臺灣博碩士論文加值系統

摘 要
背景：
據估計全民健保一年在齲齒的花費約有新台幣150多億元，而氟化防齲是目前認為最直接且積極、有效的方法；為改善兒童口腔狀況以及推廣氟化物的使用，中央健保局於2004年7月開辦『兒童牙齒預防保健服務』，提供未滿5歲兒童每年2次氟化防齲處理口腔項目。許多國內、外研究認為父、母親對於口腔預防保健的了解、支持與參與，將會影響兒童能否接受適當的醫療照護，故為了解影響兒童利用牙齒塗氟之相關因素，特別進行此次調查。

目的：
調查兒童接受牙齒塗氟經驗的實際情形，藉此探討兒童因素、家長因素與其對牙齒塗氟的認知、接受程度對兒童接受牙齒塗氟應用之相關性。

方法：
針對南部某醫學大學兒童牙科門診部就醫兒童患者之家長，立意取樣共計316位，以結構式問卷進行面訪調查。所得資料以JMP5.1.2版統計軟體進行建檔、分析。
結果：
參與本研究的兒童個案數共有316人，研究中有80.06％的兒童從未接受過牙齒塗氟；其次是曾經自費接受過的有11.39％；接受健保給付塗氟的有8.54％。根據兒童自身因素與其接受牙齒塗氟經驗做比較，分析結果在兒童基本資料方面不具統計上顯著差異，但是有接受塗氟經驗的兒童使用氟化物習慣的比例高於從未接受過的。家長因素方面，有接受塗氟經驗兒童的家長在教育程度、社經地位的表現較佳；接受過牙齒塗氟、塗氟知識得分較高的家長其兒童接受塗氟經驗比例亦較高，且具統計上顯著性差異（p<0.05）。知道牙醫師有塗氟的家長會帶小孩去接受的是不知道者的17.78倍；曾接受牙齒塗氟的家長會帶小孩接受塗氟是不曾接受者的8.12倍；贊成健保給付牙齒塗氟的家長會帶小孩接受塗氟是不贊成者的3.33倍；家長牙齒塗氟知識達40分以上會帶小孩接受塗氟是未滿40分者的4.89倍。

結論與建議；
本研究調查結果顯示影響兒童利用牙齒塗氟之相關因素，就兒童自身因素對其接受牙齒塗氟的使用率影響不大；但在家長因素方面，知道牙齒塗氟、曾接受過牙齒塗氟、贊成健保給付牙齒塗氟、牙齒塗氟知識得分較高的家長，其小孩接受過牙齒塗氟的比例較高。是故，在牙科醫療院所或是報章雜誌、網路媒體等針對家長大力宣導並在宣導時加強牙齒塗氟預防齲齒的安全性與重要性，必可提高兒童牙齒塗氟的接受率，以收改善兒童口腔齲齒狀況、推廣氟化物使用及避免醫療資源浪費之效。

關鍵字：牙齒塗氟、牙齒預防保健

Abstract
Background:
The cost of caries treatment was about 15 billion a year, according to the Bureau of National Health Insurance (BNHI). Because fluoride gels application was proven to be the most effective and direct way to prevent dental caries. A service of dental fluoride application for children under 5 years old twice a year in the “Preventive Dental Health Service for Children” by the BNHI began in July 2004. Many studies pointed out that the attitude and awareness of parents on preventive oral health may prevent the children from receiving appropriate medical care, the study was performed to understand the associated factors affecting fluoride gels application in children.

Purpose:
The aim of this study was to evaluate the fluoride gel experience of children, and its` association between knowledge and acceptance of fluoride gels application contributed to children or parents.

Methods:
The study was performed at the department of pedodontics at a medical university hospital in southern Taiwan. With a total of 316 visiting children, were interviewed with a structured questionnaire. All of the data were coded and analyzed with compact software JMP version 5.1.2.

Results:
Among the 316 samples, 80.06% of them had never received fluoride application; 11.39% of the children received self-paid fluoride application; and 8.54% of them received fluoride application under insurance payment. There was no significant difference between children itself and the acceptance of fluoride application, but more proportion of them who had ever received fluoride application were used to fluoride than those never received. As for parental factors, the parents of those children who ever received fluoride application had better performance in educational level and socioeconomic status; more proportion of the children received fluoride application if their parents had ever received fluoride application or had high scores of fluoride application knowledge, which was statistically significant (p<0.05). It was 17.78 times for parents who know the fluoride application from their dentist had their children receive the procedure than those unaware of it; it was 8.12 times of parents who had ever received fluoride application would bring their children to receive the procedure than those not receiving the procedure; parents who agree with the fluoride application, would bring their children to receive the procedure was 3.33 times than those that did not; parents with fluoride knowledge scores over 40 would bring their children to receive the fluoride application was 4.89 times than those with scores under 40.

Conclusion and suggestions:
The result of this study showed that the children themselves has no prominent effect on the utilization of fluoride application; as for their parents, who were aware of dental fluoride application, and who had ever received fluoride application, or agreed with insurance payment for fluoride application, and those with high scores of fluoride application knowledge had a higher proportion of their children received fluoride application. We suggested that a promotion program of preventive dental health at clinics, TV and radio broadcasts, and websites with accentuation on the safety and importance of fluoride application towards parents may enhance the utilization rate of fluoride application by children, with the effect of improving caries status of children, reduce the expenditure of insurance payment for caries management.

