Vol. 8, No. 1, 2012

Transcription

1 Vol. 8, No. 1, 2012

2 제 8 권 1 호 2012 목 차 원 저 서울특별시장애인치과병원이동검진기관장애인들의구강건강조사이효설 김혜정 남선회 김민선 유혜선 백승호 1 증례보고 자폐환자의자해로인한구강내손상 : 증례보고지은혜 이효설 최형준 김성오 최병재 손흥규 이제호 10 항응고제투여중인다발성장애환자에서골수이식전발치창출혈부의전색과배농술을통한출혈과감염의조절 : 증례보고유재하 손정석 김종배 15 저산소성허혈성뇌병변환아에서혀내밀기에의해발생된혀궤양의치료 : 증례보고오미희 김소정 최성철 김광철 박재홍 22 한일교류액션플랜 2011 년일본장애인치과연수를다녀와서황지영 26 학술대회 2012 춘계학술집담회 37 부록 생의학학술지투고원고의통일양식 : 생의학논문원고의쓰기와편집 71 Ⅱ

3 The Journal of Korean Association for Disability and Oral Health Vol. 8, No. 1, 2012 CONTENTS Original Article The mobile oral health survey of the disabled in facilities in Seoul Hyo-Seol Lee, Hye-Jung Kim, Sun-Hei Nam, Min-Sun Kim, Hye-Sun You, Seung-Ho Baek 1 Case Reports Self-injurious behavior in a patient with autism : a case report Eunhye Ji, Hyo-seol Lee, Hyung-Jun Choi, Seong-Oh Kim, Byung-Jai Choi, Heung-Kyu Son, Jae-Ho Lee 10 Bleeding & infection control by the packing and drainage on bleeding extraction socket before bone marrow transplantation in a multiple disabled patient with anticoagulation drug : report of a case Jae-Ha Yoo, Jeong-Seog Son, Jong-Bae Kim 15 Treatment of lingual ulcers caused by tongue thrust with Hypoxic-Ischemic Encephalopathy Mee Hee Oh, So Jung Kim, Sung Chul Choi, Kwang-Chul Kim, Jae Hong Park 22 Academic Exchange Program [Action Plan] between KADH and JSDH Study program participation report on Special Needs Dentistry in Japan Ji-young Hwang 26 Scientific Meeting 2012 Spring Scientific Meeting 37 Supplement Uniform requirements for manuscripts submitted to biomedical journals: writing and editing for biomedical publication 71 Ⅲ

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5 대한장애인치과학회지 8(1) 2012 원 저 서울특별시장애인치과병원이동검진기관장애인들의구강건강조사 이효설 * 김혜정 ** 남선회 ** 김민선 ** 유혜선 ** 백승호 ** * 연세대학교치과대학소아치과학교실, ** 서울특별시장애인치과병원 Abstract THE MOBILE ORAL HEALTH SURVEY OF THE DISABLED IN FACILITIES IN SEOUL Hyo-Seol Lee*, Hye-Jung Kim**, Sun-Hei Nam**, Min-Sun Kim**, Hye-Sun You**, Seung-Ho Baek** *Department of Pediatric Dentistry, College of Dentistry, Yonsei University, **Seoul Dental Hospital for the Disabled Mobile oral exam at the facilities for the disabled in Seoul is to improve the oral health of the disabled who can hardly approach dental clinic. We analyzed 1609 oral exam records at 24 facilities (11 special-education schools, 10 living facilities, 2 mental hospitals, 1 health care facility for the elderly) in The purpose of this study is to figure out the oral health state of the disabled in facilities in Seoul and to compare with the non-disabled in National Survey 2010 and Special-education school : DMFT index of age 15 is 5.4 which is higher than 3.6 (DMFT index of age 15) of National Survey in Living facility : DMFT index of ages 35~44 is 8.4 which is higher than 5.2 (DMFT index of ages 35 ~44) of National Survey in DT rate is higher (31.3% vs 19.2%) and MT rate is lower (7.6% vs 15.5%). 3. Mental hospital : DMFT index of ages 35~44 is 11.3 which is higher than 5.2 (DMFT indext of age 35~44) of National Survey in DT rate is significantly higher (50.7% vs 19.2%) and FT rate is lower (35.1% vs 65.3%). 4. Health care facility for the elderly : DMFT index of ages 65~74 is 7.1 which is slightly lower than 8.7 (DMFT index of ages 65~74) of National Survey in The number of existing natural teeth is similar (16 vs 18). Key words : The disabled, Seoul, Mobile oral exam, SDHD, Facility, DMFT 교신저자 : 백승호 서울특별시성동구홍익동 102 서울특별시장애인치과병원 Tel: Fax: shbaek@snu.ac.kr Ⅰ. 서론 1981년 WHO는 세계장애인의해 를선포하였으며, 우리나라에서는장애인복지법을제정하였으나, 복지혜택및사회적인식은낮은수준이었다. 1988년서울올림픽을거 원고접수일 : / 원고최종수정일 : / 원고채택일 : * 본연구는서울특별시장애인치과병원 2011 년임상연구사업의지원을받아시행되었음

6 Korean Association for Disability and Oral Health 8(1) 2012 치고 1990년대들어서면서장애인복지에대한관심이높아졌고, 2000년대에는재정적, 정책적뒷받침으로실질적인보장과혜택이확충되게되었다 1). 등록장애인수는 2000년 958,196 명, 2005년 1, 645,555 명, 2010년 2,517,312 명으로 10년동안약 150만명이증가하였다. 의학발달로만성질환을가진고령자가증가하여후천적장애인으로등록하는경우가많아지고, 선천적장애를가진아동의생존율이높아졌기때문이다. 또한, 법적으로장애인의범주가 5종에서 15종으로확대되고 ( 초기 5종, 2000년 1차확대 10종, 2003년 2차확대 15종 ), 정책적으로장애인에대한복지가확대되어등록장애인의수가증가한것으로사료된다 1,2). 장애인수의증가및복지확대에따라장애인구강보건에대한관심도증가되었다. 그동안장애인구강건강은장애및생명에직접적인연관이있는전신건강에비해상대적으로소홀히다루어졌었다. 또한, 장애인이치료를받고싶어도일차적으로신체적, 정신적장애로치과치료에협조를못하거나, 이차적으로경제적, 물리적 ( 이동수단등 ), 치과설비 ( 휠체어접근불가, 전신마취시설미비 ), 전문인력부재등의이유로치과치료를받기어려웠다 4). 그러나, 구강보건은장애인의삶의질향상을위해서반드시필요하며, 이에대한관리가필요하다. 구강을통해서식사를하여생명을유지하고, 치과질환예방을통해통증을경험할가능성이줄어들며, 대화하고심미성을유지해사회생활을가능하게하기때문이다 5). 장애인구강건강실태에대한선행조사를살펴보면, 대상기관에따라비장애인과비슷하거나열악한구강상태를보인다. 2004년시행된 전국장애인구강보건실태조사연구 에서는장애유형별로나누어전국 1,476 명의장애인을조사하였다 4). 우리나라특수학교및복지관이용장애인의치아우식증경험율은비장애인과비교하였을때비슷하게나타났으나, 치료받지못한우식치아와치아우식증으로인해발거한치아비율은장애인에서상당히높게나타났다. 반면, 치주질환유병율은비장애인에비해장애인이뚜렷이높게나타났고의치보철필요도도높았다. 566명의정신장애인을대상으로한양 6) 의연구에서는낮은연령층에서도우식발생율이높으며, 연령이증가할수록우식발생율이급격히높아진것으로나타났다. 2008년양등 7) 은노인요양시설입소자 758 명의구강실태조사를하였다. 그결과우식경험영구치지수는같은연령대대조군에비해높게나타났으며, 고령으로갈수록증가하였다. 잔존치아수는같은연령대의대조군보다요양시설에서낮게나타났고, 나이가들수록감소하였으며상악보다하악에서높았다. 총의치장착자율은대조군보다노인요양시설에서매우낮게나타났으며, 보철치료에대한수요도는 67.82% 로대조군 35.4% 에비해큰차이를나타내었다. 서울특별시장애인치과병원은 2005년에중증장애인의치과치료및장애인구강보건증진을위해설립되었으며, 내원환자수는꾸준히늘어나고있다. 그러나, 서울특별시의장애인수가 50만명임을감안할때, 장애인치과병원의혜택을받는사람은아직소수이다. 또한, 치과병원에서의진료는이미심각하게진행된치과질환위주여서적극적인예방과교육에대한필요성과스스로내원하기힘든중증장애인은여전히구강보건의사각지대에놓여있다는점이문제점으로제기되었다. 따라서, 서울특별시장애인치과병원에서는 2008년부터장애인시설로찾아가는이동치과진료사업을시행하게되었다. 이동진료의목적은첫째, 특수학교, 복지관등재가장애인들이이용하는장애인시설에서구강질환에대한예방과교육, 검진등을시행하는것과둘째, 장애인시설을이용하며스스로치과에내원하기힘든중증장애인에대한정기검진과진료였다. 본조사의목적은서울특별시장애인치과병원에서이동검진을시행하는서울시의장애인기관소재장애인들의구강건강조사를통해, 기관장애인들의질병발생수준과양태를측정함으로써구강보건실태와진료수요에관한정보를수집하는것이다. 이를통해, 체계적인이동검진사업의개발, 수립및사업우선순위결정에필요한기초자료를확보하고자하였다. Ⅱ. 연구대상및방법 1. 연구대상 1) 연구대상자 2011년서울특별시장애인치과병원에서이동검진을시행하는서울시산하장애인기관소재장애인약 6000 명중 2000명을선별하여대상으로하였다. WHO 표준조사연령및연령군에대한분석을시행하였다. WHO 표준조사연령및연령군은유치조사용으로 5세, 영구치에대한조사로 12 세, 15세, 성인에대한 35~44세연령군, 노인에대한 65 ~74세연령군이필요하다 8). 2) 이동검진대상장애인기관 (1) 특수학교 (special-education school) 특수학교란특수교육법제 15조에근거하여시각장애, 청각장애, 정신지체, 지체장애, 정서행동장애, 자폐성장애, 의사소통장애, 학습장애, 건강장애, 발달지체및대통령령으로정하는장애를가진사람을대상으로특수교육을행하는교육기관이다. 2011년기준전국특수학교는 155개교가있으며, 서울에있는 29개학교에서이동검진을시행하였다. 시각장애, 청각장애, 정신지체, 지체장애, 정서장애학교총 11개소에 - 2 -

7 대한장애인치과학회지 8(1) 2012 서검진결과를수집하였다. (2) 장애인시설 (living facility) 장애인시설은장애인생활시설, 장애인지역사회재활시설, 장애인직업재활시설, 장애인유료복지시설, 장애인생산품판매시설로분류된다 (Table 1). 장애인생활시설과장애인지역사회재활시설중 13개소에서검진결과를수집을계획하였으나, 최종적으로 10개소에서결과를얻었다. 있는노인의료복지시설이다. 대상자는스스로일상생활이곤란한 65세이상노인과치매, 뇌혈관성질환, 파킨슨병등노인성질환은가진 65세미만자이다. 2011년 7월서울에는 434개의시설이있으며, 입원인원수약 400명의대형시설 1곳에서이동검진및결과수집을시행하였다. 2. 연구방법 (3) 정신병원 (mental hospital) 정신병원이란정신병자를입원시켜서전문치료를하여사회복귀를시키려는목적으로설립된병원이다. 최근에는환자를구금하던병실에서개방하는병실이늘어나고, 향정신약물의발달로호전된환자에게레크리에이션요법, 생활요법, 직업요법, 연극, 회화요법등을실시함으로써사회복귀를하루빨리시키려고노력하고있다. 2011년기준서울시산하 4개의정신병원에서이동검진을시행하였으며, 2개병원의검진결과를수집하였다. (4) 노인요양센터 (health care facility for the elderly) 2008년 7월부터시행된노인장기요양보험제도에따라장기요양보험판정을받은노인이입소하여신체활동지원, 심신기능의유지, 향상을위한교육, 훈련등을제공받을수 검진팀은치과의사 1인, 치과위생사 2인, 총 3인의구강검사요원으로구성되었으며, 총 9개의팀이참여하였다. 이동치과검진및진료가가능하도록개조한대형버스를이용하였며, 치과의사가환자에게시행하는것으로충분한조명하에치경이나탐침으로검사하는시진의방식을채택하였다. 구강상태를검진하는치과의사에대하여일치도를확보하고치과위생사들의검진기록이해를돕기위해훈련을시행하였다. 이를통해기록에대한오류를최소화하였으며, 검진자간및검진자내일치도가카파지수 0.8 이상이되도록훈련하였다. 조사내용은 Table 2와같다. 구강검진기준은세계보건기구 (WHO) 에서권장하는기준을우리나라실정에맞게사용하였으며, 2010 국민구강건강실태조사조사지침을참고하였다. Table 1. Number of the disabled in 2000, 2005, 2010 Kind of Disability Total 958,196 1,645,555 2,517,312 Physical disability 606, ,096 1,337,722 Brain disease 33, , ,746 Visual disability 90, , ,259 Hearing disability 87, , ,403 Speech impediment 17,207 Intellectual disability 86, , ,249 Autism spectrum disorder 1,514 8,293 14,888 Mental disorder 23,559 56,783 95,821 Renal disease 23,427 39,285 57,142 Heart disease 4,971 11,978 12,864 Pulmonary disease 4,311 15,551 Hepatic disease 1,229 7,920 Facial disorder 1,229 2,696 Intestinal & urinary fistula disease 8,574 13,072 Epilepsy 5,691 9,

8 Korean Association for Disability and Oral Health 8(1) 2012 Table 2. Research contents Age Contents Children 5 df rate, dmf prevalence, dmf index, dt rate, ft rate Adolescent 12 DMF rate, DMFT index, DT rate, MT rate, FT rate, Residual natural Adult 35 ~ 44 teeth (adult, senior), SiC Senior 65 ~ 74 Adult 35 ~ 44 State of implant Senior 65 ~ 74 State and need of prosthesis Ⅲ. 결과 3. 보철검사결과 ( 성인및노인 ) 1. 조사대상기관및인원총 24개기관 ( 특수학교 11, 장애인시설 10, 정신병원 2, 노인요양센터 1) 에서 1727명의검진을실시하였다. 이중, 5, 12, 15, 35~44, 65~74세의 WHO 평균연령군의피검자수는총 3565명이었다 (Table 3). 장애등급은 1, 2급중증장애인이전체의 62.1%, 응답자중에서는 90% 였다 (Table 4). 2. WHO 연령군의치아상태 WHO 연령군인 5, 12, 15, 35~44, 65~74세의결과와 2010 국민구강건강실태조사와 2008 국민영양조사의결과를비교하였다 (Table 5~9). 1) 임플란트수진율상악임플란트수진자는전체 677명중 3명으로 0.4% 였으며, 총 9개가조사되었다. 하악임플란트수진자는전체 677명중 6명으로수진율은 0.9%, 개수는 7개였다. 2) 보철검사결과 - 보철물수진상태 ( 성인및노인 ) 상악보철물을장착하고있는비장애인이장애인에비해 2~5배정도많았다. 상악보철물의형태는저연령일수록보철물이없거나, 한개의 Bridge를하고있으며, 연령이증가할수록복잡한형태의보철물을하였다. 하악보철물을장착하고있는비장애인은장애인에비해 2 배정도많았다. 하악보철물의형태는상악과마찬가지로저연령에서는없거나간단한형태이며, 노인이될수록복잡한보철물을하고있었다. Table 3. Distribution by age and facility (ED : health care facility for the elderly, LF : living facilities, MH : mental hospitals, SS : special-education schools) Facilities ED LF MH SS Age ~ ~ N % Table 5. Teeth state of age National Survey SDHD Non-disabled Disabled df rate (%) dmf prevalence (%) dmf index dt rate (%) ft rate (%) Table 4. Distribution by grade of disability Grade etc Total N %

9 대한장애인치과학회지 8(1) ) 보철검사결과 - 보철물필요상태 ( 성인및노인 ) 상악보철물필요도는 2008 국민영양조사에비하면 2~9 배정도높았으며, 특히, 35~44세젊은성인에서높았다. 상악보철물필요형태는저연령일수록간단한형태를고연령일수록틀니같은복잡한형태를필요로하고있었다. 하악보철물필요도는 2008 국민영양조사와비교하면, 2~6배정도높은수치였다. 상악과는달리 55~64세의보철물수요가가장많은차이를보였다. 하악보철물필요형태는상악과마찬가지였다. Table 6. Teeth state of age National Survey SDHD Non-disabled Disabled DMF rate (%) DMFT index DT rate (%) MT rate (%) FT rate (%) SiC 5.7 Table 7. Teeth state of age National Survey SDHD Non-disabled Disabled DMF rate (%) DMFT index DT rate (%) MT rate (%) FT rate (%) SiC 11 Table 8. Teeth state of age 35~ SDHD Total MH LF National survey DMF rate (%) DMFT index DT rate (%) MT rate (%) FT rate (%) Residual natural teeth SiC 17.9 Table 9. Teeth state of ages 65~ SDHD Total ED MH LF National survey DMF rate (%) DMFT index DT rate (%) MT rate (%) FT rate (%) Residual natural teeth SiC 19.1 Table 10. Prosthesis state of Mx. N Number of the people Rate of the people with Mx.prosthesis with Mx. prosthesis National survey 35~ ~ ~ ~ ~ 전체

10 Korean Association for Disability and Oral Health 8(1) 2012 Table 11. Prosthesis state of Mn. N Number of the people Rate of the people with Mn.prosthesis with Mn. prosthesis National survey 35~ ~ ~ ~ ~ 전체 Table 12. Prosthesis need of Mx. N Number of the people Rate of the people needing Mx. prosthesis needing Mx. prosthesis National survey 35~ ~ ~ ~ ~ 전체 Table 13. Prosthesis need of Mn. N Number of the people Rate of the people with Mn.prosthesis with Mn. prosthesis National survey 35~ ~ ~ ~ ~ 전체 Ⅳ. 고찰현대사회에서선진국은복지국가라고도불린다. 우리나라에서도경제성장과함께복지에대한관심이커지고인식개선과정책적, 경제적뒷받침이이루어졌다. 복지대상의일선에있는사람들은장애인, 어린이, 노인, 여성인데, 이는사회적약자로보호되고도움받을부분이많기때문일것이다. 특히, 장애인에대해서는시설에격리되었던과거와달리사회에서함께동등한권리와의무를누리면서살아간다는사회통합과정상화의개념이일반화되면서, 일상생활이가능하도록하는여러가지사업이이루어져왔다. 예를들면, 이동권을보장하는장애인콜택시, 시각장애인을위한시각장애인심부름센터, 청각장애인을위한수화통역센터, 중증장애인을위한활동보조인, 취업을위한직업재활시설등이있다. 장애인구강보건증진사업도이런맥락에 서장애인의구강보건이비장애인과동등하게이루어질수있도록계획된사업이다. 장애인구강보건증진사업의하나로 2005년서울시장애인치과병원이설립되었다. 장애인자체의신체적, 정신적, 경제적문제와치과자체의전문인력부족, 설비부족등의문제를극복하여중증장애인도양질의진료를편하게받게되었다. 내원객수도해마다증가하여연간 2만명을넘고있다. 그러나, 몇가지문제점도발견되었다. 첫째, 장애인치과병원등록환자수는약천명으로서울시장애인수 50만명에비하면아직적은수이다. 즉, 아직장애인치과병원을모르고내원하지못하는환자가많다고할수있다. 둘째, 치과질환이심각하게진행된상태로내원하는환자들이많아서치료위주의진료가중심이다. 구강질환예방및교육의필요가있었다. 셋째, 지체장애등스스로내원할수있는환자위주였다. 스스로내원하지못하는환자들에게찾아가 - 6 -

11 대한장애인치과학회지 8(1) 2012 서치과진료를해줄필요성이대두되었다. 따라서, 2008년부터찾아가는이동진료서비스를시행하였다. 서울시와협약을맺어서울시산하의 29개특수학교와 4개의시립정신병원및복지관을비롯한각종장애인생활시설, 노인요양센터등을대상으로하고있으며, 해마다 6000~8000 명의검진및진료를해왔다. 본연구에서는이동검진을시행하는시설장애인들의구강상태를파악하여, 과거선행연구및비장애인을대상으로한연구와비교하고자하였다. 이를통해문제점을찾아내고, 그에맞도록해결책을모색하고, 이동검진, 나아가장애인구강보건정책에방향성을제시할수있기를기대하였다. 조사대상기관은총 24개로특수학교 11개소, 장애인시설 10개소, 정신병원 2개소, 노인요양센터 1개소였다. 특수학교는장애별로학교가나뉘어진다. 지적장애, 시각장애, 청각장애, 지체장애, 정서장애학교가있으며, 균등한학생수를고려하여대상학교를선정하였다. 장애인시설은용도에따라여러가지로구분되나, 각시설마다수용인원이적어서장애인시설한가지로분류하였다. 차후에검진데이터가많이쌓이면, 시설용도별로상태를분석해보아도흥미로운결과가나올것이다. 기관별로연령분포를살펴보았을때, 노인요양센터는원칙적으로는 65세이상이입소대상자이나, 77% 가 75세이상의고령자였다. 장애인생활시설의피검자는 3~74세까지분포하였으며, 18~34세의청년층이 47% 로가장많았다. 아동은영유아생활시설에서생활하고있었으며, 중증장애로집에서부모들이양육할수없어위탁하거나친권을포기한경우가있었다. 청년들은주간보호시설, 단기보호시설등에서검사되었다. 이러한시설의장애인들은연령이낮고, 사회에서살아갈만큼협조도가좋아서정기검진및스케일링같은간단한예방진료가큰도움이될수있을것이다. 또한, 부모가있는경우도많아서치료가필요한경우치과에내원하도록지도할수도있을것이다. 반면, 정신병원은 45~54세의중장년층이많았다. 환자들은사회와격리되어있고, 병원은교외지역에자리잡고있어서치과치료에대한접근이어려웠다. 장애유형별분포는지적장애가 23.6% 로가장많았고, 지체장애가 2.1% 로가장낮았다. 보건복지부등록장애인은지체장애인이거의 50% 로가장많은데, 본조사에서지체장애가적은이유는지체장애는고령자들에게많고, 지적장애가동반되지않은경우특수학교에다니지않기때문이다. 또한, 뇌성마비환자같은경우, 지체장애보다는장애등급이높은뇌병변장애를선호하고있어, 지체장애특수학교아동들도뇌병변장애를받은경우가많았다. 미등록자도 399명이었다. 280명이미등록자인노인요양센터의경우뇌병변의정도는심각하나, 장애판정은받지않고노인요양등급판정만받은경우가많았다. 정신병원에도정신장애외 에지적장애, 발달장애, 미등록자등이다수있었다. 따라서, 장애별로구강상태를분류하는것보다, 기관별로구강상태를파악하는것이환경에따른구강상태의차이를볼때더타당하다고생각되었다. 장애등급별분포는 1등급이 46.1%, 2등급이 19.5% 로중증장애인이전체의 65.6% 를차지하였으며, 기타를제외하면 92.1% 였다. 3등급까지포함하면 70.4%, 기타를제외하면 99% 였다. 등급이높은중증장애인일수록스스로일상생활을돌보기힘들며, 사회에서격리되기쉽다. 이동진료를시행하는기관의장애인들이스스로구강건강을관리하거나, 치과에찾아오기힘들다는것을알수있다. 타연구와의비교를정확하고폭넓게하기위하여 WHO 표준조사연령및연령군에대해서통계를내었다. 비교대상으로는 2010 국민구강보건실태조사와 2008 국민영양조사, 2005 전국장애인구강보건실태조사를참조하였다 국민구강보건실태조사는아동을대상으로하였으며, 장애인에대한구강조사도되어있어더좋은비교가되었다 국민영양조사는성인에대한것이다. 5, 12, 15세연령군에서특수학교별로나누어통계를내려하였으나표본수가작은군이있어시행하지않았다. 대신, 후행연구과제로삼기로하였다. 5세아동 14명의유치우식경험자율과유치우식유병자율, 우식경험유치지수는 2010 국민구강보건실태조사보다낮다. 긍정적인결과이긴하나, 피검자수가 14인밖에되지않으므로신뢰하기는어렵다. 추가조사를통해조사의신뢰성을확보할필요가있을것이다. 12세청소년의영구치우식경험자율, 영구치우식경험지수는국민구강보건실태조사와비슷한수준이다. 그러나, 우식영구치율과충전영구치율이매우높다는점에서, 우식이있어도치료받기어렵다는점을알수있다. 이것은 2004 전국장애인구강보건실태조사와도같은결과이다. 15세청소년의영구치우식경험자율과영구치우식경험지수는국민구강보건실태조사에비해월등히높다. 15세는영구치가구강내에맹출한지 3~9년되는시기로, 이때우식치아많다는것은우식활성도가높다는것을의미한다. 그러나, 국민구강보건실태조사의장애인군은영구치우식경험지수가본조사보다 2배가량낮았다 (5.4 vs 2.82). 국민구강보건실태조사에서는국내 15개특수학교에서장애를구별하지않고조사한결과이다. 조사내에서도적은표본수와편의적표본추출방법으로인해대표성과신뢰성을제고해야한다고하였다. 본연구의결과에의하면, 특수학교에서는일반학교보다더철저한구강위생관리가필요할것이다. 현재추진되고있는특수학교의구강보건실설치사업이꼭필요하다는근거가될수있을것이다. 그리고, 우식영구치율은두배가량높아여전히치료받기어렵다는것을보여주었다

