北台灣機構內身心障礙者口腔健康狀況之探討

Oral Health Status of Institutionalized People with Disabilities in Northern Taiwan

石瑞香(Jui-Hsiang Shih)

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在職專班/碩士(2005年)

摘要

研究背景：根據內政部統計資料指出，2003年底台灣戶籍登記總人口為22,534,761人，其中以居住北部地區者，佔43.59％最高，幾乎達戶籍登記人口之半；然而截至2003年底止台灣身心障礙人口數為857,263人，而北台灣就有320,581人，佔37.40％為最多；但是以身心障礙者佔該地區總人口之比率來分析，北台灣則僅佔3.26％反而是各地區中比率最低的，由此可看出不論是否為身心障礙者或是牙科醫療資源均有往北部集中的情形，因此本研究係探討北台灣機構內身心障礙者之口腔健康狀況，醫療需求及健康照護是否受到較好的照顧。
研究目的：1.探討北台灣機構內身心障礙者之口腔健康狀況與牙科醫療需求。2.探討北台灣機構內身心障礙者之口腔健康狀況與飲食及生活習慣、潔牙習慣、就醫行為的相關性。
研究方法：研究對象取自高雄醫學大學口腔衛生科學研究所執行的「台灣身心障礙者之口腔健康狀況調查」計畫中，就北台灣身心障礙者320,581人中，居住在機構內領有身心障礙手冊者共6820人，來進行抽樣調查。口腔檢查表係遵循世界衛生組織（WHO）所頒佈的標準，研究內容主要是透過牙醫師在完成檢查者一致性訓練後，對身心障礙者做口腔健康狀況檢查並評估其醫療需求。同時利用結構式問卷對身心障礙者之主要照護者或父母親來進行口腔健康狀況與飲食、潔牙生活習慣問卷調查。採分層集束抽樣調查法，抽樣機率以等比隨機抽樣方式抽取2001人，其中一致完成口腔檢查及問卷者共1465人（男性868人，女性597人），回覆率為73.2％，並以JMP5.01來進行統計分析。
研究結果：研究分析結果顯示北台灣機構內身心障礙者平均DMFT指數為9.08，以45歲以上16.14最高，19-44歲10.03次之；平均齲齒數為4.23，以19-44歲4.70最高，45歲以上4.47次之；平均缺牙數為2.89，以45歲以上10.22最高，19-44歲2.93次之；平均填補數為1.97，以19-44歲2.40最高，18歲以下1.75次之；平均齲齒盛行率為86.76％，以45歲以上99.05％最高，19-44歲91.39％次之；平均填補率為32.36％，以18歲以下34.40％最高，19-44歲34.06次之。 整體而言，有82.90％的人有牙菌斑堆積，80.66％的人有牙齦炎，52.85的人有牙結石堆積；上顎有57.86％的人有補綴需求，下顎61.72％的人有補綴需求，57.21％的人有矯正需求。
研究結論：北台灣機構內身心障礙者之口腔健康狀況，受到性別、年齡、障礙程度、機構型態、吃甜食的習慣與次數、飲食的種類與性質、每次用餐的時間、口腔清潔能力、刷牙次數與時機、看牙醫的配合度、全身麻醉下接受治療牙齒的經驗、定期做口腔檢查等因素的影響而有所不同。雖然北台灣醫療資源豐富，但是身心障礙者之口腔健康狀況普遍不佳，平均DMFT指數、齲齒盛行率、牙菌斑堆積及牙齦炎的比率均比一般人偏高，填補率則偏低。故期待政府及相關機構能制訂一套完整之口腔保健計畫，以落實身心障礙者口腔衛生保健措施。

