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1 J Dent Hyg Sci Vol. 15, No. 2, 2015, pp RESEARCH ARTICLE 구강건강관리행위에따른치면세균막지수와의관련성 임순환ㆍ황지민 1 수원과학대학교치위생과, 1 백석문화대학교치위생과 Relationship of Oral Health Management Behavior to Plaque Index Systems Soon-Hwan Lim and Ji-Min Hwang 1 Department of Dental Hygiene, Suwon Science College, Hwaseong , 1 Department of Dental Hygiene, Baekseok Culture University, Cheonan , Korea A self-administered survey was conducted on the dental hygiene students at three different colleges located in Gyeonggi Province and South Chungcheong Province respectively from October, 2013, to the same month of 2014 to grasp their oral health management behavior, differences in plaque index according to plaque index systems and the correlation of the two. And their plaque index was measured. The findings of the study were as follows: 62.8% of the respondents replied they got a dental checkup over the past year, and 84.1% answered they received preventive dental treatment once at least or more. 80.5% replied they used a fluorine-containing dentifrice. 90.9% answered they used the rolling method to brush their teeth, and 50.0% replied it took three minutes to brush their teeth. They got a mean of when O'leary index was used among plaque index systems. Their PHP index and PHP-M index were respectively a mean of 1.30 and a mean of Their plaque index became lower when they spent more time brushing their teeth, and the toothbrushing time made a statistically significant difference to that (p<0.05). The factor that exerted the largest influence on plaque index was whether to brush teeth for the sake of oral health (B=-9.747, t=-3.752, p<0.001) or not. That made a statistically significant difference to it. The above-mentioned findings illustrated that more patients visited dental clinics than before to receive preventive dental treatment or to get dental checkups, and that toothbrushing time and whether to brush teeth for the sake of oral health or not were identified as the oral health management behaviors to affect plaque index. Key Words: Dental plaque, O'leary index, Oral health management behavior, PHP index 서론 현대의학은발전을거듭하면서인간의수명을날로연장시켜왔다. 평균수명이증가함에따라구강건강의중요성은날로높아지고있으며, 이는전신건강과밀접한관련이있기에더욱중요하다고생각된다. 구강은생물학적차원에서보면신체를전신감염으로부터보호하고, 씹고, 삼킴으로써삶의질에기여하며, 사회및정신적차원에서구강은자기평가및표현, 의사소통그리고아름다움을통해기여한 다 1). 구강건강이란신체적개념에국한되었던과거와는달리육체적ㆍ정신적ㆍ사회적인의미로확대해서해석할수있다. 또한개인이하고자하는사회적역할을계속할수있게하는편안하고기능적인치아상태라고정의할수있다 1). 뿐만아니라사회적, 문화적, 경제적측면등다양한관점에서규명되고이해되어야하는동적과정이다 2). 