12 Korean Association for Disability and Oral Health 8(1) ~44세성인의영구치우식경험지수가국민영양조사에비해 2배가량높았는데, 정신병원에서특히높았다. 우식영구치율도정신병원, 장애인생활시설, 국민영양조사순으로낮아져서, 정신병원이우식발생도많고, 치료도잘이루어지지않음을알수있었다. 65~74세노인의영구치우식경험자율은정신병원, 국민영양조사, 노인요양센터, 장애인생활시설순이었고, 영구치우식경험자율은정신병원, 국민영양조사, 장애인생활시설, 노인요양센터순이었다. 우식영구치율은정신병원이노인요양센터의약 2배, 장애인생활시설의약 2.5배, 국민영양조사의약 5배인반면, 상실영구치율과충전영구치율은제일낮았다. 정신병원환자들의우식발생이많고, 치료도잘이루어지지않음을확인할수있었다. 현존자연치아수는정신병원이제일많고, 장애인생활시설이가장낮았는데, 국민영양조사에비하면 5가낮았다 (13 vs 18). 이는장애인생활시설에서발치치료가많이이루어진다고추정할수있는데, 경제적인이유와진료협조도, 자기관리부재등이그원인으로추측된다. 상, 하악보철물필요상태는동일하게전체 677명중 297명으로 43.9% 였다. 상악은 2008 국민영양조사에비하면 2~9배정도높은수치이며, 특히, 35~44세젊은성인에서필요율이높았다. 하악은 2~6배정도높으며, 55~64세에서수요가가장많았다. 필요한보철물형태는저연령일수록간단한형태를, 고연령일수록틀니같은복잡한형태를필요로하였다. 본조사를통해이동검진시설장애인들의치아상태가비장애인에비해대체적으로열악하며, 특히, 사회와격리되어있고스스로돌볼수없는정신병원의경우그정도가심각함을알수있었다. 상대적으로치과에대한접근성이좋은특수학교나장애인생활시설의장애인들도우식발생율이높게나타났다. 치아우식증은통증을유발하고, 치료되지않으면치아상실로이어질수있다. 치아상실은저작기능과심미성, 발음에중대한손실을주고이는영양부족과사회성감소로이어질수있어장애인의사회통합에구강보건이중요하다고할수있다. 그러나, 치아우식증은그발생초기에통증이나불편을수반하지않기때문에본인이그발생을감지하기가어려워방치되기가쉽다. 그래서주기적으로구강검사를받아서치아우식증및다른구강질환의이환여부를알아서, 필요한예방조치나조기치료를받아야구강건강을유지할수있다. 그런방법으로는시설내에구강관리실을설치하거나, 치과와결연을맺어주기적으로검진및교육을할수도있고, 본원처럼이동진료차량을이용할수도있을것이다. 노인요양센터에서는우식영구치율이약간높았지만, 비장애인군과비슷한결과를보였다. 노인요양센터의입소자들은치매, 뇌졸중등의뇌병변장애로노인요양등급판정을 받은 65세이상의노인이다. 대개스스로 ADL을할수없으며, 침상에누워만있거나, 휠체어를타고이동할수있는경우가많은등전신건강이매우쇠약해져있다. 따라서, 우식치아의치료보다는, 구강질환, 섭식장애, 흡인성폐렴등의예방에집중해야할필요가있을것이다. 한가지더중요한점은치과진료가시설장애인과치과의료진과의관계만이아닌장애인을돌보는보호자들에게경각심을일깨워주며, 구강관리방법을알려주고치과에대해친숙하게하는역할을해야한다는것이다. 이를위해기관의특징및장애의특징을고려한교육자료등의개발도필요할것이다. 향후, 본연구의미흡한점을보완한추가연구가필요할것이다. 첫째, WHO 연령군중 5, 12, 15세군의조사를보강해특수학교별로비교해보는것이다. 둘째, 장애인생활시설의용도별로비교해보는것이다. 셋째, 비슷한조건을가진기관내에서장애별로차이가있는지를비교해보는것이다. 넷째, 치주질환에대한조사를추가해야한다. 다섯째, 생활습관등의주관적인부분을조사하여구강질환을일으키는습관에대해조사해볼필요가있다. Ⅴ. 결론서울특별시장애인치과병원은 2008년부터서울시소재장애인시설에서이동검진및진료를시행하고있다. 치과에오기힘든시설장애인들의구강건강증진을도모하기위해서이다. 24개장애인시설 ( 특수학교 11, 장애인생활시설 10, 정신병원 2, 노인요양센터 1) 의 1609명의 2011년구강검진기록을분석하였다. 첫째, 시설장애인의구강상태를파악하고, 둘째, 국민구강건강실태조사와비교하기위함이다. 1. 특수학교 : 15세 DMFT index는 5.4로 2010 국민구강건강실태조사 (DMFT index = 3.6) 에비해높았다. 2. 생활시설 : 35~44세 DMFT index는 8.4로 2008 국민영양조사 (DMFT index = 5.2) 보다높았다. DT rate는더높고 (31.3% vs 19.2%), MT rate는더낮았다 (7.6% vs 15.5%). 3. 정신병원 : 35~44세 DMFT index는 11.3으로 2008 국민영양조사보다높았다 (DMFT index = 5.2). DT rate는현저히높고 (50.7 % vs 19.2%), FT rate는더낮았다 (35.1% vs 65.3%). 4. 노인요양센터 : 65~74세 DMFT index는 7.1로 2008 국민영양조사에비해약간높았다 (DMFT index = 8.7). 현존자연치아수는비슷했다 (16 vs 18). 연구는서울특별시장애인치과병원의 2011년이동검진기록의일부를분석하여얻은결과로시설장애인의구강상태가비장애인에비해취약함을알수있었다. 이를토대로장애인을대상으로한구강질환에대한예방교육강화및치 - 8 -

13 대한장애인치과학회지 8(1) 2012 과에오기힘든시설장애인에게는정기적인검진및진료가더확대되어야할것이다. 또한, 다음연구에는장애의종류및개인의습관과환경이구강상태에미치는영향에대해서도폭넓게조사되어야할것이다. 참고문헌 1. 장애인복지론, 나혜숙, ( 주 ) 중앙경제, 장애인현황, 보건복지부, 국가통계포털, 장애인구강보건정책연구, 대한장애인치과학회, 보건복지부. 4. 전국장애인구강보건실태조사연구, 재단법인스마일, 보건복지부, 공중구강보건학제 5판, 김종배외, 고문사, 양동선. 정신질환자의구강건강상태에관한조사연구, 단국대학교대학원, 양순봉, 문홍석, 한동후등, 노인요양시설에있는노인환자의구강실태및치료수요도. 대한치과보철학회지, 46; , 구강건강조사법, 장기원, 김진범공역, 고문사, 구강검사에따른추후관리, 문혁수, 한국학교보건학회지, 13, 195~198, 년장애인실태조사, 한국보건사회연구원, 보건복지부, 구강보건통계및실제제 2판, 강용주외, 대한나래출판사, 년국민구강건강실태조사, 보건복지부, 년장애인분류, 보건복지부, 서울특별시장애인종합홈페이지, Seoul.go.kr - 9 -

14 Korean Association for Disability and Oral Health 8(1) 2012 증 례 자폐환자의자해로인한구강내손상 : 증례보고 지은혜 이효설 최형준 김성오 최병재 손흥규 이제호 연세대학교치과대학소아치과학교실 Abstract SELF-INJURIOUS BEHAVIOR IN A PATIENT WITH AUTISM : A CASE REPORT Eunhye Ji, Hyo-seol Lee, Hyung-Jun Choi, Seong-Oh Kim, Byung-Jai Choi, Heung-Kyu Son, Jae-Ho Lee Department of Pediatric Dentistry, College of Dentistry, Yonsei University Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could be tried initially before employing more invasive approaches. Key words : Autism, self-injurious behavior(sib), mouthguard Ⅰ. 서론 교신저자 : 이제호 서울특별시서대문구신촌동 134 연세대학교치과대학소아치과학교실 Tel: Fax: leejh@yuhs.ac 자해행위는자살의의도는없이자신의신체일부를무의식적이거나고의로손상시키는것 1) 으로미세한손상에서부터, 불구를유발할수있는손상까지다양하게나타난다. 흔히자해행위는머리및몸때리기, 피부절단혹은손가락깨물기등의형태로나타나며눈, 성기및구강내자해행 원고접수일 : / 원고최종수정일 : / 원고채택일 :

15 대한장애인치과학회지 8(1) 2012 위가포함된다. 자해행위의유병율에관해정확히알려진바는없으나여성에서좀더호발하며일반인의경우 100,000명중 750 명정도의비율로추정되고정신지체가있는환자의경우 7.7% 에서 22.8% 의비율로나타나며심한정신지체가있는환자의경우 40% 까지그빈도가증가하는것으로알려져있다 2,3). 자해의원인은명확히밝혀져있지않고매우복잡한것으로생각되고있는데추정되는원인으로는 Cornelia de Lange 증후군 4,5), Gilles de La Tourettes 증후군 6), Lesch-Nyhan 증후군 4) 같은유전질환이있는경우, 선천적으로통증을느끼지못하는감각신경병 4) 을앓는경우, 뇌염같은감염성질환 4,7) 에걸린경우, 자폐 2,8,9) 나정신지체 5) 가있는경우에발생하는것으로알려져있다. 이와같이자해증상은발육장애나여러증후군과관련하여다양한정신질환관연관되어나타난다. 이러한자해행위는대부분통증을느끼면서도지속적으로스스로의신체에손상을가하기때문에이를막기위한적극적인개입이필요하고다양한분야에서의접근이필요하다. 본증례에서는정신지체를동반한자폐증환아로서자해로인한하순의심각한손상을입었으나 soft mouthguard 를이용하여증상의악화를막을수있었고양호한하순의치유과정을보였다. Ⅱ. 증례 13세 9개월된여아로입술을계속깨무는증상이나아지지않는다는주소로내원하였으며전신병력상자폐, 정신지체, 발육지연등을보이고있었고이로인해소아정신과에서계속치료를받고있는상태였다. 본환아는이전에도 가족등주변사람에게폭력을행사하거나자해행위로인하여수차례입원병력이있었고본원소아치과에내원전에도입술을깨무는증상으로인해소아청소년과에서약처방을받고 2주간소독처치를받았으나증상이나아지지않고더심해지는양상을보였다고하였다. 구강내검사시하순의전반적인부종이있었으며괴사성조직으로덮혀있고궤양이형성되어있는것을볼수있었다 (Fig. 1). 자해로인한하순손상의방지를위한보존적처치로상악에 soft silicone mouthguard를계획하고인상채득을시행하였다. 인상채득시환아의협조를구할수없어환아를 unit chair에누운상태로강제속박을하고개구기를이용하여강제로입을벌린후인상채득을하였다. 다음날 mouth guard를제작하여장착하였고 mouthguard의삼킴을방지하기위해치실을묶어주었다. Mouthguard 장착시처음에는환아가거부하였으나주변으로관심을돌리자곧적응하였고보호자에따르면장치를잘사용하였다고하였다. 1개월검진시장치를분실하고다시입술을깨무는증상이나타나장치를재제작하였고현재까지잘사용하고있다. Ⅲ. 총괄및고찰자폐성장애는 1934년 Kanner에의해최초로소개된질환으로자폐증상의발현시기는 36개월이전이며사회적대인관계영역의문제에서감정표현의장애, 대인관계에서의무관심, 부적절한고착등을나타내며기이한이상행동영역에서과도한불안, 자기파괴적행동, 이상언어행동등을보인다. 또한주변환경에과도하게저항하면서공격적인행동이나다른부적응행동을보이기도하는것으로알려져있다. 이러한자폐환자는 10,000명중 1.3~16명의비율로발생하고자폐환자의 70% 가자해를하는것으로보고 Fig. 1. Ulcer, necrotic tissue from the lower lip at the initial examination

16 Korean Association for Disability and Oral Health 8(1) 2012 Fig. 2. Soft silicone mouthguard with dental floss. Fig. 3. Follow-up after 1 month. Almost wound healing following appliance therapy but starting biting lower lip after lost the appliance. 되고있다 10,11). 자폐환자의경우의사소통의어려움과통증인지의변화로자해행위를차단하기가어렵다. 본환자의경우정신지체를동반한자폐로진단을받았고약물요법을위해소아정신과에서약처방을계속받고있는상태였으나자해증상이개선되지않아추가적인다른처치가필요할것으로생각되었다. 자해행위의치료방법으로는약물을이용한치료방법, 행동조절을통한조절방법, 물리적억제방법등이사용될수있고구강내손상을예방하기위해구강내또는구강외장치를사용하거나악교정수술, 관련치아의발거등이제안되고있다. 약물을이용한치료의경우주로 dopaminergic, opiate, serotonin system에대한연구가많으나도파민수용체나세로토닌수용체에만관여하는약제의경우한계가존재한다. 세로토닌-도파민길항제들은다른항정신병약물에비해비교적일관된효과들이보고되고있다 12). 자해행위를대체할만한적절한행동을유도하거나각개인에맞는강화인자를부여하는등의긍정적강화와같은행동조절을이용한방법이이용될수있으나이는증상이경미한자해증상을보이는경우에는가능하다. 그러나자폐환자의경우의사소통의어려움이있고개인에맞는적절한강화인자를찾는것이어렵다 2). 긍정적강화를통한행동개선을시도할경우적절한행동을했을때 30분간격으로칭찬을하고보상인자를주는것이필요하고보호자의시간투자와인내심이필요하다. 물리적속박이필요할경우최소한의억제를하는동시에효율적인보호를하는것이중요한데억제정도는자해의심각성정도에따라결정되어야한다 2). 팔이나머리에자해를가하는경우헬멧이나 arm-board, 속박용의복등을이 용한신체적속박을사용할수있으나이역시자해행위가심한경우에는큰효과가없는것으로보고되고있다 13). 구강내장치나구강외장치의경우 bite block을이용하여전치부개방교합을유도하거나 facemask, chin-cup 같은장치와함께구내, 외탄성고무를이용한장치, 교정용 band 나기성금속관에 soldering한 lip bumper, 혀와입술을보호할수있는다양한형태의 shield 등을사용할수있다 14). 또한가장흔하게사용할수있는구강내장치로 soft mouthguard를사용할수있는데 mouthguard의경우제작이간편하고환자혹은보호자가장치를제거하는것이용이하다. 또한장치의청소와구강위생에도유리하며장치의파손으로인한 2차적인구강내손상의염려가없어안전하다는장점이있다 15). 그러나심한치주질환이있는경우사용이어렵고장치의표면이쉽게마모되어재제작이필요할수있으며치열이계속변화하는어린이의경우재제작이계속필요하다는단점이있다. 또한제작과정중환자의큰교합력으로인해인상채득이어려울수있고유지력과견고성이떨어져효과적인자해예방에한계가있을수있다 16). 다른자해예방방법으로보존적인술식들이실패하는경우손상을야기하는해당치아를모두발거하는방법 4) 이사용될수있는데 Rashid 와 Yusuf 17) 에따르면전치아의발거가극단적이기는하나완전하게자해행위를차단할수있는방법이라고하였고보존적인방법들은연령증가와함께증상이심해질수록성공률이낮아져해당치아의발거가필요하다는주장 12) 도있다. 또한상, 하악골의악교정수술을이용하여인위적으로개방교합을형성시켜주는방법을사용할수있는데 Macpherson 18) 등은악교정수술을이용하여만족스러운

17 대한장애인치과학회지 8(1) 2012 결과를얻었다고보고하기도하였다. 본증례의환자는우선가장보존적인방법이라고생각되는 mouthguard의제작에대해보호자에게설명하였고이장치가실패할경우다른종류의가철성장치제작을고려해보기로하였다. 보호자에게 mouthguard의탈착법및관리에대해설명을하고환아의공격적인행동으로인해 mouthguard의유지가어렵거나환아스스로장치를제거할경우다시내원할것을설명드렸으나검진날짜에는내원을하지않았고 1개월뒤장치분실로인해재내원시하순의상처는치유가된상태였고환아의거부반응도미약하여장치를잘사용했음을확인할수있었다. 환자의병력상자해나폭력으로인한수차례의입원경험이있고증상의완화와악화가반복될수있어장기적인관찰이필요하며장치뿐아니라약물치료가계속병행되어야할것으로생각된다. 자해행위를방지하기위한표준화된방법은아직정해져있지않으나각환자의자해양상및정도에따라적절한접근이필요하다. 가능한약물치료와행동조절, 교상방지장치등을이용한보존적인방법이시행된후효과가없을경우치아발거나악교정수술등의방법이고려될수있을것이다. 유전질환이나정신지체, 자폐등으로인한자해환자들에대한관심이높아지면서이러한환자들에게치과의사로서의역할또한증가하고있다. 따라서치과의사로서구강영역의자해행위에대한원인및손상의원인을정확히파악하고적절한치료법을찾으려는노력이필요할것으로생각된다. Ⅳ. 요약자폐증및정신지체가있는환자의입술깨물기증상을 mouthguard를사용하여성공적으로조절하였다. 치과적으로접근가능한구강내자해증상의치료는가철성혹은고정성장치를이용하거나관련치아의발치, 악교정수술등을시도할수있으며각환자에맞는적절한치료법을선택하는것이중요하다. 자해행동이일시적으로개선되었다해도재발의가능성이높으므로장기적인관리와소아정신과와의협진하에정신심리학적환경개선및약물치료가병행되어야할것이다. 참고문헌 1. Lucavechi T, Barberia E, Maroto M, et al.: Selfinjurious behavior in a patient with mental retardation: review of the literature and a case report. Quintessence Int, 38:e , Medina AC, Sogbe R, Gomez-Rey AM, et al.: Factitial oral lesions in an autistic paediatric patient. Int J Paediatr Dent, 13: , Saemundsson SR, Roberts MW: Oral self-injurious behavior in the developmentally disabled: review and a case. ASDC J Dent Child, 64: , 228, Fardi K, Topouzelis N, Kotsanos N: Lesch- Nyhan syndrome: a preventive approach to selfmutilation. Int J Paediatr Dent, 13:51-56, Cauwels RG, Martens LC: Self-mutilation behaviour in Lesch-Nyhan syndrome. J Oral Pathol Med, 34: , Shimoyama T, Horie N, Kato T, et al.: Tourette s syndrome with rapid deterioration by self-mutilation of the upper lip. J Clin Pediatr Dent, 27: , Chen LR, Liu JF: Successful treatment of selfinflicted oral mutilation using an acrylic splint retained by a head gear. Pediatr Dent, 18: , Johnson CD, Matt MK, Dennison D, et al.: Preventing factitious gingival injury in an autistic patient. J Am Dent Assoc, 127: , Mobily PR, Herr KA, Kelley LS: Cognitive-behavioral techniques to reduce pain: a validation study. Int J Nurs Stud, 30: , Wing L: The definition and prevalence of autism: A review. Eur Child Adolesc Psychiatry, 2:61-74, Howlin P: Behavioural techniques to reduce selfinjurious behaviour in children with autism. Acta Paedopsychiatr, 56:75-84, 김지희, 최병재, 김성오, 최형준, 손흥규, 이제호 : Lesch-Nyhan 증후군환아의자해에의한혀의외상. 대한소아치과학회지, 35: , Eguchi S, Tokioka T, Motoyoshi A, et al.: A selfcontrollable mask with helmet to prevent self finger-mutilation in the Lesch-Nyhan syndrome. Arch Phys Med Rehabil, 75: , Jeong TS, Lee JH, Kim S, et al.: A preventive approach to oral self-mutilation in Lesch-Nyhan syndrome: a case report. Pediatr Dent, 28: , Finger ST, Duperon DF: The management of self-inflicted oral trauma secondary to encephalitis: a clinical report. ASDC J Dent Child, 58:

18 Korean Association for Disability and Oral Health 8(1) , Kumar P, Bhojraj N: Successful prevention of oral self-mutilation using a lip guard: a case report. Spec Care Dentist, 31: , Rashid N, Yusuf H: Oral self-mutilation by a 17- month-old child with Lesch-Nyhan syndrome. Int J Paediatr Dent, 7: , Macpherson DW, Wolford LM, Kortebein MJ: Orthognathic surgery for the treatment of chronic self-mutilation of the lips. Int J Oral Maxillofac Surg, 21: ,

19 대한장애인치과학회지 8(1) 2012 증 례 항응고제투여중인다발성장애환자에서골수이식전발치창출혈부의전색과배농술을통한출혈과감염의조절 : 증례보고 유재하 * 손정석 * 김종배 ** * 연세대학교치과대학구강악안면외과학교실 ( 원주기독병원 ), ** 계명대학교의과대학동산의료원치과 ( 구강악안면외과 ) Abstract BLEEDING & INFECTION CONTROL BY THE PACKING AND DRAINAGE ON BLEEDING EXTRACTION SOCKET BEFORE BONE MARROW TRANSPLANTATION IN A MULTIPLE DISABLED PATIENT WITH ANTICOAGULATION DRUG : REPORT OF A CASE Jae-Ha Yoo*, Jeong-Seog Son*, Jong-Bae Kim** *Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University(Wonju Christian Hospital), **Department of Dentistry (Oral and Maxillofacial Surgery), Dong San Medical Center, College of Medicine, Keimyung University Extraction of all nonrestorable teeth prior to bone marrow transplantation is the major dental management of the patient being prepared for the transplantation. But, there are four principal causes for excessive bleeding in the immediate postextraction phase ; (1) Vascular wall alteration (wound infection, scurvy, chemicals, allergy) (2) Disorders of platelet function (3) Thrombocytopenic purpuras (4) Disorders of coagulation (liver disease, anticoagulation drug-heparin, coumarin, aspirin, plavix) If the hemorrhage from postextraction wound is unusually aggressive, the socket must be packed with local hemostatic agent and wound closure & pressure dressing are applied. But, in dental alveoli, local hemostatic agent (gelfoam, surgcel etc) may absorb oral microorganisms and cause alveolar osteitis (infection). This is a case report of bleeding and infection control by suture, pressure packing and iodoform gauze drainage on infected active bleeding extraction socket under sedation and local anesthesia in a 57- years-old multiple disabled patient with anticoagulation drug. Key words : Bleeding extraction socket, Pressure packing, Iodoform gauze drainage, Anticoagulation drug, Bone marrow transplantation Ⅰ. 서론 교신저자 : 유재하 강원도원주시일산동 162 연세대학교원주의과대학원주기독병원치과학교실 Tel: , Fax: yun8288@hanmail. net 골수이식이예정된환자는향후혈소판, 적혈구및백혈구감소증으로인해감염과출혈의위험이높아, 사전에치성감염증에대한치과적관리를반드시받아야한다 1,2). 이식전에모든회복할수없는치아들과진행성치주질환에이환된치아들은발치되어야하고, 잇솔질과치실사용, 식 원고접수일 : / 원고최종수정일 : / 원고채택일 :

