智能障礙者之口腔健康狀況與相關因素之探討

Oral Health Status and Related Factors of People with Mental Retardation in Taiwan

劉秀月(Hsiu-Yueh Liu)

指導教授 ： 黃純德

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士班/碩士(2004年)

摘要

背景：由於外國早期衛教介入，使智能障礙者的口腔健康狀況已有改善。因此，口腔預防效果是可以期待的。但目前國內較少智能障礙方面的相關研究，若要針對智能障礙者的口腔健康狀況來做改善，必須先了解國內智能障礙者的口腔健康現況。研究目的：簡述分為二大部分：1.探討智能障礙者之口腔健康狀況，包括：D、M 、F與DMFT指數、齲齒盛行率、填補率、牙科醫療需求與牙周狀況等。2.探討智能障礙者之口腔健康狀況與飲食及生活習慣、口腔清潔習慣、看牙醫的經驗等之相關性。研究方法：研究對象取自台灣身心障礙者之口腔健康狀況調查計畫中，領有身心障礙手冊之智能障礙者，共有1,435人。其中，18歲以下有585人，19-44歲有724人，45歲以上有126人。研究內容為主要是透過專業的牙醫師來對智障者做口腔健康狀況檢查，與利用標準化問卷的調查方式對智障者之主要照護者來進行口腔健康狀況與飲食、潔牙生活習慣問卷調查。抽樣方法為分層集束抽樣調查法(PPS)，以等比隨機抽樣機率、機構為抽樣單位，來進行抽樣。以MS Access來設計資料庫，SAS與JMP來做統計分析。結果：研究分析結果顯示，智障者平均DMFT指數為9.46，明顯以45歲以上17.94為最高，19-44歲10.19次之(P<0.001)﹔平均齲齒盛行率為92.82%，以45歲以上97.62%為最高，19-44歲93.92%次之(P=0.0047)﹔平均齲齒數為4.33，以19-44歲4.44為最高，18歲以下4.23次之﹔平均缺牙數為2.95，以45歲以上13.16為最高，19-44歲3.01次之(P<0.001)﹔平均填補率為26.26%，以18歲以下28.81%為最高，19-44歲28.29%次之(P<0.001)﹔有牙齦炎或牙結石者平均為75.26%，以19-44歲79.56%為最高(P<0.001)。
結論：整體而言，智障者的口腔健康狀況普遍不佳。智障者的口腔健康問題在各階段有所差異，在青少年時期為齲齒，成年、中年時期為牙周病，老年時期則為缺牙。此外，少醫療補綴、潔牙行為不足，則是智障者共同的口腔健康問題。會造成此問題，除了受到智障者本身障礙程度與行為能力特質差異的影響外，也因身心障礙者福利機構型態、吃甜食的頻率與次數、吃東西的習慣、飲食種類與性質、用餐時間的長短、刷牙次數與時機、看牙醫時的配合態度與有無定期口腔檢查而不同。

關鍵字

智能障礙 ； 身心障礙 ； 口腔健康狀況 ； 齲齒經驗指數

並列摘要

Background: Due to oral health education intervention in early age, the oral health status has improved in many countries and the effect is prominent in people with mental retardation. It is expected that people with mental retardation will have good oral health. But, there have been fewer studies about oral health in people with mental retardation in Taiwan. We must know the current oral health condition before we can improve it. Purpose: The purpose of this study was to investigate the current oral health condition and the related factors of people with mental retardation. The items in the oral examination include D, M, F and DMFT index, prevalence of caries, filling rates, dental treatment needs and periodontal status. The items in related factors include oral health status, dietary and living habits, oral cleaning habits and the experience of dental visit. Methods: The samples were the people with mental retardation extracted from the study of “Oral health status and related factors of disabled people in Taiwan”. A total of 1,435 people with mental retardation participated in this study. The samples were devided into three age groups: under 18, 19-44 and over 45 years old, and their sample size were 585, 724 and 126 respectively. The oral examinations were carried out by dentists. The dietary habits, oral health habits and status of daily activities were collected in a standardized questionnaire. Stratified cluster sampling design and Probability Proportional to Size (PPS) were used, database was designed by MS Access and data were analyzed using SAS and JMP. Results: In this study, people with mental retardation had a DMFT index of 9.46. The group aged over 45 had a significantly higher DMFT index than other age groups (P<0.001), and the DMFT index was 17.94. Caries prevalence was 92.82%and the group aged over 45 was the highest at 97.62%(P=0.0047). Caries teeth were 4.33 and the group aged 19-44 was highest at 4.44. Missing teeth were 2.95 and the group aged over 45 was the highest at 13.16(P<0.001). Filling rate was 26.26%and the group aged under 18 was the highest at 28.81%(P<0.001). There were 75.26%of individuals who had gingivitis or calculus and the group aged 19-44 was the highest at 79.56%(P<0.001). Conclusion: The people with mental retardation had bad oral health. The oral health problems at each age group are different. The most severe problem in teenagers was caries, in adult periodontal disease and in elder loss of teeth. The common problems of individuals were lack of prosthesis and cleaning of teeth. The main reasons for causing the poor oral health condition were depended on their characteristics of behavior and degree of mental retardation. The other reasons for that were included institution types, frequency of sweet, kind of diet, frequency and times of teeth brushing, dietary habits, the attitude to visiting dentist and regular examination.

並列關鍵字

DMFT index ； oral health ； disabled ； mental retardation

參考文獻

1. 中華民國智障者家長總會。心智礙者家長手冊－如何協助我們永遠的寶貝。台北：1997。

2. 內政部a。中華民國八十九年台閩地區身心障礙者生活需求調查提要報告。取自：http://www.moi.gov.tw/W3/stat/Survey/body89.htm。2003年9月26日取得。

3. 內政部b。內政部統計資訊服務網。內政統計月報/身心障礙人數-障礙、縣市及年齡。取自：http://www.moi.gov.tw/stat/index.asp。2003年10月20日取得。

4. 內政部c。內政部統計資訊服務網。內政統計通報/九十三年第九週(92年底身心障礙者人數統計)。取自： http://www.moi.gov.tw/stat/index.asp。2003年10月20日取得。

5. 行政院衛生署a。各類身心障礙之鑑定人員及鑑定方法與工具。取自： http://www.doh.gov.tw/NewVersion/content.asp?class_no=1andnow_Fod_list_no=698andarray_Fod_list_no=1,andlevel_no=1anddoc_no=1452。2003年11月25日取得。