By 倪 貴 城 牙周治療科專科醫生 Dr. Ngai Kwai Shing Vincent 老人科牙齒健康 By 倪 貴 城 牙周治療科專科醫生 Dr. Ngai Kwai Shing Vincent

琺瑯質 象牙質 牙骨質 牙髓 牙齦(牙肉) 牙周膜 牙槽骨

Dental/Oral Structures mucosa(ulcers, pathology) lips (Herpes, angular Chilitis) Tongue (taste, geographic tongue) Jaws (pathology, inflammation, cyst, impacted tooth, tumour, occlusion), Salivary glands (mucus retention cyst, tumour) Temporal mandibular Joint (TMJ pain dysfunction syndrome)

Systemic conditions, Medications Nutrition, Thrush, ANUG Inter-relationship with other systemic conditions e.g.-2 ways interations Perio-DM, Psychological, emotional aspects Social-economical aspects

常見問題 -從病人的角度看 牙痛 喪失功能 (嘴嚼,說話) 影響外表儀容

常見問題 蛀牙 (牙根表面) 牙周病 牙齒磨損 缺牙 鑲配假牙

蛀牙 蛀牙 = 牙齒 + 細菌 +糖份 +時間

Caries 蛀牙

僅餘牙根

症狀 Sign - Size, location(ID, root), depth(involving pulp), associated with abscess or sinus tract Symptoms – None, sensitivity, occasional pain, severe spontaneous pain, Diagnosis – visual, tactile, percussion, X-ray, Electric Pulp Test Treatment- “Prevention”, Filling, RCT, Crown, Extraction

六十五歲至七十四歲的非居於院舍長者 以｢齲失補恆齒｣指數衡量非居於院舍長者的蛀牙經驗 (2001 年及 2011 年) 特 衞生署全港性口腔健康調查

非居於院舍長者牙根表面有蛀蝕經驗的百分率 (2001 年及 2011 年)

有僅餘牙根的非居於院舍長者百分率 (2001 年及 2011 年)

預防蛀牙 Diet- Stephan’s curve 氟化物 ?lack of Calcium

Stephan’s curve

預防蛀牙 Diet- Stephan’s curve 氟化物 ?lack of Calcium

一般口腔護理用品的含氟化物比例和使用指引 食水： 在1961年，氟化物開始給加入香港的食水中，自此香港居民的蛀牙率就大大降低。現在香港自來水的氟化物含量是0.5ppm(百萬分之0.5)，只要我們飲用開水，就可從中吸收氟化物，達到預防蛀牙的效果。 成人牙膏1,000－1,450ppm 每天早上起床、晚上睡前使用一顆青豆分量的牙膏刷牙兒童牙膏 500ppm 漱口水230ppm 0.05%NaF 每天一次含在口腔內一分鐘 Source - toothclub.gov.hk

Prevention of Caries Diet- Stephan’s curve 氟 ?lack of Calcium

牙周病

Biofilm 生物膜

症狀 Redness, swelling, bleeding, bad breath, recession, mobile teeth, drifting, Pain and abscess formation, self exfoliation Pocket formation 牙周袋 Diagnosis- history, clinical examination, probing, radiographs, Pulp test

牙周病 Periodontal disease

症狀 Redness, swelling, bleeding, bad breath, recession, mobile teeth, drifting, Pain and abscess formation, self exfoliation Pocket formation 牙周袋 Diagnosis- history, clinical examination, probing, radiographs, Pulp test

量度牙周袋深度

Disease Progression Experimental gingivitis in man, Loe et al. 1965 The Natural History of Periodontal Disease in Man, Loe et al. 1986

六十五歲至七十四歲的非居於院舍長者 按個人最深牙周袋的深度劃分尚有牙齒的非居於院舍長者的百分率 (2001 年及 2011 年)

三十五歲至四十四歲成年人

預防牙周病 Prevention – Tooth brushing Electric tooth brush, modified tooth brush handle Mouth rinse? Denture care

按刷牙習慣劃分尚有牙齒的長者的百分率

半數或以上的牙齒有可見牙菌膜覆蓋的長者的百分率

Tooth Brushing Technique Normal brushing technique Interdental cleaning Denture cleaning

清潔牙齒鄰面的習慣

在使用假牙的長者中 88.4% 長者每天使用牙刷清潔假牙 約四分之一 25.4% 長者更輔以假牙清潔劑清潔假牙 接近 80% 長者每天睡覺前會除下假牙托。

Denture Hygiene

牙齒磨損

Tooth Wear - Tooth Brush Abrasions

Tooth Wear – Attrition/Erosion

缺牙 按牙齒數目劃分非居於院舍長者的百分率 (2001 年及 2011 年)

非居於院舍長者使用各類假牙的百分率 (2001 年及 2011 年)

Nutrition Food quality and quantity Habits, preference, appetite, knowledge, ignorance, money, ability to obtain food, skill to prepare food Ingestion – Mastication and swallowing Saliva, time for chewing Digestion and absorption Proportion of solid food is directly related to no. of teeth present

Oral hygiene Dental care Masticatory function General health Nutritional status Socioeconomic status Dietary habits

Nutrition Reduced no. of teeth cause malnutrition? Reduced no. of teeth is definitely a contributory factor

活動牙托 Around two-thirds of NOP had dental prostheses Need vs Demand

固定牙橋,植牙

Focus on Prevention 預防 Diet, Self cleaning 及早診斷 Regular dental check-up 治療 Early intervention

長者的口腔健康相關行為 檢查口腔習慣長者的百分率

長者前往的牙科診所類別

Focus on Prevention 預防 Diet, Self cleaning 及早診斷 Regular dental check-up 治療 Early intervention