20 Korean Association for Disability and Oral Health 8(1) 2012 이조절, 불소도포, 클로르헥시딘이나리스테린같은살균구강위생용액과양호한구강위생유지법이교육되어야한다. 또한골수이식을시행하는관련의학과 ( 주로혈액종양내과 ) 와상의해서환자에게침습적인치과술식이시행되기전에장기 (organ) 기능이상의정도, 치과치료를견딜수있는환자의능력, 예방적항생제사용의필요성여부등을결정하게된다 3,4). 그러나관련의학과협진등사전준비를하여도, 발치시행후발생된출혈이빠르게계속되면우선혈액이입안과인두부위에고이게되어상기도폐쇄의위험이있고, 고인피를뱉어내면주위환경을오염시킴은물론피를본다는것 (sight of blood) 자체로불안과공포가가중되어실신가능성도있으며, 피를삼키는경우위장관자극이과도해오심과구토의가능성이높아지는등심각한응급상황에직면할수있다 5,6). 또한계속되는출혈로인한순환혈류량의감소는완서관류조직 ( 내장, 근육, 피부 ) 의혈액이급서관류조직 ( 심장, 폐, 뇌, 신장 ) 으로이동되는혈역학의변화로심신의약화가초래되며, 과도한출혈은저혈량성쇼크의발생으로생명의위협을가져올수있다 7,8). 따라서구강내과다출혈을신속정확하게지혈시키고후처치를제대로시행함은환자의전신건강관리에매우중요하며, 이런점에서치과임상에서발치를시행할때는사전에환자의병력과신체검진을철저히시행해서발치후출혈의원인들에대한파악을하고그에따른적절한관리를신속정확히시행함이매우중요하다. 발치후초기단계에서과도한출혈의주요원인들에는 (1) 창상감염, 괴혈병, 화학물질에의한혈관벽취약 (2) 유전, 아스피린같은약물, 자가면역질환에의한혈소판기능장애, (3) 방사선, 백혈병같은혈소판감소성자반증, (4) 혈우병, 크리스마스질환같은선천성응고장애, (5) 간장질환, 비타민결핍, 쿠마린, 헤파린, 아스피린, 플라빅스 (plavix) 같은항응고약제등에의한후천성응고장애들이있다 9,10). 만약발치창출혈이매우과도해서전신탈수와기도문제가위협된다면발치창상은통상적으로봉합술을시행하거나트롬빈 (thrombin) 을적신젤라틴스폰지 (gelfoam) 또는 surgicel 같은국소지혈제로채워서창상봉합과압박지혈을시도하게된다. 트롬빈은신속한지혈을형성하려고피브리노겐을직접응고시킨다. 그러나발치된치조와내부에서국소지혈제는구강내미생물을흡수해서발치와골염 ( 감염 ) 을야기해창상치유를지연시키는동통과 2차적출혈을더야기할수도있어사용에신중을기해야하며, 2차적후출혈발생시대책도마련되어있어야한다 11,12). 이런면들을종합적으로고려할때치과임상에서는충치나치주염증이과도한경우에발치의적응증이될정도의치성감염치아들도가능한한발치보다는약물요법, 근관치료, 절개배농술같은출혈이적은술식을구사해서치성감 염을감소시키고, 관련의학과의협진과임상병리검사 ( 흔히 CBC, P.T., P.T.T. 등 ) 를통해발치후출혈문제를확인한후에발치를시행하게된다 13,14). 또한발치시행시에도반드시발치창상의크기를감소시키려는봉합술이필요하고, 혈종형성에의한감염의우려를줄이려는발치창상내배액제 (rubber strip drain 또는 iodoform gauze drain) 삽입술및습윤거즈 (wet gauze) 압박도고려되어야한다 15,16). 이원칙에따라발치를시행하고후관리를시행했음에도계속적인발치창후출혈이지속된항응고제투여중인다발성장애환자에서, 골수이식전발치창출혈부의재봉합, 전색 (packing) 과배농술등을통한출혈과감염의조절을달성했기에이를보고한다. Ⅱ. 증례보고 57세남자환자로약 10년전부터만성골수성백혈병으로항암화학요법을시행받았고, 고혈압, 당뇨병, 관상동맥질환, 일과성뇌허혈, 만성신부전, 녹내장, 골관절염에기인한척수협착증, 만성기관지염, 알레르기성접촉성피부염등이연합되어있는장애자 ( 장애진단서병명 : 만성골수성백혈병으로인한어지러움증, 전신무력감, 소화장애및양안증식성당뇨망막증 ) 가골수이식 (Bone marrow transplantation) 을받기에앞서서치성감염조절을위해 2012년 5월 7일본치과에내원했다. 구강검사및방사선사진검사결과상악좌측제 1대구치 ( 치식 :#26) 의진행성충치와치주염이있어우선항생제와소염진통제경구투약을하고서, 발치시출혈과감염가능성을알고저혈액검사를시행했고, 관련의학과 ( 혈액종양내과 ) 와상의 (consult) 해서골수이식전에발치를계획했다 (Fig. 1). 혈액검사결과 (Table 1) 처럼검사결과에약간은이상이있었으나, 이는관상동맥질환과일과성뇌허혈개선을위한아스피린경구투약에기인하는면이있으므로, 아스피린을 3일간중단하고항생제사전경구투약후발치를시행하면될것으로관련의학과와협의진료가이루어져 5월 10일 Fig. 1. Initial panoramic view

21 대한장애인치과학회지 8(1) 2012 오전 10시발치를시행키로했다. 통상적인 2% 리도카인 (1:10만에피네프린함유 ) 2앰플로국소마취를시행하고서 10분을기다린다음에치아를분할해서발치를시행했고, 창상봉합완료 (3-0 black silk이용 ) 후에지혈되었음을확인하고서귀가했다. 그러나발치시행후약 3시간경과된시점에발치창상부출혈이과도해져서다시본치과 ( 구강악안면외과 ) 로내원했는데 (Fig. 2), 발치창내출혈과혈액이많이적셔진 wet gauze가관찰되었다. 다행히혈압등생징후는정상범주였기에, 다시국소마취를시행하고서발치창상에추가봉합술을시행한다음에, 발치창내부압박과발치창내혈종침착에의한 2차적인감염을방지하고자, 요오드포름거어즈 (iodoform gauze) 를추가로삽입해, 발치창내부에압력이가해지고발치창감염부의배농효과도있도록, 요오드포름거즈전색 (packing) 겸배농로 (drainage route) 를설정하고서, 습윤거즈를압박 (biting) 하는시술을했다 (Fig. 3). 약 1시간후에지혈이되었음을확인하고서, 우선당뇨병에의한저혈당반응을방지하고자유동식 (soft diet) 섭취를하게했으며, 습윤거즈압박술 (gauze biting) 을시행치 않고서국소마취가종료되는 2시간후에, 에피네프린의후출혈경향을관찰한결과다시약간의출혈 (blood oozing) 이보였다 (Fig. 4). 환자의생징후 (vital sign) 에이상은없었으나, 발치창상감염의우려가있고, 후출혈로인한탈수증상과불안감을나타내, 수액약물요법 (Normal Saline 1,000cc IV, 항생제와진정제 IV 등 ) 을시행하면서, 습윤거즈 (wet gauze) 압박술만을시행한결과지혈은되었으나, 저녁시간이되어서잠을잘수가없어, 습윤거즈압박 (biting) 을수면중에도용이하게하려고, 탄력붕대로두부와하악을감싸주는 Barton s elastic bandage 방법을적용했다 (Fig. 5). 다시약 2시간경과후에지혈을확인했고, 만약귀가후또출혈이되면가정에서습윤거즈압박과탄력붕대이용법을실천할것을설명드린후에귀가했다. 다음날본치과 ( 구강악안면외과 ) 외래로내원했을때는확실히지혈이되어있었으며, 3일후에발치창내삽입했던 iodoform gauze 를교환했고, 7일후에봉합사를제거했으며, 정상적인창상치유과정을확인할수있었기에아스피린투여도계속했고, 다음달에시행키로한골수이식일정에도차질이없었다. Table 1. Initial major laboratory data &normal range WBC: (4.0~10.0) Na: 132 (136.0~145.0) RBC: 3.36 (4.2~5.7) K: 5.5 (3.5~5.1) Hemoglobin: 10.4 (13.5~17.0) Cl: 99 (98.0~107.0) Hematocrit: 32.1 (40~53) BUN: 42 (.~< 20.0) Platelet count: 367 (165~360) Glucose: 278 (80~115) P.T.: 13.6 (9.5~12.8) P.T.T.: 36.4 (27.9~37.8) SGOT: 10 (.~< 35) I.N.R.: 1.23 (0.85~1.15) SGPT: 20 (.~< 35) Fig. 3. Re-suture & iodoform gauze packing drainage. Fig. 2. Post-extraction bleeding view. Fig. 4. Re-blood oozing view in the extraction wound(#26)

22 Korean Association for Disability and Oral Health 8(1) 2012 Fig. 5. Wet gauze biting & Barton s elastic bandage view. Ⅲ. 총괄및고찰골수이식은조혈모세포의채집및이식을기술하는본래의용어이지만, 최근에말초혈액과제대혈액역시모세포의유용한공급원이확인된후조혈모세포이식 (hematopoietic cell transplantation) 이라는용어가이시술을표현하는일반적용어로되었다. 골수이식은수많은후천성 ( 재생불량성빈혈, 골수이형성증, 백혈병, 림프선암 ) 또는유전성의혈액질환과면역질환을치료하기위해이용된다 3,4). 본증례의골수이식뿐만아니라모든이식술과관련된의학적합병증들이많아서 (Table 2), 모든장기이식술이계획된환자들에서는치의학적관리가매우중요하다 (Table 3) 1). Table 2. Major medical complications associated with transplantation 1. Excessive immunosuppression Infection Tumors Delayed healing 2. Rejection of allograft 3. Graft failure-heart, kidney, liver, pancreas 4. Increased risk for excessive bleeding-liver, kidney, bone marrow 5. Overdosage-if drugs metabolized or excreted by kidney or liver are administered in normal amounts 6. Death or retransplantation-heart, liver, bone marrow 7. Insulin, hemodialysis or retransplantation-kidney, pancreas 8. Side effects caused by immunosuppressent agents Hypertension Diabetes mellitus Infection Excessive bleeding Anemia Osteoporosis Adrenal crisis (significant stress from surgery, trauma) 9. Special organ complications: Heart transplants Accelerated coronary artery atherosclerosis Bone marrow Graft-versus-host disease Table 3. Dental management of the patient being prepared for transplantation Complete dental evaluation Patients receiving dental treatment including dental prophylaxis 1. Poor dental status-consider extractions and dentures 1. Medical consultation 2. Good dental status-maintain dentition a. Degree of organ failure 3. Other-decide on individual patient basis b. Current status of patient Patients maintaining their dentition c. Need for antibiotic prophylaxis(wbc count depressed) 1. Extract all nonrestorable teeth d. Need to modify drug selection or dosage(kidney or liver failure) 2. Extract all teeth with advanced periodontal disease e. Need to take special precautions to avoid excessive bleeding 3. Perform endodontic treatment or extraction of nonvital teeth f. Other special management procedures that may be required 4. Initiate an active, effective, oral hygiene program 2. Laboratory tests (surgical procedures planned) a. Toothbrushing, flossing a. Access to current PT, PTT, platelet count b. Diet modification if indicated b. Access to WBC count and differential c. Topical fluorides d. Plaque control, calculus removal e. Chlorhexidine or Listerine mouthwash

23 대한장애인치과학회지 8(1) 2012 그러나골수이식술시행전발치를한치아에서발치부출혈이지속되면구강전체로번져, 구강내과량의출혈은기도폐쇄나삼켜진혈액의구토에의한흡인성폐렴형성의우려이외에도상당한심신의스트레스를야기하며, 인체는여기에적응을하고자격렬한신경내분비반응을초래하게된다. 그리하여출혈의양이증가되고이로인한면역력의저하로주위조직에염증반응 ( 동통, 종창, 발적, 고열, 기능이상 ) 이형성됨에따라고혈압, 빈맥, 과환기, 과혈당증, 의식장애등이발생된다 17). 구강내출혈은그자체로도위험하지만치과진료시흔히문제가되는것은치성감염으로, 구강에는수많은세균들의작용으로충치나치주질환의빈도가높고, 더욱이항응고제를투여받는심장질환 ( 넓은의미에서는심혈관질환 ), 뇌혈관질환, 간질환, 신장투석환자들은전신의면역성이저하된상태이므로치성감염의관리에어려움이따르게된다 15,16). 즉출혈성장애를가진전신질환자에서는충치나치주염이과도한경우도발치같은출혈을조장하는치료술식을안심하고적용할수없을뿐만아니라치성감염과출혈성질환이연합되어치은이나점막출혈을야기하는경우치과와의과의긴밀한협의진료가이루어져야지혈처치와치성감염의조절이달성되는것이다. 이런관점에서치과의사는출혈성장애와면역성이저하된환자를체계적으로파악해대처함은중요한과제이다. 출혈성질환자는 (Table 4) 와같이혈소판의정상숫자를가진환자 (nonthrombocytopenic purpuras : 비혈소판감소성자반증 ) 와혈소판수의감소에의한환자 (thrombocytopenic purpuras : 혈소판감소성자반증 ), 응고의장애를가진환자로분류할수있다 1,14). 괴혈병이나감염, 화학약품혹은알레르기의일종은출혈문제를초래할정도로혈관벽의구조와기능을변화시키며, 혈소판의숫자뿐만아니라기능이상 (disorders) 에서도출혈이일어날수있다. 본증례와연관된항응고약제등에의한후천성응고질환은가장흔하게장시간의출혈을일으키며, 외상이나발치같은수술후에확실히알수있다. 통상적으로치과임상에서발치와관련된출혈에는 (1) 발치시행중의과도한출혈, (2) 발치시행당일의출혈, (3) 발치시행후 3~5일경과후출혈로구분된다. 우선발치시행도중의과도한출혈의원인에는시술범위내혈관의절단손상, 염증이과도한충혈조직 (hyperemia tissue) 에서발치시행, 발치창상에과도한손상을가함등이있고, 발치시행후당일의출혈원인도유사한데, 특히본증례처럼전신상태가약화되어출혈의정상조절기전 (Table 5) 에문제가있는환자들에서빈도가높다 1,11). 한편발치등의수술시행후출혈을조절하기위한지혈방법에는습윤거즈를이용한압박지혈, gelfoam 등을이용 Table 4. Classification of bleeding disorders 1. Nonthrombocytopenic purpuras a. Vascular wall alteration (1) Scurvy (2) infections (3) Chemicals (4) Allergy b. Disorders of platelet function (1) Genetic defects(bernard- Soulier disease) (2) Drugs (a) Aspirin (b) NSAIDs (c) Alcohol (d) Beta-lactam antibiotics (e) Penicillin (f) Cephalothins (3) Allergy (4) Autoimmune disease (5) von Willebrand s disease (secondary factor VII deficiency) (6) Uremia 2. Thrombocytopenic purpuras a, Primary-idiopathic b. Secondary (1) Chemicals (2) Physical agents(radiation) (3) Systemic disease(leukemia) (4) Metastatic cancer to bone (5) Splenomegaly (6) Drugs (a) Alcohol (b) Thiazide diuretics (c) Estrogens (d) Gold salts (7) Vasculitis (8) Mechanical prosthetic heart valves (9) Viral or bacterial infections 3. Disorders of coagulation a. Inherited (1) Hemophilia A(deficiency of factor VIII (2) Hemophilia B(deficiency of factor IX (3) Others b. Acquired (1) Liver disease (2) Vitamin deficiency (a) Biliary tract obstruction (b) Malabsorption (c) Excessive use of broad - spectrum antibiotics (3) Anticoagulation drugs (a) Heparin and Coumarin (b) Plavix (c) Aspirin and NSAIDs (4) DIC (5) Primary fibrinogenolysis

24 Korean Association for Disability and Oral Health 8(1) 2012 Table 5. Normal control of bleeding 1. Vascular phase a. Vasoconstriction in area of injury b. Begins immediately after injury 2. Platelet phase a. Platelet and vessel wall will become "sticky" b. Mechanical plug of platelets seals off openings cut vessels c. Begins seconds after injury 3. Coagulation phase a. Blood lost into surrounding area coagulates through extrinsic and common pathways b. Blood in vessel in area of injury coagulates through intrinsic and common pathways c. Takes place more slowly than other phases 4. Metabolic(fibrinolytic) phase a. Release of antithrombotic agents b. Spleen and liver destroy the antithrombotic agents 한전색 (packing), 손상혈관의결찰, 전기응고법, 국소지혈제 (Surgicel, Bone wax, Topical bovine thrombin, Fibrin sealant 등 ) 적용, 전신적약제 (Thrombokinase, Vitamin K 등 ) 투여, 유출재 (rubber strip drain, iodoform gauze drain 등 ) 에의한지혈법등이있어각증례에맞는선택을필요로한다 18,19). 본증례의경우도관련의학과 ( 심장내과와신경과 ) 에자문을구해아스피린투여중단등내과진료를시행했고, 전신상태가백혈병이외에도여러질환이연합되어내과관리도시행받으면서치과적으로는발치창자체의염증과출혈소견이확실하기에, gelfoam같은국소지혈제등을이용한압박지혈대신에창상내혈종이나장액종및염증의제거를통한전색과지혈, 즉유출재 (iodoform gauze : 상품명 Nu-gauze 이용 ) 에의한지혈법을시도한셈이다. 즉출혈되는발치창창상내부를확인하고, 발치창봉합술을추가로촘촘히시행한다음에발치창내부의비어있는공간 ( 사강 :dead space 역할 ) 에는압박지혈에도움을얻고새로형성되는혈종 (hematoma) 과장액종 (seroma) 의배액로 (drainage route) 로도도움을얻기위해요오드포름거즈를채워넣는유출재방법을적용한다음, 습윤압박거즈를다물고있게함 (biting) 으로써확실한지혈을이루게했다. 하지만발치창상치유기전상창상감염에관련된요소들이 (Table 6) 처럼많이있고 15,16), 통상적으로이용되는국소지혈제 (gelfoam, Surgicel, Fibrin sealant 등 ) 사용은오히려발치창상내부감염만차후에조장할우려가크기에, 본증례에서는사용치않았다. 또한보트로파제등전신적지혈약제들은약물부작용으로혈전형성의우려가있어, 심장질환이있는환자에서는사용상큰주의가요망되기에, 본환자의경우는사용치않았다 20). Table 6. Factors in wound infection 1. Local factors Number of bacteria Virulence of bacteria Devitalized tissue Decreased blood supply Foreign bodies (traumatic or implants) 2. Systemic factors Generalized sepsis Decreased host defenses diabetes malnutrition cytotoxic-immunosuppressive drugs malignancies Extremes of age 3. Environmental factors Operating room traffic Defective air system Inadequate sterilization techniques The surgeon as source of infection 4. Endogenous factors Patient s skin and hair Presence of infected tissue at time of surgery (cellulitis, abscess, fistula) Presence of resistant or opportunistic organism in the patient s oral cavity or nasopharynx 5. Surgical factors Insufficient hemostasis Presence of dead space Insufficient debridement Tissue necrosis from suture, retractors, or dressings Inappropriate or long-term use of drains Excessive operating time Primary closure of infected wounds

25 대한장애인치과학회지 8(1) 2012 Ⅳ. 결론저자등은만성골수성백혈병과양안증식성당뇨망막증및다발성내과적질환이연합된 57세의항응고제투여중인장애환자에서, 골수이식술시행에앞서서관련의학과와상의해항응고제를중단하고서발치와봉합술을시행했으나, 후출혈이지속되어다시발치창상의추가봉합술, 요오드포름거즈전색배농술, 습윤거즈압박술및 Barton씨탄력붕대적용, 수액약물요법등으로지혈을달성하고, 정상적인발치창치유과정도관찰할수있었다. 참고문헌 1. Little JW and Falace DA: Dental management of the medically compromised patient, Sixth edition. Saint Louis, CV Mosby , , Sonis ST, Fazio RC and Fang L : Principles and practice of oral medicine. Second edition. Philadelphia, WB Saunders , Heimdahl A : The oral cavity as a port of entry for early infections in patients treated with bone marrow transplantation, Oral Surg 68: , Rhodus NL, Little JW : Dental management of the bone marrow transplantation patient. Comp Cont Educ Dent 13: , Conley JJ : Complications of head and neck surgery. Philadelphia, WB Saunders , Falace DA : Emergency dental care. Baltimore, Williams and Wilkins , 김진복, 김춘규, 이용각, 장선택 : 최신외과학, 제 1판. 서울, 일조각 , 의학교육연수원편 : 의학연수교육총서제 1집, 증보판 응급처치. 서울, 서울대학교출판부 , Patton LL and Ship JA : Treatment of patients with bleeding disorders. Dent Clin Nor Am 38: , Rodgers GM : Overview of platelet function. Clin Obstet Gynecol 42: , Bonoliel R, Leviner E and Katz J : Dental treatment for the patient on anticoagulant therapy. Oral Surg Oral Med Oral Pathol 62: , Kruger GO : Textbook of oral and maxillofacial surgery. Sixth edition. Saint Louis, CV Mosby , Kelly MA : Common laboratory tests. their use in the detection and management of patients with bleeding disorders. Gen Dent 38: , Schardt SD : Update on coagulopathies. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 90: , Topazian RG and Goldburg MH : Management of infections of the oral and maxillofacial regions. Philadelphia, WB Saunders , 김경욱, 김경원, 김수관외 14인 : 구강악안면감염학, 서울, 지성출판사 , Fonseca RJ and Walker RV : Oral and Maxillofacial trauma, Vol I. Philadelphia, WB Saunders , 민병일 : 악안면성형외과학. 서울, 군자출판사 , 강현숙, 문희정, 송경희, 김수관 : 최신구강악안면외과학. 서울, 고문사 , 최현림, 김수영, 김철환, 신호철, 이혜리, 조경환등 : 가정의학, 임상편. 서울, 계축문화사 ,

26 Korean Association for Disability and Oral Health 8(1) 2012 증 례 저산소성허혈성뇌병변환아에서혀내밀기에의해발생된혀궤양의치료 : 증례보고 오미희 김소정 최성철 김광철 박재홍 경희대학교치과대학소아치과학교실및구강생물학연구소 Abstract TREATMENT OF LINGUAL ULCERS CAUSED BY TONGUE THRUST WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY Mee Hee Oh, So Jung Kim, Sung Chul Choi, Kwang-Chul Kim, Jae Hong Park Department of Pediatric Dentistry and Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul, Korea Hypoxic ischemic encephalopathy(hie) is a condition that occurs when the entire brain is deprived of an adequate oxygen supply and associated in most cases with oxygen deprivation in the neonate due to birth asphyxia. Children with HIE develop problems such as cerebral palsy, mental retardation, learning difficulties, and other disabilities. We hereby report the case of treating a child patient with HIE whose chief complaint of severe lingual ulceration. A 12-month-old boy referred to our hospital to treat ulcers of ventral surface of tongue. He has been suffering from lingual ulceration due to persistent tongue thrusting. He has bitten his own tongue involuntary. The ulceration was apparently seemed to be not healed because of the constant irritation by lower incisors. So we designed tongue protector to prevent lingual ulcers. The appliance was proved to be effective to reduce tongue trauma by lower incisors and periodic follow-up is needed. Key words : Riga-Fede disease, Traumatic sublingual ulceration, Tongue protector Ⅰ. 서론 Riga-Fede disease는흔하지않은양성의점막병소로하악유전치위로지속적인혀의전후방적운동에의한외상으로나타나는혀배면의궤양을의미한다. 이병소는 1881년 Antonio Riga에의해언급된바있으며 1890년 Fede는이병소에대한조직학적연구를시행하고추가적 교신저자 : 박재홍 서울특별시동대문구회기동 1 번지경희대학교치과대학소아치과학교실 Tel: , Fax: pedojh@khu.ac.kr 으로증례를보고한바있다 1). 이는유아의설하증식 (sublingual growth in infants), 외상성혀궤양, 외상성위축성설염, 혀의외상성육아종, 설하섬유-육아종등다양한이름으로도불리운다 1). 궤양은하악유전치에의한지속적인외상에의해야기되며다른악성혹은양성의질환과감별진단을요한다 2-4). 보통 Riga-Fede disease는선천치혹은신생치와연관되나하악유전치맹출후에도나타날수있으며이러한병소는 Lesch-Nyhan syndrome이나 familial dysautonomia와같은의학적문제의또다른표현이라고할수있다 2). 이병소는혀배면의궤양으로나타나며반복되는외상에의해비대된섬유성종물로궤양성육아종의형태로나타날수있다 5). 치료는보존적으로시행해 원고접수일 : / 원고최종수정일 : / 원고채택일 :

27 대한장애인치과학회지 8(1) 2012 야하며외상의원인을제거하는데에초점을맞추어야한다. 만약적절한진단과치료가이루어지지않는다면탈수와부적절한영양공급및의학적문제를야기할수있다 6). 이번연구에서는 Riga-Fede disease로알려져있는광범위한외상성혀궤양을주소로내원한저산소성허혈성뇌병변환아의치료증례를보고하고자한다. Ⅱ. 증례저산소성허혈성뇌병변을가진 12개월의남자환아가광범위하고잘낫지않는혀의궤양을주소로경희대학교소아치과에내원하였다. 2주전에어머니가숟가락으로분유를먹이던중숟가락이혀에끼인채입을다물어하악유전치에물리면서상처가발생하였으며그후에도지속적인혀내밀기로인한하악유전치의자극으로상처가낫지못하고궤양으로발전한상태였다. 임상검사결과상 하악유전치가맹출중이었으며혀배면에심한궤양이관찰되었다 (Fig. 1). 또한안정 (rest) 시에혀를내밀고있는상태로지속적으로천천히혀내미는것을반복하는것으로보아환아의혀내밀기습관이관찰된다 (Fig. 2). 환아는출생시탯줄에목이감겨발생한산소부족에의해저산소성허혈성뇌병변으로진단받았으며현재발달지연과간질로한양대 구리병원소아과및재활의학과에정기적으로내원중이다. 항경련제를복용하고있으며젖병을제대로빨수있는혀운동이이루어지지않아숟가락으로분유및이유식을먹고있다. 이러한광범위한혀의궤양은하악유전치의지속적자극으로인한 Riga-Fede disease로진단할수있다. 혀궤양을치료하기위해 tongue protector를계획하였으며첫내원시인상을채득한후 Mouth guard재료인 Drufosoft (Dreve corp., Unna, Germany) 를이용하여 tongue protector를제작하였다 (Fig. 3). 다음내원시장치를장착하였으며장착후환아는큰불편감을호소하지않았다 (Fig. 4). 장치장착 3주후재내원시아직남아있긴하지만혀배면의궤양이많이사라졌으며아이의혀내밀기습관도개선되었다 (Fig. 5). 또한혀궤양이치료되면서통증도감소되어적절한영양공급이이루어졌다. 치료후관찰되는별다른부작용은없었으며, 주기적인관찰을시행하기로하였다. 장치장착 3개월후재내원시하악 4전치의맹출로인해장치가탈락된다고하여내면삭제를시행하였고궤양의크기는많이감소하였다 (Fig. 6). 6개월후정상적인유치의발육이이루어지고있으며혀배면의궤양은완전히사라진것을알수있다 (Fig. 7). 향후주기적인정기검진을계획중이다. Fig. 1. The ventral surface of tongue was severely ulcerated and it was painful for this patient. Fig. 2. Tongue thrusting habit was observed during resting period. Fig. 3. Tongue protector. Fig. 4. Delivery of tongue protector

