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1 Journal of Korean Academy of Oral Health 2015 September 39(3): Original Article 국내외권장칫솔질방법의조사비교 김찬희 1,2, 김경민 1,2, 이주영 1,2, 권호근 1,2, 김백일 1,2,3 1 연세대학교치과대학예방치과학교실, 2 BK21 플러스통합구강생명과학사업단, 3 구강과학연구소 A comparison of tooth brushing methods recommended in different countries Chan-Hee Kim 1,2, Gyung-Min Kim 1,2, Joo-Young Lee 1,2, Ho-Keun Kwon 1,2, Baek-Il Kim 1,2,3 1 Department of Preventive Dentistry & Public Oral Health, 2 BK 21 PLUS Project, 3 Oral Science Research Institute, Yonsei University College of Dentistry, Seoul, Korea Received: August 13, 2015 Revised: September 11, 2015 Accepted: September 21, 2015 Corresponding Author: Baek-Il Kim Department of Preventive Dentistry & Public Oral Health, Yonsei University, College of Dentistry, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: Fax: drkbi@yuhs.ac Objectives: The aim of this study was to compare the tooth brushing methods recommended by dental associations and toothbrush manufacturers in various countries including South Korea. Methods: Eighteen countries 6 Asian, 2 North American, 2 Oceanian, and 8 European were selected from members of the OECD, EU, and APEC, using information obtained from the primary address of each dental association and information obtained from the websites of the associations regarding the officially recommended tooth brushing methods. In addition, 12 major toothbrush manufacturers were selected based on their market share, including 4 Asian manufacturers, 2 North American, and 2 European. Information about recommended tooth brushing methods was obtained from their websites. Results: The countries recommending a particular tooth brushing method by name were South Korea, Hong Kong, and Taiwan. While South Korea recommended the rolling technique, Hong Kong and Taiwan recommended the bass technique. Except for these countries, the other countries presented their recommended methods by explaining the initial position or motion of the toothbrush. The most commonly recommended method was tilting the brush head at an angle of 45 degrees to the gingival margin; this was recommended by 8 countries (44%) and 6 toothbrush manufacturers (75%). Brushing with a vibrating motion was also recommended by 9 countries (50%) and 4 manufacturers (50%). Conclusions: The most recommended brushing method was initially positioning the toothbrush at an angle of 45 degrees to the gingival margin and using a vibrating motion, which is effective against periodontal diseases. However, South Korea recommended the rolling technique, which is effective for controlling dental plaque. Given the high frequency with which periodontal disease occurs in South Korea, vibrating the toothbrush on the gingival margin should be recommended in addition to the rolling technique. Key Words: Dental association, Oral hygiene, Rolling technique, Tooth brushing method 서론 칫솔질은구강내에침착된치태를제거하기위해칫솔에다양한움직임을주어물리적인힘을가하는행위이다. 칫솔질의효 과는횟수와시간, 칫솔을사용하는개인의능력이나방법에의해좌우된다고보고되고있으나 1), 많은횟수의칫솔질이반드시구강건강상태를향상시키는것은아니다. 2012년도국민구강건강실태조사 2) 에따르면우리나라국민 Copyright 2015 by Journal of Korean Academy of Oral Health This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. JKAOH is available at pissn X / eissn