이러한구강건강은구강건강행위에따라그상태가좌우되며, 구강건강행위에대한관심과행동변화가무엇보다선행되어야구강병 Received: March 5, 2015, Revised: March 16, 2015, Accepted: March 17, 2015 Correspondence to: Ji-Min Hwang Department of Dental Hygiene, Baekseok Culture University, 76 Munam-ro, Dongnam-gu, Cheonan , Korea Tel: , Fax: , 621zimina@hanmail.net ISSN (Print) / ISSN (Online) Copyright 2015 by the Korean Society of Dental Hygiene Science This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 J Dent Hyg Sci Vol. 15, No. 2, 2015 발병률을감소시키고, 예방할수있다. 구강건강행위는구강내의질환이발생하기전의건강한구강상태에서구강건강을계속유지하기위해수행되는제반활동을지칭하는것으로구강병의증상이나증후가없음에도불구하고이루어지는행위라는특징을지닌다 2). 개인의구강건강과구강병은생의학적원인에의해서만이아니라구강건강행위에따라달라지며구강건강증진행위는생물학적인과정이라기보다는사회심리학적인특징을가짐으로써개인이스스로책임감을가지고지속적으로수행해야하는과정이다 3). 하지만구강건강증진행위는안다고해서즉시실천되는것은아니며건강에대한인식으로부터시작해지각및이해, 지식의수용, 분석단계를거쳐행동으로나타나기때문에지속적인교육이필요하다 3). 치면세균막이란치아나치은및다른구강구조물표면에형성된연한침착물로숙주의존적 biofilm인동시에주성분이세균인아교질의미생물집단이다 4). 치면세균막은치아우식병과치주병을유발하는제1원인물질이며, 세균즉병원체요인이작용하도록하는환경요인이다. 특히교합면의치면열구에형성ㆍ부착되어있는치면열구세균막은치아우식병을지속적으로발생하도록하는환경요인이고, 치은열구에형성ㆍ부착되어있는치은열구세균막은치주병이지속적으로발생하도록하는환경요인이다 5). 중대구강병인치아우식병과치주병의발생률을감소시키고, 효과적으로관리하기위해서는필요요인인치면세균막관리가가장우선적으로행해져야하는기본적인과정이다. 치면세균막을관리하는방법중가장일반적으로사용되는방법은치면착색제로치아에부착되어있는치면세균막을염색하여관찰하는방법이다 6-9). 이는육안으로확인과관찰이가능해대상자에게동기를부여할수있는가장효율적인방법으로 6,9) 치태의양과위치를확인할수있다. 건강한구강을유지및증진시키기위해서는구강건강관리행위의실천과치면세균막관리가동시에이루어져야가능하다. 하지만구강건강관리행위와치면세균막과의관련성에대한선행연구들이미비하기에이둘의상관성에대한분석과이해가매우필요하다. 따라서본연구는구강건강관리행위의실태를파악하고, 검사법에따른치면세균막지수의차이를보고자하였다. 또한구강건강관리행위와치면세균막지수검사법에따른관련성을분석하고평가하여, 치면세균막관리의필요성과치과위생관리지침작성을위한기초자료를제공하고자한다. Table 1. Plaque Index Systems Variable 연구대상및방법 1. 연구대상본연구는 2013년 10월부터 2014년 10월까지경기도수원에소재한 1개대학과충청남도천안에소재한 1개대학의치위생 ( 학 ) 과학생을대상으로실시하였으며, 수원에소재한대학의경우 108명이, 천안에소재한대학의경우 71 명이연구대상자로참여하였다. 사전에연구의목적을설명하고, 본인의동의를얻어자기기입식설문지작성과 O'leary index, PHP index, PHP-M index를각각측정하여진행하였으며, 대상자선정시교정장치나 bridge를장착하고있는 13명은제외하였다. 최종적으로 164명의자료를연구자료로분석하였다. 2. 연구방법사용된도구는 Lee 10) 와 Jung 11) 의연구에이용된도구를본연구의목적에맞게수정ㆍ보안하여사용하였다. 치면세균막지수의평가는점심식사후 30분이상이경과된상태에서칫솔질을제한한후에치면착색제를이용해치면을착색하고, 물로강하게양치하게한후착색된치면을평가하였다. 평가는정확도와일치도를위해교육을받은 2인이각각평가하여치면세균막지수가일치하는것만사용하였으며, 본연구에사용된 3종류의치면세균막지수검사의산출법 5) 은다음과같다 (Table 1). - O'leary index: 구강내모든치아를교합면과절단면을제외하고, 근심, 원심, 협면, 설면 4개치면으로나누어치면세균막부착여부를평가한후이들의합을산출하여총치면의수로나누어백분율로표기 - PHP index: 6개치아의 6개치면을대상으로, 1개치면을 5등분하여치면세균막부착여부를평가후산술적평균 O'leary index PHP index PHP-M index Plaque unattached Score 0 Score 0 Score 0 Plaque attached Score 1 Score 1 Score 1 Minimum 0% 0 0 Maximum 100% 5 60 Corresponding teeth Every tooth 11 buccal 13 buccal, lingual 16 buccal 15 buccal, lingual 26 buccal 26 buccal, lingual 31 buccal 32 buccal, lingual 36 lingual 36 buccal, lingual 46 lingual 44 buccal, lingual 160

