12(2) fm

Journal of Dental Hygiene Science Vol. 12, No. 2, pp. 171~179 (2012) 전타액분비율과구강건조증의관련요인분석 박은선 최준선 1 가천대학교보건대학원, 1 가천대학교치위생학과 The Associated Factors with Whole Saliva Flow Rate and Xerostomia Eun-Seon Park and Jun-Seon Choi 1 Graduate School of Public Health, Gachon University, Incheon 406-799, Korea 1 Dept. of Dental Hygiene, College of Medical Science, Gachon University, Incheon 406-799, Korea Abstract The aim of this study was to analyze the factors related to whole saliva flow and the xerostomia for the ground use of the materials in developing oral health improvement program and life quality improvement program. So, this study performed a questionnaire survey, targeting at 160 adults, older than 40 years, living in Gyeonggi and Incheon provinces from January to February 2011 and measured unstimulated salivary flow rate and stimulated salivary flow rate. The results are as followings. The group of participants who took gums and candies to relieve oral dryness had low stimulated whole saliva flow. The group of participants who graduated from middle schools, who separated by death, who were not healthy with menopause, and who recognized periodontal disease symptoms and tongue burning sensation recognized more symptoms of dry mouth than others. In addition, the group of participants who were not satisfied with life so much, who couldn t feel the meaning of life, and who recognized negative feelings frequently recognized symptoms of dry mouth more. Women, the group of participants who graduated from middle schools, who suffered from depressive symptoms, and who recognized halitosis had low unstimulated whole saliva flow. The group of participants who graduated from middle schools, who were not satisfied with life so much, who couldn t feel the meaning of life, and who were not satisfied with themselves had low stimulated saliva flow. Key words Quality of life, Whole saliva, Xerostomia 서 론 타액은구강점막과치아표면에얇은막을형성하여각종자극으로부터조직을보호하고, 치아의재석회화를돕는다. 또한자정작용과항균작용뿐만아니라음식물의연하와소화작용을돕고미각과발음기능의유지에도중요한역할을한다. 최근노년층에서뿐아니라중년층에서도구강건조를호소하는사람들이증가하고있는데, 이러한구강건조증은개인의정서적인안녕 (well-being) 과삶의질에부정적역할을한다 1). 구강건조증 (xerostomia) 은구강건조에대한환자의주관적인느낌을말하는것으로, 정상보다타액이적게분비되는타액분비부전증 (hyposalivation) 과는구별된다 2). 최근에환자의경험을바 Corresponding author Tel: 032-820-4374 Fax: 032-820-4374 E-mail: junseon@gachon.ac.kr Citation: 박은선, 최준선 : 전타액분비율과구강건조증의관련요인분석. 치위생과학회지 12(2): 171-179, 2012. ISSN: 1598-4478(Print), 2233-7679(Online) 탕으로한주관적건강평가의중요성이부각되면서구강건조에대한환자의인식이상대적으로중시되고있다. 구강건조증을진단하기위하여 당신은평소낮시간에입안이건조하다고느끼십니까? 등의주관적경험이중심이되기도하고, 주관적인경험과함께객관적인평가방법인타액분비율을측정하기도한다 3). 타액분비가감소되어구강건조증이나타나지만구강건조증과타액분비율과의연관성은아직까지논란의여지가많다. 타액분비가정상보다 50% 이상감소하였을때구강건조증이나타나기도하고 4), 타액분비율이정상임에도불구하고구강건조증을호소하는경우도있기때문이다 5-6). 정상인의비자극성전타액분비율은 0.25-0.35 ml/min 이고, 자극성전타액분비율은 1.0-3.0 ml/min 이다 7). 또한타액분비율이낮다고고려되는범위는비자극성전타액분비율은 0.10-0.25 ml/min, 자극성전타액분비율이 0.70-1.00 ml/min 이며, 비자극성전타액분비율과자극성전타액분비율이각각 0.1 ml/min, 0.7 ml/min 미만인경우타액분비부전증으로진단한다 7). 타액분비율이나구강건조증은성별, 연령및약물복용 171

