牙周炎患者种植修复维护治疗依从性的影响因素

doi:10.19723/j.issn.1671-167X.2024.01.007

摘要/Abstract

摘要：

目的: 分析牙周炎患者种植修复后进行维护治疗依从性的影响因素，以期改进医患沟通内容，提高患者依从性，增进种植体周健康。方法: 选择2022年3月至2023年8月于北京大学口腔医院牙周科进行复查且完成种植修复治疗5年以上的牙周炎患者，通过问卷了解患者口腔卫生习惯、全身情况、吸烟情况、对医嘱记忆的准确性、对牙周及种植修复体维护的重视程度，以及影响其复查的具体原因，通过病历记录获得患者的牙周炎严重程度、实际复查频率及复查原因，分析以上因素对患者牙周及种植维护治疗依从性的影响。结果: 共纳入92例患者，调查问卷数据分析显示口腔卫生习惯、医嘱记忆准确性均与患者维护治疗依从性相关(P < 0.05)，影响患者复查的主要因素为没有时间(47.0%)和挂号难(24.8%)。虽然大多数患者对牙周及种植修复体维护治疗的重视态度良好，但是55.4%的患者在医院电话通知后才接受复查，且患者对于天然牙健康的重视程度明显低于种植修复体。结论: 临床工作中应该重视对患者进行口腔卫生指导，督促患者养成良好口腔卫生习惯，在宣教中还应增加预防牙周炎相关知识，并结合患者的个性特征激发其主动维护牙周及种植修复体的动力。对于教育程度较低者和年龄较大者应该给予更多的关注和耐心，改进医嘱内容，增加记忆点，这些都有助于提高患者维护治疗的依从性。

关键词: 依从性, 种植修复, 维护治疗, 牙周炎, 牙周维护治疗

Abstract:

Objective: To find out factors influencing the compliance of supportive treatment of patients with periodontitis who have received implant restoration therapy. Methods: Patients who had completed periodontal and implant restoration treatment for more than 5 years in Department of Periodontology, Peking University Hospital of Stomatology were subjected to inclusion between March 2022 and August 2023.A questionnaire was compiled to gather the information including patients ' basic information (gender, age, and educational background etc.), smoking habits, general health conditions, oral hygiene habits, willingness to undertake periodontal and dental implant supportive treatment, actual fact on supportive treatment recorded in medical records, whether medical advices were correctly remembered, and reasons affected them to implement supportive therapy. The questionnaires were handed out to the above patients and filled during the process of follow-up treatment. Chi-square test, univariate and multivariate analysis of Logistic regression were employed to explore the correlations of these factors and the patients' compliance. Results: In the study, 92 patients and questionnaires were collected and analyzed. The results indicated that oral hygiene habits and whether medical advices were correctly remembered had significant correlation with compliance (P < 0.05). Time constraint (47.0%) and difficulty in appointment registration (24.8%) were the top 2 reasons obstructed them to undertake supportive treatment. Although the vast majority of the patients indicated willingness to perform follow-ups, 55.4% of them wouldn't come back until the dentist called them back. The results of our study also indicated that the patients placed significantly less importance on the health of natural teeth than implants. Conclusion: In order to improve the compliance of supportive treatment, we suggest that dentists should put more emphasis on oral hygiene instruction, and knowledge regarding periodontitis should also be added as part of patient education contents. In the early stages of treatment, the patient should develop the habit of regular follow-up checks, More attention and patience should be given to elderly patients and those with lower level of education; use language that is easy to understand and printed medical instructions to help them remember. Patients can memorize better from refined doctors' advice, reinforcing care knowledge and refining medical advices can promote better follow-up treatment results. Motivating patients based on their characteristics is critical to improving compliance.

Key words: Compliance, Dental implant, Maintenance, Periodontitis, Supportive periodontal therapy

中图分类号:

R781.4

张晗,秦亦瑄,韦帝远,韩劼. 牙周炎患者种植修复维护治疗依从性的影响因素[J]. 北京大学学报（医学版）, 2024, 56(1): 39-44.