3 임순환ㆍ황지민 : 구강건강관리행위에따른치면세균막지수와의관련성 으로표기 - PHP-M index: 6개치아의 12개치면을대상으로, 1개치면을 5등분하여치면세균막부착여부를평가후이들의합을산출하여절대값으로표기 3. 자료분석수집된자료는통계분석용소프트웨어인 PASW Statistics ver (IBM Co., Armonk, NY, USA) 을사용하여분석하였으며, 유의성판단을위한유의수준은 0.05로하였다. 연구대상자의구강건강관리행위실태는빈도분석을하였으며, 치면세균막검사법에따른치면세균막지수는기술통계분석을실시하였다. 구강건강관리행위에따른치면세균막지수를비교하기위해서는 t-test와 one way ANOVA 분석을실시하였다. one way ANOVA 분석의등분산검정은 Levene 통계량을사용하였으며, 집단간의유의한차이를확인하기위해서는 Scheff의사후검정을실시하였다. 치면세균막지수에영향을미치는요인을알아보기위해서는다중회귀분석을각각시행하였다. Table 2. Oral Health Management Behavior Variable n (%) Dental visit experience within the past 1 year Yes 103 (62.8) No 61 (37.2) Using oral hygiene supplies Yes 91 (55.5) No 73 (44.5) Whether preventive dental treatment benefit Yes 138 (84.1) No 26 (15.9) Including fluoride in toothpaste to be used, whether or not Yes 132 (80.5) No 32 (19.5) Tooth brushing frequency 2 35 (21.3) (68.9) 4 16 (9.8) Tooth brushing method Rolling method 149 (90.9) Etc. 15 (9.1) Tooth brushing time (min) <3 41 (25.0) (50.0) >4 41 (25.0) Total 164 (100.0) 결과 1. 구강건강관리행위 1년이내에구강검진을받았다고응답한대상자는 62.8%, 구강위생용품을사용하고있는대상자는 55.5%, 예방치과처치를한번이라도받아본대상자는 84.1% 로조사되었다. 사용하고있는세치제에불소가포함되어있다고응답한대상자는 80.5% 였으며, 칫솔질은 1일 3회한다고응답한대상자가 68.9% 로가장높게나타났다. 칫솔질방법은회전법이, 칫솔질시간은 3분이각각 90.9%, 50.0% 로조사되었다 (Table 2). 2. 치면세균막검사법에따른치면세균막지수치면세균막검사법중 O'leary index로조사한결과평균 27.88로조사되었으며, PHP index, PHP-M index로조사한결과의평균은각각 1.30, 12.12로조사되었다 (Table 3). 3. 구강건강관리행위에따른치면세균막지수 1년이내에구강검진을받은대상자의경우 O'leary index, PHP index, PHP-M index 각각 27.17, 1.26, 11.42로조사되어구강검진을받지않은대상자보다모두낮게나타났다. 칫솔질횟수에따른치면세균막지수의경우도 1일칫솔질횟수가많아질수록치면세균막지수는점점낮아지는것으로조사되었다. 그러나통계적으로유의한차이는보이지않았다. 칫솔질시간에따른치면세균막지수는 3분이하일경우 O'leary index 31.37, PHP index 1.61, PHP-M index 14.61로조사되었으며, 4분이상일경우 O'leary index 23.32, PHP index 1.07, PHP-M index 9.59로조사되어칫솔질시간이늘어날수록치면세균막지수는낮아지는것으로나타났다. 특히 PHP index, PHP-M index에서통계적으로도유의한차이를보였다 (p<0.05; Table 4). 4. 치면세균막지수에영향을미치는요인독립변수로는구강건강관리행위를, 종속변수로는치면세균막지수를놓고다중회귀분석을실시한결과, 공차한계는모두 0.1 이상의수치를보였기때문에독립변수간다중공선성에는문제가없었다. 또한 Durbin-Watson의분석결 Table 3. Plaque Index according to Plaque Index Systems Plaque index systems Mean±standard deviation O'leary index 27.88±18.26 PHP index 1.30±0.86 PHP-M index 12.12±

4 J Dent Hyg Sci Vol. 15, No. 2, 2015 Table 4. Oral Health Management Behavior according to Plaque Index Variable O'leary index p-value PHP index p-value PHP-M index p-value Dental visit experience within the past 1 year Yes 27.17± ± ±8.54 No 29.10± ± ±9.23 Using oral hygiene supplies Yes 29.05± ± ±7.87 No 26.42± ± ± Whether preventive dental treatment benefit 27.77± ± ±9.32 Yes 28.50± ± ±5.54 No Including fluoride in toothpaste to be used, whether or not 27.62± ± ±8.87 Yes 28.97± ± ±8.71 No Toothbrushing frequency ± ± ± ± ± ± ± ± ±6.17 Toothbrushing method Rolling method 27.78± ± ±8.95 Etc ± ± ±7.71 Toothbrushing time (min) * 0.035* < ± ± ± ± ± ±8.41 > ± ± ±7.13 Values are presented as mean±standard deviation. *p<0.05. 