及菌量，並使用魏克生符號檢定（Wilcoxon signed ranked test）前後測之差異。對照組在晚餐後，依照該機構原本使用的口腔棉棒清潔口腔，經由口腔衛生師替住民執行連續7天的口腔清潔。實驗組在對照組結束後至少一個星期的恢復期，將原本使用的口腔棉棒更換成軟毛牙刷，作為本研究的介入。結果：本研究個案數為11位住民，男性有6人（54.5%），女性有5人（45.5%），平均年齡為59.18±15.26歲，住民牙齒平均顆數為21.73±5.88顆自然牙，對照組第一天前測與第七天後測差值之口內菌量平均數為8.02x〖"10" 〗^7±8.31x〖"10" 〗^7，實驗組第一天前測與第七天後測差值之口內菌量平均數為2.14x〖"10" 〗^8±3.20x〖"10" 〗^8，此統計檢定p值為0.173，無統計上顯著性的差異；對照組第一天前測與第七天後測差值之牙菌斑指數（PI）平均數為0.78±0.48，實驗組第一天前測與第七天後測差值之牙菌斑指數（PI）平均數為1.72±0.42，此統計檢定p值為0.011，有統計上顯著性的差異。結論：口腔衛生師替護理之家住民執行口腔清潔時，使用牙刷比口腔棉棒在移除牙齒上牙菌斑有更良好的效果。

關鍵字

口腔清潔工具；口腔細菌；牙菌斑移除；長期臥床者；護理之家

並列摘要

Background: In recent years, the population of the elderly has increased. At present, the population structure in Taiwan has been transformed into aged society. Many long-term care institutions have been established throughout the country to provide care for the elderly or special needs. The elderly with long-term care institutions often have periodontal disease and dental caries, up to 90%, which has a great correlation with plaque accumulation, while domestic long-term institutions have different use of oral cleaning tools. Purpose: For the oral care of long-term bed-ridden residents in nursing homes, compare the difference in the average number of dental plaques and oral bacteria in toothbrushes and swabs, and provide reference for the caregiver in selecting the best oral cleaning tools. Methods: Quasi-experimental designs were conducted in the same institution, and the same resident's one-group pretest-posttest was used to measure oral hygiene and bacterial counts, and the Wilcoxon signed ranked test was used to determine the difference between before and after. After the dinner, the control group cleaned the mouth according to the institution's original use of the swabs, and performed oral cleaning for 7 consecutive days by the oral hygienist. In the recovery period of the experimental group at least one week after the end of the control group, the swabs were replaced with the soft toothbrushes as the intervention in the study. Results: The number of cases in this study was 11 residents, 6 males (54.5%) and 5 females (45.5%), the average age was 59.18±15.26 years old, and the average number of teeth in residents was 21.73±5.88 natural teeth. The average number of bacteria counts in the mouth measured on changing between the post-test of day7 and pre-test of day1 of the control group was 8.02x〖"10" 〗^7±8.31x〖"10" 〗^7 and the experimental group was 2.14x〖"10" 〗^8±3.20x〖"10" 〗^8 (p = 0.173). The average number of the dental plaque index (PI) measured on changing between the post-test of day7 and pre-test of day1 of the control group was 0.78±0.48 and the experimental group was 1.72±0.42 (p = 0.011).