J Korean Acad Pediatr Dent 43(4) 2016 ISSN (print) ISSN (online) Prevalence and Etio

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1 ISSN (print) ISSN (online) Prevalence and Etiology of Molar Incisor Hypomineralization in Children Aged 8-9 Years Taehyoung Kim, Ilyong Jeong, Daewoo Lee, Jaegon Kim, Yeonmi Yang Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University Abstract This study examined the prevalence of MIH and severity of hypomineralization exhibited by MIH-affected tooth based on the clinical examination of 950 children between age 8 and 9 in the city of Jeonju. The etiology was also studied utilizing a questionnaire on the MIH risk factors. The prevalence of MIH was 7.1%. The examined MIH-affected teeth showed statically significant difference in the degree of their hypomineralization (p < 0.05). The permanent first molar showed greater frequency of MIH compared to the permanent incisor, and the MIH code 2a and 3 were only observed in the permanent first molar (p < 0.05). From the questionnaire, showed the significant relationship between the occurrence of MIH and risk factors such as stress and antibiotics intake during pregnancy, low birth weight and events like hospital admission, frequent respiratory infection, high fever and long-term antibiotics intake within the three years of children s lives (p < 0.05). Among all the possible risk factors, the antibiotics intake during pregnancy only showed high correlation with the incidence of MIH (p < 0.05). Key words : Molar Incisor Hypomineralization, Prevalence, Etiology, Risk factors Ⅰ. 서론 Molar-Incisor Hypomineralization (MIH) 는전신적원인에의한저광화로한개혹은그이상의영구치및절치의교합면또는절단연 1/3 부위에법랑질의형태학적결함이발생한경우의임상적특성을일컫는다 1). 정상법랑질과명확한경계를보이는불투과성반점형태의법랑질의질적결함을보이며색조의차이는병소의심각도를반영한다 2). 심하게이환된대구치의경우, 처음에는법랑질이정상두께로발육하다가, 교합력이작용함에따라법랑질이떨어져나가게되고하부상아질이노출되는맹출후붕괴 (post eruption breakdown) 증상이관찰된다 3). 현재 MIH 병인은명확하게밝혀진것은없으며, 다양한요인이서로영향을주는것으로추정된다 4-6). 모유로부터의다이 옥신장기노출 7), 출생과관련된의학적문제 8), 출생후초기 3 년동안의영양상태 6), 고열을동반한유아시기의질환및호흡기질환등 9) 이법랑질결함의빈도및심도와관련있는것으로보고되고있다. 진단시기는모든제1대구치와영구절치가맹출하였고, 제1 대구치가 MIH에이환되었더라도맹출후과도한붕괴증상없이상대적으로양호한상태를보이는 8세가최적이라할수있다 10). 진단은제1대구치와절치에서치태가완전히제거된후습윤한상태로시행되어야하며, 주로 European Academy of Paediatric Dentistry (EAPD) 에서제시하는 0-10의등급기준을사용하여평가한다 10). 현재 MIH의유병률은국가, 대상연령, 연구방법에따른차이로인하여 % 로광범위하게나타나며 11), 우리나라의경우 2010년 Shin 등 12) 에의해 6.0% 로보고되었다. Corresponding author : Yeonmi Yang Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University, 20, Geonji-ro, Deokjin-gu, Jeonju, , Republic of Korea Tel: / Fax: / pedo1997@chonbuk.ac.kr Received May 13, 2016 / Revised July 8, 2016 / Accepted July 7,