2 196 J Korean Acad Oral Health 2015;39: 의하루평균칫솔질횟수는 2.6회였으며, 이는 2003년도 3) 의 2.49 회와 2006년도 4) 의 2.35회에비해증가한것을알수있으나구강건강상태는 2009년 OECD 건강지표기준으로보았을때 28개의 OECD 가입국중 24번째로하위에머무르는수준이었다 5). 한편, 국내우식경험영구치지수는국민구강건강실태조사가처음실시된 2000년에비해꾸준히감소하는경향을나타내고있다 2). 그러나치주건강상태를측정하기위한지표인치석유병자율은만 12세의경우 18.3% 이었던 2006년도에비해 2012년도에는 24.8% 로증가하였으며, 15세의경우에도 27.9% 이었던 2006년도에비해 2012년도에는 35.6% 로증가하였다 2). 즉치주질환유병율은우식경험영구치지수와달리증가하고있음을알수있다. 또한치은염및치주질환은최근 5년동안국내다빈도상병순위 3위를기록하고있다 6). 이처럼치은염및치주질환이구강질환에있어높은비율을차지하고유병율또한감소하지않는이유는칫솔질을효과적으로수행하지못하기때문이다. 국내성인의경우일반적으로협면및교합면과같이칫솔이닿기용이한부위만을주로칫솔질을하고있는반면, 정작치주질환에취약한치은연부위는제대로칫솔질이이루어지지않고있다 7). 이와같이치은연부위에대한치태조절관리는중요하며이를위해서많은칫솔질방법들이개발되어왔으나국내에서는칫솔질교육시우선적으로회전법을추천받는다. 이방법은손목을돌려칫솔모가교합면방향으로쓸어내려가게닦는동작으로써치면부위의치태제거효과및실천성이좋다고알려져있다 7). 그러나어린이의경우칫솔의회전중심이치은연부위가아닌치근단쪽치은에위치할경우에는회전법을이용한칫솔질방법으로는치은연부위의치태조절관리의효과가떨어지는것으로알려져있다 7). 이처럼칫솔질방법은목적및적용부위에따라효과가달라지며구강질환예방의핵심요소로서중요한역할을하고있기때문에많은국가에서자국의실정과목적에맞는권장칫솔질방법이존재하고있다. 그러므로국내및해외여러국가들의권장칫솔질방법을조사비교하여근거중심의치의학관점에서우리나라의권장칫솔질방법을재검토하는것이필요하다. 그러나국내를포함한다른국가에서권장하는칫솔질방법에대해비교하여보고한연구는부족한실정이다. Wainwright 와 Sheiham 8) 의연구에서일부국가의칫솔질방법을비교한바있지만, 우리나라는조사대상에포함되지않았고조사된국가역시유럽국가를중심으로제한적이었다. 이에본연구의목적은국내및해외여러국가들의치과의사협회및주요칫솔제조회사에서공식적으로권장하는칫솔질방법을조사비교하는것이다. 연구대상및방법 본연구는국내외국가에서권장하고있는칫솔질방법에대한정보를수집하기위해 2014년 12월 17일부터 2015년 2월 14일까지국내외치과의사협회및주요칫솔제조회사를선정하여조사 하였다. 조사에포함된국가는 OECD ( 경제협력개발기구 ), EU ( 유럽연합 ), APEC ( 아시아태평양경제협력체 ) 의가입국이었으며, 이중치과의사협회홈페이지에칫솔질방법을기재한국가를기준으로선정하였고홈페이지에서칫솔질방법이확인되지않은국가는기재된협회대표메일주소를통해전자메일을보내어추가로자료를수집하였다 (Table 1). 치과의사협회의홈페이지는인터넷검색엔진 (Google) 을통해접속하였으며, 영어이외의자국어로기재된경우 Google Chrome ( 의웹사이트번역기능을이용하여칫솔질방법에대한정보를확인하였다. 홈페이지내에기재된칫솔질방법을검색하기위해 tooth brushing methods, oral hygiene, toothbrush 와같은검색어를입력하거나구강건강자료게시판을이용하였다. 최종적으로선정된국가는아시아국가로는한국, 일본, 대만, 말레이시아, 싱가포르, 홍콩이었고, 북미에서는미국과캐나다, 오세아니아에서는뉴질랜드와호주였으며유럽국가에서는노르웨이, 덴마크, 벨기에, 스웨덴, 스위스, 영국, 포르투갈, 핀란드로총 18개국이었다. 주요칫솔제조회사는국가별칫솔판매시장점유율을기준으 Table 1. Sources of information provided for dental associations and toothbrush manufacturers Group Dental associations South Korea Australia Belgium Canada Denmark Finland Hong Kong Japan Malaysia New Zealand Norway Portugal Singapore Sweden Switzerland Taiwan United Kingdom United States of America Toothbrush manufacturers LG household & health care (South Korea) Aekyung (South Korea) Crest (USA) Oral-B (USA) Curaden (Swiss) Tepe (Sweden) Lion (Japan) Sunstar (Japan) Sources of information Information sent by Information sent by *Websites visited between December 17, 2014 and February 14, 2015.

