Journal of Korean Society of Oral Health Science 2017, March. 5(1): 22~32 ISSN: 2288-6079 충치예방법이구강건강관리행위에미치는영향 이미옥, 이지연진주보건대학교치위생과, 경운대학교치위생학과 Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior Mi-Oak Lee 1, Ji-Yeoun Lee 2 1 Dept. of Dental Hygiene, Jinju Health College 2 Dept. of Dental Hygiene, Kyuhg-Woon University Correspondence to: Lee M-O, Tel: +82-55-740-1856 Fax: +82-55-743-3010 E-mail: forlove@hanmail.net Received Feb 12, 2017 Revised Mar 15, 2017 Accepted Mar 16, 2017 ABSTRACT A total of 155 students and members of the teaching staff who visited the dental health care room at a college located in Busan were investigated from July 1 to 30, 2010. A statistical package SAS 9.2 was employed to organize and analyze the collected data. The level of significance was all set at 0.05. Among the methods of dental-caries prevention, the removal of environmental factors had a significant positive correlation with the removal of environmental factors for periodontal diseases (r=0.25, p<.0.01), and that had a significant negative correlation with cariogenic risk factors (r=-0.17, p<.0.05). The factor that exerted an influence on the removal of host factors was gender dummy variable only, and the women made more use of the removal of host factors than the men among the methods of dental-caries prevention. The factors that affected the removal of environmental factors were age dummy variable and blood-type dummy variable, which were statistically significantly influential. In the case of blood type, the estimated standardization coefficient of AB-type dummy variable (dummy 3) was -0.233, and the respondents whose blood type was AB made less use of the removal of environmental factors than the respondents with the other blood types. In the future, every school should provide oral health education for every student and employee every year on a regular basis, and various approaches should be taken in consideration of the gender, age and blood type of individuals to urge them to get regular dental checkups, have their teeth cleaned, pay attention to periodontal care and receive dental- caries treatment as early as possible. Key words: Dental caries, Oral health, Behavior, Prevention I. 서론 구강조직의 3대기능인발음기능, 저작기능, 심미기능은주로치아에의해서발휘된다. 구강건강이확보되지않고는소화기관에부담을주어소화기질환이발생할수있고이는이차적으로전신건강에영향을미칠수있으므로구강건강관 리의필요성이증가되고있다 [1]. 또한올바른발음기능과심미기능은원만한사회생활을유지하기위해서중요한기능으로구강건강은매우중요하다고할수있다. 이러한구강건강은치아상실로치아의기본기능의저하를초래하는데, 오늘날대부분의국가에서빈발되는치아기능장애의대표적구강질병으로치아우식증과치주조직병이원인이다 [2]. 우리나라는 2010년부터구강보건사업으로예방중심의포괄 Copyright@ 2017 by the Korean Society of Oral Health Science (KOHS) 22
Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior 적국민구강건강관리를목적으로치아수명의연장을위한치아우식증과치주조직병의예방, 치료, 관리, 재활을내용으로지역사회구강보건활동인틀니보철사업, 구강보건실 ( 센터 ) 설치운영사업, 노인불소도포 스케일링사업, 구강보건이동진료차량지원사업, 불소용액양치사업, 수돗물불소농도조정사업, 장애인구강진료센터설치운영사업, 등의구강보건사업을시행하고있다. 이러한구강보건사업은구강보건실태를파악한후사업의방향을결정하는데, 구강보건실태조사는구강보건의실상을파악하기위하여치아와치주조직및기타의구강조직기관을조사하면서구강건강을파탄시키는치아우식증, 치주조직병등을조사하는제반행위를말한다. 그러므로구강보건개발사업을하려면국민의구강건강상태에대한자료가필요하게된다 [3]. 구강질병발생요인은숙주요인과환경요인및병원체요인의세가지요인으로구강질병이발생되며, 이러한발생요인들이동시에복합적으로작용하여발생되며, 이를예방하기위해각요인들의적절한관리가요구되고있다 [3]. 현대예방치학은구강건강을증진시키고구강질병을예방하기위한구체적인방법으로식이조절, 불소용품사용, 치면열구전색, 매일효과적인치면세균막관리등을제시하였으며 [4], 구강보건학계는국민보건의실태를파악하는노력으로학교및지역대상자의구강보건에대하여다각적으로조사하여검토하였다. 백 [5] 은한국인의평균잇솔질횟수는 1.93 회로평균일인당매일잇솔질횟수가계속증가되고있으나, 치아우식경험정도역시계속증가되고있다고지적하며, 잇솔질할때에불소배합세치제를사용하도록권고하였으며, 총체적으로우리나라국민의구강보건교육이강화되어야하며, 구강보건전문인력의구강보건정보전달을효과적으로전달하기위한연구가필요하다고하였다. 이 [6] 등은서울특별시시민의 99.3% 가가정구강보건행위로잇솔질에의존하고있으며, 치간잇솔질과치간세정푼시질의실천자율이매우낮았고일일평균잇솔질횟수는 2.04 회로조사되었다. 계속구강건강관리자는 24.9% 에불과하여우리나라치과의사의가정구강보건교육을전면적으로재차검토하며새로운구강보건교육법의개발과강화가이뤄져야한다고하였다. 임 [7] 은지역사회구강보건정책제안을위한광주 전남구강보건실태조사에서향후광주 전남지역의구강건강실태를주기적으로조사할필요가있으며, 연령증가에따른증가하는치아우식과치주질환을예방하고, 현존치아수의증가를위해지역사회구강보건개발의일환으로지역 특성에맞는연령층, 지역별체계적인구강보건사업이절실히필요하다고하였다. 대학교는학교규모면에서최대인조직사회로교수, 학생을비롯한행정, 근로등의직업을가진공동생활을영위하는다양한인적자원의집합체이며, 학교규모에따라서는학교, 병원, 연구기관외여러성격의기관들이조직된대규모조직집단이다. 구성원은주로만 19세에서장년에이르기까지의다양한연령층이모인성인집단들로중대구강병의관리대상자들이다. 그러므로구강보건사업을개발하기위해서는반드시학교사회구성원의구강건강실태조사가선행되어야하며, 학교의특성을고려한구강보건사업을기획수립하는것이학교사회성인의구강건강증진을위한것으로사료되어진다. 선행연구조사를살펴본결과초등학교, 중 고등학교, 노인, 지역사회근로자대상의조사는볼수있었고, 이외에는문헌검색프로그램을확인한결과관련한다수의연구조사가있음을알수있었다. 대학생을대상으로조사연구로일부대학생을대상으로연구한노 [8], 대학신입생들의구강위생상태와구강보건인식도와의관련성을연구한윤 [9], 송 [10], 조 [11] 등다수를찾을수있었으나, 대학교의전체구성원대상의정기적인구강건강교육의시행과구강보건프로그램개발을위한조사연구는보고된바가많지않았다. 이에, 저자는보건실내방자를중심으로대학교사회구성원의치아건강과구강건강관리실태를조사하고자한다. 또한구강건강관리에영향을미치는요인을분석검토한바구강질환예방대책및구강건강증진을위한교육자료및구강건강프로그램개발을위한기초자료를제공하고자한다. Ⅱ. 연구방법 1. 연구대상 본연구는부산소재 B대학교구강보건실방문자를대상으로실시하였으며, 2010년 7월 1일부터 2010년 7월30일까지본취지에동의한학생, 교직원들을대상으로조사하였다. 설문과구강검진을하여얻은자료중에서무응답문항수가있는 9부의자료를제외한총 155명의자료를최종분석하였다. 23
Journal of Korean Society of Oral Health Science Vol. 5 No. 1 March 2017 2. 연구도구및방법 Ⅲ. 결과 연구조사가진행되는동안보건실내게시판과보건실홈페이지, 교직원들의메신저를통해구강건강검진에대한홍보를계속하였으며, 예약을통해시간약속을한후매주화, 수, 목요일에일반적인구강검진과구강보건행위에관한설문조사하여연구자료를마련하였다. 설문지는일반적인특성 11 문항과 GC회사의구강건강관리프로그램 24문항으로 [12] 구성하였다. 3. 통계분석본연구는 SAS v9.2 를활용하였으며, 모든분석은유의수준 0.05 을기준으로하였다. 일반적특성에따라각각의분포와각범주마다의차이를알아보기위해 Pearson Chi square test 적용하였으며, 일반적특성이충치설문응답에미치는영향을파악하기위해단순회귀분석을실시하였다. 1. 연구대상자의일반적특성연구대상자의일반적특성을살펴보면, 성별은여자가 56.13%, 남자가 43.87% 이며, 연령분포는 20대 51.61%, 30대 16.13%, 40대 20%, 50대이상 12.26% 로 20대의비율이절반이상을차지한다. 혈액형은 A형이 32.26%, B형이 25.81%, O형이 27.74%, AB형이 14.19% 로 AB형이가장낮은비율을차지하였으며, 스케일링경험횟수가 0회인자 23.23%, 1회-2회인자 37.42%, 3회-4회인자 19.35%, 5회-6회인자 12.9%, 7회이상인자 7.1% 로나타났다. 미혼인자가 61.29% 로기혼인자 38.71% 보다높은비율을보였으며, 음주횟수는월1회미만 27.74%, 월1회정도 31.61%, 주1회- 주2회 8.39%, 주3회- 주4회 32.26% 였다. 충치치료를받은경험이있는자는 90.32%, 받은경험이없는자 9.68% 로대부분이충치치료를받은경험이있고, 입속충치를갖고있는자가 50.32%, 갖고있지않은자가 49.68% 였다. 