과그수치가각각 1.991, 1.699, 1.541로 2에가까우므로잔차들간에상관관계가없어회귀모형이적합함을확인하였다. 분석결과 O'leary index에영향을미치는요인은구강건강을위한칫솔질여부 (B=-9.747, t=-3.752, p<0.001) 로통계적으로유의한차이를보였으며, 설명력은 13.3% 로나타났다. PHP index (B=-0.375, t=-3.016, p=0.003) 와 PHP-M index (B=-4.541, t=-3.708, p<0.001) 에영향을미치는요인또한 O'leary index와마찬가지로구강건강을위한칫솔질여부로조사되었으며, 설명력은각각 12.3%, 17.5% 로나타났다 (Table 5). 고찰 구강건강을파탄시키는구강병은숙주요인, 환경요인, 병원체요인이동시에작용할때발생하며, 세가지요인중어느한가지요인을제거하면구강병을예방하거나, 발생된구강병의진행을정지시킬수있다 5,12). 그러나구강병은대부분이만성적이고, 생명을위협하지않으므로적극적인예방치료와관리를소홀히하고있다. 하지만구강병은한번 발생하면처음과같은상태로되돌리기어려운원상회복불가의특징을가지기때문에무엇보다예방과관리가필요하고, 중요하다. 이에본연구는자가관리를위해실천하고있는구강건강관리행위의실태와전문가관리인치면세균막지수를평가하고, 이들의상관관계를알아보고자수행되었다. 연구대상자중 1년이내에구강검진을받았다는응답자는 62.8%, 예방치과처치를받아봤다는응답자는 84.1% 로조사되었다. 불소가첨가된세치제를사용하고있다는응답자는 80.5% 였으며, 회전법으로이를닦고있다고응답한대상자는 90.9% 로조사되었다. 본연구대상자와마찬가지로치위생과학생을대상으로조사한 Lee 10) 의연구결과를보면과거 1년동안치과를간경험이있다고응답한대상자는 56.1% 로나타났으며, 예방치과처치를받아봤다고응답한대상자는 49.7% 로조사되어, 본연구결과보다낮게나타났다. 이는 10년이라는시간의흐름으로인해치위생과학생들의 dental IQ가높아졌으며, 구강건강관리을위한실천도또한높아졌다는것을알수있다. Lee 등 13) 은전공교육으로서구강건강을위한교육을받고있는치위생과학생들은 162

5 임순환ㆍ황지민 : 구강건강관리행위에따른치면세균막지수와의관련성 Table 5. Influential Factors for Plaque Index Dependent variable O'leary index PHP index PHP-M index B SE t p B SE t p B SE t p I get regular dental checkups I go to the dentist immediately when I feel pain. I brush my teeth all the time to <0.001*** ** <0.001*** promote my oral health. I brush my teeth three times a day or more. I brush my teeth within minutes after eating. I brush my teeth for three minutes or more. I also brush my tongue, gums and palate when I brush my teeth. I gargle with water at least when I cannot brush my teeth. Before sleeping, I don't eat anything after toothbrushing. I use a fluorine-containing dentifrice. I change my toothbrush before its bristles are bent. I use oral hygiene supplies R=0.364, R 2 =0.133, F=1.924, Durbin-Watson=1.991 R=0.350, R 2 =0.123, F=1.758, Durbin-Watson=1.699 R=0.419, R 2 =0.175, F=2.675, Durbin-Watson=1.541 SE: standard error. **p<0.01, ***p<

6 J Dent Hyg Sci Vol. 15, No. 2, 2015 교육과정을통하여구강건강에관한인식이높아져있다고보고하고있다. 치위생과학생들은학과수업을통해구강건강에대한지식과정보를습득하고익힘으로써실천도가높게나타나며, 이는전공교육의긍정적인효과로볼수있다. 치면세균막검사법에따른치면세균막지수는 O'leary index 27.88, PHP index 1.30, PHP-M index 12.12로조사되었다. O'leary index의경우치주수술이나보철치료가필요한환자는치면세균막지수를 10% 미만으로관리해야하며, 10% 미만이되기전에치주수술이나보철치료를시작하면실패율이높아지나치주수술이나보철치료가필요없는일반인들의경우는 15% 정도의치면세균막지수가적당하다고알려져있다 5). 하지만 O'leary 등 14) 은개개인의구강위생관리의적절한치면세균막지수는 10% 또는그이하로낮추라고보고하였다 세일반인을대상으로연구한 Yoo 15) 의연구에서대상자들의 O'leary index는 88.44로조사되었으며, PHP index 3.27, PHP-M index는 19.32로나타나본연구결과보다높은것으로조사되었다. 