吸菸對非手術性牙周病治療後牙周狀況及口腔健康相關生活品質之影響

Smoking on Periodontal Status and Oral Health-related Quality of Life after Non-surgical Periodontal Treatment

邱湲婷(Yuan-Ting Chiu)

指導教授 ： 黃曉靈

高雄醫學大學/口腔醫學院/口腔衛生學系碩士在職專班/碩士(2017年)

摘要

目的
本研究目的是想了解持續吸菸對於非手術性牙周病治療後的牙周狀況及口腔健康相關生活品質之影響。
方法
前瞻性研究，自105年2月到106年1月，針對台南市立醫院牙科部，前來治療牙周病的患者分為兩組，吸菸者47人，未吸菸者96人，分別做治療前、治療後以及治療完三個月後測量PPD和BOP的指數，治療前填寫成年人口腔保健問卷第一次測量，內容涵蓋基本資料、吸菸行為、口腔保健行為、口腔健康態度、口腔健康知識、口腔照護生活品質；治療完成後填寫成年人口腔保健問卷第二次測量，內容涵蓋口腔保健行為；治療完成三個月後填寫成年人口腔保健問卷第三次測量，內容涵蓋口腔照護生活品質，最後運用SPSS統計系統的獨立t檢定、廣義估計方程式中的線性迴歸分析PPD、BOP、OHIP各數值指標治療前後的差異。
結果
研究結果顯示，在治療後吸菸組牙周囊袋深度平均值(標準差, ±SD)為3.02mm(±0.47)，非吸菸組為2.84mm(±0.45)，治療三個月後吸菸組深度平均值為2.95mm(±0.52)，非吸菸組為2.73mm(±0.38)，兩組間兩個時間點皆有顯著的差異(P-值=0.032, 0.007) 。將牙位分為六區，上顎前牙區在治療後吸菸組牙周囊袋深度平均減少0.48mm(±0.43)，非吸菸組減少0.36mm(±0.28)，有統計上的顯著差異(P-值=0.036)。牙齦出血指數在治療後吸菸組減少0.12面(±0.11)，非吸菸組減少0.18面(±0.13)，有統計上的顯著差異(P-值=0.017)。口腔健康相關生活品質在組內差異中，吸菸與非吸菸組在治療後，吸菸組平均減少3.16分(±8.74)，非吸菸組減少4.24分(±7.03)，表示兩組在生活品質皆有提高，且兩組在治療後均有統計上的顯著差異(P-值=0.004,<0.001)，但兩組治療後並無顯著差異(P-值=0.450)。分為七個大構面中心裡痛苦的層面，在牙周治療後，吸菸組改善0.07分(±2.59)，非吸菸組改善0.86分(±1.89)，兩組有統計上顯著差異(P-值=0.022)。
結論
吸菸狀況與否的確會影響非手術性牙周病治療後的牙周囊袋深度、牙齦出血指數以及生活品質的改善狀況。吸菸者在接受治療後牙周數值指標(PPD、BOP)會有改善，但是改善的程度比非吸菸者差。建議吸菸者可以在治療當中暫時戒菸，以達到更好的成效。結果中發現牙周囊袋深度、牙齦出血指數以及口腔健康相關生活品質的改善是有正相關的，吸菸與非吸菸者在接受NSPT治療後生活品質都會提高，表示牙周病患者不管有無吸菸都建議接受NSPT治療，以提高口腔健康相關生活品質。

關鍵字

牙周病 ； 吸菸 ； 口腔健康相關生活品質

並列摘要

Objectives:
To investigate the influence of outcomes of non-surgical periodontal treatment and oral health-related quality of life related to risk for smoking continuously.

Methods:
Prospective study. A total of 150 patients (including 47 smokers and 96 non-smokers) with chronic periodontitis were treated in Tainan Municipal Hospital Dentistry Department from February 1, 2016 to January 31, 2017. Clinical periodontal examinations(PPD,BOP) were performed at baseline (before treatment), one month (after treatment), and three months (after treatment).The patients fill in the first questionnaire (first measurement of adult oral health questionnaire) at baseline, covering basic information, smoking behavior, oral health behavior, oral health attitude, oral health knowledge, oral care and quality of life.One month after treatment ,they fill in the second questionnaire (second measurement of adult oral health questionnaire), covering oral health behavior.And three months after treatment ,they fill in the third questionnaire (third measurement of adult oral health questionnaire), covering oral care and quality of life. Finally, comparing with the difference of PPD, BOP and OHIP before and after treatment by independent t-test of SPSS statistical system and Linear regression of Generalized Estimating Equation

Results:
The results showed that the average PPD (± SD) was 3.02 mm (± 0.47) in the smoking group and 2.84 mm (± 0.45) in the nonsmoking group one month after treatment. The average PPD was 2.95 mm (± 0.52) in the smoking group and 2.73 mm (± 0.38) in the non-smoking group three months after treatment. There were significant differences between the two groups (P = 0.032, 0.007). The depth of the periodontal pocket decreasing was 0.48 mm (± 0.43) in the smoking group and 0.36 mm (± 0.28) in the non-smoking group over anterior region of maxilla. There was a statistically significant difference (P-value = 0.036) between these two groups too. Bleeding on probing(Bop) index decreasing 0.12 (±0.11) surface in the smoking group and 0.18 (±0.13) surface in the non-smoking group, with significant difference (P-value = 0.017).
The average Oral health-related quality of life decreasing 3.16 points(±8.74) in the smoking group,with significant differences(P-value =0.004) and decreasing 4.24 points(±7.03) in the non-smoking group after treatment, with significant differences (P-value =<0.001). But there were no significant differences between the two groups (P-value =0.450).
The level of psychological pain (in quality of life classification) improved 0.07 points (± 2.59) in the smoking group and 0.86 points (± 1.89) in the non-smoking group after periodontal treatment. There were significant differences between the two groups (P- value = 0.022)

Conclusions:
Smoking status has influence on the improvement of PPD, BOP, and quality of life in patients after taking NSPT. The periodontal disease index (PPD、BOP) will improve after treatment in smoking group, but the level of improvement is less than non-smoking group. Suggest that smokers can quit smoking temporarily during treatment to achieve better results. The results found that the periodontal pocket depth, gingival bleeding index and the improvement of oral health-related quality of life are positive correlation. The quality of life of Smokers and non-smokers will improve after NSPT both, representing patients which having periodontal disease with or without smoking are recommended to accept NSPT, in order to improve the oral health-related quality of life.

並列關鍵字

periodontal disease ； smoking ； Oral health-related quality of life

參考文獻

參考文獻

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