台灣發展遲緩兒童的齲齒型態及相關因素之探討

Caries Patterns and Related Factors among Children with Developmental Delay in Taiwan

劉青穎(Qing-Ying Low)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生學系碩士班/碩士(2015年)

https://doi.org/10.6832/KMU.2015.00089

摘要

背景:發展遲緩兒童，是指在認知發展、生理發展、語言及溝通發展、心理社會發展或生活自理技能等方面，有疑似異常或可預期有發展異常情形，並經衛生主管機關認可之醫院評估確認，發給證明之兒童。之前很多研究指出身心障礙的孩童相較同齡的正常兒童有較高的齲齒盛行率和較差的口腔狀況。但是，在台灣有關發展遲緩兒童齲齒研究並不多。
傳統上，齲齒是用齲齒經驗的平均數值來測量，但是這些測量值對於某族群之齲齒過程中不同的病因、宿主反應和環境狀況是的描述是有限的。因此，後來有學者提出齲齒型態來描述某族群/個人的齲齒狀況及提高鑑別一些懷疑和齲齒有相關的危險因素。我們的研究選擇Psoter et al.學者所提出的齲齒型態為病例定義，主要是因為他們沒有採用先前的齲齒型態劃定。另外，該齲齒型態也不是階層式的分配，而一個人可以同時擁有數種齲齒型態。
目的:本研究的目的是要探討台灣的發展遲緩兒童的齲齒狀況和齲齒型態，並且鑑別出可預測齲齒型態的一些社會經濟變項和行為因素。
方法 研究進行時間是從2013年11月到2014年12月。被納入我們的研究的對象是在台灣的早療機構5歲以下的孩童。我們使用立意取樣法，獲得了188位研究對象。口腔檢查是由4位牙醫師進行，施測者間信度Kappa值為0.89。另外有一份自填式問卷由家長卅照護者填寫。本研究有通過高雄醫學大學的科學研究與倫理審查委員會（IRB）的批准，我們也請孩童的家長簽署受試者同意書。統計的分析有使用卡方鑑定、變異數分析和多元邏輯斯迴歸分析。
結果:本研究有130為男童和58位女童，平均年紀為3.10 ± 0.88。平均的deft為1.99 ± 3.50，齲齒盛行率為32.98%。四歲的時候盛行率最高的為第二乳臼齒的小窩裂溝型，接著是上顎門牙型，第一乳臼齒咬合面型，而最少的為光滑面型。社會經濟變項和上顎門牙型成反比的關係，但是其他的齲齒型態沒有或者只和其中一項社會經濟變項成反比關係。沒有刷牙習慣為上顎門牙齲齒型、第一乳臼齒咬合面型和光滑面型的顯著危險因子。進食時間較長為上顎門牙型和光滑面型的顯著危險因子。有吃甜食的習慣為第一乳臼齒咬合面型的顯著危險因子。
結論:台灣的發展遲緩兒童的齲齒狀況相較同齡的正常或者身障兒童來得好。不同的齲齒型態有各自相關的一些危險因子。我們還需要更努力地鑑定出高齲齒風險的兒童，並且採取適當的預防措施和給予優質的治療。我們建議提高發展遲緩兒童氟化物的使用和對乳臼齒進行窩溝封填來改善台灣發展遲緩兒童的齲齒狀況。

關鍵字

齲齒 ； 齲齒型態 ； 齲齒危險因子 ； 發展遲緩兒童

並列摘要

Background :Children who’s cognitive; physical; language and communication developmental are below the normal average regarding psychosocial and mental developmental and skills, as evaluated and confirmed by psychometric testing and medical specialists appointed by the authorities before issuing them certificated are known as children with developmental delay. Children with disabilities were reported to have higher caries prevalence and generally worse oral health in comparison with normal population of the same age. However, there were not much caries researches among children with developmental delay in Taiwan.
Dental caries traditionally was measured by arithmetic mean of caries experience, but these measurements have limitation in describing different etiologic agents, host responses and environment conditions of cariogenic process of a population. Hence, caries patterns were proposed to describe caries of a certain population or individual and to enhance the ability to identify associations between suspected risk factors with caries progression. We selected caries pattern proposed by Psoter et al. as our case definition because it had no priori pattern delineation. Besides, it had no hierarchical assignment to a single grouping, instead an individual may be assigned to multiple caries patterns if applicable.

Objectives :The goal of this study is to investigate the caries situation and caries patterns among children with developmental delay in Taiwan and to identify the socio-demographic factors and related behavioral habits as predictors of caries patterns.
Methods :This cross-sectional study was conducted from November 2013 until December 2014. Children with developmental delay below age of 5 from early intervention centers in Taiwan were recruited for this study. Purposive sampling method was used and the sample size of the population was 188. Oral examination was conducted by 4 trained dentist examiners, with inter-examiner reliability calibrated (Kappa value: 0.89). A self-administered questionnaire was completed by the parents or caregivers. The KMU IRB gave approval to this study and informed consent was given to parents or caregivers of each subject. Chi-square, t-test, ANOVA and multivariate logistic regression were used to analyze the data.
Results :There were 130 boys and 58 girls (mean age 3.10±0.88) in this study. The mean deft index was 1.99±3.50, caries prevalence was 32.98%. The most prevalent caries pattern at the age of 4 was Second Molar Pit and Fissure Caries, followed by Maxillary Incisors Caries, First Molar Occlusal Caries and the least was Smooth Surface Caries. All socio-economic characteristics were inversely associated with Maxillary Incisors Caries while one or neither of the socio-economic characteristics had inverse association with other caries patterns. No brushing habit was found to be significant risk factor in Maxillary Incisors Caries, First Molar Occlusal Caries and Smooth Surface Caries respectively. Long duration of eating was also significant risk factors for Maxillary Incisors Caries and Smooth Surface Caries. The habit of eating sweetened food was also a significant risk factor of First Molar Occlusal Caries.
Conclusions :Caries situation of children with developmental delay in Taiwan was better compared to normal population and children with disabilities of the same age. Each caries pattern had its associated risk factors among children with developmental delay. More effort should be put in to identify the children with the highest risk of experiencing caries so that preventive measures could be taken and access to quality dental care could be given. Increase fluoride exposure and pit and fissure sealants application for posterior primary teeth were suggested to reduce caries of children with developmental delay.

並列關鍵字

Dental caries ； caries pattern ； risk factors of caries ； children with developmental delay

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