172 The Associated Factors with Whole Saliva Flow Rate and Xerostomia 상태와연관성이높다. 이들은단순한노화현상의결과로나타나기보다는이환된질환이나약물복용상태에따라정도가다르게나타난다 8). 일반적으로약물복용은남성보다여성에서많은데, 이러한약물복용의차이로인해여성집단에서구강건조증의유병률이높게나타난다 3). 또한연령이증가하더라도약을복용하지않는건강한사람에서는타액분비율이감소되지않으나 3), 복용약물의수가증가할수록구강건조증에대한인식도가높아진다 4). 구강건조증이나타액분비율에영향을미치는요인으로는약물복용이나스트레스, 전신질환, 얼굴이나목부위의방사선조사및쇼그렌증후군등이있으며 9), 대표적인구강건조유발약물은항고혈압제와이뇨제, 항우울제, 항콜린성제제, 항히스타민제등이있다 10). 또한구강건조증을인식한자는작열감이나구강내통증을호소하기도하고, 치아우식증이나치주염의이환율이더욱증가하여구강건강상태가악화되기도하며 11), 눈이나피부등다른기관의건조가동반되기도한다 12). 이외에도음식의저작과연하에불편감을유발하고, 미각장애와발음곤란등다양한생활장애가나타난다 13). 특히젊은성인에서발생한구강건조증은삶의만족도에부정적인영향이더욱크게나타나기때문에 14) 조기부터이를예방하거나완화하기위한교육과치료가진행되어야한다. 이처럼구강건조증이나타액분비의저하는구강건강을유지하는데방해요인이될뿐만아니라개인의삶의질을저하시키는요인이다. 이제까지보고된선행연구의 대부분은연구대상이주로노인층에머물러있어연구대상의확대가필요하고, 다각적인관점에서이들과의관련요인을밝힐필요가있다. 따라서본연구에서는 40 세이상성인을대상으로구강건조증과비자극성, 자극성전타액분비율과의관련요인을분석함으로써구강건강향상및삶의질향상프로그램을개발하는데기초자료로활용하고자한다. 연구대상및방법 1. 연구대상본연구는편의표본추출법을적용하여 2011 년 1 월 14 일부터 2 월 22 일까지경기 인천지역에거주하는만 40 세이상의성인을연구대상으로선정하였다. 연구대상자에게연구목적과방법에관하여충분히설명을한후동의를받은자에한하여설문조사를실시하고, 비자극성타액과자극성타액을채취하였다. 총 172 명중에서설문지에결측치가있는등신뢰성이의심되는 12 명의설문지를제외한 160 명 (93.0%) 의자료를최종분석에사용하였다. 2. 연구도구 1) 설문지구성설문지는연구대상자의일반적특성, 전신건강인식도와구강건강인식도, 구강건강과관련된삶의질, 일반적인삶의질로구성하였다. 총 58 문항이며사용된변수에대한 Table 1. Questionnaire contents Contents Sociodemographic Gender Male, female Age Years, open type Occupation No job, manager, administrator, professional, technical, services, farming stock breeding fisheries, self-employed, housewife, others Education Uneducated, elementary school, middle school, high school, university, graduate school Marital status Married, widowed, single Living arrangement Alone, together Income Monthly household average income, open type Self-reported health General self reported health status Very poor(0), poor(1), good(2), very good(3) No. of chronic disease No(0), yes(1) Take medication Not taken(0), taken(1) Nonoral dry symptoms No(0), yes(1) Sleeping satisfaction Unsatisfaction(0), moderate(1), satisfaction(2) Menstrual status No(menopause), yes(irregular), yes(regular) Depressive symptoms(5 questions) Higher score represent worse depressive symptoms Self-reported Xerostomia(8 questions) No(0), yes(1) oral health Periodontal status(8 questions) No(0), yes(1) Mucosa status(5 questions) No(0), yes(1) Quality of life General quality of life(5 questions) Higher score represent better quality of life Oral health related quality of life (14 questions) Higher score represent poorer oral health-related quality of life

Journal of Dental Hygiene Science Vol. 12, No. 2, pp. 171~179 (2012) 173 세부내용은 Table 1 과같다. 우울증증상은 Beck 등 15) 의 Beck Depression Inventory(BDI) 척도중정신과전문의 1 인의자문으로우울감의정도를가장포괄적으로평가할수있는 5 문항을이용하였다. 자가인지한구강건강상태중치주상태는 Ng 와 Leung 16) 의연구에서사용된도구 8 문항을이용하였고, 구강점막상태는 Busato 등 17) 의연구에서사용된문항을이용하였다. 구강건조증은 Fox 등 5) 이개발한 8 문항을이용하였으며, 2 개범주로나누어 예 와 아니오 로측정하였다. 마지막으로삶의질을측정하기위하여 Slade 18) 에의해개발된구강건강관련삶의질척도인 Oral Health Impact Profile 14 문항 ( 이하 OHIP-14) 과 WHO 에의해개발된일반적삶의질척도인 WHOQOL 19) 의 2 가지를이용하였다. OHIP-14 는본연구목적에맞게수정하여적용하였으며, 일반적인삶의질의평가는가장포괄적으로삶의질을평가할수있는 5 문항을이용하였다. 2) 자극성, 비자극성전타액분비율측정전타액분비량은타액의거품으로인해정확한눈금을측정하기가어려워 0.01 mg 부터측정가능한초정밀전자저울을이용하여무게로측정하였다. 5 분동안채취한총타액의무게에서종이컵의중량을제외한후분당전타액분비율 (mg/min) 로환산하였다. 타액채취는오전 11 시부터오후 6 시사이에시행하였고, 자극성타액은비자극성타액을채취한후실시하였다. 타액채취 1 시간전부터음식물섭취와껌저작, 잇솔질및흡연을하지않도록교육하였다. 가철성의치를장착한자는의치를착용한상태로타액을채취하는것을허용하였고, 타액채취 5 분전에는편안한상태에서말없이휴식을취하도록하였으며, 타액채취직전에구강내의타액을모두삼키도록하였다. 타액채취는입안에타액이자연스럽게고이면분당 1-2 회씩뱉도록하는 spitting 법을이용하였고, 채취시간이종료되면구강내남아있는타액을종이컵에모두뱉도록하였다. 자극성타액채취시자극원으로는 1.0 g 의무향, 무맛의 paraffin wax 를이용하였고, 평상시저작속도로저작하면서비자극성타액채취와동일한방법으로시행하였다. 3. 분석방법수집된자료는 SPSS/WIN 12.0 프로그램을이용하여분석하였다. 구강건조증의인식도와전타액분비율과의연관성을분석하기위하여 t 검정을실시하였으며, 연구대상자의인구 사회학적특성, 전신건강및구강건강인식도, 삶의질에따라구강건조증의인식도와전타액분비율의차이를비교하기위하여 t 검정또는 ANOVA 분석을실시하였고, 사후분석은 Bonferroni 방법을이용하였다. t 검정시우울증의정도는각문항별응답을부정적응답의기준인 2 점이상으로 5 문항을모두응답하였을때의점수인 10 점을기준으로하여두집단으로분류하였다. 