<342EB1E8C5C2C0CFB1B3BCF6B4D42E687770>

Original article J Korean Acad Periodontol 2009;39:407-412 유도장치가부가된진동회전방식전동칫솔의구강건강증진효과에대한조사연구 박윤수, 이철우, 함병도, 구기태, 김태일 서울대학교치의학대학원치주과학교실 *, 설양조, 이용무, 류인철, 구영, 정종평 Survey study of powered toothbrush with guiding device for oral Yun-Soo Park, Chul-Woo Lee, Byoung-Do Hahm, Ki-Tae Koo, Tae-Il Kim *,Yang-JoSeol, Yong-Moo Lee, In-Chul Rhyu, Young Gu, Chong-Pyoung Chung Department of periodontology, School of dentistry, Seoul National University ABSTRACT Purpose: This study was performed to evaluate the effect of powered toothbrush with a wireless remote display on the subjective and objective oral. Methods: One hundred and fifteen subjects in healthy or mild gingivitis status between the ages of 20 and 90 were recruited and reviewed for study inclusion criteria. At first visit, 115 pre-screened subjects filled in the questionnaire form which consisted of demographic factors, behavioral factors (smoking, alcohol consumption), toothbrushing habits (brushing time and frequency), self-reported oral health status, and self-satisfaction. Baseline clinical indices (Plaque index, Gingival index) were also recorded by a periodontist. Subjects were instructed how to use powered toothbrush with a wireless remote display, and were provided with it. Thirty days after first visit, 90 subjects returned for the second assessment by self-reported questionnaire form and professional clinical checkup. Statistical analysis was performed using paired t-test for the difference between baseline and second visit data. The relationship among variables was examined with chi-square test and Fisher s exact test. Results: Significant differences were not found on self-reported satisfaction related with sex, smoking, alcohol consumption (P<0.05). Self-reported tooth brushing habit was improved in the aspect of brushing time and frequency. Significant differences were found on the self-reported oral health status, self-satisfaction, and clinical indices between the baseline and second visit data (P<0.01). Clinical indices were significantly reduced after using powered toothbrush with a wireless remote display (P<0.01). No adverse reactions were reported during the study period. Conclusions: Powered toothbrush with a wireless remote display successfully promoted oral hygiene from the subjective and objective viewpoint after 30 days of home usage. (J Korean Acad Periodontol 2009;39:407-412) KEY WORDS: oral hygiene; personal satisfaction; toothbrushing. 