28 Korean Association for Disability and Oral Health 8(1) 2012 Fig. 5. Three-week follow-up after tongue protector delivery. Fig. 6. Three-month follow-up. Fig. 7. Six-month follow-up. Ⅲ. 총괄및고찰저산소성허혈성뇌병변은뇌로가는적절한산소공급이이루어지지않는경우나타나는것으로대부분의경우출생시신생아에서의산소부족과연관된다. 출생시의질식은신생아사망원인중 23% 에해당하며생존한 100만명이상의어린이에서뇌성마비, 지적장애, 학습장애등그외많은장애를동반한다 7,8). 또한저산소성허혈성뇌병변은신생아발작의가장흔한원인으로발작이일어날경우무호흡, 강직성안구편위, 지속적인눈뜨기, 느리고율동적인혀내밀기증상을나타낸다 9). 발작의경우뿐만아니라뇌손상에의한지속적혀내밀기는치과적문제를야기할수있다. Riga-Fede disease는생후 6개월안에나타나는선천치나신생치와연관된 precocious Riga-Fede disease 와6-8개월이후신경학적장애와관련되어하악유전치에의해발생하는 late Riga-Fede disease 로분류될수있다 10). 본증례는저산소성허혈성뇌병변환아에서뇌손상으로인 한무의식적인혀내밀기로인해하악유전치의맹출후에혀의외상이발생한것으로 late Riga-Fede disease( 전신질환과연관된 Riga-Fede disease, 외상성혀궤양 ) 로진단할수있다. 외상성혀궤양의치료로는하악유전치의날카로운부분을갈아주는것, 절단면의복합레진수복, 최후의수단으로발치등을고려할수있다 11). 협조가잘되는환아에서는이러한방법들을시행할수있으나그렇지않은경우이는치과치료중아이에게감염이나외상의위험이수반할수있다. 따라서우리는대안으로 tongue protector를계획하였다. Tongue protector는치료시간이짧고앞선 3 가지방법에비해안전하며가철성장치로서치료가가역적이라는장점이있다. 환아에게 tongue protector를장착하였을때특별한불편감을호소하지않았으며혀의궤양의치료에효과적임과동시에혀내밀기습관도개선된것을알수있다. 주기적인관찰결과, tongue protector는낮에는거의탈락하지않으나밤에가끔빠져아이가혀를깨무는일이발생한다고하였다. 이는아직하악유전치가맹출중

29 대한장애인치과학회지 8(1) 2012 으로장치제작시맹출공간을고려하여그부위를 relief 해주어장치의유지력감소로인해발생하는것으로생각되며하악유전치가완전히맹출한후, 새로장치를제작하게되면이러한문제는개선될것이다. 현재의문제를해결하기위해장치의 cementation도고려해보았으나구강위생상의문제와치아가맹출중인점을고려하여시행하지않았다. Tongue protector는기존의외상성혀궤양에서사용하지않은장치로궤양의치료는물론혀내밀기습관개선의가능성이있다는점에서매우유용한것으로생각된다. 향후계속적인주기적관찰이필요하며환아가성장함에따라 tongue protector 역시주기적으로교체해주어야할것이다. Ⅳ. 요약 1. 저산소성허혈성뇌병변환아에서뇌손상으로인한혀내밀기습관에의해외상성혀궤양이발생할수있으며 Riga-Fede disease로진단할수있다. 2. Riga-Fede disease의종래의치료방법은하악유전치의날카로운부분을갈아주는것, 절단면의복합레진수복, 발치등이있으며이번보고에서는보존적이며가역적인방법인 tongue protector를제안하였고혀궤양의치료및혀내밀기습관개선에효과적인것으로나타났다. 참고문헌 1. Aaenglein AL, Chang MW, Meehan SA et al. Extensive Riga-Fede disease of the lip and tongue. J Am Acad Dermatol 2002; 47: Baghadadi ZD. Riga-Fede disease: report of a case and review. Journal of clinical Pediatric Dentistry 2001; 25: Elzay RP. Traumatic ulcerative granuloma with stromal eosinophilia(riga-fede disease) and traumatic eosinophilic granuloma. Oral Surg Oral Med Oral Pathol 1983; 55: Baroni A, Capristo C., Rossiello L et al. Lingual traumatic ulceration(riga-fede disease),int J Dermatol 2006; 45: Baghadadi ZD. Riga-Fede disease: association with microcephaly. International Journal of Pediatric Dentistry 2002: 12: Slayton RL. Treatment alternatives for sublingual traumatic ulceration(riga-fede disease). Pediatric Dentistry 2000; 22: Bryce J, Boschi-Pinto C, Shibuya K, Black RE. WHO estimates of the causes of death in children. Lancet. Mar 26-Apr ; 365(9465): Lawn J, Shibuya K, Stein C. No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths. Bull World Health Organ. Jun 2005; 83(6): Santina A Zanelli, MD; Chief Editor: Ted Rosenkrantz, MD, Hypoxic-Ischemic Encephalopathy Clinical Presentation, Medscpae reference Domingues-Cruz J, Herrera A, Fernandez- Crehuet P, Garcia-Bravo B, Camacho F., Riga- Fede disease associated with postanoxic encephalopathy and trisomy 21: a propsed classification, Pediatr Dermatol Nov-Dec; 24(6): Katsuyuki K, Mariko O, Nagasaka N, New tongue protector to prevent decubital lingual ulcers caused by tongue thrust with myoclonus

30 Korean Association for Disability and Oral Health 8(1) 2012 한일학술교류액션플랜 2011 년일본장애인치과연수를다녀와서 황지영 서울시장애인치과병원 그시작 2010년가을, 대한장애인치과학회와일본장애인치과학회사이에맺어진교육프로그램의일환으로단기간일본연수의기회가있는데지원해보겠냐는병원장님의말씀이있으셨다. 갑작스러운이야기에조금놀라기는했지만, 2005년서울시장애인치과병원이생긴이래 6년넘게장애인진료를해온나에게우리나라보다 30년이상전부터장애인치과진료를시행해온일본의현실을배우고경험할수있는기회라니너무나달콤한제안이아닐수없었다. 그렇게양국학회의허가와병원장님의허락하에 3개월가량의일본단기연수가정해지고, 자세한일정및세부적인사항에대한조절이시작되었다. 2010년 4월대한장애인치과학회에서일본의메가준이치교수님께연수참여의사를전하고, 초대메일을받게되었다. 이후메가교수님과메일을주고받으면서필요한서류를하나씩준비하게되었다. 2006년 5년기한의양국장애인치과학회학술교류액션플랜이시작되었지만실제로연수가시행된것은처음이었기에정확하게짜인프로그램은없었고, 과연내가일본에서어떤사람들과만나서무엇을하게될것인지, 어떤시간을보낼수있을것인지예측할수없었기에불안감과기대감이동시에마음속에자리잡았다. 일정조정중에동일본대지진이일어나고연이어들려오는원전사고, 그로인해누출된방사능의위험을경고하는실시간뉴스들로인해심적인부담감을느낀것은사실이었으나, 그보다는일본학회방문때느꼈던우리나라와는사뭇다른일본장애인치과학회의열기와일본치과선생님들의높은참여도등이과연어디서기인한것인가에관한궁금증과새로운경험에대한열망이더컸기에마음을다잡고일본행을준비하게되었다. 10년전에잠시공부했던일본 어의해묵은기억을떠올리면서초급회화 3개월과정에등록한날, 일본대사관에서간단한인터뷰후에비자를발급받은날, 도쿄왕복항공권을예약하고확정지은날들이하나씩흘러갔다. 2011년 10월 16일일요일, 조금은두려운마음으로일정을고려하면과하게준비한많은짐을안고내린하네다공항. 공항으로마중나오신마츠도치학부장애인치과학교실의다나카선생님과하야시선생님을만나함께내가묵게될스가모에위치하는니혼대학교게스트하우스로향했다. 10월의쌀쌀한한국날씨와는다르게일본의 10월은우리나라의 9월초처럼이른가을의아직은따듯한좋은날씨였다. 그렇게나의일본연수는시작되었다. 니혼대학마츠도치학부장애인치과학교실과부속병원특수치과 나에게일본장애인치과연수의기회를준곳은치바현에위치하는니혼대학마츠도치학부장애인치과학교실및부속병원특수치과였다. 일본에서도대학내에장애인치과학교실이개설되어있는곳은마츠도치과대학과마츠모토치과대학두곳뿐이라고한다. 일본에장애인치과를소개하고자리잡게한우에하라교수님이계셨던곳이기도하고, 한일교류를담당하신메가교수님께서주임교수로있으신곳이기도하다. 니혼대학본교는도쿄오차노미즈역근방에위치하며치과대학과치과병원도있으나, 장애인치과학교실이있는곳은마츠도치학부였다. 마츠도치학부는도쿄를벗어나, JR 조반선마츠도역에서내려서도 15분정도버스를타고들어가는곳에위치하고있었다. 우리나라로치면서울에서의정부정도위치라

31 대한장애인치과학회지 8(1) 2012 고볼수있을듯하다. 치과대학과치위생학교그리고치과대학병원으로구성되어있으며, 지리적으로치바현과사이타마현, 이바라키현이도쿄와만나는지점에위치하고있어서, 치과대학병원이없는세개현에서보면가장접근하기좋은위치이기에해당지역환자들이차로 1시간이넘는거리에서도진료를받기위해이병원을찾고있다고한다. 일본에서도우리나라에서와같이대도시중심으로의료혜택이편향되어있음을알수있는부분이었다. 마츠도에서의생활교실선생님들과진료실스텝들과의첫인사와함께마츠도에서의생활이시작되었다. 면허및언어등의문제로직접진료에참가하는것은불가능하여우선진료실 observation과치과대학생및치위생학과학생들의장애인치과학관련수업을듣는것으로스케줄을조정하였다. 원칙적으로정해진부분이있는것은아니었고, 교실의주임교수님이신메가교수님께서갑작스레병환으로자리를비우시게되었기에조금은조심스러운상황이었다. 마츠도치학부부속병원은일반적인치과전문과와특수치과및전신마취실과입원실등을갖춘치과병원으로, 특수치과는환자들이접근하기쉽도록주차장과인접한 1층에위치하고있었다. 과내부는환자들을위한대기실과상담실, 그리고각각유니트체어가있는네개의독립된진료실및공급실로이루어져규모가아주크지는않았다. 진료진은 6명의교원치과의사와 4명의상근치과의사및여러명의시간제근무자그리고일본장애인치과학회인정의연수과정중인치과의사등다양한진료의와 4명의치과위생사로구성되어있었고, 주로 PMTC, TBI 등의예방치료중심 의원내치료와방문진료, 지역장애인진료시설외근등의장애인진료를시행하고있었다. 진료실 observation을시작하니마치처음학교병원진료실실습을시작했던원내생이된것같은기분이었다. 특수치과에서진료를받기위한특별한조건은없었고, 시에서발행한장애인등록증을가진환자뿐아니라치과적인장애나문제가있는일반환자들도자유롭게진료를받고있었다. 특수치과의긴역사를말해주듯이신환보다장기간동안방문하여검진및구강보건관리를꾸준히받고있는환자들이많았고, 치료내용도수복보다예방및유지관리가더많았으며, 환자및보호자의보철요구도는그리높지않아보였다. 환자의협조도가낮은경우에는파푸스보드등을이용한물리적억제방법을사용하기도하고, 진료실내에서정맥진정법을이용한진료를시행하기도하며반드시필요한경우에는전신마취하의치과진료를시행하기도하였으나그회수는매우적었다. 원내에치과마취과가있어서, 비교적원활하게치과마취과치과의사와협진하여진정법을시행할수있다는점이큰장점으로다가왔다. 일주일에 3-4명의신환환자가있었는데, 신환이처음접수를하면예진과초진을통해장애의특징, 건강상태, 가족환경, 생활습관등의다양한특성을파악하고, 치과치료적응을위한시간을충분히거친후에진료를시작하는모습을볼수있었다. 또지적장애또는자폐성장애등을가진환자에대한행동조절방법은매우유사하였으나, 일본특유의섬세함과배려심, 다양한도구들을이용하여여유를가지고체계적으로접근하는모습이조금은시간에쫓기듯진료를하고있는국내병원에서의나의모습과비교되기도하였다. 마츠도특수치과진료실 마츠도특수치과진료진과함께

32 Korean Association for Disability and Oral Health 8(1) 2012 정맥진정하치과치료 마츠도특수치과진료실에서 일본의보험제도일본의치과의료보험제도는우리나라에비하여보험진료의종류가훨씬넓고다양하여, 보철진료의많은부분도보험진료항목으로시행되고있다. 보험의환자본인부담률은일괄적으로 30% 가적용되어일반의원은 30%, 종합병원은 40% 로환자부담률이높아지는우리나라와는달리낮게책정되어있다. 그러나치과진료시의료진의진료난이도가높은장애인및소아치과영역에서는가산점이부과되어, 제한적기준이있으나일반적으로는성인, 비장애인의진료수가의 150% 에해당하는수가가책정되어있다. 이로인해장애인환자의의료비부담률이높아지게되지만, 실제로는다보험자체계를바탕으로지역별로현, 시단위에서장애인에게는특별재정적지원이주어지는경우가많다. 지원의내용이나기준은모두상이하여, 모든보험진료수가가무료이기도하고, 1회에 500엔등정해진진료비용을받기도하는등지역에따라그규정에차이가있다. 진료를하는의료진에게는그노력에대한비용적보상이주어지고, 장애인환자에게는국가적으로재정적지원을통해치과의료서비스의부담을경감시켜주는시스템이었다. 아직장애인진료수가가산이미비한국내의료보험체계를생각하면부러운일이아닐수없었다. 섭식, 연하장애의치료최근몇년동안일본에서열리는장애인치과학회에참가하면서국내에서는찾아보기힘든섭식, 연하와관련된포스터발표가점점늘어가는것을보며일본에서섭식, 연하 장애에대한관심이크다는것을알수있었다. 마츠도특수치과에서는매주수요일치과유니트체어가없는공간에서섭식, 연하재활클리닉을운영하고있었다. 환자들이직접준비해온식사를하면서관찰되는문제점을확인하고이것을개선하기위한자세교정과도구의사용교육, 다양한운동요법교육등을함께진행하는모습은우리나라에서는경험해보지못한진료내용이었다. 단순히치아의문제해결이아닌구강기능회복을통한삶의질향상이라는측면에서접근하는이런치료들은주로장애로인해섭식, 연하운동기능을상실하거나발달이정지된소아와후천적인수술로인해해부학적이상이오거나질환으로인해운동기능을상실한성인및생리적기능의노화증상으로인한고령자를대상으로하고있었다. 이를보면서그동안분명히같은섭식, 연하장애를가지고있는환자들을진료하면서도나의영역이아니라고생각하고도외시하고있었다는사실을깨달을수있었고, 국내에서도섭식, 연하장애에대한이해를바탕으로한진료범위확대를위해노력해야하지않을까하는고민을하게되었다. 진료클리닉외에도한달에 1회씩 2년과정으로진행하는섭식, 연하장애연수회프로그램이있었다. 10년전마츠도의하야시선생님이소화대학교에서섭식, 연하연수과정을마치고그걸정리하고간추려다른선생님들에게전달하고자한것이시작이되어점점내용도증가하고강의연자도다양해지면서자리를잡게되었다고한다. 등록인원은약 200명정도로매달보통 100명정도가꾸준히참석하고있었다. 참석자구성도다양해져서처음에는치과의사및치위생사중심이었으나, 현재는참가자의 70% 이상이장애자시설의보호자, 사회복지사, 특수학교의교

33 대한장애인치과학회지 8(1) 2012 마츠도 섭식,연하 재활진료 마츠도특수치과-구강기능훈련 모습 마츠도 섭식, 연하장애 연수회-노인구강관리 1 마츠도 섭식, 연하장애 연수회-노인구강관리 2 사 등 다양한 직종의 장애인 관련 종사자로 이루어져 있다 고 한다. 장애환자가 가진 섭식, 연하 문제를 단순히 치과 의사뿐 아니라 그들과 함께 생활하고 식사를 하며 돕는 다 양한 이들과 협력하여 해결하고자 하는 노력이 실행되고 있다는 사실이 매우 인상적이었다. 이것을 보며 서울시장 애인치과병원에 근무하면서 치과의사가 할 수 있는 구강위 생관리의 한계에 부딪혔던 경험이 생각나, 한국에서도 이 런 다양한 사람들이 함께 참여하는 세미나가 존재하고 이 를 통해 협력시스템이 정착되어 갈 수 있었으면 좋겠다는 바램을 가져보았다. 마츠도 섭식, 연하장애 연수회-구강기능훈련

34 Korean Association for Disability and Oral Health 8(1) 2012 일본의치과대학과치위생학과학생들마츠도의장애인치과학관련수업커리큘럼을살펴보면, 치과대학 4학년 2학기에주 1회 2시간의장애인치과학수업을진행하고, 5/6학년실습기간에학기별 1일씩특수치과진료실 observation을시행한다. 여기에 2006년 4월부터의무화된 1년간의치과의사임상연수제도에따라선택과정으로장애인치과임상연수프로그램참여가가능하다. 또치위생학과학생대상으로는 2학년 1학기에영양학및영양지도, 2학년 2학기장애인치과학및임상실습 2시간, 3학년 1학기고령자치과학과구강기능발달학수업이있고, 3학년실습기간에학기별 3일씩특수치과진료실내임상실습을진행하고있다. 치과대학생보다치위생과학생들의수업이더충실하다는느낌을받았는데이는치과대학생들이이수해야할과목수가많기때문에수업시간을충분히낼수없어서라고했다. 사실일어수업을알아들을수있는어학실력은아니었지만, 연수기간동안수업교재를참고하여일본의학생들이학부과정에서듣는수업을함께할수있었다. 장애인치과학수업내용은기본장애의사회적개념과의학적범위부터실제장애별치과진료상의특징, 섭식연하장애, 사회복지시스템에이르기까지광범위한내용을다루고있었으며, 진료실임상실습은 observation과 assist 위주로진행되었다. 고하여정도의차이는있을지언정국내에서장애인진료가가지고있는어려움은일본도마찬가지임을느낄수있었다. 그러나학생시절에수업을받고진료실실습을진행한경험이졸업후지역사회에서치과의사의역할을수행할때분명히영향을미칠것이라는생각이들었다. 또, 점차방문진료의역할이커지고있는상황에서장애인치과의진료대상자와방문진료의진료대상자가겹치는지점이있어이를통해장애인진료의필요성을더느끼고연수를받는경우도있다고하니, 인구의고령화로인한일본의노인사업발달이노인치과, 나아가장애인치과의발달에도영향을미치고있어보이는부분이었다. 아직은일본에서도일반개원의선생님들이장애아동의섭식, 연하장애진료는어려워하지만, 노인환자의섭식, 연하장애진료는시행하는경우가조금씩늘어나고있다는것도들을수있었다. 외근을통한지역사회장애인진료반복되는치과진료를단순히견학하는것에조금은지쳐갈무렵, 마츠도선생님들이외근을나가는지역치과진료센터에함께견학을가게되었다. 그장소는매우다양했는데, 정기적으로일반장애인진료를실시하는도쿄도기타구의장애인진료센터및이바라키현의미토장애인진료센터등에외근을나가진료를시행하고, 병원이위치한치바지역의특수학교및거주시설에서섭식, 연하장애재활지도를하고, 노인요양센터와어린이센터등에서방문진료를시행하기도하였다. 대학병원스텝들이대학병원내에서만이아니라직접지역사회및대학병원이존재하지않는근교의센터로외근을나가는등특수진료를필요로하는장소에서적극적으로진료및교육을시행하고있음을알수있었다. 마츠도치위생과학생장애인진료실습 실제로진료실로실습을들어오는학생들과의대화내용을보면, 일본의일반적인치과대학생의경우에장애인치과진료는역시어려운분야이며, 본인이해야할일이라는의식은별로없어보였고, 졸업후장애인치과진료를시행하는경우도실질적인수가문제등에부딪혀많지는않다 미토장애인진료센터위생사선생님들과

35 대한장애인치과학회지 8(1) 2012 방문진료 오사카에서의열흘 일본에서본장애인진료시스템중우리나라와가장큰차이가있었던것은재택자방문진료였다. 이것은일반주택과지역시설등을의료진이직접방문하여진료를시행하는형태로전신건강상태에문제가있거나지체부자유등으로인해치과방문이불가능한장애인및격리시설에수용되어있는장애인을대상으로하고있다. 여기에장기간의병원입원후에퇴원하여재택에서요양하는환자를위한구강보건관리역시방문진료로진행하고있다고한다. 물론이동형치과장비를이용해서가능한치과진료에는한계가존재하며, 진료시간및인적자원도제한적이기때문에치과병원에서의진료와같은수준의진료서비스를제공하기에는어려운점이많다고한다. 그러나지속적인방문검진을통해구강건강에대한인식을증진시키고, 구강위생을향상시켜유지관리한다는점에서그역할이주는의미가크다고하겠다. 방문진료방식에도여러가지형태가있었다. 우선마츠도에서처럼치과대학병원과지역시설과의연계및의뢰를통해병원의스텝이이동형치과장비를가지고지역시설을정기적으로방문하여간단한치료및관리를해주는방식이있었다. 또지역치과의사회를중심으로방문진료시스템을구성하여방문진료를필요로하는환자에게가능한선생님을안내해주고, 원하는선생님에게이동형치과장비를대여하는지역도볼수있었다. 개원의자체적으로방문진료장비를갖추고팀또는개인으로인근지역의방문진료를시행하는경우도있다고한다. 11월후쿠오카학회에서인사드리고방문의사를전달했던모리사키교수님과연락을통하여오사카대학치학부장애인치과및시설견학일정이 1월 9일부터 17일까지로결정되었다. 성년의날로휴일인 1월 9일, 마츠도의다나카선생님과함께짧은교토관광후에오사카대학게스트하우스에도착하였다. 오사카에서는오사카대학치학부부속병원장애인치과치료부의진료실을견학하고오사카에위치하는특수학교, 장애인시설과장애인진료시설인고베시치과센터와카코가와구강보건센터를방문하였다. 고베시치과센터는고베대지진으로무너진도시를재건하면서만들어진병원으로처음계획을잡을때부터전신마취하장애인진료가가능한병원을설계하였다고한다. 이를위해현재치과마취과선생님이상근의로일반치과진료및전신마취를시행하고있으며, 병원내다양한전신마취관련시설이잘세팅되어있는것을확인할수있었다. 이들중특히오사카의미노시연학교방문이기억에남는다. 이날은교의이신선생님과동행하게되었는데, 선생님께서는자녀의장애를계기로장애인진료에관심을가지고공부를시작하게되었고, 아이가다니던미노시연학교의교의가되어자녀의사망후에도학교와긴밀한유대관계를형성하면서매달학교에방문하여정기적으로아이들을위한구강관리교육및치료를진행하고계시다고했다. 찾아간학교에서선생님과마주치는모든사람들이서로매우친밀한모습이었고, 보건교사및특수교사와장애학생들은높은구강보건의식과좋은관리상태를가지고있었다. 짧은시간의만남이었지만한눈에도보이는애정, 단순한치과의사로서가아니라모든아이들의어머니처럼관심과사랑을가지고있는모습이그런변화를이루어낸것이아닐까하는생각이들었다. 단기간의일정이었지만, 오사카의진료실과사람들은조금은시끌시끌하고밝고적극적인모습으로장애인진료를해나가고있다는인상을받았다. 다가올 2013년장애인치과학회를준비하고계실오사카대학선생님들께응원을보내본다. 마츠도특수치과노인요양시설방문진료