특히 O'leary index의경우는매우높게나타났다. 이러한결과는전공자와비전공자라는대상자의차이가있기는하지만최소의비용으로최대의효과를낼수있는올바른칫솔질방법과구강보건교육을통해치면세균막관리법을홍보한다면효과의극대화는물론비전공자의치면세균막지수또한낮아질것으로기대된다. 구강건강관리행위에따른치면세균막지수의경우통계적으로유의하게나온변수는칫솔질시간이었다. 칫솔질시간에따른치면세균막지수는 3분이하일경우 O'leary index 31.37, PHP index 1.61, PHP-M index 14.61로조사되었으며, 4분이상일경우 O'leary index 23.32, PHP index 1.07, PHP-M index 9.59로조사되었으며, PHP index와 PHP-M index가통계적으로유의한차이를보이는것으로나타났다. 하지만칫솔질횟수의경우는통계적으로유의한차이를보이지못했는데 Woo와 Kim 16) 의연구에서도칫솔질횟수에따른 PHP index의경우치면세균막지수가감소는하나통계적으로는유의한차이는보이지않아본연구와동일한결과를보여주고있다. 하지만 Woo와 Kim 16) 의또다른연구결과를보면칫솔질교습전 PHP index가 1.587이었지만칫솔질교습일주일후 1.097로현저히낮아져통계적으로유의한차이를보이는것으로나타났다. 이는칫솔질횟수보다는칫솔질시간과올바른칫솔질방법이치면세균막지수를낮춘다는것을의미한다. 물론습관화된칫솔질의경우회귀현상으로인해원래의잘못된방법으로되돌아갈수있지만개인에게맞는칫솔질방법을지속적으로교육해준다면효과적인결과를보일것으로기대된다. 또한환자자신이치면세균막을가장효과적으로제거할수있어야하며, 그러기위해서는전문가인치과위생사의역할이무엇보다중요할것으로생각된다. 치면세균막지수에가장영향을미치는요인은구강건강을위한칫솔질여부로조사되었다. O'leary index, PHP index, PHP-M index 모두통계적으로유의한차이를보였으며, 구강건강을위한칫솔질의중요성이부각되는결과라할수있다. 칫솔질교육을통한치면세균막지수의감소에관한연구는이미많이진행되었다 16-19). 하지만대부분의교과서나구강보건교육매체들은회전법만을강조하고권장하고있다. 다양한칫솔질방법들은특성상각각의다른효과를보이기때문에 18) 환자들의구강건강상태에따라알맞은칫솔질방법을선택할수있도록일률적인교육이아닌맞춤형교육이앞으로는필요할것으로판단된다. 치면세균막은자가또는전문가에의해관리와예방이가능하다. 그러나치면세균막은빠르게생성된다는특징때문에전문가에의한전적인관리는불가능하다 20). 앞에서도언급했듯이자가관리의가장효과적인방법은올바른칫솔질법과구강위생용품의사용이다. 개인에게맞는적합한구강위생용품의선택과사용방법숙지및주기적인전문가치면세균막관리가병행된다면구강병의예방및관리는가능할것으로생각된다. 본연구는구강건강관리행위에따른치면세균막지수검사법의상관성을함께조사하였다는면에서는의의가있지만진행과정에서일부대학의여학생만을대상으로조사하였으며, 표본수가적으므로모집단을대표하여일반화하기에는제한점을갖는다. 그러므로후속연구에서는남학생도포함하고대상자수를확대시켜야하며, 더욱더다양한치면세균막지수검사법간의차이점도이루어져야할것으로생각된다. 또한인과관계를보다명확히보기위해서는종단연구가진행되어야할것으로생각된다. 요약 구강건강관리행위의실태를파악하고, 치면세균막검사법에따른치면세균막지수의차이와이둘의상관성을조사하기위해 2013년 10월부터 2014년 10월까지경기도와충청남도에소재한 3개대학의치위생과학생을대상으로자기기입식설문지작성과치면세균막지수를각각측정하여진행하여다음과같은결론을얻었다. 1년이내에구강검진을받았다고응답한대상자는 62.8%, 예방치과처치를한번이라도받아봤다고응답한대상자는 84.1% 로조사되었다. 불소가포함된세치제를사용하고있다고응답한대상자는 164

7 임순환ㆍ황지민 : 구강건강관리행위에따른치면세균막지수와의관련성 80.5% 였으며, 칫솔질은하루에 3회한다고응답한대상자가 68.9% 로가장높게나타났다. 칫솔질방법은회전법이, 칫솔질시간은 3분이각각 90.9%, 50.0% 로조사되었다. 치면세균막검사법중 O'leary index로조사한결과평균 27.88로조사되었으며, PHP index는평균 1.30, PHP-M index는평균 12.12로조사되었다. 구강건강관리행위에따른치면세균막지수는칫솔질시간이통계적으로유의한차이를보이는것으로조사되었다. 칫솔질시간이 2분이하일경우 O'leary index 31.37, PHP index 1.61, PHP-M index 14.61로조사되었으며, 4분이상일경우 O'leary index 23.32, PHP index 1.07, PHP-M index 9.59로조사되어칫솔질시간이늘어날수록치면세균막지수는낮아지는것으로나타났다 (p<0.05). 치면세균막지수에가장영향을미치는요인은 구강건강을위한칫솔질여부 (B=-9.747, t=-3.752, p<0.001) 로나타났으며, 이는통계적으로유의한차이를보였다. 설명력은 O'leary index 13.3%, PHP index (B=-0.375, t= , p=0.003) 와 PHP-M index (B=-4.541, t=-3.708, p<0.001) 는각각 12.3%, 17.5% 로조사되었다. 