陳秀熙Chen, Hsiu-Hsi臺灣大學:流行病學研究所駱明德Lo, Ming-TeMing-TeLo2010-05-052018-06-292010-05-052018-06-292009U0001-1808200914142700http://ntur.lib.ntu.edu.tw//handle/246246/180829中文摘要究背景：根據目前相關研究指出牙周病核心治療對於早期牙周病治療具有成效，但除牙周病核心治療外，加上口腔衛生指導(OHI)介入是否具有加成效果，目前尚未明朗，尤其對於高血糖及糖尿病個案之介入成效亦未相當明確。究目的：本研究利用隨機分派試驗模式，進行除了臨床牙周病核心治療外，評估口腔衛生指導介入對於高血糖及糖尿病個案是否具有成效。究方法：本研究利用基隆社區闔家歡健康篩檢平台，針對2006-2007年35-54歲參加篩檢民眾，其禁食8小時血漿血糖篩檢結果為大於110mg/dL或及問卷自述具有糖尿病之高血糖或糖尿病個案進行邀請。總計138位牙周社區牙周治療需求指數（CPITN）初測CPI指數為2或3者進入本研究，並利用隨機分派為介入組及控制兩組，包括69名口腔衛生教育指導介入組為牙周病核心治療另外加衛生教育指導，另69名無口腔衛生教育指導控制組為單一接受牙周病核心治療。口腔衛生指導介入內容包括牙菌斑成因及其影響說明、貝氏正確刷牙法及牙線使用方法等。並利用社區牙周治療需求指數（CPITN）的(CPI)部份及指標牙齒平均出血點數(BOP)作為兩種評估指標。該研究經介入後分別採取一個月及三個月追蹤時間進行後測CPI及指標牙齒出血點數(BOP)評估。利用Wilcoxon Rank Sum test進行初步介入組與控制組之比較，並進一步利用線性混合模式分別針對CPI及BOP兩種指標結果，進行一個月及三個月口腔衛生指導介入成效評估。究結果：本研究分析結果顯示，口腔衛生教育指導介入組相對於無口腔衛生教育指導控制組，並無顯著介入成效。基於兩觀察時間獨立假設下，不論於一個月或三個月追蹤結果分析，皆呈現兩組未達統計顯著差異。本研究利用線性混合模式考量其相依性(correlation)，一個月追蹤結果呈現介入組CPI指標比控制組低(difference=-0.04881)，但未達統計顯著意義，(p-value=0.6869)，其BOP指標(difference=-0.2075)亦未達統計顯著意義(p-value=0.1917)；另三個月追蹤結果亦顯示不論於CPI或BOP測量指標皆未達統計顯著意義。論：口腔衛生教育指導介入對於既有牙周病核心治療並無顯著加成成效。鍵字：口腔衛生指導、探測出血、社區牙周指數、臨床隨機試驗、社區族群模式、牙周病、糖尿病Abstractackground While dental scaling and root planing is effective in treating early periodontal disease (PD), little is known about the additional benefit of appliying oral hygiene instruction (OHI) in patients with PD, particularly co-existing with impaired fasting glucose (IFG) or diabetes mellitus (DM). im A randomized controlled trial was conducted to assess the efficacy of OHI in treating PD in subjects with hyperglycemia.ethod The population is targeted at Keelung residents aged 35-54 years with fasting plasma glucose (FPG) greater than 110mg/dL or DM history from the participants enrolled in the Keelung Community-based Integrated Screening (KCIS) program between 2006 and 2007. A total 138 subjects with baseline CPI equal to 2 or 3 were randomly assigned to two arms, 69 subjects in the study group with core treatment together with OHI and the other 69 subjects in the control group with core treatment only. OHI consist of how to apply disclosing agent and the illustration of dental plaque, Bass tooth brushing method, and the procedure of dental floss. The primary outcomes consist of Community Periodontal Index (CPI) and Bleeding on Probing (BOP). After intervention, each participant was followed at one month and three months to keep record of CPI and BOP. Wilcoxon rank sum test was first adopted to assess the difference of CPI and BOP in the two groups. The multiple linear mixed model was further applied to assess the difference of CPI and BOP between the study group and the control group at both one-month and three-month follow-up times.esults No statistically significant differences in baseline characteristics and CPI or BOP were found between the study group and the control group. There were lacking of statistically significant difference in CPI or BOP at both one-month and three-month follow-up with consideration of independence assumption. By using a linear mixed models that take correlation with compound symmetry into account, the study group yielded lower CPI than the control group, but the difference of CPI was not statistically significant (difference=-0.04881, p-value=0.6869) at one-month follow-up. Nor was that of BOP (difference=-0.2075, p-value=0.1917) with respect to CPI or BOP. No significant difference was also found at three-month follow-up.onclusion The OHI is not effective in ameliorating PD while it was combined with dental scaling and root planing.ey word: Bleeding on Probing (BOP), Community-based, Community Periodontal Index (CPI), Diabetes, Peridontal Disease, Oral Hygiene Instruction (OHI), Randomized Control Trial (RCT).目 錄文摘要 1bstract 3一章 前言 5.1 研究背景 5.2 研究動機與目的 7二章 文獻回顧 8.1 牙周病形成及其特性 8.2 牙周病測量及盛行狀況 8.3 牙周病治療方式 10.4 糖尿病定義 11.5 糖尿病與牙周病相關性 13.6 牙周病與心血管疾病之相關研究 14.6.1. 牙周病與發炎反應 14.6.2 牙周病、發炎反應與糖尿病 16.7 刷牙及使用牙線(dental flossing)對於牙周病之預防 18.8 牙醫專業牙菌斑去除術(professional mechanical plaque removal)對於牙周病之預防 19.9 口腔衛生指導(Oral Hygiene Instruction, OHI)介入方式 20.10 口腔衛生指導(Oral Hygiene Instruction, OHI)遵從性(Compliance)對於成效之探討 21三章 材料與方法 24.1 硏究族群 24.2 隨機分派 24.3 口腔衛生指導介入 25.4 追蹤及指標測量 26.5 牙周病測量、分類及資料結構 26.6 問卷內容及資料結構 28.7 統計分析方法 29四章 結果 30.1 研究對象特性分析 30.2 隨機分派比較 30.3 前測問卷資料分析及比較 31.4 後測問卷資料分析及比較 33.5 前測CPI值資料分析及比較 35.6 後測CPI值資料分析及比較 36.7 前測BOP值資料分析及比較 39 .8 後測BOP值資料分析及比較 40.9 混合模式CPI與BOP值介入成效評估比較 41五章 討論 44.1 研究對象特性 44.2 研究設計 45.3 研究結果 46.4 研究限制 48考文獻 65附件1】 72附件2】 73附件3】 74application/pdf1093791 bytesapplication/pdfen-US口腔衛生指導探測出血社區牙周指數臨床隨機試驗社區族群模式牙周病糖尿病Bleeding on Probing (BOP)Community-basedCommunity Periodontal Index (CPI)DiabetesPeridontal DiseaseOral Hygiene Instruction (OHI)Randomized Control Trial (RCT)[SDGs]SDG3thesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/180829/1/ntu-98-R96842001-1.pdf