통계적유의성판정을위한유의수준은 0.05 를기준으로하였다. 결 과 1. 구강건조증과전타액분비율의관련성구강건조증인식도와전타액분비율의관련성을분석한 Table 2. Relation between xerostomia and whole saliva flow rate Whole saliva flow rate(mg/min) Unstimulated Stimulated N M±SD t(p) M±SD t(p) Dry at night Yes 106 0.37±0.22 0.227(0.821) 1.53±0.78-0.343(0.732) No 54 0.38±0.21 1.49±0.79 Dry at other times of the day Yes 77 0.34±0.17 1.449(0.149) 1.50±0.71 0.322(0.748) No 83 0.39±0.24 1.54±0.84 Dry when eating a meal Yes 37 0.34±0.19 0.991(0.326) 1.40±0.83 0.963(0.340) No 123 0.38±0.22 1.55±0.77 Sip liquids to aid in swallowing dry foods Yes 77 0.34±0.17 1.559(0.121) 1.47±0.71 0.794(0.428) No 83 0.40±0.25 1.56±0.84 Amount of saliva in my mouth seem to be little Yes 53 0.33±0.17 1.708(0.090) 1.52±0.71-0.079(0.937) No 107 0.39±0.23 1.51±0.81 Awake to dry mouth Yes 38 0.36±0.21 0.201(0.842) 1.62±0.77-0.891(0.376) No 122 0.37±0.22 1.49±0.78 Keep a glass of water by your bed Yes 33 0.34±0.20 0.933(0.355) 1.43±0.74 0.704(0.485) No 127 0.38±0.22 1.54±0.79 Took gums, candies to relieve oral dryness Yes 24 0.32±0.22 1.210(0.235) 1.19±0.58 2.268(0.025) No 136 0.38±0.21 1.58±0.80

174 The Associated Factors with Whole Saliva Flow Rate and Xerostomia 결과는 Table 2 와같다. 구강건조증평가문항중 구강건조완화를위해껌 사탕을섭취 하는집단에서자극성전타액분비율이적은것으로나타났다 (p<0.05). 또한평상시침의양이적다고느끼는집단에서비자극성전타액분비율이적은경향을보였으나통계적으로유의한차이를보이지않았다 (p=0.090). 2. 연구대상자의인구 사회학적특성과구강건조증, 전타액분비율과의관련성연구대상자의인구 사회학적특성과구강건조증인식도, 전타액분비율의관련성을분석한결과는 Table 3 과같다. 구강건조증인식도와관련된요인은교육수준과결혼상태로나타나 (p<0.05), 중학교졸업자와사별 ( 미혼 ) 집단에서구강건조증을더많이인식하고있었다. 또한비자극성전타액분비율과관련된요인은성별과교육수준이었고, 자극성전타액분비율과관련된요인은교육수준으로나타나 (p<0.05), 중학교졸업자에서비자극성전타액분비율과자극성타액분비율이더적었으며, 여성은남성보다비자극성전타액분비율이낮았다. 3. 전신건강및구강건강인식도와구강건조증, 전타액분비율과의관련성전신건강및구강건강인식도와구강건조증인식도, 전타액분비율의관련성을분석한결과는 Table 4 와같다. 구강건조증인식도는전신건강인식도, 월경상태, 우울증증상, 치은부종, 치은퇴축, 혀작열감, 혀통증및미각장애와관련된것으로나타나 (p<0.05), 건강상태가좋지않다고인식하고폐경상태이며우울증증상이많고, 치은부종, 치은퇴축, 혀작열감, 혀통증및미각장애가있다고응답한집단에서구강건조증을더많이인식하고있었다. 또한비자극성전타액분비율과의관련요인은우울증증상과구취로나타나 (p<0.05), 우울증증상이많고구취를인식한집단에서비자극성전타액분비율이더낮았다. 4. 삶의질과구강건조증, 전타액분비율과의관련성삶의질과구강건조증인식도및전타액분비율의관련성을분석한결과는 Table 5 와같다. 구강건조증인식도는삶의만족도, 삶이의미, 부정적기분및 OHIP-14 의모든항목과관련된것으로나타나 (p<0.05), 삶의만족도가낮고삶이무의미하며부정적기분을자주인지하고, 구강건강과관련된삶의질이낮은집단에서구강건조증을더많이인식하고있었다. 또한자극성전타액분비율과관련된요인은삶의만족도, 삶의의미및자기만족도로 (p<0.05), 삶의만족도가낮고삶이무의미하며자신에대한만족도가낮은집단에서자극성전타액분비율이더낮은것으로나타났다. Table 3. Relation between sociodemographic characteristics and xerostomia, whole saliva flow rate Xerostomia(No.) Whole saliva flow rate(mg/min) N Symptoms t(p) Unstimulated t(p) Stimulated t(p) Gender Male 33 3.06±2.41-0.419 0.47±0.23 2.682 1.75±0.77 1.909 Female 127 3.27±2.93 (0.676) 0.35±0.21 (0.010) 1.46±0.78 (0.062) Age 40-50 59 2.64±2.02 2.882 0.40±0.21 1.308 1.57±0.85 0.440 (Years) 50-60 65 3.29±2.78 (0.059) 0.38±0.24 (0.273) 1.53±0.79 (0.645) 61 36 4.06±3.74 0.33±0.18 1.42±0.66 Occupation Manager/administrator 17 2.76±2.81 0.316 0.45±0.22 1.980 1.57±0.77 2.419 Professional 25 3.20±2.08 (0.867) 0.43±0.22 (0.100) 1.78±0.83 (0.051) Services 49 3.31±2.49 0.34±0.21 1.61±0.72 Housewife 53 3.45±3.37 0.33±0.24 1.27±0.82 Others 16 2.75±3.04 0.44±0.14 1.65±0.63 Education Middle school 45 3.98±3.84 2.129 0.30±0.20-2.840 1.26±0.63-2.690 High school or above 115 2.93±2.26 (0.035) 0.40±0.22 (0.006) 1.62±0.82 (0.008) Income <2Million won 78 3.64±3.05 1.820 0.35±0.19-1.298 1.54±0.76-0.204 2Million won 82 2.83±2.55 (0.071) 0.40±0.24 (0.196) 1.51±0.81 (0.839) Marital status Married 131 2.87±2.43-3.489 0.39±0.22 1.000 1.51±0.81-0.642 Widowed, single 29 4.83±3.82 (0.001) 0.34±0.20 (0.323) 1.60±0.64 (0.524) Living arrangement Together 135 3.12±2.86 1.179 0.38±0.21-0.215 1.51±0.78 0.586 Alone 25 3.80±2.61 (0.246) 0.36±0.25 (0.831) 1.61±0.80 (0.562) Mean ± SD