서론 치태는구강내세균과그부산물이식편잔사등과혼재되어치아표면에부착되는바이오필름으로서, 치은염과치주염을일으키는주된인자로밝혀져있다 1,2). 부적절한치태제거는병원성이강한세균의증식을야기하며결국숙주에해가되는염증반응과함께가역적인치은염으로발전한 Correspondence: Dr. Tae-Il Kim Department of periodontology, School of dentistry, Seoul National University, Yeongun-dong, Jongno-gu, Seoul, Korea E-mail: periopf@snu.ac.kr, Tel: 82-2-2072-2642, Fax: 82-2-744-0051 This work was supported by Procter & Gamble Co. Received: Nov. 24, 2009; Accepted: Dec. 1, 2009 다. 또한치은염은치주염의선행질환으로서, 시간이지날수록치주조직에좀더파괴적인치주염으로진행하게된다 3). 따라서, 구강건강을유지하기위해서적절한치태조절및 관리는필수적이다. 효과적인치태제거를위해서는치과내원을통한전문적인치태관리와치석제거술을받는것이필요하지만, 일상적인칫솔질을통해평소에치태관리를하는것도중요하다 4). 왜냐하면, 산업화된사회의 80~90% 의인구가구강청결을위해서매일칫솔을사용하고있기때문이다 5). 하지만칫솔질의효과는얼마나자주칫솔질을시행하는지그리고얼마나효율적으로칫솔을사용하는지에따라달라진다 6). 따라서매일적

절한횟수와시간을유지하며올바른방법으로칫솔질을시 행하는것이중요하다고할수있다. 전동칫솔은 1855 년에 Frederick Wilhelm 7) 에의해서처음으로고안되었으며 1960년대에처음으로시장에등장하였다 8). 초기의전동칫솔은앞뒤로움직이는형태로만들어졌으나, 그후좌우회전방식, 왕복회전방식등다양한형태가고안되었다. 시간이지남에따라전동칫솔이보편화되었고, 수동칫솔과비교하여전동칫솔이구강위생도개선에미치는효과와안정성에대한연구가지속되어왔다. 또어떠한운동형태의전동칫솔을사용하는것이치태관리및치은건 강유지에효과적인가에대한관심도높아지게되었다 9). 칫솔질의효과를평가하는실험에서사용되는대표적인척도는치태의잔존여부이다. 최근에시행된대다수임상적실험의결과는전동칫솔이수동칫솔에비해우수한치태제거효과가있음을보고하고있다 10-13). 또한많은연구들이전동칫솔의일상적인사용이수동칫솔에비해위험하지않 다는사실을보여준다 14). 최근에는진동회전방식을가지며적절한칫솔질을유도하는도구가결합된전동칫솔이소개되었다 15). 본연구는경미한치은염환자들로하여금효과적인칫솔질을유도하는유도장치가부가된진동회전방식의전동칫솔을사용하게한다음, 설문조사를통해주관적인구강건강개선에어떤영향을주는지확인하고, 임상지수에대한전문가의객관적인 평가를통해서구강위생증진효과를평가하고자시행되었다. 2. 조사방법 첫내원시대상자들은설문사항을작성하는 1차검사를시행받았다. 설문은대상자의기본정보및전동칫솔사용전후의칫솔질습관과만족도를확인하기위해인구학적요소, 과거기왕력, 흡연, 음주를포함한행동적요소, 칫솔질횟수및시간, 자가구강상태진단, 그리고구강상태에대한자기만족도로구성되었다. 2차설문조사시에는만족도를세정도, 상쾌함, 일반칫솔대비세정도, 잇몸건강개선등에대한만족도로세분화시켜조사하여환자의주관적인생각을좀더객관적으로나타낼수있도록하였다. 상쾌함및세정도는 5 가지의선택지로이루어졌으며각각매우만족, 만족, 약간만족, 불만족, 전혀불만족으로이루어졌다. 1차설문조사직후치태지수및치은지수검사가숙련된치주과전문의에의해시행되었다. 모든조사가끝난후대상자들은유도장치가부가된전동칫솔 (Oral-B Triumph with SmartGuide, P&G, Cincinnati, USA) 을지급받고 전동칫솔의사용방법및제조사의지시사항에대해충분히 교육받은후귀가하였다. 대상자들은전동칫솔을록하였고총 30일간사용한후에재내원하도 90 명의대상자들이이에응하였다. 재내원한 90명의대상자는치태지수및치은지수항목의검사를 1차 검사때와동일한치주과전문의를통해받은다음 문조사에응하였다. 2차설 3. 임상지수평가 1. 연구대상 재료및방법 구강내 Ramfjord 치아 (#16,21,24,36,41,44) 의각각 4개부위( 근심협측, 협측, 원심협측, 설측혹은구개측 ) 에서임상지수측정이시행되었으며, 대상자들의치태지수와치은지 수는다음의기준을따랐다. 본연구는 3mm이하의치은열구깊이를가지며진행성치조골파괴가없는건강하거나경미한치은염증상을보이는 115 명의대상자를상대로시행하였다. 대상자들은만 20 세이상 90 세이하의성인남녀로, 구강내Ramfjord 치아 (#16,21,24,36,41,44) 가존재하는대상자를선별하였다. 본연구는서울대학교치과병원연구윤리심의위원회의승인을받았으며( 승인번호 CMP08002), 연구의모든과정은대상자 의동의를받고진행되었다. 1) 치태지수(Plaque index, Silness & Lӧe) 16) 대상치아의근심협면, 원심협면, 협면변연, 설면에대하여치태염색제를사용하지않고치태축적량을평가하여 다음의수치를부여하였다. 0 = 치태가부착되어있지않은상태 1 = 치주탐침으로치면을긁어보아확인할수있을정도로 치태가치경부에엷게부착된상태 408

