口腔衛生教育介入對一般國小一至三年級特殊教育學生之成效評估

研究背景：相關研究指出身心障礙兒童的口腔狀況普遍較一般學童不佳，且遠不及於世界衛生組織訂定2010年應達到的全球口腔保健目標：12歲兒童平均DMFT指數在2.0以下。然而，口腔衛生教育介入對提升口腔健康狀況是最直接有效的方法。研究目的：探討口腔衛生教育介入，對安置於一般國小普通班之一至三年級輕、中度智能障礙學童在口腔衛生知識與潔牙技巧的成效。研究方法：研究對象為高雄市某六所間國小不分類身心障礙資源班一到三年級輕度或中度的智能障礙學童，共計34人。全部受試學童皆接受各為期一個月兩階段的研究介入，第一階段為不予以口腔衛生教育課程的對照組，第二階段為予以口腔衛生教育課程的實驗組。兩階段的介入前後皆會進行1次前測及3次後測，測驗內容包括口腔衛生知識測驗及牙菌斑指數檢測。以Microsoft Excel進行資料建檔，及SPSS12.0版套裝軟體以paired t-test進行統計分析。結果：有口腔衛生教育課程介入的實驗組，不管在口腔衛生知識或是牙菌斑殘留率的表現上都有明顯改善。在實驗組與對照組間，牙菌斑殘留率的改變量比較方面，以全口牙面（-16.65%±18.37% vs.3.40%±15.97%）、舌側牙面（-11.10%±23.95% vs.4.95%±26.66%）、頰側牙面（-22.05%±20.71% vs.-7.20%±17.57%）、上顎頰側牙面（-21.88%±25.93% vs.-6.08%±19.30%）、上顎舌側牙面（-13.71%±25.40% vs.-3.04%±32.31%）及下顎舌側牙面（-8.79%±31.88% vs.8.38%±29.19%）等位置都達到顯著差異，即實驗組的介入成效優於對照組；而介入組結束後的效果保留方面，口腔衛生知識的效果保留至少可達四週以上，各牙面潔牙技巧的效果保留以全口牙面、舌側牙面可達至少兩週以上，頰側牙面、上顎頰側牙面、上顎舌側牙面及下顎舌側牙面則至少有四週的維持效果；然而衛教介入後，上顎頰側後牙面的潔牙效果最差。結論：本研究結果顯示，經過口腔衛生教育課程介入後，智能障礙學童的口腔衛生知識有明顯的提升，且潔牙後牙菌斑殘留率的明顯下降，可推論智能障礙學童在操作牙刷清除牙菌斑的技巧有進步。然而，學童操作牙刷進行潔牙的效果會依牙面部位的不同而有差異，上顎頰側後牙面的刷牙技巧是最需加強。整體而言，口腔衛生教育課程的介入對國小一至三年級智能障礙學童的口腔衛生具有改善的效果。

關鍵字

國小智能障礙學童；口腔衛生教育介入；牙菌斑殘留率

並列摘要

Background: The oral health status of children with disabilities was generally poorer than that of normal children in Taiwan and foreign countries, and still far lower than the global oral health goal at World Health Organization set in 2010: DMFT index of 12-year-old children's average should be below 2.0. The promotion of oral health education intervention is the most direct and effective way to improve the oral health condition for children with disabilities and normal. Objectives: The aim of this study is to evaluate the effect of the oral health education intervention and skills of cleaning teeth for one to three grades students with mild to moderate intellectual disability in general elementary school. Methods: The subjects were 34 students of reading resource classes in the six elementary schools of Kaohsiung City. A one month intervention was conducted between the first stage (control group) and the second stage (experiment group), Both control group and experiment group were given one pre-test and three times post-test. The test included the oral health knowledge and dental plaque index detection. The data were collected and organized with Microsoft Excel and were statistically analyzed with paired t-test of SPSS12.0 software package. Result: The results of the experimental group were improved either in oral health knowledge or in plaque index. Between the experimental group and control group, comparing the change of dental plaque index, there showed significant difference in the total side of teeth, lingual side of teeth, buccal side of teeth, upper buccal side of teeth, upper and under lingual side of teeth, and the experimental group was significantly better than the control group. The effect of maintenance period, oral health knowledge had four weeks, the skill of operate toothbrushes to remove dental plaque had two weeks in the total side of teeth, lingual side of teeth, had four weeks in the buccal side of teeth, upper buccal side of teeth, upper and under lingual side of teeth. Conclusion: This research showed that oral health knowledge had significant improvement, and the dental plaque index had significantly decrease after oral health education intervention. It can be inferred the skill of disable students operate toothbrushes to remove dental plaque had improvement. Therefore, the results of students operate toothbrushes to remove dental plaque will difference for difference place of teeth. Anyway, the oral health education intervention for one to three grades of mild to moderate intellectual disability students in general elementary school has improved results.