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研究生:許坤榮
研究生(外文):Kun-Jung Hsu
論文名稱:中老年人咀嚼能力之鑑定與其相關因素之探討
論文名稱(外文):A screening test on masticatory ability of middle and older aged with the exploration of the related determinants
指導教授:李惠娥李惠娥引用關係
指導教授(外文):Huey-Er Lee
學位類別:博士
校院名稱:高雄醫學大學
系所名稱:牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2012
畢業學年度:101
語文別:中文
論文頁數:136
中文關鍵詞:自然齒功能齒單位數咀嚼能力牙齒的保留檳榔抽菸
外文關鍵詞:natural toothfunctional tooth unitsmasticatory abilitytooth retentionbetel nutsmoking
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目的:本研究目的有二,第一個目的是:了解和齒列健康有關的口腔健康行為、口腔習慣及自覺健康狀況,並探討其在年齡及性別上的差異;第二個目的是:評估一個適合的食物攝取問卷,用以鑑別至少有20顆自然齒及8個功能齒單位數的中老年人 (高齒列組) 和非高齒列組中老年人 (低齒列組) 的咀嚼能力。
方法:第一個研究目的是以2071位在台灣23個縣市的牙醫診所,年齢在45歲或以上的有牙中老年患者為研究對象;在納入全口無牙者後的2244位中老年患者,則為第二個研究目的的研究對象。在參加本研究的牙醫診所中,使用問卷配合口腔檢查來收集相關資料,其中社會人口學、口腔健康行為、口腔習慣、自覺健康狀況及自評咀嚼能力的資料是以問卷收集,自評式咀嚼能力是以35種台灣常見食物所組成的23種食物項目組來測得的,而齒列狀況則是以口腔檢查來評估。第一個研究目的是以多變項羅輯斯廻歸 (Multiple logistic regression)分析,以了解低齒列組在口腔健康行為、口腔習慣及自覺健康狀況的可能預測因子。第二個研究目的則是以Receiver operation characteristic curve (ROC curve)來分析,以求得一個最適合的食物攝取問卷。
結果:在第一部分的研究方面,以多變項羅輯斯廻歸分析後發現,年齡較大者、教育程度較低者、從不用牙線者、目前有抽菸習慣者、以前有嚼食檳榔習慣者及有較差的自覺牙齒健康者,較容易是低齒列組,而目前有嚼食檳榔習慣者較不易是低齒列組。此外,口腔健康行為及口腔習慣對齒列健康的影響,在年齡較大的分組上較為顯著,但在性別的分組上則沒有明顯差異。在第二部分的研究方面,ROC curve 的分析結果顯示,共有14種食物項目組被選入最後的食物攝取問卷,一位受測者若在這14種食物項目組中,有4種或以上的答案是吃起來有困難,則其咀嚼能力就可能是低齒列組。
結論:本研究結果突顯了使用牙線的重要性,也確認了抽菸對齒列健康的不良影響,這對年齡較大者尤其明顯,另外,雖然嚼食檳榔對保留牙齒可能有幫助,但考慮其可能的致癌性,所以嚼食檳榔的習慣仍不應被鼓勵。因此,要達到保有至少20顆自然齒及8個功能齒單位數的治療目標,應鼓勵民眾培養適當的口腔健康行為及口腔習慣。其次,由本研究結果可知,最困難吃的食物未必就是理想的鑑別咀嚼能力的食物,要了解民眾的咀嚼能力是高齒列組或低齒列組,本研究所得的食物攝取問卷,提供了一個最佳的鑑別工具。


Objective: The purposes of this study were (1) to evaluate the impact of oral health behaviors, oral habits and self-perceived health status on the dental health in older Taiwanese adults and the age and gender disparity in those impacts, and (2) to evaluate a screening test based on a food intake questionnaire to discriminate the masticatory ability of Taiwanese older adults with 20 and more natural teeth and at least 8 functional tooth units (high dentition group) from the masticatory ability of those who were not high dentition group (low dentition group)
Methods: The subjects were 2071 dentate patients, aged 45 years old and over, recruited from 23 counties and cities in Taiwan for the first purpose. After recruiting dentate patients, 2244 patients were selected for the second purpose. A dental examination and questionnaire were conducted in the dental clinics. Demographic data, oral health behaviors, oral habits, self-perceived health and masticatory ability were collected via questionnaires. Dentition status was assessed by dental examination. Masticatory ability was measured for 23 food groups comprising 35 common Taiwanese foods. Multiple logistic regression analyses were used to determine predictors correlated with poor tooth retention for the first purpose. Receiver operation characteristic curve analysis was performed for the second purpose.