197 김찬희외 국내외권장칫솔질방법의조사비교 로한국의 LG생활건강, 애경, CJ Lion과일본의 Lion, Kao, Sunstar, 미국의 Crest, Oral-B와스웨덴의 Tepe, 스위스의 Curaden 및영국의 GSK, Unilever를선정하였다.

자료를수집한후각국에서하나의칫솔질방법에대해다양하게묘사된단어를표준화시키기위하여 Table 2와같이정의하였으며, 이를위해예방치의학및치위생학교과서중에서 Clinical practice of the dental hygienist 9), Dental hygiene theory and practice 10), Primary preventive dentistry

이때인접면및치은연부위에적용하는칫솔질동작만을포함하였으며교합면이나혀세정법에대한움직임은조사에서제외하였다. 명명법은본연구의조사대상국가에서주로권장되고있는방법인회전법, 바스법, 스틸만법으로구분하였다. 개시위치는칫솔질을시작할때칫솔의적합부위에대한설명으로칫솔이치은연을향하여 45도가되도록각도를주거나칫솔의기울기로설명한것을포함하였다.

문지름 (scrubbing) 동작은작은문지름동작 (small scrubbing or rubbing motion), 가벼운문지름 (gentle scrub) 으로기술되어있으며, Table 2.

3 197 김찬희외 국내외권장칫솔질방법의조사비교 로한국의 LG생활건강, 애경, CJ Lion과일본의 Lion, Kao, Sunstar, 미국의 Crest, Oral-B와스웨덴의 Tepe, 스위스의 Curaden 및영국의 GSK, Unilever를선정하였다. 이중에서홈페이지에칫솔질방법이기재되어있지않았던 CJ Lion과 Kao, GSK, Unilever 를제외한총 8개기업이최종적으로조사대상에포함되었다. 자료를수집한후각국에서하나의칫솔질방법에대해다양하게묘사된단어를표준화시키기위하여 Table 2와같이정의하였으며, 이를위해예방치의학및치위생학교과서중에서 Clinical practice of the dental hygienist 9), Dental hygiene theory and practice 10), Primary preventive dentistry 11), Textbook of oral care products 7) 에설명된방법을참고하였다. 먼저칫솔질동작을특정방법으로지칭하여표현한것은명명법 (nomenclature), 칫솔을처음위치시키는부위에대한설명은개시위치 (initial position), 칫솔의움직임을풀어서설명한것은동작 (motion) 으로분 류하였다. 이때인접면및치은연부위에적용하는칫솔질동작만을포함하였으며교합면이나혀세정법에대한움직임은조사에서제외하였다. 명명법은본연구의조사대상국가에서주로권장되고있는방법인회전법, 바스법, 스틸만법으로구분하였다. 개시위치는칫솔질을시작할때칫솔의적합부위에대한설명으로칫솔이치은연을향하여 45도가되도록각도를주거나칫솔의기울기로설명한것을포함하였다. 칫솔의동작은상하 (up-down), 원형 (circle), 문지름 (scrubbing), 진동 (vibrating) 으로구분하였다. 상하 (updown) 동작은상하 (up-down) 라는단어가칫솔질방법내용중에기술되어있고, 원형 (circle) 동작은원형의 (circular), 작은원형의 (small circular) 라는단어로기술된내용을포함하였다. 문지름 (scrubbing) 동작은작은문지름동작 (small scrubbing or rubbing motion), 가벼운문지름 (gentle scrub) 으로기술되어있으며, Table 2. Classification of tooth brushing methods Classification of tooth brushing methods Explanation Illustration* Nomenclatures Rolling Rolling the toothbrush by wrist rotation Bass Gently vibrate the toothbrush bristles at 45 degree angle along the gumline in sulcus Stillman Vibrate the toothbrush bristles at 45 degree angle on the gingiva Initial Positions Angulation 45 o, inclined, sloping Motions Circular, small circular Scrubbing Small scrubbing motion, gentle scrub, small rubbing Vibration Gently wiggle, gentle strokes, short strokes, brush back & forth in short, vibrate movements, very short horizontal movement *These pictures were from the Textbook of oral care products 7).

