8) Original Article J Journal of Korean Society of Dental Hygiene 2015; 15(1): 63-71 ISSN 2287-1705(Print) http://dx.doi.org/10.13065/jksdh.2015.15.01.63 ISSN 2288-2294(Online) KSDH 한국치위생학회 성인의골밀도와잔존치아수와의관련성 송혜정 이덕희 1 마산대학교치위생과 1 경북대학교의학전문대학원예방의학교실 Relationship between bone mineral density and the remaining teeth in Korean adults Hye-Jeong Song Duk-Hee Lee 1 Department of Dental Hygiene, Masan University 1 Department of Preventive Medicine, School of Medicine, Kyungpook National University *Corresponding Author: Hye-Jeong Song, Department of Dental Hygiene, Masan University, Hamma-daero 2640 Naeseo-eup Changwon, Gyeongnam 630-729, Korea; Tel : +82-55-230-1159, Fax : +82-55-230-1444, E-mail : so2147@hanmail.net Received: 9 October 2014; Revised: 27 January 2015; Accepted: 30 January 2015 ABSTRACT Objectives: The purpose of the study is to investigate the relationship between bone mineral density and remaining teeth in Korean adults. Methods: Using National Health and Nutrition Examination Survey(KNHANES) 5th Year 1(2010), 1,985 adults over 50 years old having bone mineral density test were selected. Male adults were 883, and female adults were 1,102. The raw data consisted of general characteristics of the subjects, bone density data, and oral examination data. The questionnaire consisted of general health survey, laboratory examination study, and nutrition study. Data were analyzed using SPSS 18.0 program for multiple regression analysis, ANOVA, t-test. The variables included general characteristics of the subjects, health behavior, diet habit, and oral health behavior. General characteristics consisted of gender, age, residence area, education level, marital status, monthly income, and vocation. Health behavior consisted of smoking, alcohol drinking, body mass index(bmi), physical activity, and mental health. Diet habit consisted of frequency of meal, milk, coffee, and calcium ingestion. Oral health behavior consisted of frequency of tooth brushing, use of oral health care devices, and oral examination. Systemic diseases were measured by the questionnaire for hypertension, diabetes mellitus, and hyperlipidemia. Bone density was measured in T-score of femoral bone, neck of femur, and lumbar vertebrae. Bone density was classified into normal(t-score -1.0), osteopenia(-2.5 < T-score < -1.0), and osteoporosis (T-score -2.5). The remaining teeth were measured by the differences between normal teeth and missing teeth. Results: Smoking and age are the most influencing factors on the number of remaining teeth and bone density(p<0.01)(p<0.05). Those who had higher bone density, younger age, and nonsmoker significantly had more remaining teeth. Those who were men, diabetic, lowly educated women, and low birth weighted persons tended to have less number of teeth(p<0.01). Conclusions: The study suggested that there were significant differences between men and women according to the oral health management behavior and systemic disease control. Proper management of the oral health and good quality of bone mineral density can reserve the remaining teeth through the whole life. Key Words: bone mineral density, oral health, remaining teeth 색인 : 골밀도, 구강건강, 잔존치아수 Copyrightc2015 by Journal of Korean Society of Dental Hygiene This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/ licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in medium, provided the original work is properly cited.