2 = 육안으로확인될수있을정도로다량의치태가치경부 에부착된상태 3 = 치태부착이치경부를넘어치간부에도채워져있는상태 2) 치은지수 (Gingival index, Lӧe & Silness) 대상치아의치은조직에대하여근심협면, 원심협면, 협면변연, 설면혹은구개면으로나누어염증을관찰하여다음 의수치를부여하였다. 0 = 정상치은 1 = 경한염증, 경미한색조변화, 가벼운부종, 탐침시출 혈성향없음 2 = 중증염증, 치은의색조변화, 발적, 부종, 탐침시출혈 3 = 심한염증, 상당한발적과부종, 궤양, 계속적인출혈 4. 통계분석 전동칫솔사용전후항목비교를위해 paired t-test를시행하였으며, 각항목간의연관성을확인하기위해 chisquare test와 Fisher s exacttest 및회귀분석을시행하였다.Pairedt-test는유의수준 0.01 로시행되었고, 나머 지통계분석은유의수준 1. 설문조사 0.05 로시행되었다. 결과 총 90명의대상자중남성은 32 명, 여성은 58 명으로남성은전체조사대상자중 35.6%, 여성은 64.4% 로여성이 17) 2/3 정도를구성하였다. 연령은평균 34.5± 9.8세의분포를이루고있었다. 음주빈도설문결과비음주자와주1회이하음주자가각각 22 명, 45명으로빈도가낮은사람의비율이 74.4% 를차지하여음주습관이별로없는사람들이조사대상자의 2/3 이상을구성하고있었다. 흡연빈도에대한설문조사결과비흡연자가 72명으로대상자의 80% 를이루 고있었다. 1차조사결과기존칫솔에대한만족도면에서만족하는경우가 22 명, 약간만족하는경우가 53 명, 만족하지못하는경우는 15 명이었으며. 매우만족과전혀불만족의경우는 0 명으로조사되었다. 성별, 음주력, 흡연력에따른현재의만족도차이를 chi-square test를이용하여알아본결과이에 따른만족도의차이는없는것으로나타났다 (Table 1). 칫솔질습관과관련한조사에서칫솔질을하루세번이상시행하는대상자가 62 명, 두번시행하는대상자가 26 명, 하루한번및기타가 2명으로전체대상자의 68.9% 만이이상적인칫솔질횟수인하루세번이상칫솔질을시행하고있었다(Table 2). 또한칫솔질시간은 3분이상시행하는대상자가 22 명,1~2분시행하는대상자가 58 명,1분이하및기타대상자가 10명으로역시과반수에훨씬못미치는 24.4% 만이적절한칫솔질시간으로추정되는 3분이상의칫솔질시간을지키고있었다. 칫솔질에대한인식도조사결과, 잘닦고있다고생각하는대상자가 19 명, 보통이라고생각하는대상자가 59 명, 잘못닦고있다고생각하는대상자가 12명으로전체의 21.1% 만이칫솔질을잘한다고생 각하고있었다. 전동칫솔사용후시행한 2 차조사결과, 칫솔질을하루에세번이상시행하는대상자가 69명으로증가하였으며전체대상자의 76.7% 를구성하고있었다. 칫솔질시간은일반칫솔대비칫솔질시간이상당히늘어난대상자가 9 명, 약간늘어난대상자가 49명이전과변화없음과줄어든대 Table 1. Satisfaction Difference Related with Sex, Alcohol Table 2. Distribution of Tooth Brushing Frequency (%) Consumption, Smoking about Old Tooth Brush Brushing frequency 1st visit 2nd visit Factors Chi-square P >3/day 67.8 76.7 Sex 2.741 0.254 2/day 28.9 18.9 Alcohol consumption 7.346 0.5 1/day 1.1 3.3 Smoking 11.848 0.158 <1/day 0 0 P = Statistical Significance 409

상자는 32명으로전체대상자중 64.4% 가일반칫솔대비칫솔질시간이늘어났다고응답하였다. 그리고전동칫솔사용시칫솔질시간증가는 10초이내가 2 명, 20초이내가 11 명, 30초이내가 29 명, 40초이내가 9 명, 1분이내가 6명으로시간이증가된 58명의대상자중 72.4% 가 30초이내로 시간이증가되었음을알수있었다. 전동칫솔사용후입속상쾌함측면에서의만족도, 세정도측면에서의만족도, 기존수동칫솔대비치아세정도측면에서의만족도, 잇몸건강개선측면에서의만족도를확인해보았다. 먼저성별, 흡연력, 음주력에따른만족도의차이는음주력에따른잇몸건강개선만족도를제외하고는없었다 (Table 3). 유의성있는차이를보였던음주력에따른잇몸건강개선도에대해좀더정확한분석을위해서 Fisher s Exacttest를시행한결과유의수준이 0.065 를나타내어통 계학적유의성이없었다. 