2 MIH 증상을보이는치아들의경우, 지각과민증상과빠르게진행되는우식의치관파괴및마취가잘되지않아치료에어려움이있다 13). 이러한이유로환자의치료협조도를얻기는힘들며, 치료를진행할수록치과치료에대한불안과걱정이심해지게된다 14). 그러므로 MIH로인한치관파괴가심해지기전에제1대구치와절치의맹출시기에맞추어 MIH에대한조기진단이필요하며예방적처치가매우중요하다 15). 최근전세계적으로 MIH의원인, 유병률및치료방법에대한연구가활발히이루어지고있으나, 우리나라에서는현재까지관련연구가부족하다. 따라서본연구는전주시초등학생 8-9세를대상으로 2003년 EAPD에서제시한기준을사용하여 MIH의유병률과절치와구치의저광화정도및상태에대해관찰하였으며, 설문조사를통해 MIH와연관성있는병인에대해서알아보고자하였다. Ⅱ. 연구대상및방법 을보이나범위가 2 mm 보다작은경우는 MIH 유병률에서제외하였다. 필요한경우 cotton roll을이용하여음식물잔사와치면세균막일부를제거하였다. MIH 진단은 2003년 EAPD 에서제시한기준을사용하였으며 0-10의 Code로나타내었다 (Table 2). 3) 설문조사설문조사는보호자를대상으로시행하였으며, 구강검사일주일이전에학교에서가정통신문형식으로배포하여, 구강검진당일에걷는형식으로시행하였다. 설문지문항은다음과같은 3가지항목으로정리하여분석하였다. (1) 어머니가임신하였을때와관련된문항 - 임신중고열과관련된약복용이나입원경력여부, 스트레스정도 (Numeric rating scale 평가 ), 전신질환여부, 항생제복용여부 1. 연구대상 전주시소재초등학교 2학년 8세 589명, 3학년 9세 361명을대상으로구내검사를통해 MIH를조사하였고, 모든연구대상자의보호자설문조사를통해병적요인을평가하였다. 조사는 2015년 4월부터 5월까지해당학교에서마련해준검사실에서이루어졌고, 조사대상의연령및성별분포는 Table 1과같다. 2. 연구방법 1) 예비조사현장방문조사이전에이번연구의대상과동일한연령대의상, 하악중절치, 측절치, 제1대구치가포함된 25명의구내사진 (Enamel Hypoplasia 5명, Fluorosis 5명, Amelogenesis imperfecta 5명, MIH 10명 ) 을이용하여감별진단교육및훈련을시행하였다. MIH에이환된환자의경우 2003년 EAPD 에서제시한기준으로평가하였으며, 2주후에재평가하여그일치성을확인하였다. 2) 구강검사각학교에서마련해준검사실에 1인의검사자가헤드라이트, 치경, 탐침, 핀셋을이용하여절치 ( 중절치, 측절치 ) 와제1대구치의저광화상태에대하여검사를시행하였다. 저광화의특징 Table 1. Distribution of gender and age of the subjects Total (%) Male (%) Female (%) Total 950 (100) 553 (58.2) 397 (41.8) Age (years) (100) 353 (59.9) 236 (40.1) (100) 200 (55.4) 161 (44.6) (2) 아이출생과관련된문항 - 임신기간, 출산방법 ( 자연분만또는제왕절개 ), 출생시몸무게, 모유수유를한기간 (3) 아이의출생후 3년기간동안에관련된문항 - 고열여부, 병원입원경력여부, 호흡기감염여부, 장기간항생제복용여부 4) 자료분석검진및설문조사자료는통계프로그램인 SPSS 18.0 (SPSS Inc., U.S.A.) 을이용하여빈도와백분율 (%) 을구하였으며, Chi-square 검정방법을시행하였고유의수준은 0.05로하였다. MIH 검사자내신뢰도를평가하기위해 Cohen s Kappa 통계를이용하였다. 또한관련요인들이 MIH 유병률에 Table 2. Criteria for scoring MIH according to EAPD Code Criteria 0 N/S 1 White / creamy demarcated opacities, no PEB 1a White / creamy demarcated opacities, with PEB 2 Yellow / brown demarcated opacities, no PEB 2a Yellow / brown demarcated opacities, with PEB 3 Atypical restoration 4 Missing because of MIH 5 Partially erupted with evidence of MIH 6 Unerupted / partially erupted with no evidence of MIH 7 Diffuse opacities (not MIH) 8 Hypoplasia (not MIH) 9 Combined lesion (diffuse opacities / hypoplasia with MIH) 10 Demarcated opacities in incisors only MIH = Molar incisor hypomineralisation, EAPD = European academy of pediatric dentistry, PEB = Post Eruption Breakdown 411