정기검진을받는자는 30.32%, 받지않는자 69.68% 로많은수가받지않고있으며, 구강보건교육경험이있는자는 38.71%, 없는자는 61.29% 로교육경험이없는자가높았고, 향후구강보건교육에참석의향이있는자는 61.29%, 없는자는 38.71% 로나타났다 <Table 1>. <Table 1> The general characteristics of study subjects (N=155) Characteristics Category N % Female 87 56.13 Male 68 43.87 20-29 80 51.61 Age 30-39 25 16.13 40-49 31 20 50-19 12.26 A 50 32.26 Blood type B 40 25.81 O 43 27.74 AB 22 14.19 0 36 23.23 1 to 2 times 58 37.42 scaling frequency 3 to 4 times 30 19.35 5 to 6 times 20 12.9 More than 7 times 11 7.1 Marital status Married 60 38.71 Single 95 61.29 <Table 1> Continued Characteristics Category N % drinking frequency dental-caries treatment experience dental caries in the mouth regular dental checkup oral health education experience Less than once a month 43 27.74 Once a month 49 31.61 1-2 weeks 13 8.39 3-4 weeks 50 32.26 Yes 140 90.32 No 15 9.68 Yes 78 50.32 No 77 49.68 Yes 47 30.32 No 108 69.68 Yes 60 38.71 No 95 61.29 Intention of receiving oral Yes 95 61.29 health education No 60 38.71 Total 155 100 24
Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior 2. 성별에따른충치유발위험요소 성별에따른충치유발위험요소를살펴보면충치유발위험요소에대한 7개의문항중 오렌지쥬스를 1회이상먹는다 에대한것을제외하고는성별에따른유의한차이가없었다. 여자중오렌지쥬스를 1회이상먹는비율은 2.3%, 남자 중차지하는비율은 13.24% 로유의한차이가나타났으며 (p=0.0085), 남자가충치유발위험요소를더갖고있다고볼수있다 <Table 2>. <Table 2> Dental caries risk factors for gender Dental caries risk factors Female Male 전체 χ2 P N % N % N % I like sweets Yes 45 51.72 35 51.47 80 51.61 No 42 48.28 33 48.53 75 48.39 0.001 0.975 I eat food frequently. Yes 59 67.82 40 58.82 99 63.87 No 28 32.18 28 41.18 56 36.13 1.3375 0.2475 Eat more than 2 cups of coffee a day Yes 40 45.98 27 39.71 67 43.23 No 47 54.02 41 60.29 88 56.77 0.6116 0.4342 Eat more than one mineral water a day. Yes 8 9.2 6 8.82 14 9.03 No 79 90.8 62 91.18 141 90.97 0.0064 0.9361 Eat yogurt once a day Yes 21 24.14 9 13.24 30 19.35 No 66 75.86 59 86.76 125 80.65 2.9066 0.0882 Eat coke at least once a day Yes 4 4.6 3 4.41 7 4.52 No 83 95.4 65 95.59 148 95.48 0.0031 0.9559 I eat orange juice at least once Yes 2 2.3 9 13.24 11 7.1 No 85 97.7 59 86.76 144 92.9 6.924 0.0085** Total 87 56.13 68 43.87 155 100 - - Pearson Chi square test * p<0.05 ** p<0.01 *** p<0.001 3. 충치예방법중숙주요인제거법 충치예방법중숙주요인제거법을살펴보면 3개의문항중 우유를하루 1회이상먹는다 에대한것을제외하고는성별에따른유의한차이가없다. 여자중우유를하루 1회 이상먹는비율은 50.57%, 남자중차지하는비율은 30.88% 로유의한차이가존재하며 (p=0.0137), 여자가숙주요인제거법을더잘지키고있다고볼수있다 <Table 3>. <Table 3> Removal of host factors for gender Removal of host factors Female Male Total χ2 P N % N % N % Use fluorine products Yes 23 26.44 18 26.47 41 26.45 No 64 73.56 50 73.53 114 73.55 0 0.9962 I have eaten xylitol tablets Yes 19 21.84 12 17.65 31 20 No 68 78.16 56 82.35 124 80 0.4192 0.5173 Eat milk at least once a day Yes 44 50.57 21 30.88 65 41.94 No 43 49.43 47 69.12 90 58.06 6.0785 0.0137* Total 87 56.13 68 43.87 155 100 - - Pearson Chi square test * p<0.05 ** p<0.01 *** p<0.001 25