Journal of Dental Hygiene Science Vol. 12, No. 2, pp. 171~179 (2012) 175 Table 4. Relation between self-reported general and oral health status and xerostomia, whole saliva flow rate Xerostomia(No.) Whole saliva flow rate(mg/min) N Symptoms t(p) Unstimulated t(p) Stimulated t(p) General health status Poor/very poor 27 4.26±4.23 2.107 0.32±0.20-1.575 1.39±0.80-0.997 Very good/good 133 3.02±2.42 (0.037) 0.39±0.22 (0.123) 1.55±0.78 (0.325) No. of chronic disease Healthy 85 2.86±2.22-1.755 0.39±0.21 0.686 1.55±0.75 0.444 1 75 3.64±3.36 (0.081) 0.36±0.23 (0.494) 1.49±0.82 (0.657) Take medication Not taken 82 2.91±2.42-1.418 0.39±0.22 0.643 1.54±0.75 0.279 Taken 78 3.55±3.19 (0.158) 0.37±0.22 (0.521) 1.50±0.82 (0.781) Nonoral dry symptoms No 129 3.34±2.78 1.009 0.39±0.23 1.842 1.58±0.81 1.698 Yes 31 2.74±3.01 (0.318) 0.32±0.17 (0.070) 0.31±0.58 (0.092) Sleeping satisfaction Unsatisfaction 102 3.38±3.05 0.933 0.35±0.19-1.747 1.49±0.82-0.701 Satisfaction 58 2.95±2.38 (0.352) 0.41±0.26 (0.083) 1.58±0.73 (0.484) Menstrual status No(menopause) 81 3.63±3.31 2.080 0.34±0.22-0.968 1.47±0.76 0.076 Yes 47 2.66±1.96 (0.040) 0.37±1.97 (0.335) 1.46±0.83 (0.940) Depressive symptoms 9Score 139 2.91±2.48-3.818 0.39±0.22 2.389 1.57±0.79 1.954 10Score 21 5.33±3.97 0.29±0.16 (0.023) 1.24±0.70 (0.061) Periodontal status Bleeding gums Yes 99 3.46±2.92 0.811 0.36±0.19 0.878 1.55±0.76 0.358 No 61 3.08±2.78 (0.419) 0.39±0.26 (0.381) 1.50±0.80 (0.721) Swollen gums Yes 53 4.08±3.39-2.442 0.38±0.21-0.028 1.53±0.82-0.245 No 107 2.80±2.41 (0.017) 0.37±0.23 (0.978) 1.52±0.77 (0.807) Receding gums Yes 67 3.82±3.08-2.224 0.35±0.18 1.418 1.49±0.80 0.479 No 93 2.80±2.56 (0.028) 0.40±0.24 (0.158) 1.55±0.77 (0.632) Diastema Yes 66 3.18±2.96 0.159 0.39±0.19-0.851 1.57±0.78-0.689 No 94 3.26±2.75 (0.874) 0.36±0.23 (0.396) 1.49±0.79 (0.492) Mobility teeth Yes 36 3.53±3.07-0.688 0.37±0.18-0.158 1.69±0.91-1.272 No 124 3.14±2.76 (0.495) 0.37±0.23 (0.875) 1.48±0.74 (0.209) Sore gums Yes 87 3.48±2.98-1.275 0.35±0.19 1.854 0.34±1.93 1.722 No 73 2.92±2.63 (0.204) 0.41±0.24 (0.066) 1.42±0.24 (0.087) Bad breath Yes 65 3.63±3.29-1.507 0.33±0.17 2.099 1.52±0.85 0.035 No 95 2.95±2.44 (0.134) 0.40±0.25 (0.037) 1.52±0.74 (0.971) Drifting teeth Yes 29 4.03±3.39-1.474 0.35±0.15 0.417 1.69±0.76-1.342 No 131 3.05±2.67 (0.149) 0.38±0.23 (0.678) 1.48±0.79 (0.187) Mucosa status Mucositis Yes 60 3.40±3.19-0.575 0.39±0.25-0.506 1.53±0.74 0.216 No 100 3.12±2.59 (0.567) 0.37±0.19 (0.614) 1.50±0.85 (0.830) Mucosal pain Yes 53 3.66±3.23-1.276 0.38±0.25-0.353 1.55±0.84-0.340 No 107 3.01±2.59 (0.205) 0.37±0.20 (0.725) 1.51±0.76 (0.735) Tongue burning Yes 23 5.39±3.79-4.169 0.34±0.19 0.662 1.66±0.84-0.895 No 137 2.86±2.47 0.37±0.22 (0.513) 1.49±0.77 (0.378) Tongue pain Yes 32 4.88±3.63-3.846 0.35±0.16 0.580 1.66±0.75-1.181 No 128 2.81±2.43 0.37±0.23 (0.564) 1.48±0.79 (0.243) Taste disturbance Yes 26 4.42±3.98-2.395 0.38±0.27-0.246 1.64±0.94-0.773 No 134 2.99±2.50 (0.018) 0.37±0.20 (0.806) 1.49±0.75 (0.446) Mean ± SD

