目的：過去職業流行病學研究顯示，健康照護工作者與一般族群相較，有較低之罹病風險；然而牙醫師工作環境中存在著各種潛在之健康危害因子，長時間暴露可能影響牙醫師之健康。（1）本研究目的之ㄧ為探討我國牙醫師族群較常被診斷之疾病病因，以及預測影響疾病發生之因子；並比較牙醫師與其他健康照護工作者罹病率之差異。（2）本研究同時也針對牙醫師工作環境之極低頻磁場進行暴露評估，藉以瞭解台灣地區牙醫師工作環境及個人之極低頻磁場暴露狀況。
方法：（1）利用國家衛生研究院全民健康保險學術研究資料庫，以回溯性世代追蹤研究方法分析2000 – 2004年7,760位牙醫師門診就醫之疾病發生密度與罹病相對風險。利用布瓦松迴歸模式預測影響疾病發生之因子，並分別與其他醫事人員及醫師2個對照組比較，推估牙醫師全病因及病因別之校正後相對罹病風險。（2）以便利取樣法選取65位牙醫師，自2008年6月至2009年2月間，進行牙醫師職場環境以及個人隨身之極低頻磁場暴露評估；並分別比較不同執業醫療機構之牙醫師極低頻磁場暴露值之差異及相關影響因素。
結果：（1）牙醫師最常被診斷的系統疾病為呼吸系統疾病（24.0%），全病因及病因別發生密度皆低於其他醫事人員或醫師族群；年齡、醫事機構權屬別及特約類別為牙醫師罹病率之預測因子。布瓦松多變量迴歸模式分析發現，牙醫師之內分泌、營養及新陳代謝疾病與免疫性疾患（與其他醫事人員相較aRR=1.04，95% CI=1.02 – 1.05）、精神疾患（與其他醫事人員相較aRR=1.04，95% CI=1.01 – 1.07）及腫瘤（與醫師相較aRR=1.06，95% CI=1.02 – 1.09）皆呈現略高之罹病危險性。（2）牙醫師職場極低頻磁場暴露評估研究顯示，牙醫師職業之環境與個人隨身測量之極低頻磁場幾何平均值分別為2.28±1.34及2.15±1.86 mG；然而牙醫師個人瞬間暴露值最高可達215.40 mG，有89.23%牙醫師瞬間最高暴露值>4 mG，平均值>4 mG的牙醫師比例則有16.62%。另外，私人牙醫診所診療區極低頻磁場算數平均值及幾何平均值顯著高於醫院牙科門診（5.54±5.69 vs. 1.51±0.77 mG，p =.008；2.66±1.34 vs. 1.35±0.68 mG，p =.026）；開業牙醫師極低頻磁場最小值平均值亦顯著高於醫院牙醫師（1.00±0.73 vs. 0.44±0.28 mG，p <.001）。儀器設備發生源之磁場強度隨著距離增加則快速減弱，在距離50公分處之數值可降低至與環境測量值相近。
結論：（1）在健康照護工作者族群中，牙醫師有較低之整體門診醫療利用率，亦呈現較低之罹病風險；然而在較嚴重之數種疾病，牙醫師卻有略高之罹病危險性。這可能與牙醫師承受高度工作壓力，並經常帶病工作及自我治療，因而忽視輕微疾病有關。（2）本研究亦發現部分牙醫師之極低頻磁場暴露強度高於背景值，有潛在職業極低頻磁場過度暴露情形。建議應考慮給予工作環境適當之空間規劃並謹慎避免暴露來源，以減少可能之職業過度暴露。

Objectives: Previous occupational epidemiological studies have showed that health care workers had lower risks of morbidity compared to the general populations. However, various occupational hazards can be found at the dental workplace, which may be a continued health threat to dentists. The purposes of this study were (1) to investigate diseases dentists may have, and potential risk factors associated with these diseases. We also investigated relative risks of the diseases associated with dentists compared to the other health care workers; (2) to assess occupational exposure of dentists to extremely-low-frequency magnetic field (ELF-MF), including the environmental and personal ELF-MF exposure status of dentists in Taiwan.
Methods: (1) The National Health Insurance Research Database between 2000 and 2004 from the National Health Research Institutes was used for this study. This study employed a retrospective cohort design to estimate incidence density and relative risk of morbidity among 7,760 dentists. We also performed Poisson regression model analysis to investigate the risk factors associated with the morbidity. We further estimated the dentists to other medical professional group and to physician group rate ratios respectively for the overall and specific disease. (2) Sixty-five (65) dentists were included to assess their environmental and personal exposures to ELF-MF at work from June 2008 to February 2009. The exposure of ELF-MF was compared between employed and self-employed dentists.