36 Korean Association for Disability and Oral Health 8(1) 2012 오사카대학장애인치과진료실 오사카대학섭식연하클리닉에서후두내시경실습 오사카대학치학부모리사키교수님과 오사카대학선생님들과아리마온천에서 일본의장애인치과진료기관연수기간동안다양한견학일정을통해마츠도치과병원뿐아니라도쿄의과치과대학, 소화대학교치과대학병원, 오사카대학치학부부속병원, 동경도립심신장애자구강보건센터와도쿄및치바, 이바라키, 오사카지역의장애인진료시설을돌아볼수있었다. 이를통해서현재일본에서장애인치과진료를시행하고있는기관및시스템은크게 a. 대학병원장애인치과 b. 지역장애인진료센터 c. 병원시설 - 어린이병원, 시민병원 d. 방문진료 로나누어볼수있다는것을알았으며, 대도시지역에서는비교적이시스템이잘연결되어서로협조가잘이루어지고있다는인상을받았다. 일본의여러지역에단위별치과의사회가운영하는장애인진료센터가위치하고있다. 인근대학병원과연계하여인력지원을받기도하고, 계약직상근의를두기도하며, 시간제근무제방식으로진료를하기도하는등진료센터를운영하는방식은모두조금씩차이가있었지만, 치과의사회를중심으로하는네트워크에서장애인진료를시행하며대학병원장애인치과와협력하는많은예를찾아볼수있었다. 이바라키현미토장애인진료센터는이바라키치과의사회에서운영을하면서도쿄의과치과대학에서 2년임기로상근

37 대한장애인치과학회지 8(1) 2012 의를파견하고그외요일별로다양한전문분야의선생님들이돌아가면서진료를시행하는방식으로운영되고있었다. 또, 고베와히메지사이에위치하는카코가와치과보건센터의장애인진료는주이틀간오전, 오후당번제로지역치과의사들이돌아가며장애인진료를시행하고있었다. 장애인진료가없는날은상근위생사가중심이되어구강관리교육등을시행하고있다고했다. 현재주치의가없는짧은시간의진료에한계를느끼고치과의사회에서도상근치과의사를두고자고민중이라고한다. 카코가와센터는작년가을무렵부터오사카치과대학마취과와연계하여전신마취하외래진료를시행하는등장애인을대상으로하는치과진료사업을점점확장하는방향으로추진하고있는병원이기도하다. 각지의시설을둘러보니지역별장애인진료센터가지역치과의사회주도하에서대학병원과상호협력하에운영되며공익적인부분을담당하고있다는사실이인상적이었으며, 생각보다다양한선생님들이장애인치과에관심을가지고학교병원의교육프로그램등을통해서끊임없이배우고경험을쌓아나가는모습을여러센터에서직접확인할수있었다. 장애인진료를하고있는일본의선생님들연수기간동안일본의장애인진료시설곳곳의사람들과다양한자리에서많은이야기를나눌수있었다. 한국과일본에대한이야기, 한류스타에서부터시작하는문화이야기, 그리고소소한일상의잡담에이르기까지. 비록짧은일본어실력으로전자사전을동원해가면서삼분의일은알아듣고, 또삼분의일은눈치로, 나머지삼분의일은채이해하지못했지만함께시간을보내며서로나누는이야기들이소중했다. 또오늘날의일본장애인치과와한국장애인치과이야기. 장애인치과진료를하고있는선배치과의사로서후배들에게어떻게흥미를갖게해줄것이며앞으로장애인환자진료에관심을가질수있는동기를줄것인지에대한이야기. 치과의사로서의우리모습과환자를위해할수있는무언가에대한이야기 함께장애인치과를배우고실천하면서치과의사로살아가는것에대한이야기는국적과장소를떠나서로이해하고나눌수있는많은부분이있었고, 같은어려움에한숨짓기도하고같은기쁨에웃기도하며, 함께라는믿음을얻을수있는기회가되었다. 소화대학에서무카이교수님과사노교수님 동경도립심신장애자구강보건센터의심화장애인치과연수교육 카코가와치과보건센터

38 Korean Association for Disability and Oral Health 8(1) 2012 또하나의즐거움연수라는목적과는별개로개인적인즐거움이라면그동안했었던짧은일본여행에서는느끼지못했던일본의생활습관이나풍속을함께할수있었다는점이아닐까한다. 11월도리노이치 ( の ) 에는신사에가서여러복을부르는물품들을사고제사를지내는사람들을구경하면서오코노미야키를사먹기도하고, 메이지신궁에서신사결혼식을올리는사람들을구경하고, 시치고산마이리 ( まいり 3, 5, 7세아이의축복을기원하는행사 ) 를하는기모노차림의꼬마아이들과젊은부모들의모습을보는것도재밌는일이었다. 12월에는대대적인연하장판매모습과오세이보 ( お 연말선물 ) 를주고받는모습을눈으로확인할수있었고, 새해첫날하츠모데 ( 새해첫신사, 절참배 ) 를하기위해메이지신궁앞으로모여든참배객들을보며그어마어마한인파에놀라고다양한연령대에다시한번놀라며삶의일부로자리잡은일본의전통문화를실감할수있었다. 새해오토시다마 ( お年 일본의세배돈 ) 를받고기뻐하는아이들의모습은우리나라아이들과조금도다를바없었으며, 성인식날에는기모노차림의여대생들이일본전역에서거리를아름답게수놓았다. 12월 29일부터 1월 3일에걸친일본의긴연말휴가에는부러움을느끼지않을수없었고, 이기간을틈타친구와함께한일본료칸에서의온천여행은특별한즐거움이었다. 도쿄지브리미술관에서 시치고산마이리를하는아이와함께 외국인을위한기모노체험이벤트에참가하여

39 대한장애인치과학회지 8(1) 2012 마무리귀국일은너무빨리다가왔다. 2012년 1월 31일마츠도치과대학병원에서마지막날을보내고, 다음날저녁환송회모임을함께했다. 정성이가득담긴메시지와선물을받고, 나도준비했던카드를전달하며이별의슬픔과감사함을전했다. 지나고나니준비도많이부족했고계획했던일들을많이하지못했다는생각이들어아쉬움도많이남지만, 그이상으로소중한경험도많았던시간이었다. 다시한번이런소중한경험을할수있는기회를주신양국의장애인치과학회에감사드리며, 앞으로양국장애인치과학회의발전과교류에있어서도움이되는일을하고싶다는바람을가져본다. 또한이런좋은기회를더많은양국의선생님들이함께나누며더욱다양한경험과공부를해나갈수있었으면한다 년 11 월후쿠오카일본장애인치과학회단체사진 마츠도선생님들과의아쉬운송별회 일본에서는장애인치과분야가등록된장애인환자뿐아니라, 치과치료를받기힘든다양한환자및섭식과연하기능에장애를가진많은사람들에게로그의미를점점확장시켜가고있었으며, 많은일반치과의사들이그에관심을가지고진료를시행해나가고있었다. 아마점점고령화되어노인인구가증가하고다양한장애를선천적, 후천적으로가지게되는빈도도높아지고있는우리나라에서도이러한일본의상황은먼미래의일이아닐것이라는생각이든다. 40년에가까운시간에걸쳐서일본이조금씩차곡차곡쌓아올린장애인치과를우린굉장히단시간내에많이따라가고시행해나가고있다. 하지만아직부족한부분이많기에더욱실질적인노력으로내실을다져가며앞으로새로운부분을만들어가야할것이다. 치과의사로서그저기계적인기능회복을위한치료뿐만아니라장애인의삶을개선하기위하여해야할일이무엇인가에대한고민, 바로거기에서시작해다양한장애인관련분야의종사자들과함께해야할일을찾고실천해나가야할것같다. 이를위해치과의료진의교육과제도적인뒷받침을위한노력이반드시필요할것이다 년 11 월후쿠오카일본장애인치과학회참가

40 Korean Association for Disability and Oral Health 8(1) 2012 하나더 아쉬움을남기고일본에서귀국한 2012년 2월의밤, 다나카선생님에게한통의메일을받았다. 귀국안부메일일거라고생각하며가벼운마음으로메일을연나에게그내용은너무무겁고슬펐다. 지난 1월 30일메가교수님께서돌아가셨으며, 내가즐거운마음으로귀국할수있도록그사실을알리지않길바라셨다고했다. 교수님의장례식은가족과몇몇지인분들만이참석하여치러졌고, 마츠도교실식구들에게도장례식이후에야그소식을알렸다고했다. 교수님께서일본에서의생활을함께해주지못해나에게많이미안해하셨다고 비록교수님을일본에서직접만난것은마츠도에도착했던첫날오전진료실에서순간적으로나누었던인사가처음이자마지막이었지만, 마츠도에서지내면서여러선생님들에게들은교수님의이야기와지금까지학회를위해애써주셨던기억들때문에더가깝게느끼고있었던모양이다. 그메일을읽으며눈물을쏟았다. 아마도교수님이계셨다면분명히더많은것을알려주시고, 공부를할수있었을거라는아쉬움이크지만, 그무엇보다도나에게기회를주시고마츠도의식구들을만나게해주신것에감사한다. 이것은이제겨우시작일뿐이니, 앞으로더많은일들이나에게남겨져있을것이고그저한걸음을걸었을뿐이니까. 다시이지면을빌어한국과일본의장애인치과학회의교류에많은관심과사랑을가지고일하시던메가교수님의명복을빌어본다. Mega い で らかにご されますようお祈りいたします. 메가교수님께전해드리지못한카드 Study program participation report on Special Needs Dentistry in Japan Hwang Ji-young Seoul Dental Hospital for the Disabled As a participant of Academic Exchange Program [Action Plan] between KADH (Korean Association for Disability and Oral Health) and JSDH (Japanese Society for Disability and Oral Health ), I have completed short-term training schedule. The shortterm training has been performed at The Department of Special Needs Dentistry of Nihon University School of dentistry at Matsudo, Japan from 17th October 2011 to 31st January I participated in special needs dentistry lectures and seminars in Nihon University School of Dentistry at Matsudo and was able to observe dental care system in the Department of Special Needs Dentistry at Nihon University Matsudo Dental Hospital and I also visited to disabled facilities and dental care facilities for the Disabled in Tokyo, Chiba and Ibaraki. For nine days Of training period I visited Osaka University and the dental center for the disabled of Kobe and Kakogawa located in the Kansai region. Although the hardships of treatment of patients with disabilities are the same in Japan and in Korea, there are many differences in Insurance Policy, Education system of Special Needs Dentistry and Treatment system for the disabled in the countries. Hence, ongoing effort is needed to do the intensification of the dental staffs' education, the improvement of the insurance policy, the expansion of Special Needs Treatment in local and public dental clinics and the cooperation between the government and dental field about policy-making in Korea. Key words : Special Needs Dentistry, disabled

41 대한장애인치과학회지 8(1)

42 Korean Association for Disability and Oral Health 8(1) 2012 대한장애인치과학회 2012 년춘계학술대회및제 9 차정기총회 2012 Annual Meeting of the Korean Association for Disability and Oral Health 기부와나눔은우리의힘 일시 : 2012년 4월 21일 ( 토 ) 12시 장소 : 서울대학교치과병원 8층강당 주최 : 대한장애인치과학회 후원 : 재단법인스마일

43 대한장애인치과학회지 8(1) 부 Oral Presentation 좌장 : 나성식회장 ( 대한장애인치과학회회장 ) 13:00 ~ 13:35 김광철 ( 동서신의학병원치과대학소아치과 ) 황지영 ( 서울시장애인치과병원 ) 2 부 Poster Presentation 13:35 ~ 14:40 3 부국제심포지엄및종합토론 : 고령장애인의구강건강 좌장 : 김선미이사 ( 전남대학교치과병원 ) 15:30 ~ 17:30 박현태 (National Center for Geriatrics and Gerontology) Yasuaki Kakinoki (Japanese Society for Disability and Oral Health) 남용옥 ( 원광보건대학교치위생학과 ) 4 부우수발표시상및제 9 차정기총회 17:30 ~ 17:40 우수발표시상및기념촬영 17:40 ~ 18:00 정기총회 사회 : 이재천총무이사 (CDC 병원원장 )

44 Korean Association for Disability and Oral Health 8(1) 2012 Oral Presentation < 국내구연발표 > 1 Study program participation report on Special needs dentistry in Japan 2 Report of research project : Development of oral health policy on the disabled Poster Presentation < 국내포스터발표 > 1 The Mobile Oral Health Survey of the Disabled in Facilities in Seoul 2 Oral health status in institutionalized psychiatric patients 3 An Understanding and Performance on the Oral Cavity Health Management of the Care Taker working in a certain Recuperation Facility in Seoul 4 Dental Treatment of a Patient with Alzheimer Disease under Ambulatory General Anesthesia 5 Propofol Target Controled Infusion Sedation for Dental Treatment in the Exaggerated Gag Reflex Patient 6 Dental management for Children with Attention-Deficit/Hyperactivity Disorder 7 A Case report: Dental treatment of a child with hemifacial microsomia 8 A Study on the Dental Treatment under Outpatient General Anesthesia for Disabled at Chonbuk National University Dental Hospital 9 Self-injurious behavior in a patient with autism : a case report 10 A case report: Treatment of pediatric patient with craniosynostosis and epilepsy 11 A Case report: Orthodontic treatment of anterior crossbite and severe crowding of a 9-year-old male patient with ADHD 12 The evaluation of dental treatment records in Charity Dental Clinic for the disabled people 13 Dental Treatment of Child with Bleeding Disorder 14 Dental Treatment of Patient with Adrenoleukodystrophy : A Case Report 15 Intractable Ulcerating Enterocolitis < 일본포스터발표 > 16 Kakogawa Dental Health Center's Organizational Profile and the State of Dental Treatment for Disabled 17 The Behavior Managements for Persons with Developmental Disabilities 18 Effects of Mouth Opening and Rubber Dam on Upper Airway Patency and Breathing Pattern in Normal Awake Subjects 19 Infants' response to their mothers' eating behaviors: A study in preterm infants before the start of weaning 20 Case Reports of Periodontal Treatment Combined with Oral Antimicrobial Therapy for Severe Periodontitis in Disabilities Patients 21 The expression of growth factors in gingival hyperplasia induced by cyclosporine A in mice

45 대한장애인치과학회지 8(1) Experimental bacteremia of Porphyromonas gingivalis induces myocarditis in mice and IL-17A is involved in pathogenesis of this disease 23 A Case of Cerebral Palsy with Self-injury of Lower Lip 24 Study on the Physical Properties of the Gel Type Oral Moisturizer. 25 Team Approach to Professional Oral Care for Hospitalized Elderly Patients 26 Does Functional Oral Care Improve Periprandial Plasma Active Ghrelin Dynamics among Dependent Elderly People Receiving Enteral Nutrition? 27 A study on the awareness of the dental assistants and receptionists regarding dysphagia rehabilitations before start of the oral health care program for improving oral function 국제심포지엄및종합토론 : Oral Health for Elderly Disability 1 Older adults, chronic disease and habitual physical activity 2 Some Certain Considerations in Treating the Disabled Elderly - View point from oral care and Management of Dry mouth - 3 Oral health management of disabled at home 정기총회관련자료 2011 년사업및결산보고 / 감사보고서 2012 년예산 ( 안 )

46 Korean Association for Disability and Oral Health 8(1) 2012 < Oral Presentation 1 > Study program participation report on Special Needs Dentistry in Japan Hwang Ji-young Seoul Dental Hospital for the Disabled As a participant of Academic Exchange Program [Action Plan] between KADH (Korean Association for Disability and Oral Health) and JSDH (Japanese Society for Disability and Oral Health), I have completed short-term training schedule about [comparative study on the Special Needs Dentistry in the Community Health Care between Korea and Japan]. The short-term training has been performed at The Department of Special Needs Dentistry of Nihon University School of dentistry at Matsudo, Japan from 17th October 2011 to 31st January I participated in special needs dentistry lectures and seminars in Nihon University School of Dentistry at Matsudo and was able to observe dental care system in the Department of Special Needs Dentistry at Nihon University Matsudo Dental Hospital and I also visited to disabled facilities and dental care facilities for the Disabled in Tokyo, Chiba and Ibaraki. For nine days Of training period I visited Osaka University and the dental center for the disabled of Kobe and Kakogawa located in the Kansai region. As the first participant of [Action Plan], I present the preparation process of short-term training to provide information to young Korean dentists who are interested in Academic Exchange Program [Action Plan]. I also report the schedule and contents of short-term training for Korean dentists who treat disabled patients or are interested in special needs dentistry. < Oral Presentation 2 > Report of research project: Development of oral health policy on the disabled Choi, Choongho Department of Preventive and Public Health Dentistry, Chonnam National University School of Dentistry 1. Background and Purposes The disabled are increasing every year, and oral health of the disabled is important issue in dental society. There is a need to evaluate the oral health program for the disabled. The purposes of this report was 1) to assess the oral health survey system for the disabled 2) to assess the oral health program for the disabled in public and clinic condition. 3) to suggest the solution about the problem of the dental center for the disabled. 2. Materials and Methods 1) Searching of reports and articles, opening of symposium and visiting the academic meeting to get the data related to evaluation of oral health program for the disabled 2) Assessment of the program of oral health department in health center, oral health roon in elementary school and some dental institutions for the disabled. 3) Survey on the satisfaction of dental center by questionnaire

47 대한장애인치과학회지 8(1) ) Survey on the state of dental center by site visit interview 3. Results We evaluated the current state of oral health program and dental center for the disabled. We found the problems of national oral health survey, oral health service and dental center management condition for the disabled. Solutions for those problems were proposed by this study. 1) For useful and effective national oral health survey There is a need to apply the probability sampling according to type of the disabled There is a need to make a connection with the other national surveys There is a need to educate the manpower according to the same criteria of other national oral health survey There is a need to make an advisory committee with professional personnels for the disabled There is a need to receive the budget for the survey from government 2) For oral health service program improvement There is a need to make a connection with the manpower who are in public and private organization. There is a need to maintain and activate more the programs about prevention service. There is a need to develop various education programs for dental service manpower for the disabled. 3) For dental center for the disabled There is a need to share of operating expenses and estimate the share rate by three stages; the central government(40, 35 and 30%), local self-government(40, 35 and 30%) and dental center(from 20, 30 and 40 %) There is a need to estimate the operating expenses for dental center by two scale; a large scale for central dental center(2.5 or 3 billion won) and a middle scale for regional dental center(1 billion won) and estimate the share rate in case of first stage; the central government(0.4 billion won), local self-government(0.4 billion won) and dental center(0.2 billion won) There is a need to change the arrangement plan and apply the central dental center model ; at least one dental center is needed for each city and province, and central dental center is needed for effective dental denter management There is a need to permit the variable system adequate to the provincial circumstances in oral health center program and mobile dental clinic program 4. Utilization plan This research will be used for setting the direction in development the new oral health policy and for program development in health center adequate to the provincial circumstances. And, this research can help to improve and reform a manpower supply, installation system and activities in oral health program for the disabled

48 Korean Association for Disability and Oral Health 8(1) 2012 < Poster Presentation 1 > The Mobile Oral Health Survey of the Disabled in Facilities in Seoul Hyo-Seol Lee, Hye-Jung Kim, Sun-Hei Nam, Min-Sun Kim, Hye-Sun You Seoul Dental Hospital for the Disabled Seoul Dental Hospital for the Disabled (SDHD) has accomplished the mobile oral exam at the facilities for the disabled in Seoul since It is for improving the oral health of the disabled who can hardly approach dental clinic. We analyzed 1609 oral exam records at 24 facilities (11 special-education schools, 10 living facilities, 2 mental hospitals, 1 health care facility for the elderly) in The purpose of this study is to figure out the oral health state of the disabled in facilities in Seoul and to compare with the non-disabled in National Survey 2010 and Special-education school : DMFT index of age 15 is 5.4 which is higher than 3.6 (DMFT index of age 15) of National Survey in Living facility : DMFT index of ages 35 ~ 44 is 8.4 which is higher than 5.2 (DMFT index of ages 35 ~ 44) of National Survey in DT rate is higher (31.3% vs 19.2%) and MT rate is lower (7.6% vs 15.5%). 3. Mental hospital : DMFT index of ages 35 ~ 44 is 11.3 which is higher than 5.2 (DMFT indext of age 35 ~ 44) of National Survey in DT rate is significantly higher (50.7% vs 19.2%) and FT rate is lower (35.1% vs 65.3%). 4. Health care facility for the elderly : DMFT index of ages 65 ~74 is 7.1 which is slightly lower than 8.7(DMFT index of ages 65 ~74) of National Survey in The number of existing natural teeth is similar (16 vs 18). DMFT index and DT rate of the disabled in special-education schools, living facilities, mental hospitals are high. Considering the poor accessibility and cooperation to the dental treatment, the prevention and periodic check should be emphasized. The oral health state of the elderly is quiet good. Considering th age and systemic condition, the prevention of the eating disorder and aspiration pneumonia should be emphasized. Key words : The disabled, Mobile oral exam, Facility, Seoul, DMFT index, SDHD < Poster Presentation 2 > Oral health status in institutionalized psychiatric patients Sunhei Nam, Hyejung Kim, Mikyung Kim, Jiyoung Hwang, Inseon Kim, Younghye Hwang, Unpyoung Kim, Eunyoung Lee, Seungho Baek Seoul Dental Hospital for the Disabled Psychiatric patients are one of the special groups requiring attention as they are often neglected. The present study was conducted to assess the oral health status and treatment needs of institutionalized psychiatric patients. The author surveyed 89 psychiatric patients in order to compare to national survey in Korea such items as DMF survey, CPI survey. 69% were male, mean age was years DMF rate:97.8% DMFT index:8.71 (DT:1.57 MT:5.39 FT:1.74) CPI:2.88 Mean PT:23.84 Mean No. of Tooth with cervical abrasion : 7.02 The percentage of polpulation wearing fixed prosthesis was 17.1% in the maxilla, 13.6% in the mandible. Only 1 per

49 대한장애인치과학회지 8(1) 2012 son has CD(complete denture) in maxilla. The rate of needing prosthodontic treatment appeared to be 45.5% in maxilla and 41% in mandible. The rate of needing complete denture is 2.3% in the maxilla, 3.4% in the mandible. Conclusion : Most of institutionalized psychiatric patients has high DMFT, CPI index, cervical abrasion, needing prosthodontic treatment. And they dont' have ability to care and use denture. So early prosthetic treatment and preventive care and instructing.t.b.i could help their quality of human life. Also periodic oral examination and early diagnosis and treatment should be performed for them and their caregivers to enhance the oral hygiene ability. Key words : psychiatric patients, oral health status < Poster Presentation 3 > An Understanding and Performance on the Oral Cavity Health Management of the Care Taker working in a certain Recuperation Facility in Seoul Ji Hye Lee Seoul Dental Hospital for Disabled Purpose : The importance of the oral cavity health care for the elderly is to inspire the desire for the physical strength and the life by recovering the dietary pleasure in old age by improving the oral cavity function owing to the oral cavity health care and to maintain the health in the old age and to reduce the burden of the care taker for the disease. Especially, it was reported that the state of the oral cavity healthiness for the elderly living in the recuperation facilities were poorer than the elderly residing in the local community. The role of the recuperation care taker has been enlarged in the controlling the oral cavity health for the elderly who is living in the recuperation facilities. However, the specific data for the state of the oral cavity management by the care taker is extremely short. Therefore, this study is purposed to identify the understanding, attitude, status and the need of the education for the elderly oral cavity management provided to the elderly living in the recuperation facilities and to provide it as a reference for the development of the related education for the oral cavity management by the care taker. Method : This study surveyed 122 care takers for recuperation who are working in the city owned recuperation facilities seated in Seoul for the elderly in scale of more than 250 beds by visiting one facility which allowed to collect the data from January 12 ~17, The collected data was analyzed by the Windows SAS(Statistical Analysis System) 8.2 statistics package. The frequency and the percentage were calculated to identify the general characteristics of the objects of the study. The frequency, average and standard deviation were obtained to know the understanding and behavior. T-test and one-way Anova Chisquare were performed. Result : The result for the action in case of bleeding during brushing for the question about the knowledge for the oral cavity management of the care taker himself revealed that 45.1% as the highest percentage of them answered for visiting the dentist. The result of periodic checking and scaling was that 83.6% are taking scaling regularly. But 38.5% answered that they do not have the regular checking if they were not sick. The highest percentage of 56.6% answered that the tooth paste shall be used for cleaning the dentures