Results: The results for the first purpose showed that subjects who were low dentition group were more likely to be older and to exhibit low educational levels, less frequent use of dental floss, current smoking habits, betel nut ex-chewer, bad self-perceived dental health, and the subjects who were low dentition group were less likely to be current betel nut chewers. Moreover, more impacts of oral health behaviors, oral habits and self-perceived health status on the dental health was found in older age group. No gender disparity of those impacts was observed.
Conclusions: First, these results underscore the importance of the use of dental floss and confirm the adverse effects of smoking on dental health, especially for the older age group. In addition, though betel nut chewing may help retain teeth, it should not be encouraged due to carcinogenicity. Hence, to achieve the goal of maintaining 20 or more NT and at least 8 FTUs, the dental profession should continue to encourage proper oral health behaviors and oral habits, especially for the elderly. Second, foods that are the most difficult to eat are not necessarily good discriminatory indicators. Hence, the 14-food group questionnaire can be considered the best screening test for masticatory ability of Taiwanese older adults in terms of the presence of 20 and more natural teeth (NT) and at least 8 functional tooth units (FTUs).


第一章 緒論………………………………………………………1
第一節 總研究背景與動機………………………………………1
第二節 總研究目的………………………………………………3
第二章 影響台灣中老年人齒列健康的口腔健康行為、口腔習
慣及相關因素…………………………………………………… 4
第一節 研究背景與動機…………………………………………4
第二節 研究目的…………………………………………………6
第三節 研究假設…………………………………………………7
第四節 文獻探討…………………………………………………8
4.1. 齒列健康和口腔健康行為的相關性…………………… 8
4.2. 齒列健康和口腔習慣的相關性………………………… 10
4.3. 齒列健康和自覺健康狀況的相關性…………………… 12
第五節 研究方法…………………………………………………13
5.1. 研究對象………………………………………………… 13
5.2. 問卷內容………………………………………………… 13
5.3. 口腔檢查………………………………………………… 14
5.4. 統計方法………………………………………………… 16
第六節 結果………………………………………………………18
6.1. 基本資料描述…………………………………………… 18
6.2. 存留齒數的分佈狀況…………………………………… 19
6.3. 口腔健康行為、口腔習慣及自覺健康狀況的分佈狀況 20
6.3.1. 在年齡的分佈狀況………………………………………20
6.3.2. 在性別的分佈狀況………………………………………21
6.4. 口腔健康行為和口腔習慣的相關性………………………22
6.5. 口腔健康行為、口腔習慣及自覺健康狀況和齒列分組的相
關性…………………………………………………………22
6.6. 低齒列組的預測因子………………………………………23
6.6.1. 社會人口學變項…………………………………………23
6.6.2. 口腔健康行為……………………………………………24
6.6.3. 口腔習慣…………………………………………………24
6.6.4. 自覺健康狀況……………………………………………25
6.7. 中老年人齒列健康在口腔健康行為、口腔習慣及自覺健康
狀況的預測因子,在年齢上的差異………………………27
6.7.1. 45-54歲中老年人齒列健康在口腔健康行為、口腔習
慣及自覺健康狀況的預測因子……………………………27
6.7.2. 55-64歲中老年人齒列健康在口腔健康行為、口腔習
慣及自覺健康狀況的預測因子……………………………28