176 The Associated Factors with Whole Saliva Flow Rate and Xerostomia Table 5. Relation between quality of life and xerostomia, whole saliva flow rate Xerostomia(No.) t or N Symptoms F(p) General QOL Life satisfaction Unsatisfied 9 5.78±5.38 a 4.412 (0.014) Oral health related QOL Unstimulated Whole saliva flow rate(mg/min) t or F(p) Stimulated 0.28±0.12 1.270 Moderate 76 3.26±2.76 b 0.36±0.21 (0.284) 1.37±0.65 a Satisfied 75 2.88±2.32 b 0.39±0.23 1.68±0.86 b t or F(p) 1.40±0.87 ab 3.108 (0.047) Enjoy life Not at all 14 4.64±4.76 2.295 031±0.12 1.337 1.26±0.66 1.022 Moderate 60 3.32±2.94 (0.104) 0.35±0.20 (0.266) 1.49±0.76 (0.362) Much 86 2.93±2.24 0.39±0.23 1.58±0.81 Life to be meaningful Not at all 6 5.17±5.77 3.168 * 0.29±0.14 1.749 1.04±0.55 3.925 * Moderate 50 3.74±3.23 (0.045) 0.33±0.19 (0.177) 1.33±0.73 (0.022) Much 104 2.87±2.29 0.39±0.22 1.64±0.79 Self satisfaction Unsatisfied 14 4.57±3.67 1.758 0.28±0.13 2.291 1.32±0.97 ab 3.555 Moderate 66 3.08±3.08 (0.176) 0.35±0.20 (0.105) 1.36±0.65 a (0.031) Satisfied 80 3.11±2.38 0.40±0.23 1.68±0.81 b Negative feeling Often 25 5.40±3.74 a 10.533 0.40±0.23 1.304 1.59±0.80 1.079 Hardly ever 71 3.08±2.71 b 0.36±0.20 (0.274) 1.53±0.76 (0.342) Never 64 2.53±2.07 b 0.32±0.20 1.32±0.76 Difficulty chewing No 100 2.43±2.31-4.572 0.38±0.23 0.521 1.49±0.75-0.501 Yes 60 4.55±3.11 0.36±0.18 (0.603) 1.56±0.84 (0.617) Taste worse No 131 2.76±2.21-4.754 0.38±0.22 1.052 1.54±0.78 0.733 Yes 29 5.34±4.12 0.33±0.21 (0.285) 1.42±0.76 (0.465) Tongue pain No 141 2.84±2.34-5.085 0.38±0.22 1.440 1.52±0.75 0.011 Yes 19 6.11±4.22 0.31±0.18 (0.162) 1.52±0.97 (0.991) Mucosal pain No 137 2.79±2.29-5.132 0.38±0.22 1.119 1.49±0.77-0.871 Yes 23 5.83±4.13 0.33±0.14 (0.280) 1.66±0.86 (0.391) Self conscious No 141 2.76±2.32-6.341 0.38±0.22 1.723 1.52±0.77 0.054 Yes 19 6.68±3.78 0.31±0.14 (0.095) 1.51±0.88 (0.957) Tense No 128 2.49±2.01-7.649 0.37±0.22-0.052 1.50±0.75-0.627 Yes 32 6.16±3.65 0.37±0.19 (0.959) 1.60±0.91 (0.534) Diet unsatisfactory No 141 2.70±2.16-7.493 0.38±0.22 2.015 1.55±0.79 1.837 Yes 19 7.16±3.97 0.30±0.15 (0.053) 1.25±0.65 (0.078) Interrupt meals No 147 2.90±2.41-5.195 0.38±0.22 1.425 1.55±0.78 2.014 Yes 13 6.85±4.45 0.30±0.18 (0.175) 1.15±0.67 (0.062) Difficult to relax No 145 2.83±2.32-5.998 0.38±0.22 1.775 1.54±0.79 1.066 Yes 15 7.00±4.29 0.30±0.15 (0.090) 1.31±0.70 (0.288) Been embarrassed No 150 2.96±2.50-4.913 0.37±0.22 1.281 1.54±0.78 1.389 Yes 10 7.20±4.36 0.30±0.18 (0.227) 1.21±0.72 (0.194) Irritable with other people No 147 2.91±2.49-3.451 0.37±0.22 0.560 1.52±0.79 0.292 Yes 13 6.77±3.96 0.34±0.16 (0.583) 1.46±0.70 (0.774) Difficulty doing usual jobs No 143 2.85±2.41-5.204 0.37±0.22 0.540 1.52±0.78-0.010 Yes 17 6.35±3.99 0.35±0.17 (0.594) 1.52±0.81 (0.992) Life less satisfaction No 141 2.72±2.25-7.094 0.37±0.22 0.311 1.54±0.79 1.353 Yes 19 7.00±3.75 0.36±0.19 (0.758) 1.32±0.67 (0.188) Unable to function No 148 2.86±2.35-6.458 0.37±0.22 0.734 1.53±0.78 0.623 Yes 12 7.75±4.15 0.33±0.18 (0.475) 1.38±0.80 (0.544) Mean ± SD a,b The same characters are not significant by Bonferroni's multiple comparison at α=0.05. * Showed significant differences by one-way ANOVA, but not found the differences between each group.

