口腔清潔劑對於長期照護機構之患者口腔健康之影響

Abstract

過去，長期照護機構的住民口腔衛生及牙科照護，常常都被忽略，住民的口腔衛生不好，齲齒、牙齦出血、牙周病及口臭的人很多，是疏於照護所致。 市售的各種口腔清潔劑或產品，對口腔是有幫助的，因此，本研究將探討Chitosan與Chlorhexidine潄口水、蒸餾水、酵素牙膏及含氟牙膏，對長期照護住民，口腔內牙結石、牙菌斑、牙垢、牙齦出血及牙周囊袋的影響，以及找出適合長期照護機構住民使用的口腔清潔劑，並導入衛教於照護者，教他們如何刷牙及如何維持口腔衛生、期望能減少住民的口臭，改善牙周狀況、減少牙齦出血及預防齲齒。 實驗分兩個階段進行，每一階段為期三週，再加以評估。評估項目包括牙垢、牙齦發炎、牙周囊袋深度、探測出血、及牙結石等指數。另外我們還加上照護者可以自行觀察及監測的口臭指數及刷牙出血指數。結果發現 整體來看Chitosan、Chlorhexidine、酵素牙膏、含氟牙膏及蒸餾水都有效，可以有效的降低牙垢、牙齦發炎、牙周囊袋深度。在第一階段三個星期的處理以Chitosan 的效果最好，但在統計上並無顯著差異；在第二階段的處理以含氟牙膏的效果最好，在統計上無顯著差異。整體來看，含氟牙膏在去除牙垢及減少出血點上有顯著差異，其原因在於照護者及患者不習慣使用液體物質的刷牙方式，因此我們建議在長期照護中心使用的口腔清潔劑以含氟牙膏為主，當然也可以輔以其他的口腔清潔劑。 本研究也發現以照護者能夠認同、了解的口臭及刷牙出血當指標，做為口腔清潔的依據是有意義的。但由於牙醫師的認知與照護者的認知有落差，因此在未來除了應加強照護者的知識與技能外，應將牙醫師的專業照護及治療納入長期照護機構中，以獲得更好的結果。

The importance of patients’ oral hygiene as well as dental care in the long-term care center has been overlooked for a long time. This results in the dental problems that are generally found among the patients in the long-term care center, including tooth decay, gum bleeding、periodontitis and halitosis. It is found that many kinds of on-the-shelf mouth-cleansing products help a lot in dental care. This study aims to investigate whether the mouth-cleansing products (e.g., Chitosan, Chlorhexidine, distilled water, fluoride toothpaste, and enzyme toothpaste) have effects on solving the dental problems that the patients in the long-tern care center generally have. In this study, the current researcher intends to find out which kind of mouth-cleansing product is suitable for the patients living in the long-term care center. As well, the researcher highlights the importance of educating the caregivers in the long-term care center. As long as they are trained properly, those caregivers can play an important role in maintaining the patients’ dental health, particularly for those who may have problems in cleaning their teeth by themselves. With the help of the trained caregivers, it is hopeful that the patients in the long-term care center can improve their periodontal condition, reduce the cases of gum bleeding or halitosis in the mouth, and ultimately prevent dental caries. This experiment consists of two stages. Each stage lasted three weeks and was evaluated afterwards. The evaluated items include the index number in dental plaque, gingivitis, pocket depth, bleeding on probing, and calculus as well as the index number that can be observed by the caregivers or monitored automatically (e.g., index of halitosis and bleeding on brushing). The findings indicate that, overly, Chitosan, Chlorhexidine, fluoride toothpaste, or enzyme toothpaste, distilled water works effectively in reducing the deposition of dental plaque, gingivitis, pocket depth, calculus, and bleeding on probing. Fluoride toothpaste works effectively in reducing plaque and bleeding on probing, and there is statistically significant difference. But when we look closely at each stage of experiment, it is found out that Chitosan works best at the first stage of experiment although there is no statistically significant difference; while the fluoride toothpaste works most effectively at the second stage of the experiment and there is no statistically significant difference. This is because the caregivers and the patients in the long-term care center were not used to using the liquid mouth-cleansing products to brush teeth. Based on the findings, it implies that the fluoride toothpaste may be effective for the patients living in the long-term care center to improve or maintain dental health, while other mouth-cleansing products are used. Findings also indicate that it is significant to use the index number of halitosis and bleeding on brushing recognized by caregivers how well the mouth cleaning is done. However, due to the gap that exists between the dentists’ and the caregivers’ understanding of dental care, it is strongly suggested that the dentists’ professional care and practices be included in the long-term care center in addition to improving the caregivers’ knowledge and skills in dental care. In doing this way, better dental health for the patients living in the long-term care center can be possibly achieved.