中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 central Taiwan

林炎英(Yen-Ying Lin)

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

背景：由於身心障礙者口腔衛生較常人差且隨著年齡惡化的速度也較常人快，若不注重其口腔衛生保健或無法協助其潔牙，常造成身心障礙者不同程度的齲齒以及牙周疾病等問題，嚴重影響身心障礙者的口腔健康、甚至引發其他合併症。依據內政部統計處九十二年底資料顯示台灣地區身心障礙人數計857,263人，占總人口之比率為3.81％，比率逐年上升，中台灣身心障礙人數則為244,225人佔身心障礙者總人數28.49％，由於目前國內相關大型研究較少，若要針對身心障礙者的口腔健康狀況來做改善，必須先了解國內身心障礙者的口腔健康現況。
研究目的：分為兩大部分：一、研究身心障礙者之口腔健康狀況二、探討身心障礙者的口腔健康相關影響因素。
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」，以領有身心障礙手冊之身心障礙者為研究對象，機構內身心障礙者計2,040人，取得之樣本數為1,898人，同時完成口腔檢查與填寫問卷者計1,464人，回收率77.13％。其中，男性有730人，女性734人。18歲以下有845人，19-44歲有565人，45歲以上有54人。研究內容主要是經由牙科專科醫師對身心障礙者進行口腔健康檢查，並配合問卷對身心障礙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Microsoft Access來設計資料庫，以Excel 2000版與JMP 5.0版來進行統計分析。
結果：研究結果顯示身心障礙者平均DMFT指數為8.27，以45歲以上17.24為最高，19-44歲10.52次之，18歲以下5.26為最低(P<0.05)﹔平均齲齒盛行率為90.30％，45歲以上為98.15％，19-44歲為96.11％，18歲以下最低為85.92％(P<0.05) ﹔平均齲齒數為4.19，以19-44歲4.71為最高，18歲以下3.85為最低﹔平均缺牙數為1.95，以45歲以上12.39為最高(P<0.05)﹔平均填補率為32.78％，以19-44歲35.93％為最高，45歲以上8.31％為最低(P<0.05)。
結論：與國內外同年齡或相關研究相較之下身心障礙者的口腔健康狀況普遍欠佳仍有大幅改善的空間，齲齒、牙周疾病、缺牙與未確實潔牙等共同的口腔健康問題，除了受到障礙程度與行為能力特質差異的影響外也因身心障礙者的飲食習慣、口腔衛生習慣與就醫經驗而分別有不同程度的影響，受檢者中半數以上可自行完成口腔清潔，但各項指數均高於部份或全賴他人協助者；因此教導身心障礙者及其照護者正確的口腔衛生保健觀念、有效的潔牙方式，才可確保口腔健康。

關鍵字

口腔健康狀況 ； 身心障礙 ； 齲齒經驗指數

並列摘要

Background: Due to the disabilities of the handicapped the oral health status is worse than the general public. If attention is not paid to oral health status or they cannot be helped to clean their teeth. will cause caries of the data base and periodontal disease. According to the statistic department of the Ministry Interior for the year 2003. There is a total of 857,263 people with disabilities in Taiwan which occupies 3.81% of the whole population. The number of people with disabilities in central Taiwan is 244,225 person and occupies 28.49% of the total number of people with disabilities. There are few studies about oral health in people with disabilities . We must know the current oral health condition before we can improve it.
Purpose:Ι.The purpose of this study was to investigate the current oral health condition.Π.To investigate the relationship between the oral health status and its factors of people with disabilities .
Methods: The samples were extracted from the study of“Oral health status and related factors of institutionalized with disabilities people ” which was conducted by Department of Health to trust Kaohsiung Medical University Investigated. A total of 1,464 people completed a questionnaire and an oral examination. There were 730 males and 734 females . The samples were divided into three age groups: under 18 years old 845 persons , 19-44 years old 565 persons and over 45 years old 54 persons. The oral examinations were carried out by dentists. The dietary habits, teeth clearning habits and status of daily activities were collected in a standardized questionnaire. Stratified cluster sampling design and Probability proportional to Size (PPS) were used, a database was designed using MS Access and data were analyzed using MS Excel and JMP5.0.
Results: In this study the DMFT index for the total sample was 8.27 the persons over 45 years old was 17.24 , 19-44 years old was 10.52 and under 18 years old was 5.26(p<0.05).The caries prevalence was 90.30% and over 45 years old were 98.15% and 19-44 years old were 96.11% and under 18 years old were 85.92%(P<0.05). The missing teeth of the total sample was 1.95,the figures for under 18 years old was 0.58 and the figures for 19-44 years old was 3.01 and over 45 years old was 12.39. The filling rate was 32.78% , the figures for under 18 years old was 31.97 % and 19-44 years old were 35.93% and over 45 years old were 8.31%(p<0.05).
Conclusion: According to the results reported from the studies surveyed for people with disabilities in they show a that the oral health status of people with disabilities was poor. Taiwan and foreign countries on same ages or related study show disabilities oral health were poor . We need to improved their oral health . the common problems such as caries、periodontal disease、missing teeth would be influenced either by the degree and charactertistics of disabilities or by the dietary habits、teeth clearning habits、experience of visiting dentists s .Over half of the people with disabilities can perform teeth clearning by themselives . The index were higher than Partial independent and Complete dependent. Therefore,teaching people with disabilities and their carers correct concept of oral hygiene and effective cleaning of teeth are importance.

並列關鍵字

oral health status ； disabilities ； DMFT index

參考文獻

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