6.7.3. 65歲(含)以上老年人齒列健康在口腔健康行為、口
腔習慣及自覺健康狀況的預測因子………………………29
6.8. 中老年人齒列健康在口腔健康行為、口腔習慣及自覺健康狀況
的預測因子,在性別上的差異……………………………30
6.8.1. 45歲(含)以上男性中老年人齒列健康在口腔健康行為、
口腔習慣及自覺健康狀況的預測因子……………………30
6.8.2. 45歲(含)以上女性中老年人齒列健康在口腔健康行為、
口腔習慣及自覺健康狀況的預測因子……………………31
第七節 討論…………………………………………………… 33
7.1.口腔健康行為對齒列健康的影響………………………… 33
7.2.口腔習慣對齒列健康的影響……………………………… 36
7.3.自覺健康狀況對齒列健康的影響………………………… 37
7.4. 中老年人齒列健康在口腔健康行為、口腔習慣及自覺健康狀
況的預測因子,在年齡及性別上的差異…………………38
7.4.1.在年齡方面……………………………………………… 38
7.4.2.在性別方面…………………………………………………39
7.5. 口腔健康行為及口腔習慣的相關性……………………… 40
7.6. 研究限制…………………………………………………… 42
第八節 結論與建議………………………………………………44
8.1.結論……………………………………………………… 44
8.2.建議……………………………………………………… 44
第三章 咀嚼能力的評估方法……………………………… 46
第一節 研究背景與動機……………………………………46
第二節 研究目的……………………………………………48
第三節 研究假設……………………………………………48
第四節 文獻探討……………………………………………49
4.1.影響咀嚼能力的齒列因素……………………………… 49
4.2.客觀性咀嚼能力………………………………………… 50
4.3.主觀性咀嚼能力………………………………………… 53
第五節 研究方法……………………………………………57
5.1.研究對象………………………………………………… 57
5.2.食物攝取問卷…………………………………………… 57
5.3.口腔檢查………………………………………………… 58
5.4.統計方法………………………………………………… 59
第六節 結果……………………………………………… 62
第七節 討論…………………………………………………65
第八節 結論與建議…………………………………………71
8.1.結論……………………………………………………… 71
8.2.建議……………………………………………………… 71
第四章 總結論與建議…………………………………………73
第一節 總結論…………………………………………………73
第二節 建議……………………………………………………74
參考文獻……………………………………………………… 75
表1. 社會人口學變項、齒列分組、口腔健康行為及口腔習慣
的分佈狀況……………………………………………… 94
表2. 存留齒數及年齡在齒列分組的分佈狀況………………96
表3. 口腔健康行為口腔習慣及自覺健康狀況在年齡的分佈狀
況…………………………………………………………97
表4. 口腔健康行為、口腔習慣及自覺健康狀況在性別的分佈
狀況 ………………………………………………………99
表5. 口腔健康行為在抽菸習慣的分佈狀況…………………101
表6. 口腔健康行為在嚼食檳榔習慣的分佈狀況……………102
表7. 社會人口學資料、口腔健康行為、口腔習慣及自覺健康
狀況在齒列分組的分佈狀況……………………………103
表8. 低齒列組的預測因子……………………………………105
表9. 45-54歲中年人齒列分組在社會人口學變項、口腔健康行為
、口腔習慣及自覺健康狀況的分佈狀況………………107
表10.45-54歲中年人低齒列組的預測因子………………… 109
表11.55-64歲中年人齒列分組在社會人口學變項、口腔健康行為
、口腔習慣及自覺健康狀況的分佈狀況………………111
表12.55-64歲中年人低齒列組的預測因子………………… 113
表13.65歲(含)以上老年人齒列分組在社會人口學變項、口腔健
康行為、口腔習慣及自覺健康狀況的分佈狀況………115
表14.65歲(含)以上老年人低齒列組的預測因子……………117
表15.男性中老年人齒列分組在社會人口學變項、口腔健康行為
、口腔習慣及自覺健康狀況的分佈狀況…………… 119
表16.男性中老年人低齒列組的預測因子……………………121
表17.女性中老年人齒列分組在社會人口學變項、口腔健康行為
、口腔習慣及自覺健康狀況的分佈狀況…………… 123
表18.女性中老年人低齒列組的預測因子………………… 125
表19.社會人口學變項在齒列分組的分佈狀況…………… 127
表20.存留齒數及年齡在齒列分組的分佈狀況…………… 128
表21.社會人口學變項在齒列分組上的分佈狀況………… 129
表22.高齒列組及低齒列組在每一種食物項目組中選「困難吃」
的比例及其差異值………………………………………130
表23.不同累積數量的食物項目組對應的曲線下面積之分佈情
形…………………………………………………………131
表24.以選出的14種食物項目組鑑別高齒列組和低齒列組咀
嚼能力的可能分界點(cut-off point) 的分佈情形………132
表25.在最佳食物問卷中,每一種食物項目組鑑別度的分佈狀
況………………………………………………………………133
附錄……………………………………………………………134
問卷……………………………………………………………134


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