南台灣機構內身心障礙者口腔健康狀況探討

中文摘要研究背景：南台灣的牙科醫療資源及人力，在台灣屬於中等程度的發展，究竟南台灣的身心障礙者有無受到良好的預防保健或醫療服務，是十分值得探討之事，國內目前有關身心障礙者之口腔流行病學研究資料不多，且缺乏具有系統性的口腔保健資料，為使身心障礙者能實際受惠，提昇其生命與生活品質，首先需要瞭解身心障礙者之口腔健康狀況及其醫療需求。研究目的：探討南台灣機構內身心障礙者：1.口腔健康狀況與其醫療需求。2.口腔健康狀況與飲食及生活習慣、就醫行為等之相關性。3.口腔健康狀況與障礙程度及不同照護機構之相關性。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」，2003年底南台灣8縣市身心障礙者有251,226人，居住在教養、養護機構的有5,345人，以機構為單位分層集束抽樣，再採等比隨機抽樣法抽出2,076人進行研究調查，其中完成口腔檢查1,765人，完成問卷調查1,405人，兩者均完成之有效樣本數為1‚364人。研究內容包括口腔檢查及由主要照護者填寫問卷，口腔檢查表係參考世界衛生組織（WHO）所頒布之口腔健康調查診斷方法與標準，牙醫師口檢前之一致性訓練，首先選20位個案做初步練習，與檢查團隊一起檢查且共同討論或鑑別較常發生的問題，檢定不同時間及不同檢查者間的一致性，並檢定檢查者與紀錄者的信度與效度，再以JMP 5.0進行統計分析。研究結果：本研究分析結果DMFT指數為11.21，齲齒數為4.27顆，缺牙數為5.32顆，填補數為1.61顆，齲齒盛行率為90.83％，填補率為25.38％，有 81.53％的人有牙菌斑堆積， 75.84％的人有牙齦炎， 60.13％的人有牙結石堆積， 63.15％需要製作上顎假牙，67.85％需要製作下顎假牙，尚有75％的填補需求。結論：南台灣機構內身心障礙者的口腔狀況比國內一般同年齡及國外的研究差，而口腔各項問題之間並非各自獨立，是環環相扣緊密相關、且每下愈況持續惡化的，其缺牙數及牙周狀況隨著年齡增加而變差，若沒有即時加以治療或注意口腔衛生，將造成缺牙數增加，影響口腔正常功能及生活品質和增加醫療支出。其口腔健康狀況，因為受到性別、年齡、障礙程度、居住機構的型態、飲食生活、口腔衛生習慣、是否定期至牙科檢查等因素的影響其口腔健康狀況亦有所差異。建議：一、及早訂定身心障礙者口腔保健計畫：二、加速相關專業人員的培訓：基層醫療院所牙醫師及專業口腔衛生師。三、持續定期進行口腔檢查與建檔，連續追蹤其口腔健康狀況與口腔衛生情形，提出具體改善計畫。

關鍵字

身心障礙者；口腔健康狀況；齲齒經驗指數；機構

並列摘要

Background: The development of dental and medical treatment and the human resources in southern Taiwan is in middle rank of the whole country. If the institutionalized people with disabilities in southern Taiwan are provided with proper dental health protection and medical treatment is a subject that needs to be studied . There are few studies related to the oral medical treatment and epidemiology of people with disabilities in Taiwan. There is also an insufficient amount of data related to oral health protection and oral care. In order to improve the living standards of people with disabilities, it is necessary to understand their state of health and treatment needs to improve their quality of life. Purpose: There are 3 subjects that we focused on for institutionalized people with disabilities in southern Taiwan: 1, their oral health condition and medical needs: 2, their dental visits, oral health condition and dietary and living habits and the correlation between these: 3, the correlation between their health condition, level of disability, and the different nursing and care institutions they attend. Methods: the samples in this study were extracted from a study by the Graduate Institute of Oral Health Sciences, Kaohsiung Medical University, titled “The Oral Health Status and Related Factors of Institutionalized People with Disabilities in Taiwan”. There were 251,226 people with disabilities enrolled in this study from eight cities and counties in southern Taiwan in 2003. Of these, 5,345 people were residing in institutions. We used institutions as the unit, then stratified cluster sampling design and geometric ratio random sampling of 2,076 people to be the subjects of study. There were 1,765 people who completed the oral health examination and 1,405 people who finished the questionnaire. The valid samples of both were 1,364 people. The research content included an oral health examination and a questionnaire that was filled out by the workers of the nursing home or care centers. The oral health examination form is a referral of the Method and Standard of Oral Health Examination And Diagnosis that the WHO has proclaimed as valid. Before the dentists performed the oral health examination they all underwent special training. They had to ensure the consistency between different examination times and different examiners. They also had to check the reliability and the validity of the examiners and recorders. Then we used JMP 5 to compile statistics and analyze the data. Results: The analyses of the study DMFT index number was 11.21. The number of caries teeth was 4.27. The number of missing teeth was 5.32 . And the filling rate was 1.61 teeth. The prevalence rate of caries was 90.83%, the teeth-filling rate was 25.38%, 81.53% had dental plaque, 75.84% had gingivitis, 60.13% had dental calculus,63.15% required maxilla denture , and 67.85% required mandible denture , and 75% prosthesis.. Conclusion: The oral health condition of the institutionalized people with disabilities in southern Taiwan is worse than that of the general public in Taiwan and the foreign research. The problems of oral health are not simple, they are always interrelated and getting worse and worse. If we do not provide medical treatment and improve the oral hygiene, the missing-teeth rate will rise and affect the normal oral function and quality of life. Most of all that will increase our medical treatment expenses. The state of oral health is affected by these factors : the gender, age, disability level , the type of institution, the dietary and living habits, the oral hygiene habits, and if they make regular visits to their dentists. Suggestion: 1. Make the oral hygiene and health protection plan at an early date. 2. Reinforce the training of professional workers of oral hygiene and health, the dentists and the oral hygienists of basic medical centers and hospitals. 3. Continuously provide oral examinations and compile data of oral health and hygiene condition, make a specific improvement program.