회귀분석모형에서는통계학적으로유의한차이는없었으며결정계수가 0.05 이상은나타나 지않아 5% 에도못미치는연관성을보였다(Table 4). 전동칫솔사용전후의만족도측면에서는상쾌함, 세정도, 일반칫솔대비치아세정도, 잇몸건강개선만족도에서많은사람들이불만족및약간만족에서만족및매우만족으로변화함을볼수있으며유의수준 0.01 미만의통계학적유의성을보였다(Table 5). 전동칫솔사용과관련하여특별한불만사항이나치주조직에유해한부작용은보고되지않았다. 2. 임상지수 전동칫솔사용전후로객관적지표인치태지수, 치은지수도큰차이를보였다. 치태지수의경우 1차조사시에는대상자의치태지수평균이 1.488 이었으나, 30일후 2차조사에서는 0.555 로측정되었다. 이는 1차조사에비해한단계정도의지수개선을보여준것으로유의수준 0.01 미만의통계학적으로유의한차이를나타내었다. 치은지수도비슷한 Table 3. Satisfaction Difference Related with Sex, Alcohol Consumption, Smoking about Powered Tooth Brush (P ) Factors Freshness Cleansing degree Cleansing degree compared with old tooth brush Gingival health improvement Sex 0.514 0.227 0.804 0.19 Alcohol Consumption 0.156 0.605 0.447 0.017* Smoking 0.786 0.565 0.504 0.504 * Statistically significant relationship exists between individual factor and satisfaction. Table 4. Regression Analysis of Satisfaction at 2nd visit (P ) Analysis type Simple regression analysis Multiple regression analysis Factors Freshness Cleansing efficacy Cleansing efficacy compared with old tooth brush Gingival health improvement Sex 0.879 0.147 0.289 0.105 Alcohol consumption 0.946 0.929 0.245 0.663 Smoking 0.589 0.839 0.881 0.118 Sex 0.862 0.107 0.13 0.321 Alcohol consumption 0.973 0.762 0.184 0.476 Smoking 0.59 0.484 0.393 0.412 Table 5. Distribution of Satisfaction Before and After Using Powered Tooth Brush (Frequency) Time Questionnaire Excellent Good Fair Poor Worst 1st visit Satisfaction degree 0 22 53 15 0 Freshness 16 53 20 1 0 2nd visit Cleansing degree 14 52 14 10 0 Cleansing degree compared with old tooth brush 16 48 15 11 0 Gingival health advancement 9 48 32 1 0 410

결과를보였는데 1차조사시평균 1.304, 2차조사시평균 0.488 을나타내어한단계정도의지수개선을보여주었 으며, 통계학적으로유의한차이를나타내었다 (Table 6). Table 6. Result of Plaque Index and Calculus Index Clinical index 1st visit 2nd visit Plaque index 1.488 0.555* Calculus index 1.304 0.488* * Statiscally significant between 1st and 2nd visit. 고찰 1960 년대에전동칫솔이나온이후로치태제거효과및효율성에대하여수동칫솔과비교한연구들이시행되었으며, 최근에는전동칫솔의효율적인치태제거효과때문에수동칫솔을대체할만한칫솔로서인정하고있다 18). 현재의전동칫솔은좌우회전운동이나음파진동운동및진동회전운동등다양한형태의운동방식을채용하고있는데, 전동칫솔의운동방식에대한연구를종합한결과진동회전운동을하는전동칫솔의경우치태제거나치주질환예방측면에서수동칫솔보다더뛰어나다는연구결과가보고되었으며다른형태의전동방식을가지는전동칫솔의경우수동칫솔에비해지속적으로나은효과를보여주지못했다 19). 본연구에사용된전동칫솔은진동회전방식의전동칫솔로서치태제거효과를비교한실험에서좋은결과를보여준바있으며 20), 본연구에서도통계적으로유의할만한치태지수및치은지수의감 소를나타내었다. 1 차내원시설문조사에서성별, 흡연력, 음주력에의한만족도는통계학적으로유의할만한차이를나타내지않았다. 