50 Korean Association for Disability and Oral Health 8(1) 2012 More than 70% of the care taker for recuperation knew that the dentures shall not be sterilized into the boiling water and it shall be taken out during sleeping. The percentage of informing to the guardians was 88.5% in the highest when the elderly appealed the inconvenience of the artificial teeth in the facilities. The result from the survey on the possibility of the oral cavity management by the elderly in the facilities showed 48.4% as the highest of that the care taker shall do everything as they are not able to do. The interest of the care taker for the health condition of the elderly in the facilities showed more than 88% of experience of brushing in stead, looking into the oral cavity and fitting or taking out the dentures The lack of the cooperation as a difficulty in controlling the health of the oral cavity in the facilities was 72.1% as the highest. The most essential knowledge for the oral cavity health was the method of the brushing as 45.1% in highest. The next was 27.1% of controlling the gingiva disease. The hours of education for the oral cavity management were 1-2 hours after obtaining the license for the care taker of the recuperation which is the highest percentage of 46.7% and 40.2% was answered for no education for it. The survey on the necessity and the method of the oral cavity health management for the elderly revealed 59.0% that the education will be helpful when they have time. The survey on how the oral cavity health knowledge to be educated revealed 56.6% in the highest for direct visiting of the dentist or dental hygienist. Conclusion : According to the result of this study, it seems that the care takers are not educated properly and about 90% of them wanted to have education for the oral cavity management for the elderly. The education for the oral cavity management will be necessary in more specialized and practical contents and methods because it is expected that the role of the care taker will be more important in the ageing society in the future. The countermeasure for the less cooperative elderly shall be included in the contents of the education. With regard to the oral cavity management, more strict control on the oral cavity environment of the elderly in the facilities will be necessary by means of the independent practice of the specialist. Key words : Oral cavity care, Oral cavity management for the elderly, Long-term recuperation insurance system for the elderly, Care taker for recuperation < Poster Presentation 4 > Dental Treatment of a Patient with Alzheimer Disease under Ambulatory General Anesthesia Soonyoung Shin, Mi Seon Kim, Kwang-Suk Seo, Hyun-Jeong Kim, Hyo Jo Han, Teo-Jeon Shin 1, Juhea Chang 2 Department of Dental Anesthesiology, 1 Department of Pediatric Dentistry, 2 Clinic for Persons with Disabilities, Seoul National University Dental Hospital, Seoul, Korea Background : Elderly patients with progressive dementia including Alzheimer's disease (AD) are more and more often scheduled to undergo general anesthesia for various pathologies including dental problem. But, there is high risk of deterioration of underlying mental diseases and other co-morbidities. So it is important to implement preventive strategies and take adequate measures to minimize negative perioperative events in these patients. Methods : We reviewed the 17 cases of 11 patients with AD who underwent ambulatory general anesthesia for dental treatment at the clinic for the disabled in Seoul National University Dental Hospital. Results : The mean age was 68 (57-81) years. All of them were diagnosed with AD and some had hypertsnsion, bronchiectasis, urinary incontinence. For anesthesia induction, 3 cases (1 patient) was needed physical restraint, but

51 대한장애인치과학회지 8(1) 2012 others showed good or moderate cooperation. Drugs used for anesthesia induction was thiopental (11 cases), propofol (3 cases) and sevoflurane (3 cases). All patients received nasotracheal intubation without difficulties. Mean total anesthetic time was 3 hour 44 min ± 60 min and staying time at PACU was 83 ± 34 min. All the patients except one who showed hypertension discharged without any complication. There was no death or long term hospitalization because of severe complications. Conclusions : If general anesthesia is needed, pertinent diagnostic tests and workup about other medical problems, and appropriate anesthetic planning are essential for safety. Key words : Alzheimer; General anesthesia; Dental treatment; Disabilities < Poster Presentation 5 > Propofol Target Controled Infusion Sedation for Dental Treatment in the Exaggerated Gag Reflex Patient Soonyoung Shin, Kwang-Suk Seo, Hyun-Jeong Kim, Jung Man Lee, Juhea Chang* Department of Dental Anesthesiology, *Clinic for Persons with Disabilities, Seoul National University Dental Hospital, Seoul, Korea Background : The gag reflex is a physiological reaction, but, an exaggerated gag reflex can be a severe limitation not only to treat dental caries but also to do oral exam. Procedures such as surface anesthesia of the palate and pharyngeral area, sedation, or general anesthesia can be options as behavioral management. But, there are no golden rule for the sever gag refelx patients. We present a case report of propofol intravenous sedation using TCI pump for simple dental treatment. Cases : A 44-year-old man, who had past history of general anesthesia for dental treatment because of severe gag reflex was scheduled intravenous sedation for simple dental treatment. After 8 hour fasting he entered clinic for persons with disabilities. We explained about intravenous deep sedation and got informed consent. First, we kept intravenous catheter(22g) in the arm and stated monitoring ECG, non-invasive blood pressure, pulse oxymetry and end-tidal CO2 through nasal cannula. We started propofol infusion with TCI pump at the target gconcentration of 3 mcg/ml. The patient became sedated, but he showed involuntary movement during dental treat, so we increased the target concentration to 4 mcg/ml. We finished the dental treatment without and complication during 30 min. And after 40 min recovery room stay he was disccarged without any complications. Key words : Gag reflex; deep sedation; Dental treatment; Propofol < Poster Presentation 6 > Dental management for Children with Attention-Deficit/Hyperactivity Disorder Mi Sun Kim, Soo Eon Lee, Jae Hong Park, Kwang-Chul Kim, Yeong Chul Choi, Sung Chul Choi Department of Pediatric Dentistry and Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul, Korea Attention-deficit hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity, which can result in significant functional impairment. Children with ADHD have poor oral hygiene, which can result in a higher incidence of oral diseases. They have difficulties with communica

52 Korean Association for Disability and Oral Health 8(1) 2012 tion, overactivity, impulsivity and staying focused, which can make a dental practice challenging. A 7-year old girl who was diagnosed with ADHD was referred to our hospital for the treatment of dental caries. She was treated with three times and regularly visits for the follow-up check. A 10-year-old boy who was diagnosed with ADHD came to our department to treat mucocele on his right lower lip. Mucocele was removed and pit & fissure sealants on first molars were done. They had difficulty sustaining attention, did not seem to listen when spoken to directly, often leaved dental chair when remaining seated was expected and often interrupted on others. At the outset of the appointment, information about what is going to be done during treatment was described. During treatment, issuing one instruction at a time, shorter chair time and giving frequent breaks were considered. After treatment, positive reinforcements for the appropriate behavior were given. In addition, shorter dental recall periods, increased preventive treatment, parental monitoring of oral hygiene practices and encouragement to modify diet where it is a problem was concerned. Due to symptoms of children with ADHD, dental treatment is often very challenging. Dental treatment for children with ADHD should include an understanding of their behavior management needs. Accordingly, it is necessary for the clinician to be familiar with the disorder as well as with specific strategies for the treatment of oral diseases in children with ADHD. Key words : ADHD, dental management < Poster Presentation 7 > A Case report: Dental treatment of a child with hemifacial microsomia Park MunSung Department of Pediatric dentistry, Seoul National University Dental Hospital Hemifacial microsomia is a congenital disorder that affects the development of the lower half of the face, most commonly the ears, the mouth and the mandible. The term, "hemifacial", refers to one side of the face and "microsomia" refers to having a small body. There are no definitive reasons for the development of the condition. However, something occurs in the early stages of development to cause this condition. During the fetal stage of pregnancy at approximately 4 weeks of gestation, vascular problem leads to clotting and a poor supply of blood to the face. And there is some evidence of hereditary. The occurrence of hemifacial microsomia estimates one in 3500 births. Common oral manifestations of hemifacial microsomia include a significant delay of tooth development on the affected side, frequent absence of mandibular third molar on the affected side, and increased frequency of missing teeth on the affected side. Some of hemifacial microsomia patients have agenesis of the ramus on the affected side. The maxilla is narrowed on the involved side with decreased palatal width. Associated cleft lip and/or palate is found in 7% of hemifacial microsomia patients. This article presents a case report: dental treatment of a hemifacial microsomia patient with dental caries. Key words : Hemifacial microsomia, dental treatment, dental caries

53 대한장애인치과학회지 8(1) 2012 < Poster Presentation 8 > A Study on the Dental Treatment under Outpatient General Anesthesia for Disabled at Chonbuk National University Dental Hospital Yu-Jin Moon, Yeon-Mi Yang, Jae-Gon Kim, Byeong-Ju Baik Department of Pediatric Dentistry and Institute of Oral Bioscience, School of Dentistry, Chonbuk National University General anesthesia has been used in dentistry as on type of management technique to sedate patients who, handicapped patient, may be uncontrollable or require medical consideration. From 1 January 2005 until 15 March 2012, we reviewed the cases of 219 handicapped patient who underwent outpatient general anesthesia at the Special clinic in Chonbuk National University Dental Hospital. Followings are concluded. 1. Patient's age ranged from 2 to 62, with under 5 being the largest group with 79 members(36.1%). 2. The study included more men than women, with 138 male members(63%) patients(86.7%) received dental care under general anesthesia once and 29 patients(13.3%) received dental care under general anesthesia two or more times. 4. Type of dental procedure performed were as follows(per person) : (9.0) Number of Total dental treatment teeth, (4.8) Dental restoration, (1.7) extractions, (1.48) Pulp treatment, (1.57) prothodontic treatment and (1.1) etc. Procedures took an average of 180 minutes patients(52%) had mental retardation, autism, and cerebral palsy. Key words : general anesthesia, dental treatment, handicapped patient < Poster Presentation 9 > Self-injurious behavior in a patient with autism : a case report Eunhye Ji Department of Pediatric Dentistry, College of Dentistry, Yonsei University Introduction : Self-injurious behavior (SIB) has been defined as the deliberate destruction or alteration of body tissue without conscious suicidal intent. It occurs in conjunction with a variety of psychiatric disorders as well as various developmental disabilities and some syndromes. The behavior is destructive and causes concern and distress to all involved in the care and treatment of the affected individual. Case report : A 13-year-old girl with autism, mental retardation and delayed development was reffered from her pediatrician because of severe and painful lower lip biting. An intraoral examination revealed a diffuse swelling of lower lip. It was covered with necrotic slough and the ulcer and scarring of the lower lip was observed. We chose to use an oral removable prosthesis for Conservative treatment. It was decided to use a soft silicone mouthguard in the maxillary arch. Initially, she could not tolerate the appliance inside her mouth but soon adapted with the appliance. After one month, she lost the mouth guard and started lip biting. So we made mouth guard again. Summary : There are no standard methods for preventing self-injurious behavior in a patient who is developmentally disabled. Appropriate preventive methods must be developed for each individual patient based on close observation and clinical findings. Behavior modification techniques, pharmacological treatment, extraction of teeth, orthognathic surgery and intra/extra oral appliances can be performed for adjust self-injurious behavior. A suitable oral guard could

54 Korean Association for Disability and Oral Health 8(1) 2012 be tried initially before employing more invasive approaches. Key words : Autism, self-injurious behavior(sib), mouthguard < Poster Presentation 10 > A case report: Treatment of pediatric patients with craniosynostosis and epilepsy Seongil Choi, DDS Department of Pediatric Dentistry, Seoul National University Dental Hospital Introduction : Dentists often confront with the patients with epilepsy, very likely to be medicated with antiepileptic drugs. As they are known, commonly used anti-epileptic drug phenytoin sodium may result in gingival hyperplasia and subsequent gingivitis. Moreover, patients with craniosynostosis show increased chance of the mental retardation with a significant reduction in IQ. Children with intellectual disability may have a higher incidence of poor oral hygiene, gingivitis, malocclusion, and untreated caries. Therefore, these patients require our special attention during regular dental check-ups. Case : Born with congenital brain lesions, the 5-year-old patient's chief complaint, addressed by his parents on his first visit, was severe dental caries and gingival hyperplasia. Upon dental examination, multiple caries affecting most of the primary dentition and drug-induced gingival hyperplasia were observed. Treatment plans were established accordingly and first, upper anterior teeth were extracted. Then, rest of the dentition affected by dental caries also were treated and restored with stainless steel crowns under general anesthesia. Treatment of the multiple dental caries and restorations were done successfully and the patient is on the regular check-up, since then. Discussion : Dentists should always be aware of the limitations of self-oral hygiene care that the patient with brain lesions can make. Dentists are responsible for professional care of the handicapped patients and implementation of the preventive dental treatment plan as wells as reinforcement of the good home dental care. Key words : craniosynostosis, epilepsy, caries treatment < Poster Presentation 11 > A Case report: Orthodontic treatment of anterior crossbite and severe crowding of a 9-year-old male patient with ADHD Kim ARAM Department of Pediatric dentistry, Seoul National University Dental Hospital Attention Deficit Hyperactivitiy Disorder (ADHD) is a neurobiological behavioral disorder characterized by inattention, impulsivity, and overactivity. It is not an uncommon disorder, but the most common behavioral disorder that starts during childhood. It has been estimated that 5~8% of Korean children have the condition. An individual with ADHD finds it much more difficult to focus on something without being distracted. He has greater difficulty in controlling what he is doing or saying and is less able to control how much physical activity is appropriate for a particular situation compared to somebody without ADHD. With regard to causes of ADHD, it is now believed that heredity accounts for approximately 80% of cases. Several candidate genes have been related to the susceptibility to ADHD (eg. dopamine transporter gene, dopamine receptor gene). The goal of treatment is to contain the disorder or reduce the symptoms

55 대한장애인치과학회지 8(1) 2012 rather than to cure the condition. The medications used to treat ADHD mainly impact the neurotransmission of catecholamines. Most of them are stimulants (eg. Amphetamines, Methylphenidate etc). The successful orthodontic treatment requires following conditions ; the patient's awarance of his/her serious dental problems, the will to correct the problems, cooperation with the dentist, and regular attendance to the appointment. These are somewhat difficult to the patient with ADHD. In addition, in contrast to the most of other dental treatments, the orthodontic treatment requires more frequent appointments and longer treatment period. It makes the patient with ADHD encounters more difficult during the orthodontic treatment. This article presents a case report: orthodontic treatment of anterior crossbite and severe crowding of a 9-year-old male patient with ADHD. The special considerations of dental care, especially orthodontic treatment for the patient with ADHD are discussed. Key words : Attention Deficit Hyperactivity Disorder (ADHD), orthodontic treatment, anterior crossbite, crowding < Poster Presentation 12 > The evaluation of dental treatment records in Charity Dental Clinic for the disabled people Sun Young Kim, Sung Chul Choi 1, Jae Hong Park 1, Kwang Chul Kim Department of Pediatric Dentistry, Kyung Hee University Hospital at Gangdong 1 Department of Pediatric Dentistry, School of Dentistry, Kyung Hee University, Seoul, Korea Most of disabled people face hardness in caring their general oral hygiene by themselves. So that, they are once involved in dental caries or periodontal disease, they have much bigger chance of aggressive progress. Therefor preventive dentistry is more important to disabled one than non-disabled. They need to be checked with routine periodic dental examination and by that, oral disease must be found at initial stage. We selected 37 patients from newly visited 237 patients who had dental treatment at the free dental clinic, Gangnam district, Seoul, between 2000 and This study is a comparative evaluation of first 2 years' treatment records of selected 37 patient(male 28, female9) with that of their last 2 years. 24 of 37 have mental retardation, 9 have autistic disorder, 2 have auditory disorder, 1 has brain disorder and 1 has crippled disorder. Their dental treatment records categorized by 4 level; score 4 stands for endodontic treatment, score 3 stands for general conservative treatment, score 2 stands for preventive treatment, such as sealant and score 1 stands for routine check. In first 2 years of treatment, average score was 2.85 which score means approximately general conservative treatment. And that of last 2 years was 1.44, which means routine check. In early time of their visit, they will receive the treatment due to their chief complaint. And after that early times, they can have a routine check so that they can be treated before the disease get worse. The patient's oral health can remain decent only by a simple treatment. Key words : Preventive therapy, Disabled person < Poster Presentation 13 > Dental Treatment of Child with Bleeding Disorder Ji Eun Lim, Mi Yeon Sohn, Jae Hong Park, Kwang Chul Kim, Yeong Chul Choi, Sung Chul Choi Department of Pediatric Dentistry and Institute of Oral Biology, School of Dentistry, Kyung Hee University, Seoul, Korea

56 Korean Association for Disability and Oral Health 8(1) 2012 Hemophilia, the most common of the inherited bleeding disorder, is the result of a deficiency of clotting factor. The patients with hemophilia do not bleed any faster than normal, but they can bleed for a longer time. Since bleeding after dental treatment may cause severe or even fatal complications, people with hemophilia must be given special dental care. We report on the diagnosis and treatment of a 9-year-old hemophiliac boy with the complaints of pus discharge on the left lower molar region. In the clinical and radiographic examination, periapical abscess on 55, 74, 75, 84 and dental caries on 53, 55, 85 were noted. Considering complexity of the treatment and complication in the coagulation, it was decided to carry on the treatment under general anesthesia. Clotting factor concentrates were intended to provide 60-80% plasma level. The patient was infused intravenously just before and 8 hours after surgery, and received an additional infusion for two days. Pulpectomy followed by resin restoration in 53, resin restoration in 16 and Stainless steel crown in 85 were given under general anesthesia. 52, 54, 55, 84, 85 were extracted and the sockets were packed with Surgicel(Oxidized Regenerated Cellulose, Johnson and Johnson Co.) under general anesthesia. Transpalatal arch and lingual arch were given for extraction area before the patient was discharged. For people with severe hemophilia, factor replacement is necessary before scaling, surgery or regional block injections. Therefore, if several extractions are needed, dental care under general anesthesia would be effective and efficient management. Key words : hemophilia, dental treatment, extraction, clotting factor < Poster Presentation 14 > Dental Treatment of Patient with Adrenoleukodystrophy : A Case Report Eunji Lee, Soyeon Bak, Kwang-suk Seo, Hong-Keun Hyun Department of Pediatric dentistry, Seoul National University Dental Hospital Adrenoleukodystrophy (ALD) is a rare, inherited disorder that leads to progressive brain damage and failure of the adrenal glands. It is passed down from parents to their children as an X-linked genetic trait. Therefore, it affects primarily males especially under the age of 10. People with ALD have excessive accumulation of very long chain fatty acids (VLCFA) in their brain because they do not have the enzyme which break down these fatty acids. The symptoms of ALD include loss of previously acquired neurologic abilities, seizures, ataxia, Addison's disease, and degeneration of visual and auditory function. Special method for treatment of ALD is not available. Eating a diet low in VLCFA and taking special oils, called Lorenzo's oil, can lower the blood levels of VLCFA. But this oil cannot stop the destruction of nerve cell. Adrenal dysfunction can be treated with steroids like cortisol. This is a case report of a 12-year-old boy suffering from ALD. This patient has many dental caries to be treated but his medical history makes it difficult. Careful management must be required during treatment procedure because of the possibility of life-threatening accident occurred by difficulty in cooperation, seizure disorders, life-threatening airway obstruction, copious oral secretion and possibility of aspiration. General anesthesia is used successfully to manage this patient during dental procedure. Key words : Adrenoleukodystrophy, General anesthesia, dental caries

57 대한장애인치과학회지 8(1) 2012 < Poster Presentation 15 > Intractable Ulcerating Enterocolitis Hyo-Seon Mim, Je-Seon Song, Jae-Ho Lee, Seong-Oh Kim, Heung-Kyu Son, Byung-Jai Choi, Hyung-Jun Choi Department of Pediatric Dentistry, College of Dentistry, Yonsei University Introduction : Intractable ulcerating enterocolitis (IE) is an uncommon Inflammatory bowel disease (IBD) syndrome of neonatal onset first described in The main symptom of active disease is usually constant diarrhea mixed with blood, of gradual onset. IE usually presents in the neonate with mouth ulceration and subsequent development of perianal disease and colitis. The mouth ulcers were deep with sharply demarcated borders. It is clearly differentiated from neonatal Bechet disease by lack of extra-intestinal features such as ocular, dermatological and genital involvement. Also, IE have similarities to Crohn's disease. But, Crohn's disease very rare occurs in infancy. Case Operation Procedure : The infants referred from department of pediatrics, Yonsei university hospital in 18days from birth, some with ulcerative lesion on hard palate for systemic differential diagnosis about oral lesion. From 4days before came to the hospital, he had mild fever, poor oral intake and oral ulceration. At that time he took peripheral blood smear test, genetic test, colonoscopy, and so on. But, there is no abnormality, except oral lesion like Aphtous ulcer. He discharged from pediatrics, but after 3weeks, came to hospital again with blood diarrhea. As a result of endoscopy, there were large ulcerating lesions. And he was diagnosed IE. After that he had a subtotal colectomy and followed until these days. Summary : Early recognition of IE appears beneficial because colectomy, as opposed to immunosuppression, appears to be be effective in controlling disease symptoms and progression. And most of Infants who affected IE are normal at birth and had no diarrhea on the first day of life. Oral manifestation is earlier than others. So, it is very meaningful to know symptoms and features about IE for a dentist. Key words : Intractable ulcerating enterocolitis, Bechet disease, Crohn's disease < Poster Presentation 16 > Kakogawa Dental Health Center's Organizational Profile and the State of Dental Treatment for Disabled Masafumi Kamada 1, Masahiro Nakagami 1, Katsuya Ogata 2 1 Kakogawa Dental Health Center, 2 Ogata Pediatric Dental Clinic Summary : Kakogawa Dental Health Center, established by the regional administration and to be managed by the Dental Association, is advancing three major dental services: dental treatment for disabled, emergency dental treatment on vacation, and dental health guidance. This time, amongst three major services, the state of dental treatment for disabled adults and children will mainly be discussed. Presentation Method : Poster Outline of the Program for Dental Treatment for Disabled Kakogawa Dental Health Center was established in April 1995 by the regional administration of the two cities and two districts of East-Harima, and commenced operations in May of that year. The center's founding purpose, similar to those of other dental health centers nationwide, was to act as a base for dental

58 Korean Association for Disability and Oral Health 8(1) 2012 health care activities in the region, providing dental health care of a higher quality to area residents than standard dental offices are capable of providing. About the Committee on Dental Care for Disabled 1) Treatment system : The Committee on Dental Care for Disabled consists of 16 dentists from the Harima Dental Association, 3 full-time dental hygienists, and 7 part-time dental hygienists along with 2 oral and maxillofacial specialists and 2 dental anesthesiologists serving as dental cooperators. 2) Records of treatment : Since its opening, the center has accepted a total of 37,770 patient visits by 631 different patients. The breakdown by condition is AU:720(30.3%), MR:698(29.3%), CP:369(15.5%), DS:271(11.4%), cerebrovascular disease: 87(3.6%), circulatory disorder: 9(0.3%), other 230(9.6%). In 2011, outpatient dental treatments under day-stay general anesthesia were introduced using behavior control. As of February 2012,30 cases have been handled. 3) Training system : In addition to the clinical conferences and lecture classes held by the regular committee, training meetings led by outside lecturers for participants in disabled dental care are held regularly and training activities including dental cooperators and general dental practitioners are being conducted. Active participation and presentation in the academic meetings is also encouraged, and we are promoting an increase in the staff's knowledge of dental care for disabled. Finally, we regularly receive advice from an instructing dentist in the form of things such as educational lectures and clinical instruction to help with matters related to staff education, medical practice, and administration. 4) Regional link system : We are cooperating with tertiary medical institutions such as university hospitals and public general hospitals, as well as with primary medical institutions such as regional general practitioners, cooperating dentists for the disabled, and general dental practitioners. 5) Operational issues 1 Since the number of new members in the Harima Dental Association has been decreasing in recent years, it is highly likely that obtaining dentists will become difficult in the future. 2 Because the scope of outpatient treatment is fixed, compliance with regard to the increase in patients in recent years as well as with regard to response during emergencies, is limited. 3 When we introduce patients to primary medical institutions, staffs in them often experience difficulties because of inexperience or equipment related problems. < Poster Presentation 17 > The Behavior Managements for Persons with Developmental Disabilities Nozomu Harano 1,2, Mitsuhiro Yoshida 2, Kazumasa Morikawa 3, Teppei Sago 2, Masahito Nunomaki 2, Shunji Shiiba 2 1 Division of Special Care Dentistry, Kyushu Dental College Hospital 2 Division of Dental Anesthesiology, Kyushu Dental College 3 Division of Pediatric Dentistry, Kyushu Dental College Introduction : Some educational and medical institutions have reported that the number of persons with developmental disabilities is increasing by more than 1% per year because developmental disabilities are diagnosed in early stage. Developmental disabilities include autism, Asperger syndrome, diffuse development disability, leaning disability, attention-deficit hyperactivity disorder, and other similar brain dysfunction. These symptoms usually occur at early age and the difference is ambiguous. For these reasons, we sometimes meet difficulties when we deliver dental procedures for these patients. We have sought better behavior management for these patients in dental procedures. We made protocol for behavior management in dental procedures in We will present our dental procedures for these patients fol