3 미치는영향을살펴보기위하여다중로지스트회귀분석 (multiple logistic regression analysis) 을실시하였으며, 유의수준은 p < 0.05를기준으로하였다. 이모형의적합도는 Nagelkerke R 2 (0.058), 그리고 Hosmer and Lemeshow test (Sig. = 0.790) 으로평가하였다. 5) 윤리적고려사항본연구는전북대학교치과병원의임상연구윤리위원회의지침에따라수립하였으며, 심의절차과정을통과하였다 (IRB 번호 : ). 2. MIH 유병률총 950명의 MIH 임상검사결과 67명이 MIH에이환되었으며, 그유병률은 7.1% 였다. 남아는 517명중 36명으로 6.5%, 여아는 366명중 31명으로 7.8% 의유병률로, 남녀간의차이는없었다 (χ 2 = 0.611, p > 0.05) (Table 2). 연령별로는 8세 (5.6%), 9세 (9.4%) 로나타났으며통계적으로유의한차이를보였다 (χ 2 = 4.971, p < 0.05) (Table 3). 3. MIH 이환분포 Ⅲ. 연구성적 1. 예비조사모의구내사진으로시행한두차례의감별진단및 MIH 진단검사결과에대해, Cohen s Kappa statistics를이용하여검사자내신뢰도를평가한결과 0.89로우수한일치도를보였다. MIH에이환된검사자의모든치아는 MIH code 0-3에분포하고있었으며, 검사가시행된치아간에는통계적으로유의한차이를보였다 (χ 2 = , p < 0.05) (Table 4, Fig. 1). MIH에이환된부위를상악과하악으로분류해본결과통계적으로유의한차이가있었으며, 상악은하악에비해 MIH code 1a, 2, 3이많은반면에 2a는적은것으로나타났다 (χ 2 =14.099, p < 0.05) (Table 5). 절치와제1대구치간의비교 Table 3. Prevalence of MIH subjects by gender and age Variables Children Without MIH Children With MIH Total Sample n % n % n % Gender Male Female Age Total Chi-square test (* : p < 0.05) MIH = Molar incisor hypomineralisation χ 2 p - value * Table 4. Type of MIH defects in the index teeth (Permanent incisors and first molars) by MIH code MIH Code 0 1 1a 2 2a 3 χ 2 p - value Max. Perm. Incisors # # # # Mand. Perm. Incisors # # < 0.001*** # # Perm. 1st molars # # # # Total Chi-square test (*** : p < 0.001) MIH = Molar incisor hypomineralisation, Max = Maxilla, Mand = Mandibular, Perm = Permanent 412

결과를 Table 7에나타내었다. 임신기간동안산모의스트레스가 Numeric rating scale 4 이상인경우에서아이가 MIH 증상을보이는경우가많았으며 (χ 2 = 13.026, p < 0.05), 항생제를복용하였을경우 MIH 이환군은 4.5% 로 MIH 비이환군에비해높게관찰되었고유의한차이를보였다 (χ 2 = 11.085, p < 0.05). 출생시의경우에서는, 2.

4 결과를 Table 7에나타내었다. 임신기간동안산모의스트레스가 Numeric rating scale 4 이상인경우에서아이가 MIH 증상을보이는경우가많았으며 (χ 2 = , p < 0.05), 항생제를복용하였을경우 MIH 이환군은 4.5% 로 MIH 비이환군에비해높게관찰되었고유의한차이를보였다 (χ 2 = , p < 0.05). 출생시의경우에서는, 2.5 Kg 미만의저체중으로태어났을때 MIH 이환군은 9.0%, MIH 비이환군 3.9% 로통계적으로유의한차이가관찰되었다 (χ 2 = 6.980, p < 0.05). 또한출생후 3년동안입원경력이있거나 (χ 2 = , p < 0.05), 자주감기에걸리는지여부 (χ 2 = 6.690, p < 0.05), 고열 (χ 2 = 4.972, p < 0.05), 장기간항생제를복용한적이있는경우 (χ 2 = 6.870, p < 0.05) 에서 MIH 증상을보이는경우가많았다. 하지만모유수유를한기간과 MIH와의관계를조사한결과에서는유의한차이를보이지않았다 (χ 2 = 4.914, p = 0.296). Fig. 1. Frequency of MIH in the index teeth by MIH code (The following graph is drawn with Table 4). 