牙體技術人員職業暴露危害調查

Medical Surveillance on Dental Technicians in Taiwan

牙體技術人員的職業性暴露，以粉塵、各種金屬以及化學物質為主，其職業性呼吸系統或神經系統疾病，在國外的研究中已著墨甚多，卻鮮見於台灣。因此，本研究以結構式問卷、肺功能檢測、皮膚疾病的臨床診斷、生化檢驗以及檢體中重金屬含量測定等項目，同時輔以環境粉塵檢測，以評估牙體技術人員職業性症狀的盛行率及其與環境間的關係。結果受訪的牙體技術人員共243人，其中男性佔200人，全體平均年齡32歲，就業年數平均約10年，由問卷及體檢結果顯示，其最大壓力來源是與牙醫師溝通的困難，在健康方面以消化道、皮膚與呼吸道的疾病，以及神經、視覺與聽力方面的自覺症狀較多；肺功能檢查結果則顯示，在 140 名受檢者中，侷限性通氣障礙者有 50 名約佔 36%，其比率與公司規模大小之趨勢呈統計上有意義的負向關係。由於局部集塵器的使用，室內可吸入性粉塵的濃度平均多在500μg/m3以下，但若於通風不良的作業環境下做齒模研磨時，則其瞬間濃度可超過 10,000μg/m3；尿中金屬含量除了鈹未被檢出外，其平均值分別為鈷11.9ppb，鉻 6.2ppb及鎳9.1 ppb，與國內另一研究之檢測值相近，但較之食品製造業者為高；又由現場觀察發現，部分工作者在工作中有同時吸菸或飲食的習慣，可見其工作條件、工作環境及工作衛生習慣均有改善之必要。齒模製作為牙科贗復必要之一環，牙體技術人員有其存在之必要性，然而目前仍未能被列入正式行業之中，以致無法將業者納入管理。綜合以上所見，本研究建議若要提升我國牙醫醫療品質水準，保障國民口腔健康，更為了保障牙體技術人員的福祉，實有必要儘速推行證照制度，將該行業正式納入管理，除了應定期舉辦健康檢查外，更應加強在職教育，輔導紓解工作壓力以及改善作業環境，以預防職業傷病的發生。

Most dental technicians are frequently exposed to dusts, metals, and chemicals. Occupation related lung, skin and neurological diseases have been documented in several studies, yet they are rarely reported in Taiwan. In this study, interviews with a structured questionnaire, lung function tests by using the spirometer, clinical diagnosis of skin diseases, biochemical examination of blood and urine samples were used to evaluate the health status of workers. The dust levels in local air were monitored for more than seven hours in a working day, and personal air samplers were used to assess the individual exposure. Levels of heavy metals in dusts, blood and urine were also detected in order to determine the association with health conditions of dental technicians. A total of 243 dental technicians (male 200, average age 32, mean employed duration 11 years) were investigated. The results showed that communication difficulty with dentists, improper work style and the inherent job activity were the key problems. Work-related health complaints of respiratory, gestation-intestinal, neurological, eyesight and hearing problems were most frequently mentioned. There are 50 in 140 technicians (36%) with restrictive disorder of lung function. But, the time-weighted average level of inhalable particulate in 10/12 work sites were below 500ɢg/m3. In addition, urinary beryllium was not detected, average levels of metals in urine samples were Co 11.9ppb, Cr 6.2ppb and Ni 9.1 ppb, consistent with the data of another study in Taiwan, but higher than those of the foodstuff manufacturing industry. It is suggested that the validation of professional license, the periodic health surveillance, the improvement of workplace sanitation and health education in dental technicians should be performed.