牙醫情況及項目與民眾社經地位相關之
探討－以南區健保局為例

中文摘要背景：探討台灣地區牙醫醫療體系中之醫療服務供需情形，牙科醫療的利用，多半以健保醫療費用的資料作為探討，對於社經地位與牙科就醫行為國外已有不少研究，在台灣則較為有限。目的：探討社經地位、人口學變項與牙醫醫療次數、費用及各項牙醫治療行為，及嚼檳榔、抽菸、喝酒習慣與牙醫醫療費用及項目的相關性。方法：本研究利用「台灣地區檳榔盛行率調查」所得之社區代表性樣本，與健保牙科門診費用作勾稽分析，探討南區健保局轄區民眾社經地位與牙科醫療之關係。本研究乃針對台南、嘉義、雲林等地區並設有戶籍，年滿18歲以上的居民口腔保健、牙科就醫現況、飲食習慣等作調查，並探討彼此間的相關性。研究設計以抽樣調查方式，採分層多階段集束抽樣調查法，抽樣機率以等比隨機抽樣方式。調查項目包括：口腔保健、牙科就醫行為之狀況、民眾對檳榔健康危害之認知程度及態度。結果：分析受訪者之有無投保健康保險的結果顯示，有保險者佔99.37%為最多，無參加健康保險者僅佔0.63%。比較社會人口學於90年上半年至92年上半年的兩年半期間看牙科門診總次數僅佔33.40﹪（三分之一），有66.60﹪的人未看過牙科門診。牙醫醫療需求與牙科就診次數之比較分析有逐年下降，由90年上半年的16.24%、依序降為90年下半年的14.37%、91年上半年的13.97%、91年下半年的13.65%、92年上半年的12.73﹪，由此分析可見民眾對牙科醫療需求有明顯下降，可能原因之一為保健觀念隨媒體訊息有顯著改善。有嚼檳榔、抽菸、喝酒習慣等因素，可能會影響牙醫醫療需求的使用次數，其中無嚼檳榔者比有嚼檳榔者在兩年半看牙科總次數略高，佔34.09﹪有嚼檳榔者佔33.30﹪；另外有抽菸較無抽菸者略高佔33.50%，有喝酒較無喝酒略高佔33.51%；城市比鄉鎮的牙科總診次數高出很多，佔39.13﹪，鄉鎮佔28.20%。預防性質的全口牙結石清除及緊急治療性質的根管難症特別處理方面在教育程度上都有統計學上非常明顯的顯著性（p＜0.0001）：專科以上教育程度者沒有使用根管難症特別處理方面比率最高，佔97.83%；保健方面全口牙結石清除均以專科教育以上者使用率最高，佔25.80%。在單、雙、三根根管治療以年齡層65歲以上使用率最低佔3.79%，使用率以51-64歲組群之8.50%為最高，有接受全口牙結石清除者的比率於各年齡層間有明顯差異：以18-34歲族群之21.22%最高，以65歲以上者之9.96%最低，與年齡層有明顯差異，本研究同時發現沒有定期看牙醫的民眾仍佔多數為89.73﹪，而有定期檢查看牙科習慣者僅10.27%，其中以91年下半年之有定期看牙醫者23.10﹪，比無定期看牙醫者佔12.21﹪有略高的比率（p＜0.0001）具有非常顯著性的差異，其餘90、91、92年上半年及90年下半年所佔比率很接近未有明顯差距。結論：整體而言，經由本研究結果得知各個層級的民眾間有不同的口腔保健、需要及不同的牙科就診行為，其中使用診次以保健性質略高其他治療性質，因此經由更積極的教導正確潔牙方式以落實口腔保健行為，且透過傳播媒體宣導衛教，定期口腔檢查及牙科就醫的重要性，並將口腔自我檢查推展到每個社區各角落，將是提昇國人口腔健康的重要策略之一。關鍵詞：口腔保健、牙科就醫、嚼食檳榔認知、刷牙方式

關鍵字

口腔保健；嚼食檳榔認知；刷牙方式；牙科就醫

並列摘要

ABSTRACT Background： This study aimed to understand the dental service and needs in the Taiwan area. Most studies that researched the utilization of dental services depended on General Public Health data. There have been many studies about the association of socioeconomic status and dental service utilization in other countries, but not in Taiwan. Study objective： To understand the correlation between socioeconomic status, demographic conditions, the frequency of dental service utilization, expenses, the different treatment condition, and the association of smoking, alcohol, and betel nut users with dental service expenses and treatment items. Methods： We used the community sample information collected by the Taiwan Areca quid Prevalence Survey (TAPS) study to delineate the dental service expenses. Then discussed the relationship of socioeconomic status and the expenses of dental service residents of 18 years old and older, Southern Division Area of NHI (including Tainan city/county, Cha-yi city/county, Yu-Lin county). A stratified multi-stage cluster sampling was employed to select the subjects randomly with probability proportional to size. The data management was implemented by SAS software, and statistical analysis was conducted by JMP software. Results： The analytic results indicated that 99.37% of the population participated in GHI (general health insurance) and 0.63% did not. When comparing, if the subjects have been to dental clinics or a dental department between 2001 and 2003, the dental service needs and the frequency of accepting dental service descended from 16.20% (2001) to 12.73% (2003). The decreasing rate was significant. The oral health behaviors including areca/betel chewing, cigarette smoking, and alcohol drinking may influence the utilization frequency of dental services. After analyzing the data, the utilization rate of dental services in the areca/betel-chewing group (34.09%) was a little higher than in the non-betel-chewing group (33.30%). People who smoked and drank (33.50) was also higher than the non-smoking and non-drinking group (33.51). The utilization rate in the non-smoking group was 33.11%, and the non-drinking group was 31.97%. It is higher in urban areas (39.13%) than in rural areas. Full mouth calculus removal and emergent difficult endodontic treatment had very significant variations in education level in statistical analysis. It indicated that the non-utilization rate in difficult case treatment is highest in the group educated above high school (97.83%). Preventive full mouth calculus removal was highest in the group educated above high school the non-utilization rate (95.38%) in endodontic root canal filling treatment was the highest in 18-34 y/o. But the utilization rate (9.68%) was the highest in 51-64y/o. Full mouth calculus removal was the highest in 18-34 years old (21.22%) and lowest in the group aged above 65 years old and over. This research also found that there was 89.73% people who do not utilized dental services regularly and only 10.27% utilize it regularly. But it was a little higher rate in utilizing dental service (23.10%) than in non-utilizing (12.21%) in the last half year of 2002 (p<0.0001). It revealed significant difference in data. But there was no significant difference in other years. Conclusion： In general the present study shows there are different needs in each sub-population. The dental visiting treatment behavior as well as the knowledge, attitude, and practices of oral health should be reinforced and promoted to every corner of the community through the constant instruction of oral hygienists and through the promotion by mass media. Key words：oral health, dental visit, cognition of areca/betel quid, tooth brushing methods