에서는제1대구치의 MIH 이환빈도가높았으며, 특히 MIH code 2a와 3은제1대구치에서만관찰되었다 (χ 2 = , p < 0.05) (Table 6). 4. MIH 와예상위험요인과의연관성 MIH 와추정되는예상위험요인과의관계에대한설문조사 5. MIH 위험요인의다중로지스트회귀분석 (Multiple logistic regression analysis) 임신기간동안어머니의스트레스, 고열, 항생제복용여부와출생시태아의저체중, 출생후 3년동안의아이의고열및장기간항생제복용등유사한결과를보이는 6가지독립변수에대한다중로지스틱회귀분석을시행하였다. 그결과, 임신기간동안어머니가항생제를복용한경우에서만 MIH 증상에유의한영향을미치는것으로나타났으며 (p = 0.020), 임신중항생제를복용한경우가임신중항생제를복용하지않은경우에비해서 6.364배 MIH 증상을보이는경향이있었다 (Table 8). Table 5. Type of MIH defects in the maxilla arch and mandibular arch by MIH code MIH Code 0 1 1a 2 2a 3 χ 2 p - value Max. Arch Mand. Arch * Total Chi-square test (* : p < 0.05) MIH = Molar incisor hypomineralisation, Max = Maxilla, Mand = Mandibular Table 6. Type of MIH defects in the permanent incisors and first molars by MIH code MIH Code 0 1 1a 2 2a 3 χ 2 p - value Perm. Incisors Perm. 1st molars < 0.001*** Total Chi-square test (*** : p < 0.001) MIH = Molar incisor hypomineralisation, Perm = Permanent 413

5 Table 7. Presence of possible aetiological factors in children diagnosed as with or without MIH Characteristics MIH (N = 67) Non-MIH (N = 883) n % n % χ 2 p - value Prenatal factors (during pregnancy) High fever Maternal Stress Mild (1-3) Moderate (4-6) ** Severe (7-10) Maternal systemic disease Antibiotic use ** Perinatal factors Preterm delivery (< 37 weeks) Method of delivery vaginal delivery Cesarean section Low birth weight (< 2.5 kg) * Postnatal factors (during the first 3yr of life) Breast-feeding duration None < 3 month month month > 12 month Hospital admission *** Frequent cold * High fever * Antibiotic use (Long-term) Chi-square test (* : p < 0.05, ** : p < 0.01, *** : p < 0.001) MIH = molar incisor hypomineralisation Table 8. Multiple logistic regression analysis between maternal stress, high fever, antibiotic use (prenatal factors during pregnancy), low birth weight (perinatal factors) and high fever, antibiotic use (postnatal factors during the first 3yr of life) Variable Sig. Adjusted odds ratio Confidence interval 95% Lower Upper Prenatal factors (during pregnancy) Maternal stress High fever Antibiotic use 0.020* Perinatal factors Low birth weight (< 2.5 kg) Postnatal factors (during the first 3yr of life) High fever Antibiotic use (Long-term) Multiple logistic regression analysis (* : p < 0.05) Sig. = significance Ⅳ. 총괄및고찰전세계적으로 MIH의보고가증가하는추세이다. MIH에이환된치아는맹출후치관붕괴증상을보이며, 빠른우식이환율과심한통증증상을보일수있으므로조기발견이무엇보다중요하다 16). 한국에서의 MIH에관한연구는 2010년 Shin 등 12) 이 MIH 유병률을보고한것이외는주로증례보고만이이루어 졌다. 따라서본연구는최근 MIH 진단에서가장많이사용하는 EAPD의진단기준을사용하여 17), 전주시에거주하는 8-9 세를대상으로유병률뿐만아니라절치및제1대구치의 MIH 증상을분석하고자하였다. 8-9세를대상으로한이유는모든절치와제1대구치가맹출하고, 제1대구치가 MIH에이환되었더라도맹출후과도한붕괴없이상대적으로양호한상태를보이기때문이다 18). 또한 MIH와관련있는위험요인에대해선행 414

