南臺灣原住民學童口腔健康的調查分析及氟化物介入對預防齲齒的成效之追蹤研究

Researches on the Oral Health Status and the Caries Preventive Effects of Fluoride Intervention to Aboriginal Children in Southern Taiwan

謝蕙如(Hui-Ju Hsieh)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/牙醫學研究所/博士(2014年)

摘要

研究背景與目的：台灣地區學童齲齒盛行率居高不下，尤以山地鄉口腔健康問題明顯較平地鄉嚴重，因嚴重醫療資源不足，更顯口腔預防保健的重要。因此，本研究主要在調查原高雄縣原住民鄉鎮學童之口腔健康狀況、飲食及口腔衛生習慣、其主要照顧者相關因素，及不同口腔衛生策略介入的監測及成效評估。本研究為能達到長期防齲效果，施予氟錠預防平滑面的齲齒；使用裂溝封填劑預防第一大臼齒咬合面及裂溝縫隙的齲齒，此法對恆牙的保護較為持久。
材料與方法：本研究為類實驗設計法，以立意取樣調查法進行橫斷式研究，並以縱貫式追蹤調查。針對 2007 年至 2009 年間就讀 12 所學校的 3-9 歲兒童為對象，約計有 572 位。本研究主要施行口腔檢查、問卷調查、氟錠及裂溝封填劑的介入，再進行卡方、t-test 及複邏輯回歸分析比較。
結果：偏遠山區的原住民學齡前兒童有很高的齲齒盛行率（95.6%），及很低的填補（10.3%），其乳齒齲齒指數（deft）會隨年齡增長有顯著性地升高。主要照顧者本身的口腔保健態度良好，然而口腔保健知識程度卻很差，影響因素包括教育程度及職業。進一步分析其中的 S-ECC 之主要照顧者的相關因素，結果顯示學童低頻率刷牙習慣與主要照顧者的刷牙習慣有關。主要照顧者的低頻率刷牙習慣是學童不正確的刷牙方法的危險因子（OR=3.45）。另外分析學齡兒童的齲齒其相關因素，可發現學童的齲齒指（面）數是受其喝飲料的習慣及刷牙的次數之影響。主要照顧者的刷牙頻率是學童口腔衛生狀況的重要指標；嚼食檳榔的習慣會造成學童口腔衛生不良的風險（OR=2.04）。針對學齡兒童的裂溝封填劑運用，追蹤一年發現， 229 顆第一大臼齒塗佈後，有 14 顆發生齲齒（6.1%），相較低於對照組追蹤 258 顆第一大臼齒卻有 60 顆齲齒（23.3%）；裂溝封填劑塗佈與第一大臼齒齲齒的預防有顯著性相關，在對照組的齲齒率大約高於裂溝封填劑塗佈組的四倍。針對學齡前兒童的氟錠投予，研究結果顯示，介入組在接受氟錠投予 12 個月後，DMFT 指數增加量較控制組少 0.16 顆，DMFS 指數增加量較控制組少 0.19 面。氟錠投予的抗齲齒效益，可減少 DMFT 指數增加量 51.61% 與 DMFS 指數增加量 50%。介入組在接受氟錠投予 24 個月後，可減少 DMFT 指數增加量 12.50% 與 DMFS 指數增加量 18.84%。其中，氟錠在非咬合面的防齲成效遠高於咬合面，兩者相差 45.36%。
結論：本研究的結果顯示原住民口腔衛生狀況是不足的，主要照顧者的刷牙頻率及嚼食檳榔習慣是學童口腔衛生不良的重要因子；然而，對於剛萌發的第一大臼齒進行裂溝封填劑塗佈，可有效的（94.54%）預防齲齒，當裂溝封填劑完全脫落時會陷入齲齒的風險，有必要立即重新塗佈。另外，對於具有高齲齒風險或身處氟化物缺乏地區的兒童，建議以學校為基礎，來實施氟錠投予齲齒防治計畫。

關鍵字

原住民學童 ； 口腔健康 ； 齲齒預防 ； 主要照顧者 ； 刷牙習慣 ； 氟錠 ； 尿中氟濃度 ； 裂溝封填劑 ； 嚼食檳榔

並列摘要

Background/purpose：In Taiwan, the caries prevalence of school children is stubbornly high, especially in the aboriginal areas. The oral health problem in those areas is significantly more serious than the downtown area. Due to the lack of medical resources, the prevention of oral health deterioration is more important. Therefore, the purposes of this study were to investigate the dental health, dietary and oral hygiene habits, the related factors of caretakers, and the evaluation of oral health intervention strategies. To achieve long-term effectiveness, we use fluoride tablets to prevent dental caries on the smooth surface of teeth and the application of fissure sealant on first permanent molars. Those strategies are more durable in protecting the permanent teeth.
Materials and methods：This is a quasi experiment design. We use cross-sectional positive sampling study and longitudinal (panel study) survey. There were 572 children aged 3-9 years old from twelve schools at remote aboriginal areas in the year 2007-2009. We conducted oral examination, questionnaires, applications of fluoride tablets and fissure sealant in the study. The data were analyzed by chi-square test, t-test, and multiple logistic regression.
Results：There were high caries prevalence rate (95.6%) and low filling rate (10.3%) among aboriginal children in remote areas. The deft index was significantly arising with age. Caretakers might have a good attitude but they might not have a good knowledge on oral hygiene due to their educational and occupational backgrounds. Further analysis on the relation of deft to the habits of caretakers showed that children with low frequency of tooth-brushing habit were associated with caretakers that also had a low frequency of tooth-brushing habit. Caretakers of children using improper tooth-brushing methods had a low brushing frequency (OR=3.45). Among school-aged children, the deft and defs indices were affected by the frequencies of drinking sweetened beverages and daily tooth brushing. Caretaker’s tooth-brushing frequency was a significant predictor for the children’s oral hygiene status. The children had caretakers with betel quid chewing habits had also poor oral hygiene (OR=2.04). After one year of the application of pit and fissure sealant, 14 out of the 229 (6.1%) first molars treated with sealants were carious and 60 out of the 258 (23.3%) molars in the control group were carious. Sealant application was significantly associated with the prevention of tooth decay. The caries rate of the control group was approximately four-fold higher than the sealant group. The fluoride tablet ingestion showed higher reductions of 0.16 DMFT index increment as well as 0.19 DMFS index increment than in the control group. After 12 months follow-up, the observation on dental caries proved that the anti-cariogenic benefit of fluoride table ingestion was effective with 51.61% of new DMFT index and 50% of new DMFS index. There were 12.50% of new DMFT index and 18.84% of new DMFS index being examined after 24 months follow-up. Among that, anti-cariogenic benefit of fluoride tablet ingestion was more effective with 45.36% (DMFS) difference between non-occlusal surfaces and occlusal surfaces.
Conclusions：The present study indicated that the oral hygiene among the aboriginal children was inadequate. Caretaker’s tooth brushing frequency and betel quid chewing habit were significant predictors for the poor oral hygiene in children. The application of pit and fissure sealant was 94.54% effective for the prevention of caries on the newly erupted permanent molars among Taiwanese aboriginal school children. Complete sealant failures demonstrated a high risk for caries and should be resealed immediately. In addition, the application of fluoride tablets should be regarded as a caries preventive means in school-based caries prevention programs for children in fluoride-deficient countries and for individuals with high caries risk.

並列關鍵字

aboriginal children ； oral health ； caries prevention ； caretaker ； tooth-brushing habit ； fluoride tablet ； urinary fluoride concentrations ； fissure sealant ； betel quid chewing habit

參考文獻

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