影響定期回診牙周炎患者治療成效的相關因素

The associated factors of treatment outcome among patients with periodontitis under regular follow-up

曾雅鈴(Ya-Ling Tseng)

指導教授 ： 林英助

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(2016年)

摘要

研究背景：
牙周炎若不處理，嚴重時可能會導致牙齒掉落，過去的研究結果建議，牙周炎治療後1-2年內有無回診及支持療法 (supportive periodontal treatment, SPT) 被認為與其牙齒的存活時間長短有關，但目前更長期的追蹤資料則較少被探討。

研究目的
藉由長期病歷回溯收集臨床治療記錄來瞭解1）牙周炎患者治療後有無回診者的牙周臨床健康指標的差異，2）影響有回診者牙齒存活時間長短的可能危險因子。

材料與方法：
本研究採回溯性世代研究方式，以高雄醫學大學附設紀念醫院牙周病科某主治醫師經牙周炎治療後的門診病人為主，牙周炎治療後平均每3~6個月回診一次，病歷回顧收集牙周炎患者治療前後和每一次回診口腔檢查的charting表為主要統計資料來源。使用coding book進行調查變項編碼，病歷資料使用Access 2013建檔輸入，最後以統計方法來分析其相關性。

結果：
在280位牙周炎患者病歷回溯資料顯示，最長有11年 (2003~2014) 的病歷資料，有無回診的牙周炎患者在人口學基本資料的分布並無明顯差異，進一步比較牙周探針探測有無出血以及牙周囊袋探測深度、牙周附連喪失深度和牙齒動搖度等分組的頻率分佈，皆無統計上顯著差異，但牙菌斑累積在有回診的牙周炎患者的牙齒的分佈頻率明顯高於無回診者 (X2＝9.088，p-value =0.011)，達統計上顯著差異。
有回診的牙周炎患者最後納入分析的牙齒有3258顆，比較治療前、治療後、及最後一次治療等不同階段的各項牙周健康指標，發現在探針探測有無出血 (X2＝170.184，p-value <0.001)、牙周囊袋探測深度 (X2＝1253.475，p-value <0.001)、牙周附連喪失深度 (X2＝1678.564，p-value <0.001)、牙齒動搖度 (X2＝140.619，p-value <0.001)、牙菌斑有無 (X2＝140.619，p-value <0.001) 等，在治療後的在統計上皆有顯著改善。進一步以存活曲線分析，有抽菸習慣 (log-rank test=3.960，p-value=0.047)、自我報告心臟病 (log-rank test=6.405，p-value=0.011)，糖尿病 (log-rank test=6.666，p-value=0.010)，牙周附連喪失深度增加 (log-rank test =139.888，p-value <0.001)、牙周囊袋探測深度增加 (log-rank test=200.099，p-value <0.001) 以及牙齒動搖度增加(log-rank test=161.689，p-value <0.001)，相對於沒有疾病或沒有抽菸習慣或牙周健康指標最好的分組，牙周炎治療後牙齒的累積存活率明顯較差，且達到統計上顯著，但牙周炎治療後牙齒的累積存活率在不同性別、是否有高血壓或肝炎帶原、喝酒與嚼食檳榔習慣有無之間則無明顯不同。進一步以multivariate cox regression analysis 顯示抽菸(AHR=4.46, 95% CI =0.96-20.60 )、糖尿病(AHR=0.18, 95% CI =0.09-0.95)、 心臟病(AHR=4.81, 95% CI =1.73-13.41)皆是牙齒存活時間明顯較短的危險因子。

結論：
本研究顯示牙周炎患者持續定期回診且接受SPT治療，各項牙周健康指標皆有顯著改善，治療前和治療後第一次口腔檢查結果之牙周健康指標可以作為牙齒存活時間明顯較短的預測因子。我們建議治療前與治療後的牙周健康指標無法明顯改善的牙齒可以進行更積極的治療來提升其存活率。

關鍵字

牙周炎 ； 牙周健康指標 ； 牙齒存活 ； 牙周支持性療法

並列摘要

Background:
Periodontitis is an inflammatory disease caused by the infection of periodontal pathogens. Long-term effects of severe periodontitis may lead to the tooth loss. After periodontal treatment, scheduled dental check-up and supportive periodontal treatment (SPT) could improve the tooth health and increase the life expectancy of damage tooth. However, the change of periodontal index and life expectancy of damage tooth after the treatment of periodontitis were rare found in the long-term follow-up study.

Aim:
Our aims were to investigate 1) the difference in periodontal index and dempgraphics between periodontitis patients with and without dental check-up after the treatment; 2) the risk factors associated with the reduction of tooth life expectancy after the treatment in the long-term follow-up.

Materials and method:
Clinical records and demographics were collected from patients treated by the same visiting staff of the periodontal division, dental department at Kaohsiung Medical University Hospital. Average time period of recall in dental clinic was 3-6 month. The charting data of each dental check-up and before treatment were collected to compare the changes in periodontal index. Periodontal index included pocket depth (PD), bleeding on probing (BOP), clinical attachment loss (CAL), plaque accumulation on tooth surface (PAOTS), and mobility. The software of Access 2013 was used to key in clinical data and demographics. Statistical analysis was used to analyze the association.

Result:
A total of 280 patients with periodontitis were collected in the initial stage. The longest follow-up period was eleven years (2003-2014). No differences in the frequencies of demographic variables, BOP, and different levels of PD, CAL (p-value =0.561), and tooth mobility were found between periodontits patients with and without dental check-up. However, the frequencies of PAOTS were significantly higher in periodontits patients with dental check-up (X2= 9.088, p-value = 0.011).
A total of 3258 teeth were selected into the analysis. The frequencies of tooth with BOP (X2 = 170.184 , p-value <0.001) and PATOS (X2= 140.619, p-value <0.001), and the worsest of PD (X2=1253.475, P-value <0.001), CAL (X2 = 1678.564, P-value <0.001), and tooth mobility (X2= 140.619, P-value <0.001) were significantly reduced in patients with periodontitis and dental check-up, especially in the last recall compared with their periodontal index before treatment. Survival curve and log-rank test showed that patients with the habit of cigarette smoking (log-rank test=3.960，p-value=0.047), self-reported heart diseas (log-rank test=6.405，p-value=0.011), diabetics (log-rank test=6.666，p-value=0.010), and the worsest of CAL (log-rank test=139.888，p-value <0.001), PD (log-rank test=200.099，p-value <0.001), and tooth mobility (log-rank test =161.689，p-value <0.001) were all significantly correlated with a lower teeth accumulated survival rate compared with their control group. However, no such result was found in the variables of gender, hypertention, hepatitis infection, and the habits of drinking and betel quid chewing. Multivariate cox proportional hazards model analysis indicated that smokers (AHR = 4.46, 95% CI = 0.96-20.60), diabetes (AHR = 0.18, 95% CI = 0.09-0.95), heart disease (AHR = 4.81, 95% CI = 1.73-13.41) were risk factors to decrease the tooth survival time after the treatment.

Conclusion:
Our reults showed that patients with periodontitis and scheduled dental check-up could significantly improve their periodontal health and accumulated teeth survival rate after the treatment. However, the more intensive care were needed to treat those teeth with high severity of damage in periodontal health, especially in damage teeth without improvement after the treatment.

並列關鍵字

periodontits ； periodontal index ； tooth survival ； supportive periodontal treatment

參考文獻

參考文獻

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