臺灣博碩士論文加值系統

背景：
糖尿病患者對口腔保健認知不足，無法意識到自身疾病對口腔疾病及其併發症影響，因而未能採取適當的口腔預防保健行為。
目的：
評值第二型糖尿病患者接受非手術型牙周治療與臨床口腔衛生指導後其牙周狀況改變成效、口腔健康知識、態度及口腔照謢行為改變之成效。
研究方法：
本研究使用準實驗設計。研究對象選取高雄醫學大學附設中和醫院內分泌新陳代謝科，參與糖尿病共同照護網之第二型糖尿病患者。納入條件為35歲以上、至少有16顆牙齒(不包含第三大臼齒)、最近一年未接受牙周治療；排除條件為非第二型糖尿病患者、定期服用抗生素及骨質疏鬆症等藥物治療、有抽菸、嚼食檳榔或戒除菸、檳榔尚未達半年以上者及嚴重損害之疾病(如:癌症、腎或肝功能衰竭、心臟病等)。實驗組接受非手術型牙周治療及臨床口腔衛生指導，對照組無任何介入。兩組總共28位完成前後測。使用Wilcoxon rank sum test及Fisher’s exact test, McNemar exact test/marginal homogeneity test判斷兩組口腔保健知識與態度、行為前後測變化情形。使用Wilcoxon sign rank test/two sample t-test/Repeated-measures ANOVA檢定實驗組介入前後牙周狀況差異。
結果：
非手術型牙周治療後，糖尿病患牙周狀況有顯著改善。口腔照謢行為，刷牙的時間與刷牙方法介入後有顯著的提升；口腔健康知識及態度，則無顯著差異。
結論：
臨床口腔衛生指導僅針對基本的潔牙技巧及輔助工具的使用，未能影響糖尿病患口腔知識、態度與保健行為改變，建議針對糖尿病患者給予適切性牙周照護指導，以強化牙周保健行為。

Background:
Awareness of oral health care is insufficient for diabetes patients to realize their disease impact on oral disease and its complications, and thus failed to take appropriate preventive oral health behaviors.
Objective:
To evaluate the effectiveness of non-surgical periodontal therapy and oral hygiene instruction on periodontal status, oral health knowledge, attitude and behaviors among type II diabetic patients.
Method:
A quasi-experimental experimental design was used. Type II diabetic patients were recruited from the Division of Endocrinology and Metabolism in Kaohsiung Medical University Hospital, Taiwan. Inclusion criteria of participants were having type II diabetes, aged 45-65, having at least five teeth in oral cavity, having gingival bleeding when screening, and probing pocket depth (PPD)≧5mm. Diabetic patients who had periodontal treatment within six months, regular used antibiotic and bisphosphonates and had seriously harmful diseases were excluded. Non-surgical periodontal therapy will be used for experimental group, the control group will be offered no receive clinical oral health education. A total of 28 patients finished the study. Wilcoxon rank sum test and Fisher’s exact test, McNemar exact test/marginal homogeneity test analyzed the differences in oral self-care behavior knowledge attitudes between pretest and post-test. Wilcoxon sign rank test/two sample t-test/Repeated-measures ANOVA analyzed the differences in periodontal status between pretest and posttest.
Result:
There was significant improvement of the periodontal index among experimental group after non-surgical periodontal therapy intervention. Clinical oral hygiene instruction increased the frequency of brushing method; however, oral health knowledge and attitude had no significant increase at post-test.
Conclusion:
The oral health knowledge and attitude had no significant change after oral hygiene instruction. Further periodontal-related health education should provide for diabetes patients to increase their oral health care behaviors.

中文摘要 i
Abstract iii
目錄 v
第一章 緒論 8
第一節 研究背景 8
第二節 研究動機 10
第三節 研究目的 12
第二章 文獻探討 13
第一節 糖尿病患的口腔健康狀況 13
第二節 牙周病與糖尿病的相關性探討 15
第三節 口腔健康知識、態度、口腔照護行為與牙周病的相關性探討 17
第四節 糖尿病患之牙周病照護介入探討 19
第三章 研究方法 23
第一節 研究對象 23
第二節 研究倫理審查 24
第三節 研究設計 25
第四節 選樣方法 26
第五節 研究流程 27
第六節 介入執行 29
第七節 研究工具 31
第八節 施測過程 35
第九節 變項測量 36
第十節 資料處理及統計分析 44
第四章 研究結果 47
第一節 糖尿病患基本人口學變項分佈 47
第二節 實驗組糖尿病患者治療前後之牙周狀況比較 49
第三節 糖尿病患口腔健康知識前測與後測比較 50
第四節 糖尿病患口腔健康態度前測與後測比較 51
第五節 糖尿病患口腔照謢行為前測與後測比較 52
第六節 糖尿病患口腔照謢行為前測與後測改變階段比較 54
第五章 討論 55
第一節 牙周狀況成效探討 55
第二節 口腔照謢行為介入成效探討 57
第三節 口腔健康知識、態度成效探討 60
第四節 研究限制 62
第六章 結論與建議 64
參考文獻 65
分析圖表 71
附錄一：評值第二型糖尿病患者口腔知識、態度、行為及生活品質、飲食前測問卷 84
附錄二：牙周病檢查表 84
附錄三：訪員訓練手冊 84

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