6 된연구들을 5,6,9,10) 바탕으로임신기간, 출생시, 출생후 3년간의기간에대해설문조사를시행하여병인에대해분석하였다. MIH의유병률은 % 로광범위하게나타나며 11), 이와같은유병률의차이는국가, 대상연령및 MIH의진단기준차이등이영향을주는것으로생각된다 19). 본연구의 MIH 유병률은 7.1% 이었으며, 2010년 Shin 등 12) 의연구결과 (6.0%) 보다높은수치를보였다. 이는대상연령및지역적차이가영향을준것으로보여진다. 높은 MIH 유병률을보이는연구들은 MIH 증상이관찰되는범위가 2 mm 미만인경우에도 MIH 이환에포함시키는경우가많았다 9,20). MIH 유병률과성별및연령과의연관성에관한대부분의연구들은통계적으로유의한차이가없으나 21-23), 본연구는 9세가 8세보다높은수치를보였으며통계적으로유의하였다 (p < 0.05). 이는 9세가 8세에비해조사대상인원이부족하였으며, 횡단적연구의한계라할수있다. 절치와제1대구치에관한 MIH 저광화정도및상태에대한조사에서치아간에통계적으로유의한차이가있었다 (p < 0.05). MIH로인한법랑질발육성결함의경우형태및분포에서비정형적으로관찰되며 24), 각개인안에서도치아마다 MIH 증상의심도차이가다를수있기때문이다 25). 절치와제1 대구치를비교한결과, 제1대구치가절치에비해 MIH 이환빈도가높았으며, 2 이상의 MIH code를보이는경우가많았고, 특히 MIH code 2a와 3은제1대구치에서만관찰되었다 (p < 0.05). MIH 증상의정도는절치에비해제1대구치에서좀더심하고 26), 더자주이환되며 18), 맹출후붕괴증상과 MIH로인한비전형적수복은주로구치부에서관찰된다는점에서선행연구와일치하였다 27). 현재 MIH는다양한요인이서로영향을주는것으로추정되며, 이와관련하여유전적요인과환경요인에대한연구가이루어지고있다 6). 특히환경요인과관련하여어머니임신기간, 출생시그리고출생후 3세까지기간으로나누어연구가진행되고있으며 28), 그중에서도법랑질형성단계에서성숙시기와일치하는출생시부터출생후 3세까지의발육단계에대한관심이높다 29). 따라서본연구는선행연구를바탕으로어머니임신기간, 출생시그리고출생후 3세까지기간으로나누어설문조사를진행하였으며, 각각의기간에서통계적으로유의하게영향을미치는요인들을알아보았다. 임신기간동안산모의스트레스와항생제를복용한경우에아이가 MIH에이환되는경우가높게관찰되었다 (p < 0.05). 산모의스트레스는저혈압성빈혈을일으킬수있고이는태아의발육성결함빈도를높일수있다고하였다 30). 또한스트레스로인한영양실조의경우산모의건강에좋지않은영향을주어간접적으로 MIH와연관이있다고알려져있다 31). 항생제복용과치아발육과의관계에대해사람의경우는그둘의연관성이불확실하다. 그러나 Amoxicillin과 erythromycin을임신한쥐에게투여하였을때법랑모세포의기능저하로인해수산화인회석결정의구조와특성에영향을미쳐법랑질발육저하에영향을주는것으로보고되었다 32). 따라서사람의경우절치와제1대구 치의발육이임신 4개월경에시작된다는점을고려한다면 33), 임신기간동안항생제복용이태아의절치와제1대구치의법랑모세포의기능저하에영향을미칠수있는가능성을생각해볼수있다. 출생시저체중의경우, MIH의이환군이 9.0%, 비이환군이 3.9% 로통계적으로유의한차이를보였다 (p < 0.05). 출생시저체중의경우불완전한폐의발육으로인하여산소의부족뿐만아니라혈청, 칼슘과인의낮은체내수치와연관이되어있다 34). 법랑질형성이활발히일어나는단계에서법랑모세포에산소의공급이감소되는경우법랑질의형성에결함이생길수있다 35,36). 중절치의법랑질형성시작은 3개월경에시작하여 5세말경에완성되고, 제1대구치는출생시형성을시작하여 3세경에완성되므로, 출생후 3년까지영구절치와제1대구치는전신적환경요소에의하여법랑질결함이발생할가능성이높다 29,33). 특히, 상기도관질환, 천식, 중이염, 편도염, 수두, 홍역, 풍진, 고열의병력등, 생후 3년간흔한질병들이 MIH를일으키는중요한요인으로알려져있다 9,15,19,28,37). 이번조사에서도출생후 3년동안에병원입원경력의유무, 빈번한호흡기감염여부, 고열의병력에서통계적으로유의한결과를보였다 (p < 0.05). 이들요인들은어린이들의만성적인질환으로 MIH와연관이있으며, 선행연구와일치된결과를보였다 29). 특히고열의경우, Tung 등 38) 의연구는 38.5 까지고열을유지하였을때치아의석회화초기단계에서법랑모세포의활성이일시적으로저해되는결과를보고하였다. 