Results: (1) The most frequently reported diseases of dentists were diseases of the respiratory system (24.0%). The overall and disease-specific incidence densities of dentists were significantly lower than those of other medical professional or physician groups. Age, hospital ownership, and hospital accreditation level were the significant predictors for morbidity of dentists. The multivariate Poisson regression model analysis revealed no significant difference in risk of relatively mild diseases. However, dentists were found to experience significantly increased risks of endocrine, nutritional and metabolic diseases, and immunity disorders (compare to other medical professionals aRR=1.04, 95% CI=1.02 – 1.05), mental disorders (compare to other medical professionals aRR=1.04, 95% CI=1.01 – 1.07) and neoplasms (compare to physicians aRR=1.06, 95% CI=1.02 – 1.09). (2) Results of assessing the occupational exposure to ELF-MF of dentists showed that the geometric means (GM) of environmental and personal exposures were 2.28±1.34 and 2.15±1.86 mG, respectively. The maximum spot ELF-MF level was 215.40 mG, and 89.23% of participated dentists had a maximum instant exposure of >4 mG. The results also showed that 16.62% of dentists had a mean exposure of >4 mG. Compared with treatment areas at hospitals, the ELF-MF exposures at clinics was significantly higher according to the arithmetic mean (AM) (5.54±5.69 vs. 1.51±0.77 mG, p =.008) and GM (2.66±1.34 vs. 1.35±0.68 mG, p =.026). The mean of minimum exposure was also significantly higher of clinic dentists than that of hospital dentists (1.00±0.73 vs. 0.44±0.28 mG, p <.001). The ELF-MF intensity decreased with the increase of distance to the dental equipments, and reduced to the background level at a distance of 50 cm.
Conclusions: (1) Compared with other health care workers, dentists have less overall ambulatory care visits with lower risks of mild ailments. On the other hand, dentists have higher risks of relatively severe diseases, which could be accounted by work-related stress of dentists who might tend to work through illnesses and self-treating, thereby ignoring the minor disease. (2) This study also found that some dentists are exposed to ELF-MF higher than the background. It is suggested that appropriate space arrangement and prudential avoidance sources of exposure may be useful to further reduce the possible over-exposure.

致謝
摘要 i
Abstract iii
目錄 vii
表目錄 x
圖目錄 xiii
第壹章 緒論 1
第貳章 文獻探討 4
第一節 台灣地區牙醫師醫療人力現況與工作服務量 4
一、牙醫師醫療人力現況 4
二、牙醫師醫療人力分布 5
三、牙醫師醫療工作服務量 5
四、國際間牙醫師醫療人力密度比較 5
第二節 牙醫師職業之疾病罹病風險 6
第三節 牙醫師與健康照護工作者之極低頻磁場暴露 20
一、醫院環境及健康照護工作者之極低頻磁場暴露強度 21
二、牙科工作環境及牙醫師之極低頻磁場暴露強度 26
第參章 材料與方法 28
第一節 牙醫師門診就醫之常見疾病與罹病風險 28
一、研究資料來源 28
二、研究世代選取方法與流程 29
三、擷取醫事機構基本資料檔方法與流程 31
四、擷取承保資料檔方法與流程 32
五、擷取門診處方及治療明細檔方法與流程 32
六、研究變項操作型定義 33
七、追蹤與觀察人年數之計算 34
八、統計分析 35
第二節 牙醫師職場極低頻磁場暴露評估 37
一、研究樣本選取 37
二、測量工具 37
三、測量方法 38
四、統計分析 39
第肆章 結果 41
第一節 牙醫師門診就醫之常見疾病與罹病風險 41
一、牙醫師、其他醫事人員及醫師研究樣本人口學特性 41
二、牙醫師、其他醫事人員及醫師研究樣本門診就醫常見診斷病因 41
三、牙醫師樣本門診就醫之疾病發生密度 42
四、牙醫師樣本門診就醫之罹病風險預測因子 44
五、與其他醫事人員及醫師世代族群比較牙醫師世代門診就醫之罹病風險 50
第二節 牙醫師職場極低頻磁場暴露評估 51
一、牙醫師職場極低頻磁場測量之樣本特性與時間分布 51
二、醫院牙醫師及開業牙醫師職場極低頻磁場暴露強度分布與比較 52
三、牙科部門儀器設備固定發生源之極低頻磁場暴露強度分布 53
第伍章 討論 54
第一節 主要研究結果 54
第二節 牙醫師職業之疾病罹病風險 55
第三節 牙醫師職場極低頻磁場暴露評估 61
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