4 198 J Korean Acad Oral Health 2015;39: 진동 (vibration) 동작은가볍게상하좌우로짧게움직이기 (gently wiggle), 가벼운진동 (gentle strokes), 짧은진동 (short strokes), 짧은전후칫솔질 (brush back and forth in short), 진동시키는동작 (vibrate movements), 짧은수평동작 (very short horizontal movement) 으로기술된내용을포함하였다. 이외에특정동작이아닌모든칫솔질동작을권장한내용은모든방법의추천 (recommended all methods) 으로분류하였다. 연구성적 각조사국가별치과의사협회및칫솔제조회사에서권장하는칫솔질방법은 Table 3과같다. 특정방법을지칭하여명명한것은한국의회전법과홍콩및대만의바스법이있었다. 3개국가를제외한모든조사국가에서는특정칫솔질방법을명명하지않고칫솔의개시위치및동작으로풀어서설명하였다. 가장많이권장된칫솔질방법은칫솔을초기위치시치은연에 45도각도로위치시키는것으로 18개조사국가중 8개국가 ( 약 44.4%) 와 8곳의칫솔제조회사중 6곳 (75%) 에서이방법을추천하였다. 권장칫솔질동작을국가와칫솔제조회사로구분하여비교한것은 Fig. 1과같다. 9개국가 (50%) 와 4곳의칫솔제조회사 (50%) 가진동 (vibration) 동작을권장하고있었으며, 그다음으로원형 (circle) 동작은 6개국가 ( 약 33.3%) 와 2곳의칫솔제조회사 (25%) 에서권장하고있었다. 문지름 (scrubbing) 동작은 4개국가 ( 약 Number of organization Vibration Scrubbing Toothbrushing motions Dental associations Toothbrush manufacturers Rolling Recommended all methods Fig. 1. The number of organizations according to recommended tooth brushing motions. Table 3. Tooth brushing methods recommended by dental associations and toothbrush manufacturers Group Classification of tooth brushing methods Nomenclatures Motions Initial positions Dental associations South Korea Rolling Rolling Australia, Scrubbing, Vibration Belgium 45 o Canada,, Scrubbing, Vibration 45 o Denmark, Scrubbing, Vibration Sloping Finland Inclined Hong Kong Bass Vibration 45 o Japan Vibration 45 o Malaysia Recommended all methods New Zealand Scrubbing, Vibration 45 o Norway Recommended all methods Portugal Singapore Recommended all methods Sweden Vibration 45 o Switzerland Taiwan Bass Vibration, Rolling 45 o United Kingdom United States of America, Vibration 45 o Toothbrush manufacturers LG household & health care (South Korea) Rolling Rolling Aekyung (South Korea) Rolling Rolling, Vibration 45 o Crest (USA) 45 o Oral-B (USA) 45 o Curaden (Swiss) 45 o Tepe (Sweden) Vibration Lion (Japan) Vibration 45 o Sunstar (Japan), Vibration 45 o