64 J Korean Soc Dent Hyg 2015; 15(1): 63-71 서론 최근의료기술의발전과경제성장에따라인간의삶의질이향상되고사람들의평균수명이연장되면서노인인구가점점증가하는추세이다. 우리나라는 2000년이후고령화사회로진입하면서 2013년고령자는전체인구의 12.2% 로매년증가하는추세이며고령자의진료비는전체진료비의 ⅓ 수준으로 2018년이되면노인인구가전체의 14% 를넘어 1) 사회보건학적문제가심각할것으로전망된다. 치주질환은치면세균막내각종세균으로인해치아주위조직에염증이발생되는질환으로당뇨, 흡연등전신질환과연관성이있다. 치주질환을방치하였을경우전세계인구의 90% 까지영향을미칠수있으며 2), 치주결합조직및뼈지지체의흡수를초래하여나아가성인치아상실의주요한원인으로작용한다 3). 치아상실은치아기능을떨어뜨리고영양섭취에영향을주어삶의질을감소시킨다. 2010년국민구강건강실태조사결과에따르면치아우식상태는 2000 년이후부터꾸준히개선되고있는반면치주건강상태는 35-44세 29.8%, 45-54세 46.4%, 55-64세 57.3%, 65-74세 55.2% 로개선되지않아치주건강관리의필요성이시급하다고지적하였다 4). 치아가상실되는원인은다양하지만성인기이후부터는치주질환으로상실되기때문에치아상실을방지하기위한다방면의노력이필요하다. 한편, 골다공증은골강도의저하에의해골절위험이높아지는골격계질환으로연령증가와함께대부분폐경기이후의여성이나고령의남성과깊은관련이있다. 처음엔자각증상없이진행되다가방치하면충격등에의해골절을일으켜와병생활의원인이된다 5). 또한골밀도의감소로치조골에영향을미쳐치아상실을야기할수있으며, 고령인구가증가하여골절로인한의료비상승에따라사회경제적으로의료손실을야기할수있다. 골다공증유병률은 2007년 53만 5천명에서 2011년 77만 3천명으로 5년간 44.3%, 연평균 9.7% 증가하였고, 골다공증총진료비는 2007년 535억원에서 2011년 722원으로 5년간 35%, 연평균 7.9% 증가하여 6) 앞으로심각한보건 경제적문제가될것으로예상된다. 골다공증은당뇨병, 고혈압, 심장병등과같은만성질환의증가와함께심각한사회문제로대두되고있으며 7) 일단시작되면자신도모르게심각하게진행될뿐아니라경제적으로도많은손실을가져오기때문에골다공증예방이시급하다고할수있겠다. 골다공증과치주질환은미국에서심각한공중보건문제이며 8) 남 여모두에서연령증가에따라골절위험의증가를보이고골손실에의해치주질환과치조골흡수뿐만아니라치아상실의결과를가져온다 9). 골다공증과치주질환의결과인치아상실은전신적, 국소적골소실이라는공통점을가진질환으로공통으로관련된위험인자를가진다 10). 현재그관련성을규명하기위하여여러가지연구가이루어 지고있는데치주질환은골다공증여성에서보다일반적으로나타났다고보고되었고 11), 골다공증을가진하악골에서치은퇴축과치주질환이발생하며, 낮은골밀도는치주질환진행의위험인자로취급해야된다고하였다 12). 또한전신골밀도와평균치조골높이와의관계 13) 가연구되고있다. 골다공증인경우전신적골밀도가낮아질뿐만아니라치아를싸고있는치조골에도영향을주어 14) 치주질환및치조골흡수를동반한치아상실이일어날수있는환경을더빨리제공한다. 이등 15) 은연령증가에따라구강건조에불편감을느끼고상실치아수는증가하며치아의상실은저작능력을저하시키고섭취할수있는음식물의선택범위가좁아져노인에있어서는건강유지가더욱어려워진다고하였다 16). 한편, 평균현존치아수는구강보건의성과로서치아수명이연장된결과적현상을표시하는구강보건지표로 17) 개인의구강건강상태를예측할수있다. 성인에있어골밀도와치아상실후잔존치아수와의관계를파악하는것은구강건강관리사업을위한지침을세우는데보건학적으로의미가있다고하겠다. 골밀도와치조골사이의상관관계를나타내는연구가이루어지고있으나골다공증은여성의유병률이남성보다높아일반적으로여성의건강문제로인식되어왔으며, 에스트로겐의영향과관련이많으므로이전연구들은주로폐경기여성에서의골다공증과치조골및치주질환과의관계들 18) 이연구되어왔다. 그러나최근발표된자료에의하면 2005 년우리나라 20세이상성인의골다공증유병률은여성 7.4%, 남성 0.49%19) 임에비해, 2007년에는여성 7.2%, 남성 0.8% 14) 로여성의유병률은변화가거의없었던반면남성은약 1.5배이상증가하였다. 