Han ZHANG,Yixuan QIN,Diyuan WEI,Jie HAN. A preliminary study on compliance of supportive treatment of patients with periodontitis after implant restoration therapy[J]. Journal of Peking University (Health Sciences), 2024, 56(1): 39-44.

图/表 3

表1

不同依从性患者的一般情况、行为特征及依从性影响因素的单因素Logistic回归分析"

Factor	Good compliance	Medium compliance	Poor compliance	χ²/F	P
Gender, n/(%)				0.491	0.808
Male	12 (46.1)	16 (55.2)	18 (48.6)
Female	14 (53.9)	13 (44.8)	19 (51.4)
Age/years, ${\bar x}$±s	53.81±11.00	57.34±9. 76	55.84±11.38	0.740	0.480
Age groups/years, n(%)				1.571	0.482
≥60	7 (26.9)	12 (41.1)	15 (40.5)
< 60	19 (73.1)	17 (58.6)	22 (59. 5)
Educational background, n(%)				1.684	0.830
High school or below	1 (3.8)	3 (10.3)	4 (10.8)
Junior college	4 (15.4)	6 (20.7)	7 (18.9)
College or above	21 (80.8)	20 (69. 0)	26 (70.3)
Oral hygiene habits, n(%)				17.598	0.002
Well	19 (73.1)	16 (55.2)	10 (27)
Medium	3 (11.5)	3 (10.3)	3 (8.1)
Poor	4 (15.4)	10 (34.5)	24 (64.9)
Periodontitis severity, n(%)				9. 499	0.067
Minor	0 (0.0)	1 (3.4)	4 (10.8)
Moderate	21 (80.8)	15 (51.7)	23 (62.2)
Severe	5 (19.2)	13 (44.8)	10 (27.0)
Whether medical advices were correctly remembered, n(%)				13.033	0.002
Correct	23 (88.5)	27 (93.1)	22 (59. 5)
Incorrect	3 (11.5)	2 (6.9)	15 (40.5)
Willingness to undertake periodontal supportive treatment, n(%)				6.783	0.199
High	18 (69. 2)	15 (51.7)	19 (51.4)
Medium	8 (30.8)	12 (41.4)	13 (35.1)
Low	0 (0.0)	2 (6.9)	5 (13.5)
Willingness to undertake dental implant supportive treatment, n(%)				7.781	0.033
High	26 (100.0)	28 (96.6)	29 (78.4)
Medium	0 (0.0)	1 (3.4)	5 (13.5)
Low	0 (0.0)	0 (0.0)	3 (8.1)
The reason for the last follow-up, n(%)				10.839	0.039
Active revisiting by patients	13 (50.0)	14 (48.3)	8 (21.6)
Active follow-up appointments by doctors	12 (46.2)	14 (48.3)	25 (67.6)
Presence of associated signs and symptoms	1 (3.8)	1 (3.4)	4 (10.8)

表1

表2

表3

参考文献 28

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Compliance	Factor	B	SE	Wald	df	P	OR	95%CI
Medium	Intercept	-0.451	0.404	1.243	1	0.265
	Oral hygiene habits=well	1.543	0.613	6.341	1	0.012	4.678	1.408-15.546
	Oral hygiene habits=medium	0.714	0.943	0.574	1	0.449	2.043	0.322-12.968
	Oral hygiene habits=poor
	Medical advices were correctly remembered	2.398	0.847	8.012	1	0.005	11.007	2.091-57.931
	Medical advices were incorrectly remembered
Good	Intercept	-1.399	0.559	6.266	1	0.012
	Oral hygiene habits=well	2.611	0.712	13.450	1	< 0.001	13.615	3.373-54.960
	Oral hygiene habits=medium	1.645	1.013	2.636	1	0.104	5.178	0.711-37.707
	Oral hygiene habits=poor
	Medical advices were correctly remembered	1.915	0.785	5.949	1	0.015	6.785	1.457-31.610
	Medical advices were incorrectly remembered

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