59 대한장애인치과학회지 8(1) 2012 lowing this protocol for 3 years. Methods : The subjects are 100 patients who are delivered dental procedures at Kyushu Dental College Hospital in the 3 year period from April 2008 to March We reviewed sex, age, the type of developmental disability, the type of treatment, the way of behavior management, and dental checkup after treatment. Results : The subjects consisted of 76-male and 24-female. The subjects ranged in age from 4 to 49. Of the total, 31 were from 7 to 12, 20 were from 13 to 19, 17 were from 20 to 29, 16 were from 30 to 39, 9 were from 4 to 6, and 7 were from 40 to 49 years old. The type of developmental disability consisted of 81 persons with autism, 14 persons with Asperger syndrome, 4persons with diffuse development disability, and a person with leaning disability. The type of treatment consisted of 45- conservative treatment, 29- conservative treatment and tooth extraction, 20-preventive treatment, and 6-tooth extraction. The way of behavior management consisted of 36-structured teaching case, 15-inhalational sedation case, 6-intravenous sedation case, 43-general anesthesia case. We delivered dental checkup after treatment for 58 patients. Discussions : More than half of our patients were under 20 years old and male. This result is in accordance with former reports. Some our patients who were under 20 years old were diagnosed as Asperger syndrome and diffuse development disability because diagnosis criterion of these diseases has been established. Structured teaching was useful for the dental treatment when we needed to deliver dental procedures for a small number of teeth. When we needed to dental procedures for many teeth, we needed to deliver inhalational sedation for the patients. We needed to deliver intravenous sedation and general anesthesia for the patients who were not able to manage by structured teaching and inhalational sedation. Intravenous sedation was delivered for the patients when we needed to dental procedures for a small number of teeth and general anesthesia was delivered in other cases. The patients who were 7 years of age or more were applied ambulatory anesthesia in our hospital. We had no cases with any complications during general anesthesia. More than half of our patients accepted dental checkup after treatment. We were able to operate our protocol as a dental care system effectively Conclusion : We should have various ways of behavior managements for dental procedures for these patients because the character of these patients shows wide variety. Therefore, the protocol for behavior management in dental procedures should be established and introduced to deliver dental procedures effectively for these patients. < Poster Presentation 18 > Effects of Mouth Opening and Rubber Dam on Upper Airway Patency and Breathing Pattern in Normal Awake Subjects Koichiro Matsuo, Kazuhiro Iwatani, Soichiro Kawase, Nina Wakimoto, Tadashi Ogasawara Department of Special Care Dentistry, Matsumoto Dental University, Nagano, Japan Purpose : Rubber dams increase the quality and safety of dental treatment. However, the condition of a rubber dam over an open mouth may also obstruct upper airway patency. We tested whether an open mouth with or without a rubber dam would affect upper airway patency and breathing pattern. Methods : Twenty-two young healthy volunteers were imaged with a magnetic resonance system under three conditions: mouth closed, mouth open, and rubber dam with mouth open. Respiration was concurrently monitored with

60 Korean Association for Disability and Oral Health 8(1) 2012 plethysmography. Results : The volume of the upper airway became significantly decreased with the mouth open. Analysis of each crosssectional area of the upper airway revealed that while the oropharyngeal area was significantly narrower with an open mouth, the retro-palatal and hypopharyngeal areas were not affected. Placing a rubber dam had no additional influence on upper airway patency, but was seen to significantly shorten mean respiratory duration and decrease tidal volume. Conclusion : Our findings show that open mouth position with a rubber dam may alter upper airway patency and disrupt breathing pattern. Accordingly, respiration and oxygenation monitoring may be useful during dental treatments requiring a rubber dam for patients with respiratory disorders. < Poster Presentation 19 > Infants' response to their mothers' eating behaviors : A study in preterm infants before the start of weaning Kemi Utsumi 1, YoshiharuMukai 1, Reiko Hoshi-Shiba 2,3,4, YurliNonaka 3, HiromiNito 4, KatsumiMizuno 5, Kazuo Okanoya 2,3,4 1 Department of Hygiene and Oral Health, Showa University School of Dentistry, Tokyo, Japan 2 Graduate School of Arts and Science, the University of Tokyo 3 JST ERATO Okanoya Emotional Information Project 4 Emotional Information Joint Research Laboratory, RIKEN, Brain Science Institute 5 Department of Pediatrics, Showa University School of Medicine Objectives : Eating environments are important for eating function acquisition in infants. We have reported that when 3- or 4-month-old infants see scenes of their mothers eating, muscle movements around their mouths are activated. However, the recognition process of eating behaviors in preterm infants and low-birth-weight infants, which is increasing in recent years, has not been clarified. In the present study, to elucidate when preterm infants become interested in eating or how eating environments influence their oral motor function in the acquisition process of eating function, we analyzed the infants' behaviors using recorded videos. Subjects and Method : The subjects were 2 full-term male infants at 17 to 21 weeks after birth (f group) and 6 preterm male infants at 14 to 19 weeks of corrected age (34-35 weeks of gestation) (p group). The infants were made to sit on their mothers' laps in front of the monitor in the measurement room. Motion images were used for visual stimulation. The infants' behaviors recorded with a three-way camera and were examined using behavioral analysis software. Results and Conclusion : Infants in both the f and p groups had a high rate of behavioral responses when eating scenes of their own mother (M) and other children (C) were shown. In addition to muscle movements around the mouth, infants in the p group showed many other responses such as verbal expressions and facial expressions, eg, smiling at other children (C). Because the p group showed more activation of muscle movements around the mouth in response to other children's eating scenes as compared with the f group, the relationship between infants and their brothers, sisters, relatives, etc. (eating as well as the interaction between mothers and infants in their daily lives) was considered to be more important in the p group than in the f group. Key words : preterm infants, behavior analysis, eating environments

61 대한장애인치과학회지 8(1) 2012 < Poster Presentation 20 > Case Reports of Periodontal Treatment Combined with Oral Antimicrobial Therapy for Severe Periodontitis in Disabilities Patients OSADA Yutaka 1, AYUSETakao 2, MIMURAKyoko 1, INOMOTOTakuyo 1 1 Nagasaki Prefectural Oral Health Center, 2 Division of Dental Anesthesiology, Nagasaki University Hospital We report two cases of periodontal treatment combined with oral antimicrobial therapy for severe periodontitis in disabilities patients. A cerebral palsy patient and a patient with mental retardation suffering from severe periodontitis were recruited for this study. Combined therapy was carried out of oral antimicrobial therapy and one-stage full mouth scaling and root planing(os-fm-srp) under intravenous sedation. Two patients received OS-FM-SRP under intravenous sedation after systemic administration of antibiotics at day 1 for the initial stage. Subgingival Plaque samples were analyzed for 4 species of periodontal pathogenic bacteria i.e., Aggregatibacter actinomycetemcomitans(aa), Porphyromonas gingivalis(pg), Tannerella forsythensis(tf), Prevotellai ntermedia(pi) using Invader Assay. In addition, the clinical outcome was assessed by parameters of probing depth and tooth mobility. These clinical and microbiological parameters were monitored at baseline, and at 1month, 3months,6months and 3years during the post treatment periods. This combined therapy results in improvement of the clinical outcome and microbial effect. These results suggested that this combined therapy was an effective periodontal therapeutic method for severe periodontal patients with disabilities. < Poster Presentation 21 > The expression of growth factors in gingival hyperplasia induced by cyclosporine A in mice Fumishige Oseko 1, ToshiroYamamoto 1, Kenichi Honjo 1,2, Hiroaki Ichioka 1,2, TakeshiAmemiya 1, NarisatoKanamura 1 1 Department of Dental Medicine, 2 Department of Immunology, Kyoto Prefectural University of Medicine Graduate School of Medical Science Objectives : Drug-induced gingival hyperplasia, due to the side effects of certain medicines such as immunosuppressive agents, anti-epileptic drugs and calcium channel blockers, is distinct from chronic marginal periodontitis, which is caused by an infection of oral bacteria into the gingival sulcus. Cyclosporine A (CsA) is a widely used immunosuppressant with clinical applications ranging from organ transplants to chronic inflammatory diseases. We have developed a CsA-induced gingival hyperplasia mouse model, and here we examine the expression of cytokines and growth factors in gingival hyperplasia. Methods : The C57BL/6 mice used in this study were specific pathogen free 4-week-old males (n=5). For eight weeks, CsA-induced gingival hyperplasia mice received CsA (Sandimmun, Novartis Pharma) intraperitoneally five times a week (40 mg/kg body weight). Control mice received saline intraperitoneally five times a week. The mice were killed by anesthesia, and the mandibular halves dissected. They were stained with hematoxylin and eosin (HE). The expression of IL-6, EGF, FGF and TGF-b mrna in gingival tissue was determined by real-time RT-PCR method. Results : Thickening of the mucous membrane epithelium was determined by HE staining in CsA-induced gingival hyperplasia mice. The IL-6 and EGF mrna levels in CsA-induced gingival hyperplasia mice were significantly higher than in control mice. However, FGF and TGF-b mrna levels in CsA-induced gingival hyperplasia mice were not significantly higher than in control mice

62 Korean Association for Disability and Oral Health 8(1) 2012 Conclusion : These results suggest that EGF and IL-6 play important roles in the pathogenesis of gingival hyperplasia.(236/300words) Key words : gingival hyperplasia, growth factors, cyclosporine A < Poster Presentation 22 > Experimental bacteremia of Porphyromonas gingivalis induces myocarditis in mice and IL-17A is involved in pathogenesis of this disease Hiroaki Ichioka 1,2, YukiAkamatsu 1, MasaruNishigaki 1, FumishigeOseko 1, ToshiroYamamoto 1, NarisatoKanamura 1 1 Department of Dental Medicine, 2 Department of Immunology, Kyoto Prefectural University of Medicine Graduate School of Medical Science Objectives : Although an association between periodontitis and cardiovascular diseases has been suggested, the role of Porphyromonas gingivalis (P.gingivalis) in cardiovascular diseases is not clear. In this study, we examined whether experimental bacteremia of P. gingivalis causes cardiovascular diseases and investigated the mechanism of pathogenesis of cardiovascular diseases induced by P. gingivalis. Materials and Methods : C57BL/6 mice were intravenously inoculated with CFU of P. gingivalis (A7436). Mice were sacrificed at specified days and their hearts were collected. The collected organs were divided into two halves and used for histological evaluation and cytokine analysis. Mice from C57BL/6 background with targeted disruption of TNF-α(TNF-ᾱ /- ), IFN-γ(IFN-γ -/- ), and IL17-A (IL-17A -/- ) were also intravenously inoculated with CFU of P. gingivalis and the histological changes of hearts in mice were examined. Results : Myocarditis was observed in mice injected with P. gingivalis. The levels of IL1-β, IL-6, IL-17A, IL-18, TNFαand IFN-γmRNA increased significantly after P. gingivalis injection. In particular, high levels of IL-17A and IFN-γ mrna expression were observed in hearts of mice after P. gingivalis injection in comparison with these levels before injection. Furthermore, the production of IL-17A was detected in hearts of wild-type mice after P. gingivalis injection. In wild-type, TNF-ᾱ /- and IFN-γ -/- mice, moderate infiltration of neutrophils and monocytes was observed in hearts at 5 days after injection. In contrast, no inflammatory findings were observed in hearts of IL-17A -/- mice. Conclusion : We have demonstrated that an experimental bacteremia of P. gingivalis could induce myocarditis in mice, and IL-17A plays an important role in the pathogenesis of this disease.(260/300words) < Poster Presentation 23 > A Case of Cerebral Palsy with Self-injury of Lower Lip Tomohiko KUBOTA, Megumi KANEMATSU, Miyuki UEHARA, Fujiko UEMURA Wakakusu Ryouikuen, Tosu, Japan Introduction : Self-injury is known as one symptom of autism. Also, self-injury of lip was reported in Lesch-Nyhan syndrome, intellectual disability and others. Cerebral palsy often cause self-injury of tongue and buccal mucosa due to the muscle tonus. We report that a case of the bite wound of lower lip was caused by self-injury in cerebral palsy. Case report : This case was 6-years-old female patient with hypoxic encephalopathy and epilepsy. She was on medica

63 대한장애인치과학회지 8(1) 2012 tion for antiepileptic, minor tranquilizer and antipsychotic. She caused the tetanic spasm seizure of epilepsy and the bite wound of lower lip from 2-years-old. The bite wound was diagnosed that induced by epilepsy seizure. But the bite wound often produced without epilepsy seizure. For this reason, self-injury was added in the cause of bite wound. She was attached a fixed appliance to the mandibular for self-injury in other dental hospital. It had removed before 5months for the deciduous anterior tooth. Clinical Progress : Because patient had the injury of lower lip, she was referred from the pediatrics. Lower lip was deformed by repeated injury. We chose mouthpiece-type alliance as symptomatic treatment. Self-injury was continued, but wound of lip was resolved. Discussion : Methods to prevent of the bite wound include mouthpiece-type appliance, plate-type appliance, botulin-injection therapy, and others. We chose mouthpiece-type appliance for bite rising and guard of lower lip in this case. It was deduced that the cause of lip self-injury in this case combined with 3 factors, side-effect of medications, mental stress and tetanic spasm of epilepsy. And it was thought that the repeated self-injury was caused by mental stress-induced tetanic spasm. Key words : Cerebral palsy, self-injury, lip < Poster Presentation 24 > Study on the Physical Properties of the Gel Type Oral Moisturizer Matsuzaki Y., Kakinoki Y., Endoh M., Sakakibara Y., Kimura T., Kito A., Kubota Y., Kubota J., Ujihara I. Department of Oral Care and Rehabilitation, Kyushu Dental College, Kitakyushu, Japan Introduction : Dry mouth and decrease of saliva flow rate affect not only oral disease but also oral functional and swallowing disorders. Improvement of dry mouth and oral health conditions are important because the association with aspiration pneumonia and dry mouth in elderly people is suggested. In general, oral moisturizers are used for dry mouth of elderly people. However, almost staffs did not understand the characteristic of component. Then, we examined properties of oral moisturizers from the viewpoint of spinnability and viscosity. In this study, we investigated relationship between gel type oral moisturizers and symptom of dry mouth condition or oral function. Methods : We used carboxymethyl cellulose (CMC) which was thickener, as matrix of adjustment with spinnability and viscosity. We changed the concentration of CMC and dissolved it in Kinu-sui (mouth rinsing liquid) and purified water. Next, we measured spinnability and viscosity of them. We added CMC every 1% and final CMC concentration ranged from 1 to 10%. NEVA METER IMI-0501 type was used as spinnability measurement and VISCOMATE VM- 10A type was used as viscosity measurement. Results : As concentration of CMC became high, the spinnability increased in both purified water and Kinu-sui, however the spinnability decreased when the concentration became 5% or more. The viscosity increased in both purified water and Kinu-sui when concentration of CMC became high. Although, we could not measure the viscosity both of Kinu-sui and purified water when over 9% in purified water and over 7% in Kinu-sui. When concentration of CMC was about 6%, the properties of them were similar to commercial oral moisturizers

64 Korean Association for Disability and Oral Health 8(1) 2012 Conclusion : It was seemed that we could give physical properties similar to commercial oral moisturizers with adjusting of CMC concentration. We'd like to develop new effective oral moisturizer for the elderly people with dry mouth. Key words : Cerebral palsy, self-injury, lip < Poster Presentation 25 > Team Approach to Professional Oral Care for Hospitalized Elderly Patients Jumpei Kubota 1, Mami Endoh 1, Emi Nagatomi 2, Takayuki Kimura 1, Yuka Kubota 1, Yasuaki Kakinoki 1, Tetsuo Kubo 3,4, Yutaka Hayasida 2 1 Department of oral care and rehabilitation, Kyushu dental college, Kitakyushu City, Fukuoka, Japan 2 Kitakyushu Chuo Hospital, Kitakyushu City, Fukuoka, Japan 3 Kubo Dental Clinic, Kitakyushu City, Fukuoka, Japan 4 Kokura Dental Association, Kitakyushu City, Fukuoka, Japan Oral health is important for the well-being of elderly people. Especially, hospitalized dependent elderly people need professional oral care to maintain their oral health. Generally, almost staffs of hospitals without dental division are worried about how to perform oral care for them. In Kitakyushu Chuo Hospital, we organized a professional oral care team. This team consisted of medical doctors, a dental hygienist, nurses, speech therapists and dentists. Team members worked for the hospital except dentists. One dentist belonged to dental association and other belonged to Kyushu Dental College located near the hospital. This team provided mouth cleaning and rehabilitation of oral functions. We called the team "Oral rehabilitation team". The dental hygienist of our team performed mouth cleaning, exercises of lips and tongue, articulation therapy and so on for the patients. We made rehabilitation programs with original assessment sheet. The sheet consisted of evaluation of oral functions and physical status. We assessed their status using the sheet once a month and we had a meeting with all team members to grasp patient's condition equally. Almost the subjects were receiving enterall nutrition and difficult to communicate with others. After 1 year since we organized the team, we found some of the subjects could eat, speak and walk. The team approach with dental staffs to professional oral care for hospitalized dependent elderly people seems to be important to improve not only oral functions but also physical status. < Poster Presentation 26 > Does Functional Oral Care Improve Periprandial Plasma Active Ghrelin Dynamics among Dependent Elderly People Receiving Enteral Nutrition? Kimura T, Endoh M, Kubota J, Kakinoki Y Division of Oral Care and Rehabilitation, Department of Control of Physical Functions, Kyushu Dental College In Japan, the number of dependent elderly people has been increasing, and it is thought that among them those receiving enteral nutrition (EN) also have been increasing. Recently, dental staff members have had opportunities to participate in oral care for dependent elderly people, some of whom are receiving EN. Ghrelin is a peptide hormone and has been shown to stimulate growth hormone and increase food intake. Those physiological effects are expected to contribute for the department of gerontology and rehabilitation. Meanwhile, some studies suggested that oral sensation and salivary secretion triggered by functional oral care might affect to ghrelin secretion, however, it remains unclear. The purpose of this study was to investigate the influence of functional oral careon

65 대한장애인치과학회지 8(1) 2012 periprandialplasma active ghrelin dynamics. Six dependent elderly subjects receiving EN were studied (2 men, 4 women, mean age 82.0 years old). We carried out functional oral care for them twice a week for a month. Before and after performing functional oral care, we measured each subjects' plasma active ghrelin levels(3 times in each days; one hour after the end of morning EN, just before midday EN and one hour after the end of midday EN) with an active ghrelin ELISA kit(mitsubishi Chemical Medience, Tokyo, Japan). As a results, the periprandialplasma active ghrelin dynamics showed a flat curve without pulsatile response before performing functional oral care. In contrast, the dynamics showed a periprandial pulsatile curve consisted of preprandial rise and postprandial fall in its levels after performing functional oral care. We concluded thatf unctional oral care for dependent elderly people receiving EN could be seen to improve their periprandial plasma active ghrelin dynamics. < Poster Presentation 27 > A study on the awareness of the dental assistants and receptionists regarding dysphagia rehabilitations before start of the oral health care program for improving oral function Mami Endoh 1,2, Takato Nomoto 2, Junichi Mega 2, Yasuaki Kakinoki 1 1 Department of oral care and rehabilitation, Kyusyu dental college, 2 Department of Special Needs Dentistry, Nihon university school of dentistry at Matsudo Objectives : Some dental association started the oral health care program for improving oral function at We surveyed the awareness of the dental hygienists regarding dysphagia rehabilitation and oral health care program for improving oral function before starting the program. Methods : The subjects were 24 dental assistants and receptionists worked in private dental office which the direction in member of the dental association. The data were collected by distributing questionnaires. The questionnaire items consisted of knowledge, consciousness and attitudes toward dysphagia rehabilitation. The items of knowledge were assessed from questions on mechanisms of eating, risks associated with dysphagia, training methods, food types and cooking methods, anatomy, and diagnostic methods. The consciousness items included interest, expectation, participation, anxiety and dissatisfaction of this program. Results : The subject had lower information than dentist's and dental hygienist's knowledge significantly. In the items concerning this program,84% of the subjects were interested in this program. Seventy one percent of the subjects had consciousness of the expectation and the aggressiveness of participation, but 70% had anxiety about start of the program. Conclusion : The results suggested that the subjects had no enough knowledge, consciousness and attitude regarding dysphagia rehabilitation before starting this program. Cooperation with dentists, dental hygienists and the subjects is important for carring out this program smoothly. Therefore, the subjects should have knowledge and consciousness. These questionnaires were useful methods to contribute to the improvement of this program for oral functions. Key words : dysphagia rehabilitation, training program

66 Korean Association for Disability and Oral Health 8(1) 2012 < Symposium 1 > Older adults, chronic disease and habitual physical activity Hyuntae Park Section for Physical Functioning Activation, Department of Functioning Activation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan Aging is a universal phenomenon that is obvious as well as inevitable. The aging of Japan outweighs all other nations with the highest proportion of elderly citizens, 21% over the age of 65 in According to the Ministry of Health, Labor and Welfare, as many as 1.49 million (47.5%) of the approximately 3.14 million disabled older people who need assistance in Japan have dementia which requires some form of long-term care or assistance. The health and behavioral factors which at an individual level contribute to disability in old age include inappropriately treated diseases, depression, cognitive, sensory and physiological impairment, sedentary lifestyle, unhealthy dietary habits, etc. Conditions of work, standard of living, and availability of health care all contribute to longevity. Recent evidence suggests that the accumulation of deficits across multiple domains may better explain the development of functional limitation than decline in a single domain. In old age, pathology causes impairments (e.g. decreased muscle strength, poor balance, cognitive impairment, low oxygen consumption). Impairments predispose people to functional limitations (e.g. slow walking speed, inability to grasp with hands) which lead to disabilities (e.g. difficulties in mobility and selfcare). Research on disability in old age has identified several factors that contribute to shaping the dimensions and severity of disability. Physical inactivity is associated with an increased risk of various chronic health conditions and functional limitations. However, we lack objective evidence on the type of physical activity needed to avert these health impairments. Even though walking and walking-related activities is the most popular form of exercise among older adults, vigorous weight-bearing exercise is widely reported to have greater beneficial effects on musculoskeletal systems. It appears that high-intensity, large-impact physical activities such as resistance training and weighted-bearing exercise to maximize musculoskeletal and metabolic benefits in adults of all ages; critical factors are the applied acceleration and the number of times the stimulus is applied. However, such vigorous activities are also prone to induce injuries, and are not appropriate for elderly individuals. Therefore, it remains uncertain whether safe but low- to moderate-intensity habitual physical activity has a positive effect on muscular, skeletal, cognitive and motor degeneration in older adults. The possible influences of recreational exercise, leisure-time, occupational, and lifetime physical activity are as yet controversial. Most studies have assessed the individual's pattern of physical activity by questionnaire, asking about the frequency and/or duration of a given type of physical activity during a typical recent week. Unfortunately, such responses are subjective, and they provide only limited estimates of the yearlong volume and intensity of habitual physical activity in older adults, many of whom have difficulties in recall and/or loss of cognition. Due to the development of measuring devices such as the pedometer and accelerometer, we are now able to obtain objective values that can evaluate the quantity of our physical activity. Since walking is the main form of spontaneous

67 대한장애인치과학회지 8(1) 2012 physical activity for older adults, the average daily step count offers one promising objective indication of habitual physical activity. Such data can be collected relatively accurately by the latest designs of pedometer/accelerometer. The duration of activity at a moderate intensity also seems likely to be an important variable, and this can be ascertained by certain types of pedometer/accelerometer. We have thus been conducting a longitudinal interdisciplinary study on physical activity and health of the elderly. Our research aims are to determine what type of physical activity is most effective in promoting health and preventing disease among the elderly (the overall pattern, quality, quantity, and timing of such activity), and important factors determining whether the elderly continue with the necessary physical activity and delay aging (with an emphasis upon personal, social, genetical, and environmental determinants). Our other objectives are to improve interventions by objective and accurate accelerator monitoring of physical activity and electronic evaluation and feedback of information about personal activity based on the criteria noted above. Our cross-sectional data from this project indicate that in older adults many aspects of health (not only physical fitness and body composition, but also development of the metabolic syndrome, atherosclerosis and osteoporosis, overall quality of life depressive symptoms and cognitive function) are associated with both the quality of the habitual physical activity that is undertaken (as measured by the daily duration of effort at an intensity >3 metabolic equivalents, METs) and its quantity (as measured by the daily step count). In elderly men, better health seems associated more closely with the daily duration of moderate exercise, whereas in elderly women the closest association is with the daily step count. In both sexes, the threshold dose of physical activity associated with better health depends on whether physical or mental components are considered: >8000 vs. >4000 steps/day and/or >20 vs. >5 min/day at an intensity >3 METs, respectively; in other words, at a pace of 5 km/h, physical health requires a total of at least 20 minutes of moderate and a further minutes of light activity per day, whereas mental health is improved by even the smallest amount of deliberate physical activity. Both components of habitual physical activity are influenced by meteorological factors, particularly mean ambient temperature and precipitation. The daily step count peaks at a mean outdoor temperature of around 17 ; above and especially below this temperature, physical activity decreases quadratically. Activity also decreases exponentially to approximately 4000 steps/day as precipitation increases. The associations between the dose of physical activity and health outcomes are strongly suggestive, but a longitudinal analysis is needed to make a causal interpretation of the present preliminary findings and to elucidate further possible mediating variables

