臺灣博碩士論文加值系統

牙體技術人員因職業之故而經常籠罩於粉塵以及各種金屬與化學物質的危害之下，有關職業性肺部與神經系統疾病，在國外的研究中已著墨甚多，但在台灣卻鮮見相關的研究。因此，本計劃為暸解此等作業人員的職業傷病情形及其危險因子，以作為日後改善工作環境及預防職業病的參考，並對此類從業人員有較完善的保健及規範，故針對中華民國齒模製作協進會會員資料進行抽樣，配合結構式問卷、肺功能檢測以及尿液檢體中重金屬含量測定等項目，同時輔以粉塵及各種金屬的環境檢測，以確立牙體技術人員健康效應與環境間的互動關係。
結果顯示牙體技術人員以男性為主，受訪的113人中男性佔82人，年齡平均29歲，就業年數平均約長達9年，顯示就業年齡甚小，教育程度偏低，其每天工作時數平均約9小時，大部分工作人員均認為粉塵是主要的工作危害，而工作量太大、與牙醫師溝通不易及工作量太集中等，則是主要工作壓力來源。在生活及工作衛生習慣方面，抽菸者佔三成，吸入程度較深，且有邊抽菸或邊飲食邊工作的習慣，大部份人員會著工作服回家，有一成受訪者工作處所與住家同址，至於工作時之防護措施以戴口罩、使用局部集塵器、裝抽風機者居多，其中亦有使用風扇者。由問卷及體檢結果顯示其消化道、皮膚與呼吸道的疾病較多，而神經、視覺與聽力的自覺症狀也較多，肺功能資料則呈現126人中有41名侷限性通氣障礙者佔32.5％，是否受粉塵之影響值得關心。室內吸入性粉塵的濃度會因工作狀況及通風情況而影響其濃度，故其現場整體通風之改善及管理人員之訓練均有其必要，而由工作中吸菸及飲食的情況可知，應積極宣導以建立良好的工作衛生習慣。
本研究建議應儘速推行證照制度、加強在職教育、輔導紓解工作壓力以及改善作業環境，並應舉辦定期健康檢查，以預防職業傷病的發生。又齒模製作為牙科贗復必要之一環，牙醫師常因醫療業務繁忙而無法兼顧於此，牙體技術人員有其存在之必要性。由於目前政府並未將牙體技術人員納入管理，而業者僅依其自由意願加入職業團體組織，並無強制性，以致於無法找尋所有的牙體技術人員，而儼然成為一個龐大的隱藏行業。若要提升我國牙醫醫療品質水準，保障國民口腔健康，實有必要將該行業納入正式管理。

Dental technicians are occupationally exposed to various dusts, metals, and other chemicals. Occupational related lung, skin and neurological diseases have been documented in several studies. But it is seldom reported in Taiwan. In this study, we use structured questionnaire, lung function test and heavy metals determination in urine samples. Environmental measurements of dusts and metals will be also performed to determine the association with health conditions in dental technicians. A total of 113 dental technicians (male 82, age average 29, mean employed duration 8.8 years) were investigated. The difficulty of communication with dentists and the working style were main sources of stresses. More work-related health complaints such as respiratory, gestation-intestinal, neurological, eyesight and hearing problems were mentioned. There are 41 technicians (32.5 %) with restricted lung function, which may be induced by fine dusts or fibers. But, the time-weighted average level of inhalable particulate in 10/12 laboratories were below 500μg/m3. Average levels of metals in urine samples were Co 1.90 μg/L, Cr 2.26 μg/L, Ni 4.12 μg/L and Be 0.30 μg/L. It is suggested that the health surveillance and the improvement of workplace sanitation in dental technicians should be regulated by government.

摘要I
ABSTRACTIII
表目錄V
圖目錄VIII
第一章前言1
第二章文獻探討5
第一節牙科常見的材料5
第二節牙體技術人員的職業傷害14
第三節牙體技術人員的呼吸系統問題16
第四節牙體技術人員的其他問題20
第三章材料與方法21
第一節研究架構21
第二節研究假設22
第三節研究對象22
第四節研究方式22
第五節研究工具24
第四章結果與討論34
第一節問卷資料分析34
第二節體檢資料分析46
第三節現場訪視與環境測定結果52
第四節個人暴露與測定58
第五節環境暴露與健康之關係63
第五章結論與建議71
第一節結論71
第二節建議72
第六章研究限制73
第七章參考文獻74
附錄一牙體技術公司粉塵濃度變化圖80
附錄二牙體技術人員健康問卷93
附錄三石墨式原子吸收光譜儀檢量線圖102

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