이상의결과를정리해보면, 치면세균막지수에영향을미치는구강건강관리행위는칫솔질시간과구강건강을위한칫솔질여부로조사되었다. References 1. Kushnir D, Zusman SP, Robinson PG: Validation of a Hebrew version of the oral health impact profile-14. J Public Health Dent 64: 71-75, Lee HS, Kim GS: Oral health behavior of economically active women in Chollabuck Do, Rebublic of Korea: 2. oral preventive behavior. J Korean Acad Dent Health 23: , Suchman EA: Health attitudes and behavior. Arch Environ Health 20: , Kim MS: A study on the correlation between the dental plaque index of patients and the periodontal disease or prognosis. Unpublisfed master's thesis, Seoul National University, Seoul, Kang BW, Kang HK, Ku IY, et al.: Preventive dentistry. 4th ed. Koonja, Seoul, pp.5-7, Becker W, Becker BE, Berg LE: Periodontal treatment without maintenance. J Periodontal 55: , Wilson TG, Glover ME, Schoen J, Baus C, Jacobs T: Compliance with maintenance therary in a private periodontal practice. J Periodontal 55: , Shin SC, Riew H, Chang YS, Byun GY: Disclosing effect of dental plaque by use of red-plaque tablets. J Korean Acad Dent Health 27: 87-95, Lang NP, Ostergaard E, Loe H: A fluorescent plaque disclosing agent. J Periodontal Res 7: 59-67, Lee SM: A study on factors associated with the oral health promotion behaviors of college students. J Dent Hyg Sci 6: , Jung EJ: A study on factors affecting the oral health promotion behaviors of dental hygiene and non-dental hygiene students. J Dent Hyg Sci 10: 1-9, Kim JB, Choi EG, Moon HS: Public health dentistry. 3th ed. Komoonsa, Seoul, p.27, Lee EK, Kim JY, Yoon YS, et al.: Oral symptom experiences and oral health behaviors of dental hygiene students and non-health related students. J Korean Acad Dent Health 33: , O'leary TJ, Drake RB, Naylor JE: The plaque control record. J Periodontol 43: 38, Yoo JM: Clinical study on the comparison of various types of the dental plaque indices. Unpublished master's thesis, Dankook University, Cheonan, Woo HS, Kim DK: The effect of TBI on PHP index of workers needing scaling. J Korean Acad Dent Health 34: 65-71, Jo MJ, Min KJ: Effect of repeated directing tooth-brushing education on plaque control. J Korea Acad Industr Coop Soc 6: , Han YS, Lim SR, Cho YS: Comparison of dental biofilm reduction between rolling method and modified stillman method. J Dent Hyg Sci 12: , Choi YK, Park DY, Jeong DB: Relationship among adequacy, awareness of the difficulty in toothbrushing and plaque score. J Korean Acad Dent Health 33: , Park DY: Analysis of plaque score by tooth surfaces for improving plaque control instruction method. J Nat Sci 16: 67-82,

서론 34 2

서론 34 2 34 2 Journal of the Korean Society of Health Information and Health Statistics Volume 34, Number 2, 2009, pp. 165 176 165 진은희 A Study on Health related Action Rates of Dietary Guidelines and Pattern of