Journal of Dental Hygiene Science Vol. 12, No. 2, pp. 171~179 (2012) 177 고 찰 타액은구강건강과편안함을유지하는데중요한역할을한다 11). 타액분비율이정상보다감소되었을경우치아우식증등의구강병이발생할뿐아니라저작및연하불편감등다양한생활장애가유발한다. 그러나, 타액분비율이정상이거나크게감소하지않았음에도불구하고구강건조증을인식하기도한다. 많은수의중년층과노인에서구강건조증을호소하고있는데 20), 구강건조증은삶에대한만족도를높이기위해반드시관리하여야하는요인이다 21). 따라서공중이행복하고건강한삶을영위할수있도록구강건조증과타액분비율과의관련요인에관한연구는의미가있을것으로생각하며, 본연구의주된결과는다음과같다. 첫째, 구강건조증의인식도에따른전타액분비율을분석한결과 구강건조완화를위해껌 사탕을섭취 하는집단에서자극성전타액분비율이낮은것으로나타났다. 이외에 평상시침의양이적다 고응답한집단에서비자극성전타액분비율이낮은경향을보였으나통계적으로유의미한차이는보이지않았다 (p=0.090). 타액을채취하는것은비교적시간이많이소요되고환자가지켜야할사항이있어번거롭기때문에타액분비감소를예측할수있는자가평가문항들의개발은필요하다. 선행연구에서구강건조증의유병률을평가하기위해주로사용한단문항으로는 평상시구강이건조하다고느끼십니까? 또는 얼마나자주구강이건조하다고느끼십니까? 등이있다 3,22). 그러나, 본연구에서는타액분비율과관련된문항으로는 평상시구강건조에대한인식 보다 구강건조를완화하기위해껌이나사탕을먹는행위 에서연관성이더강하게나타났다. 이등 23) 도전타액분비율과껌사탕을먹는행위와의관련성을제시한바있으므로구강건조를완화하기위한이러한행동의파악은임상현장에서타액분비의감소를추측하는데중요한의미가있을것으로생각한다. 또한구강건조증인식도는비자극성보다자극성전타액분비율과연관되어있었다. 식사시에는물리적, 화학적자극등으로자극성타액분비가최대치에도달하므로 5), 음식물섭취시타액의부족으로인해경험했던불편감이구강건조증인식도를높였을것으로생각한다. 그러나, 전반적으로구강건조증의인식도와전타액분비율과의연관성은뚜렷하게나타나지않았다. 구강건조증은감소된타액분비량과상관관계가있으나, 타액의화학적조성의변화로도유발될수있으므로 13) 추후연구에서는타액특성에관한연구가함께진행되어야할것이다. 둘째, 연구대상자의인구 사회학적특성에따라구강건조증과전타액분비율을분석한결과중학교이하졸업자와사별 ( 미혼 ) 집단에서구강건조증인식도가높았다. 또한여성과중학교이하졸업자에서비자극성전타액분비율이낮았으며, 자극성전타액분비율은중학교이하졸업 자에서낮은것으로나타났다. 여성에서구강건조증인식도가높거나전타액분비율이낮은것은 Flink 등 24) 과이 25) 의연구결과와유사하다. 그러나, 이러한결과는단지성별이나교육수준에의한영향보다는전신질환이환정도나약물복용의차이로인해나타난간접적인영향으로해석된다. 또한사별 ( 또는미혼 ) 집단에서구강건조증의인식도가높았는데, 이는외로움이나스트레스등으로인한정신적, 심리적인요인이구강건조증의인식에영향을준것으로생각한다. 본연구에서연령은구강건조증인식도나전타액분비율과연관성이없는것으로나타났는데, 연령이라는단독요인만으로타액분비가감소하지않으며 26), 이하선의타액분비량은건강한사람에서연령의증가에따라감소하지않는다는 Ghezzi 와 Ship 27) 의결과와유사한결과라사료된다. 셋째, 연구대상자의전신건강, 구강건강인식도에따라구강건조증과전타액분비율을분석한결과건강상태가좋지않고, 폐경상태인집단에서구강건조증인식도가높았다. 또한우울증의인식도가높은집단에서구강건조증의인식도가높았을뿐만아니라비자극성전타액분비율이낮은것으로나타났는데, Anttila 등 28) 도우울증증상은구강건조증의위험요인이라고보고하였다. 이외에도전신질환에이환되었거나약물복용집단에서구강건조증의인식도가높았고타액분비량도적은경향을보였으나통계적으로유의미한차이는확인할수없었다. 이러한결과는연구대상자가소수이며, 약물복용상태만을조사하였기때문으로생각하며, 추후연구에서는연구대상자의양적인확대가필요하고약물의복용이유를함께파악하여야할것이다. 이제까지타액분비를감소시키는주된원인은대사이상과관련된전신질환과그에따른약물요법으로보고되어왔다 10,29). 특히고혈압과당뇨병치료약물, 이뇨제, 아스피린및항우울제는타액분비를감소시키는주된약물이다 11,20,30,31). Smidt 등 32) 에서고혈압치료약중칼슘채널차단제 (Calcium Channel Blockers) 와베타차단제류 (Beta Blockers) 를복용한자에서비자극성전타액분비율이 30-60% 감소한결과를보였고, 복용약물수가많을수록타액분비율이낮아짐을보고하였다. 뿐만아니라 Leal 등 33) 에의하면장기적인약물복용으로타액분비율과함께타액완충능이저하되는등타액의양과질에변화가나타난다고하였다. 따라서, 임상현장에서전신질환자나타액분비를감소시키는약물을복용하는자에게구강건조증과관련된증상등에대해세심한관심과모니터링이필요할것이며, 정기적으로구강검진과구강보건교육이이루어져야한다. 이외에도구강내증상으로치은부종, 치은퇴축, 혀작열감, 혀통증및미각장애가있는집단에서구강건조증인식도가높았으며, 구취가있는집단에서비자극성전타액분비율이낮은것으로나타났다. 구취의성분인 Hydrogen sulfide 등은타액분비율과연관성이있으며 34), 타액분비율이감소된경우