5 199 김찬희외 국내외권장칫솔질방법의조사비교 22.2%) 가권장하였지만, 칫솔제조회사에서는추천동작으로권장하고있지않았다. 상하 (up-down) 동작은 3개국가 ( 약 16.7%) 와 2곳 (25%) 의칫솔제조회사에서권장하였으며, 모든동작의사용을추천한방법은 3개국가 ( 약 16.7%) 에서권장하였다. 고안 개인의구강건강관리에서가장기본이되는방법인칫솔질은횟수나시간과같은요인들보다는얼마나정확하고효과적인방법으로수행하는지가치태조절관리에있어중요하다. 따라서국내를포함한많은국가에서교육이나다양한매체를통하여올바른칫솔질방법에대해알리고있다. 본연구결과에따르면여러국가에서특정칫솔질방법을지칭하기보다는칫솔질동작을중심으로상세하게설명하는형태였다. 특히가장많이권장한방법은칫솔을치은연부위에 45도각도로위치시킨뒤진동을주는동작이었다. 이방법은치은조직및치은열구에근접한부위의치태제거효과가뛰어나다고보고되었으며 12), 치은연을중심으로발생하는치은염및치주염의예방에있어효과적이라고알려져있다. 또한일부선행연구에따르면치은연부위에서시작하는진동법은구치부의치면세균막제거에도효과가뛰어난것으로알려져있으며 13), 문지름 (scrubbing) 동작보다치태제거효과가뛰어나다고보고되었다 14). 이와같이치은연부위에진동을주는동작은치주질환예방에효과적인칫솔질방법으로여러국가에서권장되고있지만, 정작국내에서는진동을주는칫솔질방법에비해수행하기쉽다는이유로회전법을주로권장하고있다 15). 그러나 Choi 등 16) 은바스법과회전법을교육한두초등학생집단에서칫솔질방법의난이도에대한인식은유의한차이를나타내지않았으며, 바스법에대하여반복교육을받았을경우대상자들이회전법보다바스법을어렵게느끼지않았다고보고하였다. 또한회전법은손목의힘을주고회전동작을해야하기때문에칫솔머리에가까이회전축인엄지손가락을위치시켜야한다. 그렇기때문에엄지손가락이놓이는위치가칫솔머리에서먼쪽에위치하도록디자인된칫솔을사용할경우손목에무리가갈수있다. 또한회전법의경우칫솔강모의뻣뻣함 (stiffness) 정도가중등도이상이어야치면세균막제거효과가높아진다 7). 그러나현재국내에유통되는칫솔들은칫솔강모의뻣뻣한정도가약강도 (soft) 인칫솔이대부분이기때문에이부분도회전법의유용성을떨어뜨리는주요원인으로작용하고있는것으로사료된다. 치주질환이구강질환에있어높은비율을차지하는현국내실정에서치면부위에국한되어칫솔질을수행하는회전법만을추천하는것은재고해보아야할것이다. 회전법과더불어치은연부위에진동을주는동작을함께권장한다면치면뿐만아니라치은연부위의치태조절관리에있어서도효과가나타날수있을것으로사료된다. 또한본연구를통해일부협회및칫솔제조회사에서권장하고있는칫솔질법에대한설명이일치하지않게기술한점도발견 할수있었다. 대만에서는바스법을권장하고있지만정작그에대한설명은진동및회전동작을하는변형스틸만법에준하는방법을기술하고있었다. 또한국내칫솔제조회사인애경의권장방법역시회전법을명명하고있었으나기술된내용은회전법에진동동작을더한것이었다 (Table 2). 본연구에서는우리나라가제외된유럽의국가를중심으로권장칫솔질방법을조사한선행연구 8) 와는달리국내를포함한 OECD, APEC, EU의가입국을대상으로선정된다양한국가의권장칫솔질방법을비교하였다. 또한칫솔질방법별로그방법을권장하고있는치과의사협회나칫솔제조회사의수만을기재한선행연구와는달리각국가의치과의사협회와주요칫솔제조회사별로권장하는방법을명시하여구체적이고명확한정보를기재한점또한의미있는성과라사료된다. 그러나웹사이트에서얻어진한정된정보는본연구의한계이며좀더많은비교조사가이루어져야할것이다. 향후칫솔질방법외에빈도와시간등칫솔질에관련된다른항목도조사하여통합적인칫솔질권장사항을정리하는것이필요하다고사료된다. 또한칫솔질의구비조건에대해서도국가별권장사항을조사하여칫솔질방법뿐만아니라그에맞는칫솔의선택방법에대한정립도보안되어야할것이다. 결론 본연구는국내외 18개국의치과의사협회및주요칫솔제조회사 8곳에서권장하고있는칫솔질방법을조사비교하여다음과같은결론을얻었다. 1. 권장칫솔질방법으로특정방법을명명한 3개국가 ( 약 17%) 는회전법을추천한한국과바스법을추천한대만및홍콩이었다. 2. 조사대상의대부분은권장칫솔질방법을칫솔의개시위치및동작으로설명하였고, 가장많이추천한방법은칫솔을치은연부위에 45도각도로초기위치시키는것으로 11개국가 ( 약 61%) 및 6곳의회사 (75%) 에서추천하였다. 3. 가장많이권장된칫솔질동작은 9개국가 (50%) 와 4곳의칫솔제조회사 (50%) 에서추천한진동 (vibration) 동작이었다. 치주질환유병율이높은현국내실정을고려하여볼때, 권장칫솔질방법으로회전법만이아닌치주질환예방에효과적인치은연부위에칫솔모를 45도각도로초기위치시켜진동을주는동작을함께권장해야할것으로사료된다. References 1. Loe H, Kleinmann DV. Dental plaque control measures and oral hygiene practices: proceedings from a state-of-the-science workshop. Washington DC:IRL Press Ltd;1986: Ministry of Health and Welfare Korea National Oral Health Survey. Summary. Seoul:Ministry of Health and Welfare;2013:134, Ministry of Health and Welfare Korea National Oral Health

