目的：本研究目的在了解牙科專責醫療人員介入麻醉評估後，對於手術麻醉全期降低牙齒損傷之發生率是否有實質效益;藉由三個時期，三種不同專業人員於麻醉照會室執行麻醉前牙齒評估;麻醉全期牙齒損傷的定義係指麻醉誘導、維持期、麻醉後恢復等手術全期發生的牙齒損傷，實施全身麻醉時，須於病人口腔內放置不同的氣管內管，若未事先檢查病人牙齒狀況，僅使用一般傳統插管工具進行插管，有可能造成口腔組織或牙齒的傷害。因此術前檢查出牙齒搖晃，將影響麻醉插管時選用的工具。
方法：本研究採回溯性研究法(Retrospective Study)，研究對象為執行常規麻醉手術接受各種不同麻醉方式的病人，藉由回溯民國102年5月至110年4月，共8年分成三個階段的資料為樣本進行探討分析，藉由三個階段分別由不同專業醫療人員來執行麻醉前牙齒評估，分別是第一個時期由實習醫師與麻醉護理師執行，第二個時期由牙科PGY醫師與第三個時期的牙科門診專責醫師來執行牙齒評估，符合收案共93,280位，以SPSS 20.00統計軟體進行統計分析，以描述性統計呈現頻率、百分比、平均值、標準差等，以卡方檢定分析牙齒狀況與社會人口學之差異、使用邏輯式迴歸計算勝算比，分析麻醉全期發生牙齒損傷之相關因子。
結果：研究結果發現，專責牙科醫師檢查出牙齒搖晃比率高但麻醉後發生掉牙率低。麻醉全期發生牙齒損傷的相關因素：(1)術前麻醉評估時，檢查牙齒之實習醫師及麻醉護理師與牙科門診專責醫師相較，病人於麻醉全期發生牙齒損傷高出3.37倍，p=0.048，達顯著性差異；牙科PGY醫師相較牙科門診專責醫師，病人於麻醉全期發生牙齒損傷高2.16倍(p=0.225)此結果雖未達顯著差異但可推論麻醉全期發生牙齒損傷和術前麻醉評估牙齒所介入是牙科門診專責醫師是有直接關係。(2)在性別上，男性於麻醉全期發生牙齒損傷相較女性為高3.18倍，p<0.05達顯著性差異。(3)病人牙齒中度搖晃、重度搖晃相較無搖晃之病人，於麻醉全期發生牙齒損傷分別高出無搖晃牙齒約3.06倍及 13.75倍，p<0.05統計上分別達顯著性差異，可推論麻醉全期發生牙齒損傷和病人本身牙齒搖晃是有直接關係。
結論：經牙科專責醫師檢查出牙齒搖晃後，麻醉醫師可選用影像式插管工具來降低牙齒損傷。在全身麻醉的牙齒損傷風險管理上，應先了解牙齒搖晃之高風險族群，於術前麻醉評估時，由專責牙科醫師進行牙齒評估、解說、告知，不但能減少牙齒傷害的發生率，也可於事前採取必要的預防措施，降低牙齒損傷。本研究建議術前麻醉評估時，由牙科專責醫師進行病人口腔檢查，列為麻醉前準備之標準流程。

OBJECTIVE:
The purpose of this study was to find out whether dental professionals had a substantial effect on reducing the incidence of dental damage during the whole period of anesthesia. In this study, pre-anesthesia dental examinations were performed at three different times, by three different subspecialty experts in the anesthesia consultation room. The definition of dental damage during anesthesia refers to the dental damage that occurs during the whole period of surgery such as anesthesia induction, maintenance period, and recovery phase after anesthesia.
Due to the necessity of endotracheal tube intubation during general anesthesia, patients might suffer from accidental dental injury without a pre-operative dental exam. In patients with poor dental conditions, intubation using traditional intubation tools may cause damage to oral tissues or teeth. The pre-operative dental exam not only provides general information about the patient’s teeth condition but also may influence the intubation tools which the anesthesiologists choose.
Methods:
This retrospective study included 93,280 patients with all kinds of anesthesia methods from May 2013 to April 2021. During these 8 years, the study was divided into three stages. The pre-anesthesia dental evaluation was performed by three different subspecialty experts in these three stages. The first stage was performed by the medical intern and the anesthesia nurse, and the second stage was performed by the dental post-graduate year training physicians. In the last stage, the dental evaluations were performed by professional dentists. SPSS 20.00 statistical software was used for statistical analysis. Descriptive statistics were used to present the frequency, percentage, mean, standard deviation, etc., and the chi-square test was used to analyze the differences between dental status and sociodemographics. The logistic regression model was used to calculate the odds ratio and the related factors of tooth damage during anesthesia.
RESULTS:
The results showed the detection rate of tooth shaking was increased, but the rate of dental injury decreased after professional dentists’ intervention. Factors related to tooth damage during anesthesia followed. First, compared with the pre-operative dental examination by professional dentists, the incidence of dental injury was 3.37 times higher in exams provided by medical interns and anesthesia nurses (95% CI= 1.010-11.272, p=0.048) and 2.16 times higher in dental post-graduate year training physicians (95% CI=0.621-7.526, p= 0.225). Although the last did not reach a statistically significant difference, there is a decreasing trend of perioperative dental injury by professional dentists. Second, in terms of gender, the incidence of dental damage in male patients was 3.18 times higher than in females, with a statistically significant difference (95% CI=0.156-0.631, p<0.05). Third, compared with the patients without tooth shaking, those with moderate and severe tooth shaking had about 3.06 times and 13.75 times, respectively, more tooth damage during anesthesia. Thus the severity of tooth shaking is directed related to the incidence of perioperative dental injury.
CONCLUSION:
After a pre-anesthetic dental exam by professional dentists, anesthesiologists can choose video-assisted intubation tools to prevent tooth damage. In the risk reduction of dental injury during general anesthesia, it is necessary to arrange a pre-anesthetic dental exam by professional dentists. A pre-anesthetic dental exam can not only identify the high-risk groups but also take necessary precautions beforehand to reduce the dental injury rate. It is recommended that dental examinations by professional dentists should be included in the pre-anesthetic standard operating procedure.

致謝 i
中文摘要 iii
英文摘要 vi
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 4
第二章 文獻探討 5
第一節 麻醉手術與口腔狀況之探討 5
第二節 麻醉全期牙齒損傷之發生率 7
第三節 麻醉全期發生牙齒損傷之原因分析 9
第四節 麻醉全期降低牙齒損傷之防範措施之分析 12
第五節 牙科醫師介入術前麻醉照會評估之概況分析 15
第三章 材料與方法 17
第一節 研究對象 17
第二節 研究設計 18
第三節 研究工具 19
第四節 研究架構 23
第五節 統計分析 24
第四章 結果 25
第一節 基本資料描述分析 25
第二節 牙齒狀況描述分析 27
第三節 麻醉方式描述分析 29
第四節 啟動照會牙科資料描述分析 30
第五節 評估牙齒有無搖晃資料描述分析 31
第六節 麻醉全期有無發生牙齒脫落資料描述分析 32
第七節 麻醉全期發生牙齒損傷相關因子之分析 33
第五章 討論 35
第一節 社會人口學與麻醉全期牙齒損傷之相關性 35
第二節 牙齒狀況與麻醉全期牙齒損傷之相關性 36
第三節 牙科專責醫師介入與麻醉全期牙齒損傷之相關性 39
第四節 研究限制 41
第六章 結論與建議 42
第一節 結論 42
第二節 建議 43
參考文獻 44
分析表格 50
附錄 67

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