178 The Associated Factors with Whole Saliva Flow Rate and Xerostomia 구강점막의통증뿐만아니라치면세균막과치아우식증, 치주질환, 혀의작열감및미각장애등이증가한다 11,35). 본연구에서도주관적구강건강인식과구강건조증, 타액분비율과의관련성을확인한바구강건강증진에있어타액분비의중요성을확인할수있었다. 따라서타액분비의증가를위해입체조운동 36) 이나자일리톨껌의저작 37), 설탕이함유되지않은단단한캔디의섭취 38) 및적극적인음식물저작활동 13) 등의실천이필요하며, 타액분비의감소로인해치아우식증이나치주질환이진행되지않도록주기적으로불소도포나치면세마등의예방처치가진행되어야한다. 넷째, 삶의질과구강건조증인식도, 전타액분비율과의관련성을분석한결과삶의만족도가낮고삶이무의미하며부정적기분을많이느끼고, 구강문제로인해사회적으로부정적경험이많은집단에서구강건조증을많이인식하고있었다. 또한삶의만족도가낮으며삶이무의미하고자신에대해만족하지못하는집단에서자극성전타액분비율이낮은것으로나타났다. 구강건조증을가진환자는감각저하가나타나고, 저작및연하시불편감으로빵등의일부마른음식을피하며, 음식섭취의즐거움이감소되어있는데, 이로인하여삶의만족도가저하가나타난다 13). 따라서, 이들의예방및치료는평균수명의연장으로삶의질을더욱중요하게인식하는현대사회에서삶의질향상프로그램에반드시포함되어야하는내용이다. 본연구의제한점으로는첫째, 연구대상자가경기 인천지역에제한되었으므로우리나라전체성인을대표하는결과로일반화하는데부족하며, 표본의크기가다소작은한계점을가지고있다. 둘째, 단면조사연구로수행되었기때문에구강건조증인식도와전타액분비율의관련요인들과시간적인선후관계를파악할수없다는것이다. 이러한본연구의한계점들은향후표본수증가와인과관계를파악할수있는종단연구등의체계적인분석방법을통하여해결할수있을것으로생각한다. 이러한제한점에도불구하고본연구는구강건조증과전타액분비율과의관련요인을다각적으로분석함으로써구강건조증이나타액분비부전증을예방하고완화시키며, 공중의삶의질을향상시킬수있는기초자료를마련하였다는의의를가지고있다고사료된다. 요 약 본연구는구강건조증과전타액분비율과의관련요인을분석함으로써건강인식도를높이고, 삶의질향상프로그램을개발하는데기초자료로활용하고자실시하였다. 2011 년 1 월 14 일부터 2 월 22 일까지경기 인천지역에거주하는만 40 세이상의성인 160 명을대상으로설문조사와비자극성, 자극성전타액분비량을측정하여다음과같 은결론을얻었다. 1. 구강건조증인식도와전타액분비율과의관련성을분석한결과 구강건조의완화를위해껌 사탕을섭취 하는집단에서자극성전타액분비율이낮았다. 2. 중학교졸업자와사별 ( 미혼 ) 집단에서구강건조증을더많이인식하고있었다. 또한중학교졸업자는고등학교졸업자보다비자극성전타액분비율과자극성타액분비율이더낮았고, 여성은남성보다비자극성전타액분비율이낮았다. 3. 건강상태가좋지않으며폐경상태이고, 우울증증상이많으며, 치주질환증상과혀작열감등을인식한집단에서구강건조증을더많이인식하고있었다. 또한우울증의증상이많고구취를인식한집단에서비자극성전타액분비율이낮았다. 4. 삶의만족도가낮고삶이무의미하며부정적기분을자주인지하고, 구강건강과관련된삶의질이낮은집단에서구강건조증을더많이인식하고있었다. 또한삶의만족도가낮고삶이무의미하며, 자신에대한만족도가낮은집단에서자극성전타액분비율이더낮았다. 이상의결과로볼때, 전신건강과구강건강인식도및삶의질의향상을위하여구강건조증과타액분비의저하는조기에예방하여야하며, 삶의질향상프로그램에반드시포함하여야할것으로사료되었다. 감사의글 이논문은 2012 년도가천대학교교내연구비지원에의한결과임. (GCU-2012-M016) 참고문헌 1. Fox PC et al.: Xerostomia: evaluation of a symptom of a symptom with increasing significance. J Am Dent Assoc 110(4): 519-525, 1985. 2. Orellana MF et al.: Prevalence of xerostomia in populationbased samples; a systematic review. J Public Health Dent 66(2): 152-158, 2006. 3. Nederfors T et al.: Prevalence of perceived symptoms of dry mouth in an adult Swedish population - relation to age, sex and pharmacotherapy. Community Dent Oral Epidemiol 25(3): 211-216, 1997. 4. Dawes C: Physiological factors affecting salivary flow rate, oral sugar clearance, and the sensation of dry mouth in man. J Dent Res 66(spec): 648-653, 1987. 5. Fox PC, Busch KA, Baum BJ: Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc 115(4): 501-584, 1987. 6. Sreebny LM, Valdini A: Xerostomia. part I: relationship to other oral symptoms and salivary gland hypofunction. Oral Surg Oral Med Oral Pathol 66(4): 451-458, 1988. 7. Axelsson PJ: Diagnosis and risk prediction of caries. 2th ed. Quintessence, Stockholm, pp. 94, 2000.