Key words: Fluoride gel application, Preventive dental health

目 錄
頁次
致謝.............................................................................................................I
中文摘要....................................................................................................II
英文摘要..................................................................................................IV

第一章 緒論......................................................................................1
第一節 研究背景..........................................................................1
第二節 研究目的..........................................................................3

第二章 文獻探討..............................................................................4
第一節 國內、外兒童齲齒問題之相關研究..................................4
第二節 影響兒童利用口腔預防保健服務因素之相關研究........6
第三節 牙齒塗氟應用對齲齒預防成效之相關研究…………..15
第四節 探討民眾對氟化物/牙齒塗氟的認知與接受程度.........18

第三章 研究材料與方法................................................................21
第一節 研究對象與工具............................................................21
第二節 研究流程........................................................................22
第三節 研究設計........................................................................23
第四節 研究架構........................................................................25
第五節 統計分析方法................................................................26
第六節 名詞界定........................................................................26
第七節 研究限制........................................................................27

第四章 研究結果............................................................................28
第一節 研究對象基本人口學特性..........................................28
第二節 兒童接受牙齒塗氟經驗之實際情形..........................31
第三節 兒童接受牙齒塗氟經驗與家長因素之相關性..........34
第四節 兒童接受牙齒塗氟經驗與家長接受程度之相關性..37
第五節 兒童接受牙齒塗氟經驗與家長對牙齒塗氟知識
之相關性.…………………………………………….40
第六節 影響兒童接受牙齒塗氟預防保健之相關因素……..42

第五章 討論......................................................................................44
第一節 資料收集情形………………………………………..44
第二節 研究對象基本人口學特性之現況…………………..44
第三節 兒童接受牙齒塗氟經驗實際情形與影響因素……...46
第四節 兒童接受牙齒塗氟經驗與家長因素之相關性……...48
第五節 兒童接受牙齒塗氟經驗與家長接受程度之相關性...50
第六節 兒童接受牙齒塗氟經驗與家長牙齒塗氟知識之
相關性………………………………………………..51
第七節 影響兒童接受牙齒塗氟預防保健之相關因素……...53

第六章 結論與建議..........................................................................55
第一節 結論................………………………………………..55
第二節 建議................................................…………………..56
參考文獻..................................................................................................57

表目錄......................................................................................................61
表 1. 兒童與家長之基本資料分佈情形……..……………………...62
表 2. 兒童口腔健康行為分佈情形…………..……………………...63
表 3. 家長口腔健康行為分佈情形…………………………..……...64
表 4. 兒童實際接受牙齒塗氟經驗的分佈情形…………………….65
表 5. 各年齡層兒童接受牙齒塗氟經驗的分佈情形…………….....66
表 6. 兒童接受牙齒塗氟經驗與其基本資料之關係…………….....67
表 7. 兒童接受牙齒塗氟經驗與其口腔健康行為之關係……..…...68
表 8. 兒童接受牙齒塗氟經驗與家長基本資料之關係………….....69
表 9. 兒童接受牙齒塗氟經驗與家長口腔健康行為之關係……….70
表10. 家長對兒童牙齒塗氟接受程度的分佈情形…..…….…….…...71
表11. 兒童接受牙齒塗氟經驗與家長對牙齒塗氟接受程度之關係...72
表12. 兒童與家長接受牙齒塗氟經驗對家長牙齒塗氟知識得分之
關係....…………………………………………………………..72
表13. 家長牙齒塗氟知識得分與父、母親年齡之相關性…………….73
表14. 家長牙齒塗氟知識得分依其人口學特性比較………………...74
表15. 家長牙齒塗氟知識得分與其口腔健康行為之關係…………...75
表16-1. 影響兒童接受牙齒塗氟經驗因素之對數迴歸分析……..….76
表16-2. 影響兒童接受牙齒塗氟經驗因素之對數迴歸分析…..…….77

英文表目錄..............................................................................................78
Table 1. Demographic characteristics of children and parents……….....80
Table 2. Numbers and percentages of children with oral health
behavior……………….…………………………………….....81
Table 3. Numbers and percentages of parents with oral health
behavior.…………………………………………………….....82
Table 4. Distribution of fluoride application in children..........................83
Table 5. Distribution situation of fluoride application on all ages
Children...……..…………………………………………….....84
Table 6. Relationship of fluoride application according to demography
of children…....………………...………………………………85
Table 7. Relationship of fluoride application according to oral health behavior of children………….………………...………………86
Table 8. Relationship of fluoride application in children according to demography of parents……………………………………...…87
Table 9. Relationship of fluoride application in children according to
oral health behavior of parents………………………………...88
Table 10. Distribution situation of the parents degree the fluoride application in children………….…….………………………89
Table 11. Relationship of fluoride application in children according
to parents degree the fluoride application……..……………...90
Table 12. Relationship of fluoride application in children and parents according to fluoride application knowledge of parents…..…91
Table 13. Relationship of fluoride application knowledge of parents according to parent''s age………….……….………………….91
Table 14. The association between scores of fluoride application
knowledge by parents and their demographic characteristics..92
Table 15. The association between scores of fluoride application
knowledge by parents amd their oral health behavior..............93
Table 16-1. Adjusted odds ratios for fluoride application in children
according to demographic characteristics of children and parents………………....……..………………………….....94
Table 16-2. Adjusted odds ratios for fluoride application in Children
according to oral health behavior and knowledge,
acceptance of fluoride application……………….…….…..95

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