身心障礙患者口腔健康狀況及相關因素之探討

Oral Health Status and Related Factors of People with Disabilities

陳惠怡(Hui-Yi Chen)

指導教授 ： 紀玫如

臺北醫學大學/護理學院/護理學研究所/碩士(2014年)

摘要

研究目的：身心障礙者因智力、認知、情緒和肢體協調等因素，並經常合併系統性疾病，導致身心障礙者的口腔健康維護比一般人更困難。本研究之目的即在於分析醫院特殊需求口腔照護中心身心障礙者之口腔健康狀況、醫療需求、醫療利用及相關影響因素，從而早期介入適切的預防保健措施，以降低疾病發生並減少醫療成本。
研究方法：本研究之對象為民國100年七月至101年六月間至北部某醫學中心特殊需求者牙科醫療中心初次求診之身心障礙患者，採回溯型病歷研究，追蹤至民國102年六月為止，記錄其基本資料(性別、年齡、居住場所、障礙等級、障礙類別、罹患慢性疾病、口腔清潔行為、是否使用束縛板、是否曾經鎮靜麻醉)、口腔健康狀況(齲齒數、缺牙數、填補數、DMFT指數、齲齒盛行率、填補率)以及牙科治療項目(全口洗牙、牙體復形、根管治療、拔牙治療、贋復治療)，再以one-way ANOVA與線性迴歸分析等統計方法解析其相互關係。
研究結果：收案期間初診患者數共290人，平均齲齒數為5.85顆，缺牙數為3.49顆，填補數為3.93顆，DMFT指數為13.28，齲齒盛行率93.10%，填補率為27.89%。牙科治療項目中，90.7%曾接受全口洗牙、53.4%曾接受牙體復形治療、50.2%曾接受拔牙治療、5.9%曾接受根管治療；5.7％曾接受假牙贗復。以治療需求而言，全口洗牙治療為門診中主要牙科治療項目，其次為補牙治療與拔牙治療。依性別來看，各項指數女性均高於男性，在齲齒數、填補數、DMFT指數，呈現有統計學上的顯著性差異(p < 0.05)。以年齡層觀之，齲齒數、缺牙數、填補數、DMFT指數、填補率、齲齒盛行率，均隨著年齡增加而各項指數亦隨之遞增(p < 0.05)。在障礙等級上，DMFT指數以輕度高於極重度現有統計學上的顯著性差異(p < 0.05)。在不同的居住型態上，DMFT 指數以居住在機構顯著高於家庭 (p < 0.05)。曾有全身麻醉牙科治療經驗者，其齲齒數與齲齒盛行率高於僅一般門診治療者(p < 0.05)。
結論：本研究顯示，影響身心障礙者口腔健康狀況的因素包括：性別、年齡、居住場所、障礙程度、口腔清潔行為、鎮靜麻醉經驗。臨床上建議可針對高風險因子的患者，強化其自身或家屬維護口腔清潔的知識與技術，並訂定更為嚴格的回診計畫，以有效增進身心障礙族群的口腔健康。

關鍵字

身心障礙患者 ； 口腔健康 ； DMFT指數 ； 牙科治療

並列摘要

PURPOSE: The oral care of disable patients is more difficult than health people because of the limitation on expression and the physical disease. This study analyzed the oral health status, the need of dental treatment, the usage of dental resources and relative factors of disable patients who received dental care in an oral health care center in north Taiwan. And a proper plan of prophylaxis could be performed in advance to prevent disease and to down cost of medical resource.
METHODS: The objectives were disable patients who first visited the oral health care center during JULY 2011 and JUNE 2012. It was a retrospective study design, collected the general data ( age, gender, residence, degree and classification of disability, systemic disease, habits of oral care, experience of papoose board and sedation ), the oral health status ( decayed, missing, and filled teeth, DMFT index, caries prevalence, and filling rate ) and the dental treatment ( scaling, operative dentistry, root canal therapy, tooth extraction, and prosthesis fabrication ). And their relationships were analyzed by statistical analysis include one-way ANOVA and linear regression.
RESULTS: The total number of patients is 290, and their average count of decayed teeth is 5.85, missing teeth is 3.93, DMFT index is 13.28, caries prevalence is 93.10%, filling rate is 27.89%. In dental treatments, 90.7% has received full-mouth scaling, 53.4% received operative dentistry, 50.2% received tooth extraction, 5.9% received root canal therapy, and 5.7% received prosthesis fabrication. It shows the most need of dental treatment is full-mouth scaling, followed by operative dentistry and tooth extraction. By category of gender, female show worse status in decayed teeth, filled teeth, and DMFT index statistically ( p < 0.005). Decayed, missing, filled teeth, DMFT index, filling rate, and caries experience are also raised with age statistically ( p < 0.005). By category of degree of disability, patients with mild disability shows worsen oral health then profound ones ( p < 0.005). The patient who lived in institute have higher DMFT index home then home cared ones. And patient with experience of sedation during dental treatment show higher decayed teeth and caries prevalence then others ( p < 0.005)
CONSLUSION: The risk factors of worsen oral health to disable patients are gender, age, residence, degree of disability, habits of oral care, and experience of sedation. For patient with higher risk, improving their knowledge and motivation of oral care and providing a definite follow-up program could be effective ways to maintain oral health of disable patients.

並列關鍵字

disabilities ； oral health ； DMFT index ； dental treatment

參考文獻

中文部份

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內政部統計處(2013)。民國101年第34週內政統計通報。取自http://www.moi.gov.tw/stat/news_content.aspx?sn=6631 [ Department of Statistics, Ministry of the Interior ( 2013 ) The 34th Weekly Statistical Report of 2012 from Ministry of the Interior http://www.moi.gov.tw/stat/news_content.aspx?sn=6631 ]