남성의골다공증유병율이높아짐에따라이로인한치아상실가능성이높아지고있다. 남성의골밀도감소의원인중생활양식요인으로알코올, 흡연, 카페인의연관성을볼수있는데 20) 남성의특성상여성보다더자주알코올과흡연에노출되어있고, 남 여의기본적인체질특성상폐경기여성만이아닌남 여모두에서같이연구가이루어져성별에더적합한방법으로예방하고관리하는것이보건학적인측면에서보다더효율적이라고할수있겠다. 특히, 골밀도의저하로인한골다공증은노인인구에서많이발생하고, 우리나라도노인인구가증가하고있기때문에골손실에의한치주질환뿐만아니라치아상실을야기할가능성이높아지고있으므로이에대한대책이필요하다. 대부분의연구결과에서와같이골밀도와치조골사이의상관관계가있고파골세포와조골세포사이의관계를통한골다공증과치주질환공통치료제개발연구 21) 가시행되고있듯이전신골밀도와치조골흡수에따른잔존치아수와의관계를좀더세부적으로접근하여파악할수있다면치과치료시골다공증위험에대한조기정보를제공할수있고, 반
송혜정 이덕희 / 성인의골밀도와잔존치아수와의관련성 65 대로골감소증이의심되는환자에있어서는치조골흡수와구강내잔존치아수를예측할수있다. 따라서구강질환을사전에예방하고구강건강을지킬수있는시스템이될수있을것이다. 이에본연구는국민건강영양조사제5기 1차년도 (2010 년 ) 자료를이용하여 50대이후의성인을대상으로치조골흡수에따른잔존치아수를구강건강지표로설정하고골밀도와의관계를파악하여전신질환과구강질환의포괄적인의료시스템이구축되어노년기구강건강관리가이루어질수있는데도움이되고자이연구가수행되었다. 1. 연구대상 연구방법 본연구는질병관리본부에서시행하는국민건강영양조사 (KNHANES) 제5기 1차년도 (2010년) 원시자료에서기본 DB, 골밀도 DB, 구강검진 DB를통합하여건강설문조사, 검진조사, 영양조사에참여한대상자를연구대상으로하였다. 전체대상자 8,958명중만 19세이상의성인 7,026명에서골밀도검사를받은 50대이상성인남 여 3,854명에서무응답을제외한 1,985명 ( 남 883명, 여 1,102명 ) 을최종연구대상자로선정하였다. 2. 연구방법 본연구를위해국민건강영양조사원시자료이용지침서를바탕으로건강설문조사, 검진조사, 영양조사에서골다공증위험표지자들을바탕으로독립변수를선정하였다. 2.1. 변수선정 연구에사용된변수들은일반적특성으로성별, 연령, 지역, 교육수준, 결혼관계, 소득, 직업문항을이용하였고, 건강행태로는흡연, 음주, 체질량지수, 신체활동, 정신건강을이용하였다. 식이습관으로는끼니횟수, 우유, 커피, 칼슘섭취문항을이용하였고, 구강건강행태는칫솔질횟수, 구강위생용품사용, 구강검진으로구분하였다. 전신질환으로는고혈압, 당뇨, 고지혈증설문문항을이용하였다. 2.2. 골밀도분류 골밀도의평가는골밀도검사를통하여대퇴골전체, 대퇴골경부, 요추의 T-score( 아시아기준최대골밀도자료를이용하여산출 / 골밀도 -최대골밀도연령군의골밀도평균 ) 에따라정상 (T-score -1.0), 골감소증 (-2.5 < T-score < -1.0), 골다공증 (T-score -2.5) 으로분류되었다. 2.3. 잔존치아수산정 잔존치아수는구강검사자료중우식경험상실치면, 우식비경험상실치면으로기록되어있는변수값을참고하여상실치를구한후지치를제외한정상치아수에서상실치를제외하여직접잔존치아수를산출하였다. 3. 자료분석 수집된자료는 SPSS Program/Win. 18.0 version을사용하여통계분석을실시하였다. 연구대상자의일반적특성은빈도분석을하였고, 성별골밀도와잔존치아수, 성별골밀도와구강건강행태에따른잔존치아수와의차이를분석하기위하여 t-test와 ANOVA를실시하였다. 남 여잔존치아수에영향을미치는요인을분석하기위하여다중회귀분석 (multiple regression) 을실시하였고, 범주형변수들은가변수 (dummy) 로변환하여실시하였다. 연구결과 1. 연구대상자의일반적특성 연구대상자의일반적특성은남성에서 60대가 38.1% 로가장높았고, 여성에서는 50대가 43.1% 로가장높았다. 