그러나, 음주력과상쾌함및잇몸건강개선만족도의경우상당히작은유의수준을나타내었는데, 음주를한경우운동능력의감소를가져오기때문에칫솔질능력에영향을줄수있다고생각이되나이에대해서는추가적인연구가 필요하다. 칫솔질시간의경우치주조직의건강유지에중요한요인이다 21-23). Van der weijden 등 24) 은 2분이상의칫솔질시간을권고하였다. 이번연구에서대상자들은칫솔질교육에대한협조도가매우높았으며, 이에따라칫솔질시간의증가를관찰할수있었다. 본연구에사용된전동칫솔의경우대상자들의칫솔질시동기유발을위한유도장치인 SmartGuide TM (P&G, Cincinnati, USA) 가포함되어있었으며, 이장비를사용함으로써 2분동안충분히칫솔질을시행하도록하였다. 결국, 유도장치를사용함으로써본연구의대상자들은수동칫솔을사용할때보다칫솔질시간을증가시킬수있었다고보여지며, 대상자의주관적인만족도및객관적인임상지수의개선에큰영향을주었다고생각된다. 따라서, 본연구에서구강건강도가증진된결과의주요한원인요소로서는수동칫솔에비해개선된효과를나타내는진동회전방식의전동칫솔을사용했다는점과효과적인칫솔질을유도하는유도장치의사용으로인한적정칫솔질 시간이유지된것을들수있다. 전동칫솔의효과에대한기존의연구들은치은지수, 치태지수등의객관적지표에대해서만주로시행되었다 11-13,18-20). 이에반해본연구에서는대상자의주관적지표까지함께조사하였다는데차별성이있다. 만족도를세분화하여상쾌함, 세정도, 일반칫솔대비세정도, 잇몸건강측면만족도등의구체적인항목으로구분하여조사를시행한결과, 모든만족도에서 1차조사결과와비교시 2차조사결과때에주관적인만족감이큰것으로나타났다. 전동칫솔의사용전후설문조사결과에나타난통계학적유의성을감안하면, 대상자들은유도장치가부가된진동회전방식의전동칫솔에 크게만족하였음을알수있었다. 본연구는대조군을설정하지않음으로써각대상자의초기치를일정하게맞추어줄필요성이감소한다는장점을가지고있다. 그러나, 칫솔이바뀜으로써나타날수있는효과를제거하지못했다는한계가있으며향후추가연구를통해 이러한효과를배제할수있을것으로생각된다. 결론적으로유도장치가부가된진동회전방식의전동칫솔을 1개월간사용한본연구의대상자들은치태제거및치은염증도개선이라는객관적인임상지수증진과주관적인구 강건강도개선측면에서유의할만한효과를나타내었다. 참고문헌 1. Lӧe H, Theilade E, Jensen SB. Experimental gingivitis in man. J Periodontol 1965;36:177-187. 2. Theiladӧe E,JensenSB.,Lӧe H. Experimental gingivitis in man. II. A longitudinal clinical and bacteriological 411

investigation. J Periodontal Re. 1966;1:1-13. 3. Schroeder HE, Lindhe J. Conversion of stable established gingivitis in the dog into destructive periodontitis. Arch Oral Biol 1975;20:775-782. 4. Axelsson P, Nystrӧm B, Lindhe J. The long-term effect of a plaque control program on tooth mortality, caries and periodontal disease in adults. Results after 30 years of maintenance. J Clin Periodontol 2004;31:749-757. 5. Bakdash B. Current patterns of oral hygiene product use and practices. Periodontol 2000 1995;8:11-14. 6. Janusz Karen; Nelson Bruce, Bartizek Robert D. Impact of a novel power toothbrush with SmartGuide technology on brushing pressure and thoroughness. J Contemp Dent Pract 2008;9:1-8. 7. Scutt JS, Swann CJ. The first mechanical toothbrush? Br Dent J 1975;139:152. 8. Elliot JR. A comparison of the effectiveness of a standard and electric toothbrush. J Periodontol 1963;34:375-379. 9. Heasman PA, Stacey F, Heasman L. A comparative study of the Philips HP 735, Braun/Oral B D7 and the Oral B 35 Advantage toothbrushes. J Clin Periodontol 1999;26:85-90. 