關鍵字

口腔健康狀況 ； 身心障礙 ； 齲齒經驗指數 ； 機構

並列摘要

Background：According to the statistical data provided by the Ministry of the Interior, the number of permanent residents of Taiwan was 22,534,761 at the end of 2003. The northern area occupied the highest percentage, 43.59%. The number of people with disabilities was 857,263 in Taiwan and 320,581 (37.40%) in the northern area at the same year, which occupied the highest percentage compared to other areas. But the number of people with disabilities / general population ratio in the northern area showed the lowest percentage (3.26%) compared to other areas. The number of the general population, people with disabilities even the dental resource of the northern area occupied the most part in Taiwan, we were still interested in whether the oral health of the people with disabilities had better care or not. In this study, we investigated the oral health condition, dental treatment needs and related factors of the institutionalized people with disabilities in northern Taiwan.
Purpose：1.To investigate the oral health status of institutionalized people with disabilities in northern Taiwan. 2.To investigate the oral health status and its related factors such as diet, teeth brushing habits, status of daily activities and dental visit behaviors.
Methods：The samples were extracted from the study of “Oral Health Status and Related Factor of Institutionalized People with Disabilities in Taiwan”which was conducted by the Graduate Institute of Oral Health Sciences, Kaohsing Medical University. There were 6820 people with disabilities residing in the institutions in northern Taiwan, and 2001 samples were extracted by the stratified cluster sample design and Probability Proportional to Size (PPS). There were 1,465 people with disabilities (868 male, 597 female) who responsed both to the oral examination and questionnaire, the response rate was 73.2%. The protocol of the oral examination was in accordance with the WHO’s criteria, and then carried out by trained and calibrated dentists. The dietary habits, teeth brushing habits and status of daily activities were collected in a structural questionnaire by the caregivers or parents of people with disabilities. Data were analyzed by using JMP.
Results：The institutionalized people with disabilities in northern Taiwan had a DMFT index of 9.08. The group aged over 45 was the highest at 16.14. Decayed teeth number were 4.23 and the group aged 19-44 was the highest at 4.70. Missing teeth number were 2.89 and the group aged over 45 was the highest at 10.22. The filling rate was 1.97 and the group aged 19-44 was the highest at 2.40. Caries prevalence was 86.76％ and the group aged over 45 was the highest at 99.05％. The filling rate was 32.36 and the group aged under 18 was the highest at 34.14％. The prevalence of plaque accumulation, gingivitis and calculus retained were 82.90％、80.66％ and 52.85％ respectively. The prosthodontic need was 57.86％ in the upper jaw and 61.72 ％ in the lower jaw. The orthodontic need was 57.21％.
Conclusion：The oral health status of the institutionalized people with disabilities in northern Taiwan showed a significant difference by gender, age, degree of disability, type of institution they stayed, habit and frequency of eating dessert, category and character of the diet, duration of meal time, ability of teeh cleaning, timing and frequency of brushing teeth, cooperative condition with dentist, experience of dental treatment under general anesthesia and custom of regular oral examination. The DMFT index, prevalence of dental caries, plaque and gingivitis index of people with disabilities are higher than that of the ordinary people, but the filling rate is still lower. The resources of dental treatment is abundant in northern Taiwan, but the oral health care for the people with disabilities is still poor. The health authorities and their related institutions should establish a complete plan of oral health care to provide a better service for people with disabilities.

並列關鍵字

people with disabilities ； oral health ； DMFT index ； institution.

參考文獻

參考文獻

1. 林瑩澤，林雅婷，蔡佳玲。綠島學童齲齒之調查研究。中華牙誌1999；18(4)：277-284。

2. 吉野陽子。重症心身障礙兒設施におけゐ20年間の齒科治療の變遷。障害者齒科2001；22：45-9。

3. 邱清華，謝天渝，姚振華，王宜斌，陳振漢，黃智勇。口腔疾病與保健。台北：國立空中大學；2000。P.1-2。

4. 邱奕彬。台灣桃園縣身心障礙者的口腔健康狀況與醫療需求〔碩士論文〕。高雄：高雄醫學大學口腔衛生科學研究所；2004。