6 200 J Korean Acad Oral Health 2015;39: Survey. Summary. Seoul:Ministry of Health and Welfare;2004: Ministry of Health and Welfare Korea National Oral Health Survey. Seoul:Ministry of Health and Welfare;2007: Ministry of Health and Welfare. OECD Health at a Glance Seoul:Ministry of Health and Welfare;2010: Health Insurance Review and Assessment Service the first quarter Treatment cost statistical indices. Seoul:Health Insurance Review and Assessment Service;2015:7. 7. Kim BI, Kwon HK, Kim SH, Kim YS, Kim HS, No HJ, et al. Textbook of oral care products. 1st ed. Seoul:Charm-yun publishing;2010: Wainwright J, Sheiham A. An analysis of methods of tooth brushing recommended by dental associations, toothpaste and toothbrush companies and in dental texts. Br Dent J 2014;217:E5. 9. Wilkins EM, McCullough PA. Clinical practice of the dental hygienist. 10th ed. Philadelphia:Lea andfebige;2008: Darby ML, Walsh M. Dental hygiene: theory and practice. 3rd ed. St. Louis:Elsevier Health Sciences;2010: Harris NO, Garcia-Godoy F. Primary preventive dentistry. 6th ed. New Jersey:Pearson Education Inc;2004: Poyato-Ferrera M, Segura-Egea JJ, Bullón-Fernández P. Comparison of modified Bass technique with normal tooth brushing practices for efficacy in supra gingival plaque removal. Int Dent Hyg 2003;1: Kremers L, Lampert F, Etzold C. Comparative clinical studies on 2 tooth brushing methods-roll and Bass technic. Dtsch Zahnarztl Z 1978;33: Nassar PO, Bombardelli CG, Walker CS, Neves KV, Tonet K, Nishi RN, et al. Periodontal evaluation of different tooth brushing techniques in patients with fixed orthodontic appliances. Dental Press J Orthod 2013;18: Kim JB, Baek DI, Mun HS, Kim HD, Jin BH, Choi YJ, et al. Clinical preventive dentistry. 4th ed. Seoul:Gomoonsa;2006: Choi YG, Park DY, Jeong DB. Relationship among adequacy, awareness of the difficulty in tooth brushing and plaque score. J Korean Acad Dent Health 2009;33:

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Vol.266 C O N T E N T S M O N T H L Y P U B L I C F I N A N C E F O R U M 2018.08Vol.266 C O N T E N T S 02 06 30 48 54 66 80 120 M O N T H L Y P U B L I C F I N A N C E F O R U M 2 2018.8 3 4 2018.8 1) 6 2018.8 2) 7 8 2018.8 3) 9 4) 5) 6) 10 2018.8 7) 8) 9) 10) 11 12 2018.8