Journal of Korean Society of Oral Health Science Vol. 5 No. 1 March 2017 4. 충치예방법중환경요인제거법 충치예방법중환경요인제거법을살펴보면이쑤시개를사용하는비율이여자는 17.24%, 남자는 32.35% 로유의한차이가나타났다 (p=0.0285). 또한하루 3번잇솔질을하는비율은여자는 91.95%, 남자는 69.12% 로유의한차이를보인다 (p=0.0002). 이는여자가환경요인제거법을더잘지키고있다고볼수있다. 환경요인제거법에포함되는 7개문항중 5개문항은성별에따른유의한차이가나타나지않았다 <Table 4>. <Table 4> Removal of gender and environmental factors Removal of environmental factors Female Male Total χ2 P N % N % N % Use mouthwash Yes 20 22.99 12 17.65 32 20.65 No 67 77.01 56 82.35 123 79.35 0.6647 0.4149 Use floss Yes 19 21.84 9 13.24 28 18.06 No 68 78.16 59 86.76 127 81.94 1.9089 0.1671 Use an interdental toothbrush Yes 13 14.94 12 17.65 25 16.13 No 74 85.06 56 82.35 130 83.87 0.2064 0.6496 Use gauze to massage your gums Yes 1 1.15 0 0 1 0.65 No 86 98.85 68 100 154 99.35 0.7867 0.3751 Use a toothpick Yes 15 17.24 22 32.35 37 23.87 No 72 82.76 46 67.65 118 76.13 4.7962 0.0285* I brush my teeth three times a day Yes 80 91.95 47 69.12 127 81.94 No 7 8.05 21 30.88 28 18.06 13.4478 0.0002*** Brush for more than 3 minutes Yes 38 43.68 33 48.53 71 45.81 No 49 56.32 35 51.47 84 54.19 0.3619 0.5475 Total 87 56.13 68 43.87 155 100 - - Pearson Chi square test * p<0.05 ** p<0.01 *** p<0.001 5. 치주질환에대한환경요인제거법 치주질환에대한환경요인제거법을살펴보면, 3개의문항중 잇몸치료를위해인사돌, 이가탄등잇몸치료제를먹은경험이있다 에대한것을제외하고는성별에따른유의한차 이가없었다. 여자중잇몸치료를위해인사돌, 이가탄등잇몸치료제를먹은경험이있는비율은 2.3%, 남자중차지하는비율은 10.29% 로유의한차이가나타났다 (p=0.0347)<table 5>. <Table 5> Removal of Environmental Factors of Periodontal Disease by Sex Removal of environmental factors of periodontal disease Expertise was given to the management of the bacterial membrane Purchase "Parodon tak" toothpaste from a pharmacy I have experienced gingival treatments such as Insadol and Igatan for gum treatment. Female Male Total N % N % N % Yes 21 24.14 19 27.94 40 25.81 No 66 75.86 49 72.06 115 74.19 Yes 1 1.15 1 1.47 2 1.29 No 86 98.85 67 98.53 153 98.71 Yes 2 2.3 7 10.29 9 5.81 No 85 97.7 61 89.71 146 94.19 χ2 P 0.2883 0.5913 0.0309 0.8604 4.461 0.0347* Total 87 56.13 68 43.87 155 100 - - Pearson Chi square test * p<0.05 ** p<0.01 *** p<0.001 26
Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior 6. 충치설문지문항간상관관계 충치예방법중환경요인제거법은치주질환환경요인제거법과유의한양의상관관계를보였고 (r=0.25, p<0.01), 충치유 발위험요소와유의한음의상관관계를나타냈다 (r=-0.17, p<0.05)<table 6>. <Table 6> Correlation between the questionnaire of tooth decay Cavities risk Variable factor Cavities risk factor - Removal of host factors during tooth decay prevention Removal of environmental factors in the prevention of tooth decay Removal of environmental factors of periodontal disease Removal of host factors during tooth decay prevention 0.10951 - Pearson Correlation Coefficient * p<0.05 ** p<0.01 *** p<0.001 Removal of environmental factors in the prevention of tooth decay -0.16672* 0.02591 - Removal of environmental factors of periodontal disease 법 -0.0254 0.09399 0.25202** - 7. 충치유발위험요소에영향을미치는요인 충치유발위험요소에영향을미치는요인을살펴보면, 50대이상의연령층에서충치유발위험요소에유의한영향 (t=-2.21, p=0.0287) 을미치며, 50대이상더미변수 ( 더미3) 의표준화계수추정치는 -0.1832로다른연령층에비하여충치유발위험요소 를적게갖고있다. 