임신기간동안어머니가항생제를복용한경우뿐만아니라출생후 3년이내어린이가장기간항생제를복용한경우에도통계적으로유의한결과를보였다 (p < 0.05). 장기간항생제의복용과 MIH와의관련성은질병의직접적인영향인지, 질병과관련하여처방받은항생제의장기간복용으로인한것인지는아직까지불확실하다 28). 본연구에서임신기간동안의스트레스, 고열, 항생제복용여부와출생시태아의저체중, 출생후 3년동안의어린이의고열및장기간항생제복용간의상관관계를비교한결과임신기간동안산모가항생제를복용한경우에서만 MIH에유의한영향을미친다고나타났다 (p < 0.05). 따라서본연구결과를고려한다면, 항생제사용에대해더많은주의가필요할것으로생각된다. 하지만이와같은결과는연구를진행한지역, 시기그리고대상에따라달라질수있으므로본연구에국한된의미라할수있다. 치의학계에보고되는많은연구들중치아우식과관련된연구는많으나, 법랑질발육성결함에관한대규모연구는한국에서부족하다 39,40). 따라서본연구는학교방문구강검진을통해 MIH 관련임상검사와 MIH 관련위험요인들에대한설문조사를실시하여 MIH 관련기초자료를제공하고자하였다. 본연구결과는전체어린이들에대한결과로일반화하기에는대상자의수가부족하며지역차이에따른한계가존재한다. 그러나최근전세계적으로통용되는 EAPD 진단기준을사용하여 MIH 관련유병률을조사하였다는점과, 한국에서처음으로각 415

7 치아별임상검사와위험요인들에대한설문조사를시행하였다는점에서이연구의의의가있다. 앞으로전지역에걸쳐서 MIH 유병률및위험요인에대한대단위적인추가연구가필요하며, MIH 관련위험요인을분석하여국가적인홍보가필요할것으로생각된다. Ⅴ. 결론전주시에거주하는만 8-9세 950명을대상으로 MIH 관련임상검사와설문조사를통해 MIH 관련위험요인과의연관성을조사하여다음과같은결론을얻었다. MIH 유병률은 7.1% 였으며, MIH code 0-3에주로분포하고있었다. 절치보다제1대구치의 MIH 이환빈도가높았고하악의제1대구치가상악에비해맹출후치아붕괴증상이높게관찰되었다 (p < 0.05). MIH 관련위험요인에대한설문조사결과는, 임신기간동안산모의스트레스와항생제복용이자녀의 MIH 증상과높은관련성을보였다 (p < 0.05). 또한출생시저체중, 출생후 3년이내입원경력, 빈번한호흡기감염, 고열그리고항생제의장기간복용이 MIH와의유의한연관성을보였다 (p < 0.05). 이상의결과에서, MIH는전신적환경요인들이복합적으로영향을주고있으며이환된제1대구치는중등도이상의증상을보이고있었다. 따라서어린이들이건강한치열을가질수있도록산모의임신부터관리가필요하며, 어린이의치열이영구치로교환되는시기에는좀더세심한임상검사및병력청취를통해조기진단및예방적치료를시행하여치아들을보존할수있도록해야할것이다. References 1. Weerheijm KL : Molar incisor hypomineralization (MIH): clinical presentation, aetiology and management. Dental Update, 31:9-12, Weerheijm KL, Jälevik B, Alaluusua S : Molarincisor hypomineralisation. Caries Res, 35: , Fayle SA : Molar incisor hypomineralization: restorative management. Eur J Paediatr Dent, 4: , Alaluusua S : Aetiology of Molar-Incisor Hypomineralisation: A systematic review. Eur Arch Paediatr Dent, 11:53-58, Crombie F, Manton D, Kilpatrick N : Aetiology of molar-incisor hypomineralization: a critical review. Int J Paediatr Dent, 19:73-83, Fagrell TG, Ludvigsson J, Koch G, et al. : Aetiology of severe demarcated enamel opacities: an evaluation based on prospective medical and social data from 17,000 children. Swed Dent J, 35:57-67, Alaluusua S, Lukinmaa PL, Vartiainen T, et al. : Developing teeth as biomarker of dioxin exposure. Lancet, 353:206, Brogardh-Roth S, Matsson L, Klingberg G : Molarincisor hypomineralization and oral hygiene in 10 to 12-yr-old Swedish children born preterm. Eur J Oral Sci, 119:33-39, Jalevik B, Noren JG : Enamel hypomineralization