10. Ho HP, Niederman R. Effectiveness of the Sonicare sonic toothbrush on reduction of plaque, gingivitis, probing pocket depth and subgingival bacteria in adolescent orthodontic patients. J Clin Dent 1997;8:15-19. 11. Van der Weijden GA, Timmerman MF, Reijerse E. The long-term effect of an oscillating/rotating electric toothbrush on gingivitis. An 8-month clinical study. J Clin Periodontol 1994;21:139-145. 12. Ainamo J, Xie Q, Ainamo A, Kallio P. Assessment of the effect of an oscillating/rotating electric toothbrush on oral health. A 12-month longitudinal study. J Clin Periodontol 1997;24:28-33. 13. Stoltze K, Bay L. Comparison of a manual and a new electric toothbrush for controlling plaque and gingivitis. J Clin Periodontol 1994;21:86-90. 14. He T, Carpinello L, Baker R. Safety of three toothbrushes. Am J Dent 2001;14:123-126. 15. Walters PA, Cugini M, Biesbrock AR, Warren PR. A novel oscillating-rotating power toothbrush with SmartGuide: designed for enhanced performance and compliance. J Contemp Dent Pract 2007;8:1-9. 16. Silness J, Lӧe H. Periodontal disease in pregnancy II. correlation between oral hygiene and periodontal condition. Acta Odontol Scand. 1964;22:121-135. 17. Lӧe H. The gingival index, the plaque index and the retention index systems. J Periodontol 1967;38 Suppl:610-616. 18. Warren PR. Development of an oscillating/rotating/pulsating toothbrush: the Oral-B Professional Care Series. J Dent 2005;33 Suppl 1:1-9. 19. Heanue M, Deacon SA, Deery C et al. Manual versus powered toothbrushing for oral health. Cochrane Database Syst Rev. 2003;1:CD002281. 20. Rosema NA, Timmerman MF, Versteeg P. A comparison of the use of different modes of mechanical oral hygiene in prevention of plaque and gingivitis. J Periodontol 2008;79: 1386-1394. 21. G. A. Van der Weijden, M. F. Timmerman, M. Piscaer. Plaque removal by professional electric toothbrushing compared with professional polishing, J Clin Periodontol 2004; 31:903-907. 22. Van der Weijden GA, Timmerman MF, Danser MM et al. Approximal brush head used on a powered toothbrush. J Clin Periodontol 2005;32:317-322. 23. Williams K, Ferrante A, Dockter K et al. One- and 3-minute plaque removal by a battery-powered versus a manual toothbrush. J Periodontol 2004;75:1107-1113. 24. Van der Weijden FA, Timmerman MF, Snoek IM, Reijerse E, van der Velden U. Toothbrushing duration and plaque removing efficacy of electric toothbrushes. Am J Dent 1996;9:S31-S36. 412