또한결혼여부가충치유발위험요소에유의한영향 (t=-2.17, p=0.0314) 을미치며, 기혼더미변수 ( 더미1) 의표준화계수추정치는 -0.173으로미혼에비해충치유발위험요소를적게갖고있다 <Table 7>. <Table 7> Factors affecting the risk of tooth decay Variable B S.E t P Constant 1.89706 0.13262 14.3 <.0001 0 Dummy 1 0.16041 0.17702 0.91 0.3663 0.07306 Constant 2.1875 0.12073 18.12 <.0001 0 Age Dummy 1-0.2675 0.24743-1.08 0.2814-0.0903 Dummy 2-0.4133 0.22845-1.81 0.0724-0.1518 Dummy 3-0.6086 0.27559-2.21 0.0287* -0.1832 Constant 2.16 0.15491 13.94 <.0001 0 Blood type Dummy 1-0.16 0.23236-0.69 0.4921-0.0643 Dummy 2-0.3228 0.22781-1.42 0.1586-0.1327 Dummy 3-0.2964 0.28024-1.06 0.292-0.0949 Constant 2.02778 0.17933 11.31 <.0001 0 Dummy 1 0.19636 0.2283 0.86 0.3911 0.08722 Scaling frequency Dummy 2-0.4944 0.26599-1.86 0.065-0.1793 Dummy 3 0.02222 0.30007 0.07 0.9411 0.00684 Dummy 4-0.3005 0.37068-0.81 0.4188-0.0708 Marital status Constant 2.13684 0.11081 19.28 <.0001 0 Dummy 1-0.3868 0.1781-2.17 0.0314* -0.173 Dental-caries treatment experience Constant 2.46667 0.28018 8.8 <.0001 0 Dummy 1-0.531 0.2948-1.8 0.0737-0.1441 Regular dental checkup Constant 2.00926 0.10547 19.05 <.0001 0 Dummy 1-0.0731 0.19153-0.38 0.7033-0.0308 * p<0.05 ** p<0.01 *** p<0.001 27
Journal of Korean Society of Oral Health Science Vol. 5 No. 1 March 2017 8. 충치예방법중숙주요인제거법에영향을미치는요인 충치예방법중숙주요인제거법에영향을미치는요인을살펴보면성별이충치예방법중숙주요인제거법에유의한영향 (t=1.99, p=0.0482) 을미치며, 여자더미변수 ( 더미1) 의표준 화계수추정치는 0.159로남자에비해충치예방법중숙주요인제거법을많이갖고있다 <Table 8>. <Table 8> Factors affecting the removal of host factors in the prevention of cavities Variable B S.E t P Constant 0.75 0.08971 8.36 <.0001 0 Dummy 1 0.23851 0.11975 1.99 0.0482* 0.15897 Constant 0.9125 0.08409 10.85 <.0001 0 Age Dummy 1-0.0325 0.17234-0.19 0.8507-0.0161 Dummy 2-0.0093 0.15912-0.06 0.9536-0.005 Dummy 3-0.1757 0.19195-0.92 0.3616-0.0774 Constant 0.84 0.10654 7.88 <.0001 0 Blood type Dummy 1 0.035 0.15982 0.22 0.8269 0.02057 Dummy 2 0.09023 0.15669 0.58 0.5656 0.05426 Dummy 3 0.06909 0.19274 0.36 0.7205 0.03239 Constant 0.80556 0.12554 6.42 <.0001 0 Dummy 1 0.15996 0.15982 1 0.3185 0.10398 Scaling frequency Dummy 2 0.09444 0.18621 0.51 0.6128 0.05012 Dummy 3-0.0056 0.21007-0.03 0.9789-0.0025 Dummy 4 0.01263 0.2595 0.05 0.9613 0.00435 Marital status Constant 0.89474 0.07687 11.64 <.0001 0 Dummy 1-0.0281 0.12355-0.23 0.8206-0.0184 Dental-caries treatment experience Constant 1.06667 0.19285 5.53 <.0001 0 Dummy 1-0.2024 0.20292-1 0.3202-0.0804 Regular dental checkup Constant 0.86111 0.07203 11.96 <.0001 0 Dummy 1 0.07506 0.1308 0.57 0.5669 0.04634 ** p<0.05 ** p<0.01 *** p<0.001 9. 충치예방법중환경요인제거법에영향을미치는요인 충치예방법중환경요인제거법에유의한영향을미치며 (t=3.03, p=0.0028), 50대이상더미변수 ( 더미3) 의표준화계수추정치는 0.232로다른연령층에비하여충치예방법중환경요인제거법을많이갖고있다. 혈액형의경우, AB형이충치예방법중환경요인제거법에유의한영향을미치며 (t=-2.72, p=0.0072), AB형더미변수 ( 더미3) 의표준화계수추정치는 -0.240로다른혈액형에비하여충치예방법중환경요인제거법을적게갖고있다. 스케일링경험횟수가 7회이상인경우에충치예방법중환경요인제거법에유의한영향을미치며 (t=2.02, p=0.0455), 스케일링경험횟수가 7회이상인더미변수 ( 더미4) 의표준화계수추정치는 0.175로스케일링경험횟수가 6회이하인경우에비하여충치예방방법중환경요인제거법을많이갖고있다. 또한결혼여부가충치예방법중환경요인제거법에유의한영향을미치며 (t=4.76, p<.0001), 기혼더미변수 ( 더미1) 의표준화계수추정치는 0.359로미혼에비해충치예방방법중환경요인제거법을많이갖고있다. 정기검진유무가충치예방법중환경요인제거법에유의한영향을미치며 (t=3.04, p=0.0027), 정기검진을받는집단을의미하는더미 28
Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior 변수 ( 더미1) 의표준화계수추정치는 0.239로정기검진을받지않는집단에비해충치예방법중환경요인제거법을많이갖 고있다 <Table 9>. <Table 9> Factors affecting removal of environmental factors in the prevention of cavities Age Blood type Scaling frequency Marital status Dental-caries treatment experience Regular dental checkup * p<0.05 ** p<0.01 *** p<0.001 Variable B S.E t P Constant 0.39706 0.06625 5.99 <.0001 0 Dummy 1-0.1212 0.08842-1.37 0.1725-0.1101 Constant 0.2625 0.05932 4.43 <.0001 0 Dummy 1-0.1025 0.12156-0.84 0.4004-0.069 Dummy 2 0.15685 0.11224 1.4 0.1643 0.1149 Dummy 3 0.42171 0.1354 3.11 0.0022** 0.25327 Constant 0.4 0.07732 5.17 <.0001 0 Dummy 1 6.10E-18 0.11598 0 1 4.89E-18 Dummy 2-0.1674 0.11371-1.47 0.143-0.1373 Dummy 3-0.1727 0.13988-1.23 0.2188-0.1104 Constant 0.25 0.08993 2.78 0.0061 0 Dummy 1 0.00862 0.11448 0.08 0.9401 0.00764 Dummy 2 0.08333 0.13338 0.62 0.5331 0.06029 Dummy 3 0.2 0.15048 1.33 0.1858 0.12278 Dummy 4 0.47727 0.18588 2.57 0.0112* 0.22442 Constant 0.23158 0.05495 4.21 <.0001 0 Dummy 1 0.25175 0.08832 2.85 0.005** 0.22456 Constant 0.2 0.14149 1.41 0.1595 0 Dummy 1 0.14286 0.14887 0.96 0.3388 0.07735 Constant 0.26852 0.05214 5.15 <.0001 0 Dummy 1 0.19957 0.09468 2.11 0.0367* 0.16799 Ⅳ. 고찰 우리나라의구강보건사업정책방향은예방중심의포괄적국민구강건강관리를목적으로구강보건사업을시행하고있다. 대상자별로전체국민을대상으로시행하고있는검진과수돗물불소화사업을제외하고는성인대상구강보건사업은보건소에방문자를대상으로하는검진, 개인구강보건교육, 구강보건에대한관심단체의지원이있는경우와개인적인방문이있을경우로서성인을대상으로시행하는구강보건사업이극히제한적이고소극적이라고볼수있다 [3]. 현재시행되고있는사업은예방에서치료와재활로갈수록규모의예산을필요로하고있다. 노인연령대에서시행되는노인구강보건사업인틀니보철사업의개인당할당되는예산이그좋은 예로볼수있다. 이는국가적인시간과경제의손실이아닐수없다. 송 [13] 은구강건강관련삶의질에영향을주는요인이연령, 성별, 월평균수입, 상실치개수, 충전치개수, 우식치개수의순이었으며, 김 [14] 은구강보건지식은구강보건실천에강한정의영향을미쳤으며지식이높은것에비해실천도가낮으므로구강건강실천을높일수있는구강건강교육프로그램개발이필요하다고하였다. 또한이들은구강건강이좋으면전신건강과삶의질도높다고하였고구강건강관리의중요성을역설했다. 이에조사자들은대학교의전체구성원대상의구강건강증진을위한프로그램개발을위한기초자료를제공하고자, B대학교구강보건실에서학생, 교직원등보건실내방자의동의를구한후설문지를작성하고, 구강건강관리실태를파악하여구강건강관리행위에대한영향요인을분 29
Journal of Korean Society of Oral Health Science Vol. 5 No. 1 March 2017 석하였다. 치아우식증에영향을미치는충치유발위험요소와숙주요인제거법, 환경요인제거법, 치주질환환경요인제거법으로구분하여일반적인사항에따른차이를알아보았다. 충치유발위험요소에대해서는여자중오렌지쥬스를 1회이상먹는비율은 2.3%, 남자중차지하는비율은 13.24% 로유의한차이 (p=0.0085) 가존재하며, 남자가충치유발위험요소를더갖고있다고볼수있다. 이러한결과는 2005년국민영양조사를근거하여분석한박 [16] 은과일쥬스 [OR(95% CI) =1.010(0.799~1.277)] 를섭취하지않는집단보다섭취하는집단이치아우식증경험확률이높은것으로나타났고본연구결과와유사하게나타났다. 최 [17] 는당류 (p<0.05) 를많이섭취할수록본인인지치아우식증에영향을미치는것으로나타났다고했고본연구와같은결과로해석할수있다. 치아우식증의예방법으로식이조절을권하고있는데오렌지쥬스와커피의경우함유하고있는당의성분에주시하여구강보건교육시참고해야할것이다. 성별에따른충치예방법중숙주요인제거법에서는여자중우유를하루 1회이상먹는비율은 50.57%, 남자중차지하는비율은 30.88% 로유의한차이 (p=0.0137) 가존재하며, 여자가숙주요인제거법을더잘지키고있다고볼수있다. 