復健科病房中風病患口腔健康狀況和降低牙菌斑成效之研究

摘要研究目的：本研究目的為瞭解中風住院病患口腔健康狀況及影響口腔狀況的相關因素探討，並瞭解口腔衛教前後牙菌斑指數改善之成效。材料與方法：本研究採立意取樣，研究對象共119人，針對某醫學大學附設醫院復健科中風病患，利用口腔檢查、手部等級評估、問卷調查來收集資料，經由口腔衛教和教導刷牙，評估牙菌斑改善的成效，每星期給予衛教一次並檢查牙菌斑，共完成一次前測和兩次後測。研究工具包括：口腔檢查表、手部功能評估表及問卷表。結果：樣本中，復健科住院病人的平均年齡為61.93±12.91歲，平均齲齒數(DT)為2.28±4.17，平均缺牙數(MT)為12.61±9.8，平均填補數(FT)為0.76±1.77，平均齲齒經驗指數(DMFT index)為15.63±9.46，平均現存牙齒顆數為18.32±9.96，在口腔健康上，女性口腔健康狀況顯著比男性差；復健科住院病患年齡愈大者、教育程度愈低，口腔健康狀況愈差。填補方面，和配偶同住者，填補數較高。樣本牙菌斑指數方面，平均第一次牙菌斑指數(前測值；PI1)(N=107)為22.67±25.67，平均第二次牙菌斑指數(後測值；PI2) (N=106)為22.61±25.61，平均第三次牙菌斑指數(後後測值；PI3)(N=55)為21.44±20.48；結果發現，此樣本牙菌斑指數有降低的趨勢，且在各分組變項中，如：男性、44歲以下者、45-54歲者、55-64歲者、主要照顧者為配偶者和手部等級三以下者的牙菌斑指數都有降低的趨勢；牙菌斑移除效果方面，PI1–PI2為–0.10±18.64、PI2–PI3為0.40±18.23、PI1–PI3為–1.80±18.64；而此樣本在PI2–PI3上有移除效果，且在PI2–PI3和PI1–PI3上，手部等級三以下的移除效果比手部等級四以上好。從臨床觀察發現，因手部等級嚴重者每日由照顧者清潔口腔之故，且照顧者為配偶時效果較好，反之，中風輕微者動機低，自行配合刷牙的較少。結論：總結而言，中風病患整體口腔狀況是不佳的，其相關影響因素為性別、年齡層、教育程度、婚姻狀況、主要照顧者和手部中風等級。經衛教的方式，樣本牙菌斑指數無顯著性成效，但在各分組變項中，卻有數值上降低的趨勢，即牙菌斑指數有降低的趨勢，對於中風住院病患除了復健外，應如何提供良善口腔衛教，是以後努力的方向。關鍵詞：中風、口腔健康、牙菌斑、口腔衛教

關鍵字

中風；口腔健康；牙菌斑；口腔衛教

並列摘要

Abstract Purpose: The purpose of this study was to investigate the oral hygiene and health of stroke patients living in the hospital and to examine related factors that influence their oral hygiene and health. Material and Method: We randomly selected the Ward of Department of Rehabilitation in a hospital. A total of 119 subjects were examined. The information was collected by oral health examination, the upper extremity evaluation form and questionnaire, and by reducing dental plaque effects by dental hygiene instruction and teaching correct brushing of teeth. We provided dental hygiene instruction and examination of dental plaque once each a week. The pre-test was administered once and the post-test twice. Results: The average age of the patients was 61.93±12.91. The mean decay teeth number (DT) was 2.28±4.17. The mean missing teeth number (MT) was 12.61±9.8. The mean filling teeth number (FT) was 0.76±1.77. The mean DMFT index was 15.63±9.46. The mean functional teeth number were 18.32±9.96. Oral hygiene and health of the females were significantly worse than those of the males. Oral hygiene and health were significantly worse in less-educated and the elderly patients. On the fillng teeth number, patients living with a spouse had a significantly higher teeth number than those not. On plaque index aspects, pre-test plaque index (PI1;N=107) was 22.67±25.67. Post-test plaque index (PI2;N=106) was 22.61±25.61. The second post-test plaque index (PI3;N=55) was 21.44±20.48. The results revealed that the plaque index had a reduction trend. Among each group of variables, the plaque index had the trend of reduction in variables such as male, 44 years old below, 45-54 years old, 55-64 years old, the main caregiver being the spouse, and grade 3 below of the upper extremity evaluation. On the effect of removing dental plaque, PI1–PI2 was –0.10±18.64, PI2–PI3 was 0.40±18.23 and PI1–PI3 was –1.80±18.64, therefore PI2–PI3 had the removal effect. On PI2–PI3 and PI1–PI3, the upper extremity evaluation of grade 3 below had better the removal effect than that of grade 4 beyond. From the clinical observation, we found that the above results revealed that the main caregiver being the spouse had a better effect of removal plaque because the patients with worse grade of upper extremity had oral hygiene cared by caregivers everyday. On the contrary, the motivation of the patients with less affected grade of upper extremity was too low for them to brush their teeth by themselves. Conclusion: Oral hygiene and health of stroke patients in our samples were not good. Related factors included gender, age, education level, marriage status, main caregiver, and the grade of upper extremity. By dental hygiene instruction, the plaque index had no significant effect but among each group of variables, plaque indices had the trend of reduction. Future research should focus on how we can provide oral hygiene and health for stroke patients in addition to rehabilitation. Key words: Stroke, Oral Health, Dental Plaque, Dental hygiene instruction