台灣照護機構內身心障礙孩童口腔健康與相關因素之探討

台灣照護機構內身心障礙兒童口腔健康與相關因素之探討中文摘要背景:近年來身心障礙者人數有增加的趨勢，而身心障礙孩童在社會、家庭、學校都比一般人不方便就醫。此外孩童不易配合治療、吃甜食及飲料的機率高、父母或照護者的態度都可能影響孩童的口腔健康。若孩童能改善高齲齒率問題，對於成人後的恆牙和全身健康都有幫助。我國尚缺乏身心障礙者族群口腔狀況分析大型樣本研究，希望能借此研究達到更深入的瞭解。研究目的:瞭解18歲以下身心障礙孩童的:1.基本口腔狀況，包括乳牙、混合牙齒列、恆牙的DMFT指數、齲齒數、缺牙數、填補數、齲齒盛行率、填補率和牙周狀況。2.探討口腔健康狀況與飲食及生活習慣、口腔衛生及看牙經驗的相關性。研究方法:樣本取自台灣23個縣市照護機構及特殊教育學校的18歲以下身心障礙者。共有2321人平均年齡13.5歲，6歲以下297人、7-12歲408人、13-18歲1616人。抽樣方法:分層集數抽樣調查法和等比隨機抽樣。研究工具:一、口腔健康狀況及醫療需求表。二、飲食、潔牙生活習慣調查表。統計方法: SAS 和JMP來做分析。結果:研究結果6歲以下乳牙deft指數 4.19顆, d 3.24顆,e 0.35顆,f 0.60顆,齲齒盛行率63.30%,填補率17.51%；7-12歲混合齒列dft +DMFT指數 3.97顆, d+D 2.73顆,M 0.40顆,f+F 0.84顆,齲齒盛行率76.47%,填補率 29.54%；13-18歲恆牙DMFT指數 6.70顆, D 4.09顆,M 0.61顆,F 2顆,齲齒盛行率88.18%,填補率 34.55%。牙周狀況有牙菌斑、牙齦炎、牙結石的，6歲以下52.85%、42.42%、11.45%；7-12歲72.79%、60.78%、13.04%；13-18歲82.30%、75.25%、44.01%。第一大臼齒7-12歲DMFT指數 1.26顆, D 0.82顆,M 0.04顆,F 0.39顆,齲齒盛行率50.25%,填補率 65.47%；13-18歲DMFT 指數2.18顆, D 1.07顆,M 0.22顆,F 0.88顆,齲齒盛行率79.95%,填補率 57.99%。結論:18歲以下身心障礙者孩童，在齲齒經驗指數、齲齒盛行率、口腔衛生不良的狀況和牙周健康問題，遠比非身心障礙者孩童情況差。身心障礙者的口腔狀況受到，障礙程度、機構型態、吃甜食的次數、飲食的姿勢、口腔清潔的能力、刷牙的次數有無全身麻醉下接受治療牙齒、看牙醫時的治療態度、定期口腔檢查的間隔而有所不同。因此培育口腔衛生人員、加強牙醫師治療身心障礙者的專業知識和臨床經驗、就醫場所設備的建全和照顧者的知識是很重要的。

關鍵字

身心障礙孩童；齲齒；口腔衛生

並列摘要

Oral Health and Related Factors of Institutionalized Children with Disabilities in Taiwan Abstract Background: In recent years there has been an increase in the number of disabled people. Disabled children are less likely to receive dantal treatment than normal children due to inconvenience, whether they are living in the community or institutions. Moreover, they are less co-operative in treatment, consume more sweets and drinks, and the attitude of parents and care-givers are all factors attributing to childrens’ oral health. If children can improve their caries problem, it will facilitate the healthiness of their teeth and body as they grow into adulthood. Taiwan still lacks oral condition analysis and research on disabled people, on a credible sample size. Hopefully this research will give a deeper insight into this area. Purpose: The purpose of this study was to investigate the disabled children who are under age 18: 1. Current oral health condition which included: primary teeth and permanent teeth caries experience index, decayed teeth, missing teeth, filled teeth, caries prevalence rate, filling rate and periodontal status. 2. The related factors of disability oral health status such as dietary and living habits, oral cleaning habits and the experience of dental visits. Methods: The samples were taken from disabled children who live at institutions and schools in Taiwan. A total of 2,321 people were divided into three age groups: under 6, 7-12 and 13-18 years old, with a simple size of 297, 408 and 1616 respectively. The average age was 13.5 years old. 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, a database was designed using MS Access and data were analyzed using SAS and JMP. Results: The results showed that disabled children whose age is under 6 have an average deft index 4.19, dt 3.24, et 0.35, ft 0.60, a caries prevalence of 63.30% and a filling rate of 17.5% in the primary teeth. For the age group between 7-12 years old, who have an average dft+DMFT index 3.97, dt+DT 2.73, MT 0.40, ft+FT 0.84, a caries prevalence of 88.18% and a filling rate of 34.55%.The age group between 13-18 years old, whose permanent teeth has average DT 0.82, MT 0.04, FT 0.39, caries prevalence88.18% and filling rate 34.55%. For the plaque index, the children whose age was under 6, 7-12 years old and 13-18 years old have 52.85%, 72.79% and 82.30% respectively. For the gingival idex, the children whose age was under 6, 7-12 years old and 13-18 years old have 42.42%, 60.78% and 72.25% respectively. %. For the calculus index, the children whose age was under 6, 7-12 years old and 13-18 years old have 11.45%, 13.04% and 44.01% respectively.The first molar teeth between 7-12 age group showed DMFT index of 1.26, DT 0.82, MT 0.04, FT 0.39 a caries prevalence of 50.25% and the filling rate was 65.47%, in the 13-18 age group it showed DMFT index of 2.18, DT 1.07, MT 0.22, FT 0.88 caries prevalence79.95% and filling rate 57.99%. Conclusion: Children under 18 with disabilities, according to the caries experience index, the caries prevalence rate, the oral health status and periodontal status are far more serious than healthy children. Disabled people could be affected by the oral status, level of disability, type of institution, frequency of eating -sweets, eating gesture, the ability to clean teeth, the frequency of brushing teeth, dental treatment under general anesthesia, the attitude of dentists and routine oral examinations. It is therefore important to train oral hygienists, enhance the professional knowledge and clinical experiences of the dentists regarding the needs of the disabled. Moreover, the knowledge of complete facility and caregivers is also very important.