대부분의대상자들의 73.55% 가불소를사용하지않으며, 자일리톨정제를먹은경험이없는것 (80%) 으로보인것은 20% 는불소정제를먹은경험이있다는것인데, 백 [5] 은불소치아우식예방작용인지자율이일반국민에서 69.2% 에불과하였으며, 김등 [18] 이산취급근로자에서 56.7% 에불과하였다고주장한것과비교해훨씬저조한결과를보였다. 이러한결과는시중의세치제가대부분불소를배합하고있음에도불구하고불소배합제와불소정제에대한인지자율의비율이낮은결과로사료되며성인을대상으로한치아우식증예방교육을개발하여야한다고본다. 충치예방법중환경요인제거법에사용하는방법은주로일일잇솔질과잇솔질시간에많은비중을보였으며이쑤시게, 구강양치액사용, 치실과치간치솔사용, 거즈사용유무, 이쑤시개사용여부가사용되고있었다. 성별에따라충치예방법중환경요인제거법에대한문항의응답이차이는여자중이쑤시개를사용하는비율은 17.24%, 남자중차지하는비율은 32.35% 로유의한차이가나타났다 (p=0.0285). 또한여자중하루 3번잇솔질을하는비율은 91.95%, 남자중차지하는비율은 69.12% 로유의한차이를보인다 (p=0.0002). 이는여자가환경요인제거법을더잘지키 고있다고볼수있다. 치태관련질환의예방책으로치태조절교육을실시하고정기적인검진을하여단순히증상치료가아닌원인치료를해야하고환자를재교육하여동기부여를재확인하고강화함으로써행동을교정하여장기적인성공을거둘수있다고하였다 [19]. 치아우식증은대표적인치태관련질환으로구강환경을개선하기위한방법으로다양한방법이사용되고있다. 본연구에서는구강양치액사용, 치실과치간치솔사용, 거즈로잇몸마사지유무, 이쑤시개사용여부, 하루잇솔질횟수, 한번잇솔질시간을제시했으며, 정기검진과스케일링은재교육과동기부여를재확인하고강화함으로써행동을교정의계기가되었고사료된다. 성별에따라치주질환환경요인제거법에대한문항의응답이차이에서는치주질환환경요인제거법에대한 3개의문항중 잇몸치료를위해인사돌, 이가탄등잇몸치료제를먹은경험이있다 에대한것을제외하고는성별에따른유의한차이가없었다. 여자중잇몸치료를위해인사돌, 이가탄등잇몸치료제를먹은경험이있는비율은 2.3%, 남자중차지하는비율은 10.29% 로유의한차이 (p=0.0347) 가존재하였는데, 이는잇몸치료를위해인사돌, 이가탄등복용한잇몸치료제가처방을받은것인지에대한확인되지않은관계로항생제과용과같은문제가제기될수있는결과이다. 그러므로이결과만으로는남자가치주질환환경요인제거법을더잘지키고있다고볼수는없다. 충치예방법중환경요인제거법은치주질환환경요인제거법과유의한양의상관관계를보였고 (r=0.25, p<0.01), 충치유발위험요소와유의한음의상관관계를나타냈다 (r=-0.17, p<0.05). 구강건강을증진시키기위한관리행위에영향요인으로충치유발위험요소에영향을미치는요인에는연령, 결혼이, 충치예방법중숙주요인제거법에영향을미치는요인에는성별이, 충치예방법중환경요인제거법에영향을미치는요인으로서는연령, 혈액형, 스케일링경험횟수, 결혼유무, 정기검진유무가치주질환환경요인제거법에영향을미치는요인에는연령, 스케일링경험횟수, 결혼유무, 정기검진유무였다. 본연구는내원목적별로구강내불편감호소, 구강보건실홍보로등다양한이유로내방한대상자를조사연구한것이며, 개인의경제적인배경과같은구강건강에영향을미치는요인이배제된연구의결과임을간과해서는안될것이다. 본연구에동참한대상자들은대부분연구기간동안실시되어온구강보건실의교육법에대해흥미와많은관심을보였다. 구 30
Influence of the Methods of Dental-Caries Prevention on Oral Health Care Behavior 강보건교육참석의향을질문한결과 155명중 95명의찬성으로과반수를넘어구강보건교욱에대한관심이큰것으로나타났다. 이러한결과를토대로향후학교에서는매년정기적인구강보건교육을실시하고, 개인을대상으로는성별, 연령별, 혈액형등을고려한접근법을통해정기검진과스케일링및치주관리외초기우식치치료등의다양한구강관리가실시되어재교육과동기부여를강화함으로써구강건강을증진시키는계속적인구강건강관리를지원하여야한다. Ⅴ. 결론 성인집단인대학교구강보건의실태를파악하고, 학교단위구강보건교육및치아우식병관리프로그램개발을위한기초자료를제공함으로써학교지역사회의공중과개인을대상으로한적절한구강보건교육과구강건강관리가행복한삶에도움을주는데목적을두고있다. 1. 충치유발위험요소로서는오렌지쥬스를 1회이상음용과단것을좋아하는자들, 하루에커피를 2잔이상먹는사람이충치유발위험요소를많이가졌으며, 미네랄워터를하루 1회이상먹는자들이충치유발위험요소가낮았다. 2. 숙주요인제거법에대한문항의응답은여자가 우유를하루 1회이상먹는다 에서남자보다높았게나타났다. 3. 환경요인제거법에대한문항의응답이차이는이쑤시개를사용하는비율에서남자가여자보다높았으며, 하루 3번잇솔질을하는비율은여자가높았다. 이는여자가환경요인제거법을더잘지키고있다고볼수있다. 4. 치주질환환경요인제거법에서는여자중잇몸치료를위해인사돌, 이가탄등잇몸치료제를먹은경험이있는비율은 2.3%, 남자중차지하는비율은 10.29% 로유의한차이 (p=0.0347) 가존재하였으며, 정기검진을받는자가치주질환환경요인제거법을더잘지키고있다고볼수있다. 5. 충치예방법중환경요인제거법은치주질환환경요인제거법과유의한양의상관관계를보였고 (r=0.25, p<0.01), 충치유발위험요소와유의한음의상관관계를나타냈다 (r=-0.17, p<0.05). 6. 충치유발위험요소에영향을미치는요인을알아본결과성별, 연령, 혈액형중연령더미변수만이통계적으로유의한영향이나타났다. 숙주요인제거법에영향을미치는요인은성별더미변수만이통계적으로유의하며, 여자가남자에비하여충치예방법중숙주요인제거법을많이행하고있다. 향후학교에서는전체를대상으로매년정기적인구강보건교육을실시하고, 개인을대상으로는성별, 연령별, 혈액형등을고려한접근법을통해정기검진과스케일링및치주관리등의다양한구강관리가이루어져재교육과동기부여를재확인하고강화함으로써행동을교정증진시키는계속적인구강건강관리가실시되어야한다. 