Journal of Dental Hygiene Science Vol. 12, No. 2, pp. 171~179 (2012) 179 8. Thomson WM et al.: Is medication a risk factor for dental caries among older people?. Community Dent Oral Epidemiol 30(3): 224-332, 2002. 9. Sreebny LM, Schwartz SS: A reference guide to drugs and dry mouth--2nd edition. Gerodontology 14(1): 33-47, 1997. 10. Screebny LM, Schwartz SS: A reference guide to drugs and dry mouth. Gerodontology 5(2): 75-99, 1986. 11. Bergdahl M: Salivary flow and oral complaints in adult dental patients. Community Dent Oral Epidemiol 28(1): 59-66, 2000. 12. Billings RJ. Proskin HM, Moss ME: Xerostomia and associated factors in a community-dwelling adult population. Community Dent Oral Epidemiol 24(5): 312-316, 1996. 13. Cassolato SF, Turnbull RS: Xerostomia: clinical aspects and treatment. Gerodontology 20(2): 64-77, 2003. 14. Thomson WM et al.: The impact of xerostomia on oralhealth-related quality of life among younger adults. Health Qual Life Outcome 8(4): 86, 2006. 15. Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory:twenty-five years of evaluation. Clin Psychol Rev 8(1): 77-100, 1988. 16. Ng SKS, Leung WK: Oral health-related quality of life and periodontal status. Community Dent Oral Epidemiol 34(2): 114-122, 2006. 17. Busato IMS, Brancher JA, Machado MAN: Impact of xerostomia on the quality of life of adolescents with type 1 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radio Endod 108(3): 376-382, 2009. 18. Slade GD: Derivation and validation of a short form oral health impact profile. Community Dent Oral Epidemiol 25(4): 284-290, 1997. 19. World Health Organization: Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychol Med 28(3): 551-558, 1998. 20. Thomson WM, Williams SM: Further testing of the xerostomia inventory. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 89(1): 46-50, 2000. 21. Narhi TO: Prevalence of subjective feeling of dry mouth in early. J Dent Res 73: 20-25, 1994. 22. Thomson WM et al.: The occurrence of xerostomia and salivary gland hypofunction in a population - based sample of older South Australians. Spec Care Dentist 19(1): 20-23, 1999. 23. 이정윤, 이영옥, 고흥섭 : 구강건조증증상평가를위한설문지의신뢰도에관한연구. 대한구강내과학회지 30(4): 383-389, 2005. 24. Flink H et al.: Prevalence of hyposalivation in relation to general health, body mass index and remaining teeth in different age groups of adults. Community Dent Oral Epidemiol 36(6): 523-531, 2008. 25. 이지혜 : 한국노인의구강건조증의관련요소및구강건조증이구강건강과관련된삶의질에미치는영향 [ 석사학위논문 ]. 서울대학교대학원, 서울, 2006. 26. Ben-Aryeh H et al.: Whole saliva secreted by old and young healthy subjects. J Dent Res 63(9): 1147-1148, 1984. 27. Ghezzi EM, Ship JA: Aging an secretory reserve capacity of major salivary glands. J Dent Res 82(10): 844-848, 2003. 28. Anttila SS, Knuuttila ML, Sakki TK: Depressive symptoms as an underlying factor of the sensation of dry mouth. Psychosom Med 60(2): 215-218, 1998. 29. Percival RS, Challacombe SJ, Marsh PD: Flow rates of resting whole and stimulated parotid saliva in relation to age and gender. J Dent Res 73(8): 1416-1420, 1994. 30. Sreebny LM, Valdini A, Yu A: Xerostomia. part II: relationship to nonoral symtoms, drugs, and diseases. Oral Surg Oral Med Oral Pathol 68(4): 419-427, 1989. 31. Thomson WM, Chalmers JM, Spencer AJ: A longitudinal study of medication exposure and xerostomia among older people. Gerodontology 23(4): 205-213, 2006. 32. Smidt D et al.: Associations between labial and whole salivary flow rates, systemic diseases and medications in a sample of older people. Community Dent Oral Epidemiol 38(5): 422-435, 2010. 33. Leal SC et al.: Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth. Gerodontology 27(2): 129-133, 2010. 34. 지윤정등 : 구취발생과구강환경의연관성에관한연구. 치위생과학회지 10(2): 101-107, 2010. 35. Sreebny LM, Valdini A: Xerostomia: a neglected symptom. Arch Intern Med 147(7): 1333-1337, 1987. 36. 장경애, 황인철 : 노인의구강기능향상에미치는구강운동의효과. 치위생과학회지 11(3): 257-263, 2011. 37. Odusola F: Chewing gum as an aid in treatment of hyposalivation. NY State Dent J 57(4): 28-31, 1991. 38. Daniels TE, Wu AJ: Xerostomia - clinical evaluation and treatment in general practice. J Can Dent Assoc 28(12): 933-941, 2000. (Received January 03, 2012; Revised April 25, 2012; Accepted April 27; 2012)