68 Korean Association for Disability and Oral Health 8(1) 2012 < Symposium 2 > Some Certain Considerations in Treating the Disabled Elderly - View point from oral care and Management of Dry mouth - Yasuaki Kakinoki Professor, Department of Oral Care and Rehabilitation Kyushu Dental College, Kitakyushu-city, Japan These days, because the elderly retain more real teeth and have difficulty accessing care, they experience more dental disease. In turn, this dental disease can lead to cardiovascular disease, diabetes and oral cancer and poor oral condition may often be home to respiratory pathogens responsible for hospital-acquired pneumonia (HAP). Persons with certain disabilities don't have the hand function or ability to clean their teeth and they are among the populations most affected by poor oral care, we have to understand that better dental treatment and oral care are needed for them. Most of elderly persons take many medicines, which often cause hayposalivation or dry mouth conditions. Xerostomia, or dry mouth, is an influential factor in caries formation, periodontal disease, fungal infections, masticatory dysfunctions, and impaired dentures, as well as other oral conditions, especially in bedridden elderly and disabled patients, who often suffer from the condition. Further, oral dryness is considered to be related to the reduction of resting and/or stimulated saliva levels. Many studies of xerostomia and dry mouth in the elderly have been conducted, and the results suggest that many elderly persons who suffer from those conditions do so because of the side effects of medicine or a decreased amount of water intake. Most methods for determining the degree of wetness use stimulation of oral and masticatory functions with such stimulators as gum or Saxon, which are useful for elucidating the flow rate of stimulated saliva, however, not for oral wetness conditions controlled by resting saliva. Therefore, those methods are not effective for elderly or disabled persons, who have difficulties with basic oral functions, and can't indicate the actual condition of mouth drying. As a result, we considered it important to develop an objective method of evaluating the wetness of the oral mucous membrane, and developed. a new wetness tester made from a scale membrane filter strip, for use as a diagnostic tool to measure oral mucosal moisture. We explained the points for the diagnosis of dry mouth in the elderly and the Disabled as follows: sense of dry mouth, clinical standard of dry mouth, wetness tester (KISO-Wet) and Moisture Checker. Oral wetness and saliva conditions should be the first consideration in dental treatment and oral care for dry mouth conditions in the elderly and disabled. These examinations are easy and useful to justify condition of dry mouth. Better oral health care and management of dry mouth are useful for the quality of life (QOL) of the elderly persons. Key words : Oral Care, Elderly, Dry mouth, Dental Treatment, Disabled Patients

69 대한장애인치과학회지 8(1) 년 4월 9일 ( 월 ) / 치과신문 장애인진료센터확대해야 장애인치과학회, 복지부에연구결과보고대한장애인치과학회 ( 회장나성식 ) 가보건복지부 ( 장관임채민 ) 연구용역사업이었던 장애인구강보건정책개발에관한연구 결과를발표했다. 연구는비장애인에비해취약한장애인들의구강건강증진을위한정책방안모색과실질적인사업개발도모를목적으로이뤄졌다. 장애인구강보건사업의현황에대해서는사업의기획과성공적시행을위해인력양성을위한다양한교육프로그램개발이필요할것이라고제언했으며, 장애인구강진료센터의확대 활성화를위한운영비재원분담비율조정안도제시했다. 장애인구강진료센터의경우각시도별최소 1개씩권역별진료센터를설치해수도권에편중되는것을막고진료비용을낮춰야한다는점도강조됐다. 장애인치과학회나성식회장은 가장중요한것은치과의사들의인식개선 이라며 장애인진료에대한막연한두려움과거부감을없애기위해학회차원에서도꾸준히노력할것 이라고전했다. 홍혜미기자 (hhm@sda.or.kr) 2012년 4월 9일 ( 월 ) / 치과신문고령장애인구강보건탐구장애인치과학회, 오는 21일춘계학술대회대한장애인치과학회 ( 회장나성식 ) 가오는 21일서울대학교치과병원 8층강당에서춘계학술대회및제9차정기총회를개최한다. 올해의슬로건은 기부와나눔은우리의힘. 두세션으로나뉘어진행되는학술대회는경제적어려움과사회의부정적인식, 장애로인해심신의고통을겪는 고령장애인 에초점을맞췄다. 나성식회장은 1차소화기관인구강의건강이미진한고령장애인은전신질환을앓게될가능성이높다 며 섭식장애나연하장애등고령장애인의구강질환을폭넓게다루는것을물론적극족인연구를바탕으로장애인구강보건을선도하는일본의선진사례를공유하는시간도마련했다 고설명했다. 오전에는김광철 황지영선생 ( 서울시장애인치과병원 ) 의포스터발표에이어최충호교수 ( 전남치대 ) 가 장애인구강보건정책개발 에대한장애인치과학회의최근연구결과를발표한다. 오후심포지엄에서는 Older adults, chronic disease and habitual physical activity Some Certain Considerations in Treating the Disabled Elderly - View point from Oral care and Management of Dry mouth Oral health management of elderly people with disabilities at home 등을주제로국내외연자들이지견을펼친다. 사전등록은 17일까지 문의 : 홍혜미기자 (hhm@sda.or.kr) 2012년 4월 9일 ( 월 ) / 건치신문장애인치과학회, 21일춘계학술대회 기부와나눔은우리의힘 대주제로구연발표및국제심포지움 사전등록기간 17일까지대한장애인치과학회 ( 회장나성식이하학회 ) 가오는 21 일서울대학교치과병원 8층강당에서춘계학술대회및 9차정기총회를개최한다. 가부와나눔은우리의힘 이라는슬로건아래개최되는이번학술대회에서는 1부구연발표와 2부국제심포지움으로나뉘어진행된다. 먼저 1부구연발표에서는 Study program participation report on Special needs dentistry in Japan 과 Report of research project:development of oral health policy on the disavbled 를주제로한포스터발표가진행된다. 이어 2부심포지움에서는 Older adults, chronic dis

70 Korean Association for Disability and Oral Health 8(1) 2012 ease and habitual physical activity Some Certain Considerations in Treating the Disabled Elderly-View point from Oral care and Management of Dry mouth Oral health management of elderly people with disabilities at home을주제로한연자발표가있을예정이다. 나성식회장은 장애인들의치아건강을지키기위한정책과학술의발전, 그리고장애인을바로알기위한장을마련했다 면서 함께토론하면서장애인에대한생각을새롭게하는기회가될수있도록이번학술대회에치과의료인모두를초대한다 고소감을밝혔다. 학회가주최하고재단법인스마일이후원하는이번학술대회사전등록기간은 17일까지이며, 접수문의는전화 ( ) 로하면된다. 윤은미기자 2012년 4월 12일 / 치학신문 기부와나눔은우리의힘 장애인치과학회, 21일총회대한장애인치과학회 ( 회장 : 나성식 ) 가 2012년춘계학술대회및제 9차정기총회를개최한다. 오는 21일서울대학교치과병원 8층강당에서있을이번춘계학술대회는 기부와나눔은우리의힘 이라는캐츠프레이즈아래장애인과나눔에대해참석자와함께그의미를생각해보는시간을가질예정이다. 특히이번학술대회는일본장애자치과학회와학술교류사업의일환으로일본학계인사들을비롯하여전국치과대학교수등약 150여명이참석할것으로보인다. 이날첫번째구연발표에는전남대학교최충호교수가장애인구강보건정책연구보고서를발표할예정이며, 이어경희대김광철교수및서울시장애인치과병원황지영치과의사의일본MOU와연수기발표가진행될예정이다. 이어자유연제포스터발표에서는한국과일본연자모두포함하여다양한주제로약 30개가량의포스터발표가진행된다. 마지막으로 고령장애인의구강건강 이라는주제로진행되는국제심포지엄에는일본국립장수연구센터의박현태박사와 Japanese Society for Disability and Oral Health 부회장 Yasuaki Kakinoki, 원광대학교남용옥교수가연자로나선다. 본학술대회참가자에게는대한치과의사협회보수교육점수 4점, 대한치과위생사협회보수교육점수 2점이부여된다. 2012년 4월 23일 / 치의신보 장애인과나눔 의미공유대한장애인치과학회춘계학술대회 정기총회 (21일) 대한장애인치과학회 ( 회장나성식 ) 가 (16일현재 ) 오는 21일서울대치과병원 8층강당에서 2012 춘계학술대회및제9차정기총회 를개최한다. 기부와나눔은우리의힘 을개치프레이즈로열리는이번학술대회에서는치과의사와치과위생사가하나가돼 장애인과나눔 에대한뜻을공유하는기회가될것으로기대된다. 특히이번학술대회는일본장애자치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술교류사업의일환으로일본학계인사들을비롯해전국치과대학교수등약 150여명이참석할것으로보인다. 이날첫번째세션으로진행되는구연발표에서는최충호전남대치전원교수가장애인구강보건정책연구보고서를발표할예정이며, 이어김광철경희대치전원교수및황지영서울시장애인치과병원치과의사가일본 MOU 및연수기를발표할예정이다. 이어자유연제포스터발표에서는한국과일본연자가다양한주제로약 30개가량의포스터를발표한다. 두번째세션으로진행되는국제심포지엄에서는 고령장애인의구강건강 (Oral Health for Elderly Disability) 이라는주제로세명의연자가나선다. 일본국립장수연구센터의박현태박사가 Older Adults, Chronic Disease and Habitual Physical Acticity 를주제로, Yasuaki Kakinoki 부회장 (Japanese Society for Disability and Oral Health) 이 Some Certain Considerations in Treating the Disabled Elderly - View point from Oral care and Management of Dry mouth 를주제로, 남용옥원광대교수가 Oral health management of elderly people with disabilities at home 을주제로발표한다. 이번학술대회는치협보수교육점수 4점, 치위협보수교육점수2점이부여된다. 나성식회장은 이번학술대회를통해 장애인과나눔 에대해참석자와함께그의미를생각해보는시간을가질것 이라며 장애인진료에관심을갖고많은관계자들이참석하기를바란다 고말했다. 문의 : ( 이호은 ) 안정미기자 jmahn@kda.or.kr

71 대한장애인치과학회지 8(1) 년 04 월 24 일 ( 화 ) / 건치신문 2012 년 4 월 26 일 ( 목 ) / 치학신보 장애인구강건강향상위한 정책 학술총망라 장애인구강보건정책연구보고관심 장애인치과학회, 21일학술대회서장애인이해의장마련 고령장애인구강건강 에관한국제심포지엄도.. 대한장애인치과학회 ( 회장나성식이하학회 ) 가지난 21 일서울대학교치과병원 8층대강당에서춘계학술대회및제9차정기총회를개최해성료했다. 일본장애인치과학회와학술교류사업의일환으로진행된이번학술대회에는 기부와나눔은우리의힘 이라는슬로건아래일본학계인사 30여명을비롯한전국치과대학교수및개원의, 치과위생사등약 220명이참석해성황을이뤘다. 나성식회장은 장애인들의치아와악안면주위의건강을지키기위한정책과학술의발전그리고장애인을바로알기위한장을마련했다 며 오늘학술대회를통해함께생각하고토론하면서장애인에대한생각을새롭게하는기회가되길바란다 고소감을밝혔다. 먼저나성식회장이좌장을맡은구연발표에서는전남대최충호교수가장애인구강보건정책연구보고를발표했으며, 경희대김광철교수와서울시장애인치과병원황지영선생이일본장애자치과학회와의 MOU 및연수보고에나섰다. 이어진행된자유연제포스터발표에서는총 28개의주제에관한포스터가게시됐으며, 한 일연자들이직접발표에나서눈길을끌었다. 특히이번학술대회의하이라이트로마련된국제심포지엄에서는 고령장애인의구강건강 이라는대주제아래일본국립장수연구센터박현태박사와 Japanese Society for Disability and Oral Health Yasuaki Kakinoki 부회장, 원광보건대남용옥교수가연자로참석해고령장애인에대한이해를높이고, 치과치료및구강질환예방, 관리등의필요성에대한심층적인토론을진행해주목을받았다. 아울러학회는학술대회를마친후제9차정기총회를개최하고, 2011년사업및결산보고와감사보고를진행, 2012년예산안을심의 통과시켰다. 한편, 학회는장애인의구강건강에특별한관심을갖고진료와연구에매진하고있는치과인및후원의료인, 유관단체인들을중심으로 2004년 11월 27일창립됐으며, 지난 2008년 3월 18일대한치과의사협회의정식분과학회로인준된바있다. 윤은미기자 (yem@gunchinews.com) 장애인치과학회, 학술대회성료 대한장애인치과학회 ( 회장나성식 ) 가지난 21일서울치대병원에서올해춘계학술대회및제 9차정기총회를가졌다. 이날진행된학술대회는일본장애자치과학회 (JADH) 와학술교류사업의일환으로일본학계인사 30여명을비롯하여전국치과대학교수및개원치과의사, 치과위생사등약 220여명이참석한가운데성황리에진행되었다. 먼저나성식회장이좌장을맡아진행된구연발표는장애인구강보건청책연구보고 ( 전남대학교최충호교수 ) 와일본장애자치과학회와의 MOU 및연수보고 ( 경희대김광철교수및서울시장애인치과병원황지영치과의사 ) 가진행되었다. 이어서진행된자유연제포스터발표에서는한국과일본연자모두포함하여다양한주제로 28개포스터발표가진행되었다. 이어 2부순서에서는김선미교수 ( 전남대학교교수 ) 가좌장을맡은가운데 고령장애인의구강건강 이라는주제로국제심포지엄이진행되었다. 이날심포지엄연자로나선일본국립장수연구센터의박현태박사와 Japanese Society for Disability and Oral Health 부회장 Yasuaki Kakinoki, 원광보건대학교남용옥교수가연자로나서고령장애인에대한이해를높이고, 고령장애인의치과치료및구강질환예방, 관리등의필요성에대해심층적인토론을이끌어내었다 년 4 월 30 일 / 세미나리뷰 대한장애인치과학회, 학술대회통해인식개선위한도약 작지만알찬학회로면모갖출것 대한장애인치고학회 ( 회장나성식 ) 가지난 21 일서울대학

72 Korean Association for Disability and Oral Health 8(1) 2012 교치과병원 8층강단에서 2012년춘계학술대회및제9 차정기총회 를개최했다. 기부와나눔은우리의힘 이라는테마로진행된이번춘계학술대회는일본장애자치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술료규사업의일환으로일본학계인사 30여명을비롯해전국치과대학교수및개원치과의사, 치과위생사등약 220여명이참석해성황리에마쳤다. 1부로진행된 Oral Presentation에서는나성식회장이좌장을맡아최충호 ( 전남대학교 ) 교수가 장애인구강보건정책연구보고 를실시했다. 또한김광철 ( 경희대학교 ) 교수와황지영 ( 서울시장애인치과병원 ) 치과의사는 일본장애자치과학회와의 MOU 및연수보고 를진행했다. 이어진행된 2부 Poster Presentation에서는한국과일본연자모두포함하여다양한주제로 28개의포스터를발표해호응을얻었다. 3부국제심포지움에서는김선미 ( 전남대학교 ) 교수가좌장을맡아 고령장애인의구강건강 이라는주제로진행됐다. 연자로는박현태 ( 일본국립장수연구센터 ) 박사와 Yasuaki Kakinoki(Japanese Society for Disability and Oral Health) 부회장, 남용옥 ( 원광보건대학교 ) 교수가나서고령장애인에대한이해를높이고고령장애인의치과치료및구강질환예방, 관리등의필요성에대해심층적인토론이이뤄졌다. 마지막 4부에서는우수발표시상에서국내외한명씩선정돼수상의영예를안았다. 이어진제 9차정기총회에서는 2011년사업및결산보고가됐으며, 김우성감사의감사보고가진행됐다. 아울러 2012년예산안도통과됐다. 정기총회를마친후나성식회장은 궂은날씨에시간도많이지체됐음에도끝까지자리를지켜준회원들에게감사하다 는인사말을시작으로 앞으로학회의신식개선을위해노력할것이며이것이임원들의중심으로이뤄지길바란다 고말했다. 또한그는 작지만알찬학회를위해노력하겠다. 무엇보다조금씩발전해나가는모습으로인식개선을향한발판을삼겠다. 며 우리가열심히하면반드시열매를맺을수잇을것 이라고전했다. 김수식기자 (j.kim@sseminar.net) 2012년 4월 30일 ( 월 ) / 치과신문장애인구강건강, 사회적관심필요장애인치과학회지난 21일학술대회... 일본과학술교류대한장애인치과학회 ( 회장나성식 ) 가지난 21일춘계학술대회를열고장애인의구강건강에대한사회적관심과지원을당부했다. 220여명이몰려성황을이룬춘계학술대회는구연발표, 포스터발표, 국제심포지엄및종합토론의순으로진행됐다. 최충호교수 ( 전남대치전원 ) 는 장애인구강보건정책개발 연구결과발표에서정부차원의적극적인실태조사를바탕으로구강진료센터의활성화와제도개선이필요하다는점을강조했다. 황지영선생 ( 서울시장애인치과병원 ) 은대한장애인치과학회와일본장애자치과학회간교류의일환인 Action Plan 의참가경험을소개하며일본의경우처럼치대 치전원에서장애인치과학을정규수업과정으로편성해섭식 연하장애등장애인의구강질환에대한이해를높일것을제안했다. 한국과일본, 양국연자들의지견을펼친총 28개의자유연제포스터발표도인기가높았다. 고령장애인의구강건강 이라는주제로진행된국제심포지엄및토론에서는일본국립장수연구센터의박현태박사를비롯한다수연자와패널들이고령장애인의치과치료및구강질환예방관리의필요성에공감했다. 나성식회장은 일본장애자치과학회와의학술교류에힘입어장애인구강건강에대한다양한지식과경험을나눌수있게돼기쁘다 며 이번학수대회주제처럼 기부와나눔은우리의힘 이라는사회적분위기가조성되길바란다 고전했다. 홍혜미기자 (hhm@sda.or.kr) 2012년 5월 3일 ( 목 ) / 치의신보장애인진료 사회나눔 한마음 대한장애인치과학회 ( 회장나성식 ) 가 2012년춘계학술대회및제9차정기총회를성황리에마무리했다. 학회는지난달 21일서울대치과병원 8층강당에서일본장애자치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술교류사업의일환으로학술대회를열었다. 이날학술대회에는일본학계인사 30여명을비롯해전국치과대학교수및개원치과의사, 치과위생사등약 220여명이참석했다. 구연발표에서는 장애인구강보건정책연구보고 ( 최충호

73 대한장애인치과학회지 8(1) 2012 전남대치전원교수 ) 와 일본장애자치과학회의 MOU 및연수보고 ( 김광철경희대치전원교수및서울시장애인치과병원황지영치과의사 ) 가진행됐다. 이어열린자유연제포스터발표에서는한국과일본연자가다양한주제로 28개의포스터를발표했다. 이날학술대회에서는국제심포지엄도함께개최됐다. 고령장애인의구강건강 이라는주제로열린국제심포지엄에서박현태박사 ( 일본국립장수연구센터 ) 가 Oder Adults, Chronic Disease and Habitual Physical Actibity 를주제로, Yasuaki Kakinoki 부회장 (Japanese Society for Disability and Oral Heath) 이 Some Certain Considerations in Treating the Disabled Elderly 를주제로, 남용옥원광보건대교수가 Oral Health Management of Disabled at home 을주제로발표했다. 심포지엄에서는고령장애인에대한이해를높이고, 고령장애인의치과치료및구강질환의예방 관리등의필요성에대해심층적인토론을이끌어냈다. 학술대회후에열린제9차정기총회에서는 2011년사업및결산보고및감사보고가진행됐으며, 2012년예산안도통과됐다. 나성식회장은 이번학술대회는 기부와나눔은우리의힘 이라는캐치프레이즈로열려치과의사와치과위생사가하나가돼 장애인과나눔 에대한뜻을공유하는기회가됐다 며 치과의사들이좀더장애인진료에관심을갖고사회의나눔에앞장서나가기를바란다 고말했다. 안정미기자 (jmahn@kda.or.kr) 국제심포지엄이이어졌다. 이날심포지엄연자로나선일본국립장수연구센터의박현태박사와 Japanese Society for Disability and Oral Health 부회장 Yasuaki Kakinoki, 원광보건대학교남용옥교수는고령장애인에대한이해를높이고, 고령장애인의치과치료, 구강질환예방, 관리등의필요성에대해심층적인토론을이끌어냈다. 나성식회장은 다음학술대회에서는장애인환자의보호자도참여할수있도록준비하는등장애인구강건강관련정보를공유할수있는창구를확대해나갈예정 이라고밝혔다. 박준응기자 (pje@dentalfocus.co.kr) 2012 년 5 월 7 일 ( 월 ) / 덴탈포커스 2012 년 5 월 7 일 ( 월 ) / 덴탈아리랑 기부와나눔은우리의힘 고령장애인구강건강 OK 장애인치과학회, 춘계학술대회열어 장애인치과학회, 춘계학술대회열어 대한장애인치과학회 ( 회장나성식 ) 가지난달 21일춘계학술대회와제9차정기총회를개최했다. 이번춘계학술대회는일본장애인치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술교류사업의일환으로이뤄졌다. 이날행사에는일본학계인사 30여명을비롯해 220여명이참석해, 치과계가기부와나눔에결코인색하지않다는것을보여주었다. 구연발표에서는먼저최충호교수 ( 전남치대 ) 의 장애인구강보건정책연구보고 에대한발표가있었다. 또김광철교수 ( 경희치대 ) 의일본장애자치과학회와의 MOU 관련보고와황지영선생 ( 서울장애인치과병원 ) 의실제연수결과를바탕으로연수프로그램의진행에대한보고가이어졌다. 이날학술대회에서는 고령장애인의구강건강 을주제로 대한장애인치과학회 ( 회장나성식 ) 가지난달 21일 2012 년춘계학술대회및제 9차정기총회 를서울대치과병원 8 층대강당에서개최했다. 이번학술대회는일본장애자치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술교류사업의일환으로일본학계인사 30여명을비롯하여전국치과대학교수및개원치과의사, 치과위생사등약 220여명이참석한가운데성황리에진행됐다. 나성식회장이좌장을맡아진행된구연발표에서는최충호 ( 전남대치전원 ) 교수가 장애인구강보건정채연구보고 를, 김광철 ( 동서신의학병원소아치과 ) 교수와황지영 ( 서울시장애인치과병원 ) 교수가 일본장애자치과학회와의 MOU 및연수보고 를진행했다

74 Korean Association for Disability and Oral Health 8(1) 2012 이어진행된자유연제포스터발표에서는한국과일본연자모두포함해다양한주제로 28개의포스터발표가진행돼큰관심을얻었다. 2부에서는김선미 ( 전남대치과병원 ) 교수가좌장을맡은가운데 고령장애인의구강건강 이라는주제로국제심포지엄이진행되었다. 이날심포지엄연자로나선박현태 ( 일본국립장수연구센터 ) 교수와 Japanese Society for Disability and Oral Health 부회장 Yasuaki Kakinoki, 남용옥 ( 원광보건대학교치위생학과 ) 교수가연자로나서고령장애인의치과치료및구강질환예방관리등의필요성에대해체계적이고심도있게짚어줘참가자들의심층적인토론을이끌어내었다. 학술대회이후에는제 9차정기총회가진행됐다. 한편장애인치과학회는지난 2004년 11월 27일창립돼지난 2008년 3월 18일대한치과의사협회인준학회로승인받았다. 정동훈기자 2012년 5월 10일 / 덴탈타임스 이어서 2부순서에서는김선미교수 ( 전남대학교교수 ) 가좌장을맡은가운데 고령장애인의구강건강 이라는주제로국제심포지엄이진행되었다. 이날심포지엄연자로나선일본국립장수연구센터의박현태박사와 Japanese Society for Disability and Oral Health 부회장 Yasuaki Kakinoki, 원광보건대학교남용옥교수가연자로나서고령장애인에대한이해를높이고, 고령장애인의치과치료및구강질환예방, 관리등의필요성에대해심층적인토론을이끌어내었다. 마지막으로진행된대한장애인치과학회의제 9차정기총회에서는 2011년사업및결산보고가되었으며, 김우성감사의감사보고가진행되었다. 아울러 2012년예산안도통과되었다. 한편대한장애인치과학회는장애인의구강건강에특별한관심을가지고진료와연구에열성을다하는치과인및장애인에관심과후원을보내주는의료인, 유관단체인들이모여 2004년 11월 27일창립된학회로지난 2008년 3월 18일대한치과의사협회의분과학회로인준된바있다. 장애인구강건강위한정책 학술 장애인치과학회, 정기총회개최 대한장애인치과학회 ( 회장 : 나성식 ) 가 2012년춘계학술대회및제9차정기총회를개최하였다. 지난달 21일 ( 토 ) 서울대학교치과병원 8층강당에서진행된이번춘계학술대회에는일본장애자치과학회 (JADH: Japanese Association for Disability and Oral Health) 와학술료류사업의일환으로일본학계인사 30여명을비롯하여전국치과대학교수및개원치과의사, 치과위생사등약 220여명이참석한가운데성황리에진행되었다. 먼저나성식회장이좌장을맡아진행된구연발표는장애인구강보건정책연구보고 ( 전남대학교최충호교수 ) 와일본장애자치과학회와의 MOU 및연수보고 ( 경희대김광철교수및서울시장애인치과병원황지영치과의사 ) 가진행되었다. 이어서진행된자유연제포스터발표에서는한국과일본연자모두포함하여다양한주제로 28개의포스터발표가진행되었다