of permanent first molars: a morphological study and survey of possible aetiological factors. Int J Paediatr Dent, 10: , Weerheijm KL, Duggal M, Hallonsten AL, et al. : Judgement criteria for molar incisor hypomineralisation (MIH) in epidemiologic studies: a summary of the European meeting on MIH held in Athens, Eur J Paediatr Dent, 4: , Jalevik B : Prevalence and diagnosis of Molar- Incisor-Hypomineralisation (MIH): a systematic review. Eur Arch Paediatr Dent, 11:59-64, Shin JH, An UJ, Jeong TS, et al. : The prevalence of Molar-incisor hypomineralization and status of first molars in primary school children. J Korean Acad Pediatr Dent, 37: , William V, Messer LB, Burrow MF : Molar Incisor Hypomineralization Review and Recommendations for Clinical Management. Pediatr Dent, 28: , Jälevik B, Klingberg GA : Dental treatment, dental fear and behaviour management problems in children with severe enamel hypomineralization of their permanent first molars. Int J Paediatr Dent, 12:24-32, Molar Incisor Hypomineralization: Morphological, Aetiological, Epidemiological and Clinical Considerations. Assessment service. Available from URL: (Assessd on November 3, 2015). 16. Ng JJ, Eu OC, Nair R, Hong CH : Prevalence of molar incisor hypomineralization (MIH) in Singaporean children. Int J Paediatr Dent, 25:73-78, Lygidakis NA, Dimou G, Briseniou E : Molarincisor-hypomineralisation (MIH). Retrospective clinical study in Greek children. I. Prevalence and defect characteristics. Eur Arch Paediatr Dent, 9: , Garcia-Margarit M, Catala -Pizarro M, Montiel- 416

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9 국문초록 8-9 세어린이의 Molar-Incisor Hypomineraization 의원인및유병률에대한조사연구 김태형 정일용 이대우 김재곤 양연미 전북대학교치의학전문대학원소아치과학교실및구강생체과학연구소 본연구는전주시 8-9세어린이 950명을대상으로임상검사를통해 MIH 유병률과 MIH 증상을보이는치아의저광화정도및상태에대해알아보았으며, MIH 위험요인에관한설문조사를통해병인을조사하였다. MIH 유병률은 7.1% 였으며, 이환된치아의저광화정도는통계적으로유의한차이를보였다 (p < 0.05). 제1대구치가절치에비해이환빈도가높았으며, 특히 MIH code 2a와 3은제1대구치에서만관찰되었다 (p < 0.05). 위험요인에대한설문조사에서는산모의스트레스와항생제복용, 출생시저체중과출생후 3년이내의입원경력, 빈번한호흡기감염, 고열그리고항생제의장기간복용이 MIH와유의한관련성을보였다 (p < 0.05). 위험요인들상호간의관련성은임신기간동안항생제를복용한경우에서만높은연관성을보였다 (p < 0.05). 주요어 : Molar Incisor Hypomineralization, 유병률, 병인, 위험요인 418

한국성인에서초기황반변성질환과 연관된위험요인연구

한국성인에서초기황반변성질환과 연관된위험요인연구 한국성인에서초기황반변성질환과 연관된위험요인연구 - - i - - i - - ii - - iii - - iv - χ - v - - vi - - 1 - - 2 - - 3 - - 4 - 그림 1. 연구대상자선정도표 - 5 - - 6 - - 7 - - 8 - 그림 2. 연구의틀 χ - 9 - - 10 - - 11 -