참고문헌 1. Hellyer PH, Beighton D, Heath MR, Lynch EJ: Root caries in older people attending a general dental practice in East Sussex. British Dental Journal 169(7):201-206, 1990. 2. Lee MO: Public Oral Health. Komoonsa, pp.38-40, 2009. 3. http://www.mohw.go.kr/front_new/ 4. Kang BW: Preventive dentistry. koonja, Seoul, pp.20-40, 2014. 5. Paik DI: Knowledge, attitude, and practices about dental caries among Koreans. Journal of Korean Academy of Oral Health 17(1):1-12, 1993. 6. Lee YH, Moon HS, Paik DI, Kim JB: A survey on family dental health behavior in Seoul capital city. Journal of Korean Academy of Oral Health 24(3):239-257,2000. 7. Lim SA: Results of oral health survey for community oral health policy in Gwangju, Jeonnam area doctoral dissertation, Chosun University, Gwangju, 2005. 8. Roh SI: Recognition for the health of the mouth and behaviors on some of university students. doctoral dissertation, master s thesis, Daegu Haany University, Taegu, 2008. 9. Yoon HS: The relationship between the oral health status and their knowledge of the freshman of colleges in Taegu city, master s thesis, Kyungpook National University, 31
Journal of Korean Society of Oral Health Science Vol. 5 No. 1 March 2017 Taegu, 1993. 10. Song SK: A study on the recognition and attitude of oral heath in Korean college students, master s thesis, Wonkwang University, Iksan, 2003. 11. Jo EM: A Study on the oral health cognition, behavior and community periodontal index treatment needs of university students, master s thesis, Chosun University, Gwangju, 2000. 12. http://www.gcamerica.com/products/preventive/ 13. Song KH: A study on the evaluation of health- and oral health- related quality of life in Korean adults, doctoral dissertation, Hanyang University, Seoul, 2007. 14. Kim JH: The effect of oral health on total health and quality of life: Surveyed against some of Youngnam area residents, doctoral dissertation, Keimyung University, Taegu, 2007. 15. Seo HS, Park GS: The study on the oral health status and behavior of industrial workers at Choong-Nam province, South Korea. Journal of Korean Academy of Oral Health 127(4):641-653, 2003. 16. Park MK: Multiple logistic regression analysis of elements related to dental caries based on common risk factor approach, master s thesis, Chung-Ang University, Seoul, 2008. 17. Choi JH: Relation between food intake and self-recognition of major oral disease on the Korean adults, doctoral dissertation, Chosun University, Gwangju, 2009. 18. Kim JB, Paik DI, Moon HS: Knowledge opinion and practices about oral health of workers exposed to acids in Korea. Journal of Korean Academy of Oral Health 21(1):155-184, 1997. 19. Grace EG, Cohen LA, Ward MA: Public knowledge/perceptions about AIDS transmission: concerns about use of dental services. Community Dentistry and Oral Epidemiology, 22(1):52-55, 1994. 32