지역은남성, 여성모두에서동이 72.0%, 73.3% 로가장높았고, 교육은남성에서초졸이하가 30.8%, 여성에서는 60.0% 로주로초졸이하였다. 결혼관계는남성에서유배우자 92.9%, 여성에서는 72.5% 로주로배우자가존재하였으며, 직업은남성에서비사무직이 54.2% 로가장높았고, 여성에서는무직이 58.5% 로가장높았다 <Table 1>. 2. 성별골밀도에따른잔존치아수 남성에서골밀도에따른잔존치아수는골밀도정상 23.11개, 골감소증 21.54개, 골다공증 19.48개로골밀도에따라잔존치아수가많은것으로나타났다 (p<0.01). 여성에서는골밀도정상 24.51개, 골감소증 22.91개, 골다공증 19.98개로골밀도에따라잔존치아수가많은것으로나타났다 (p<0.01)<table 2>. 3. 성별골밀도와구강건강행태에따른잔존치아수 남성에서골밀도와구강건강행태에따른잔존치아수와의관계는칫솔질횟수가 3회일때골밀도정상 23.83개, 골감소증 20.84개, 골다공증 16.75개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 구강위생용품은사용하지않는집단에서골밀도정상 22.95개, 골감소증 21.42개, 골다공증 19.23개로골밀도가높을수록잔존치아수가많은것으로나타났으며 (p<0.01), 1년간구강검진을
66 J Korean Soc Dent Hyg 2015; 15(1): 63-71 Table 1. General characteristics of the study subjects Variable Male Female N % N % Age 50 332 37.6 475 43.1 60 336 38.1 404 36.7 Over 70 215 24.3 223 20.2 Region Dong 636 72.0 808 73.3 Eup 247 28.0 294 26.7 Education Elementary 272 30.8 661 60.0 Junior 192 21.7 187 17.0 High school 257 29.1 200 18.1 College 162 18.3 54 4.9 Marital status Married 820 92.9 799 72.5 Widowed, Divorced 63 7.1 303 27.5 Monthly income Low 230 26.0 374 33.9 Average, Low 227 25.7 269 24.4 Average, High 215 24.3 232 21.1 High 211 23.9 227 20.6 Occupation Office 104 11.8 39 3.5 Non-office workers 479 54.2 418 37.9 Unemployed 300 34.0 645 58.5 Total 883 100.0 1,102 100.0 Table 2. Remaining teeth according to bone mineral density by gender Characteristic Divisions Male p-value * Female N Mean±SD N Mean±SD p-value * BMD Normal 395 23.11±6.49 <0.001 176 24.51±4.46 <0.001 Osteopenia 423 21.54±6.30 599 22.91±6.07 Osteoporosis 65 19.48±7.12 327 19.98±7.22 * by one-way ANOVA 하지않는집단에서골밀도정상 23.00개, 골감소증 21.35 개, 골다공증 19.19개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 여성에서는칫솔질횟수가 2회일때골밀도정상 22.45개, 골감소증 22.84개, 골다공증 20.16개, 3회일때골밀도정상 25.75개, 골감소증 23.37 개, 골다공증 20.69개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 구강위생용품을사용하는집단에서골밀도정상 25.45개, 골감소증 23.82개, 골다공증 21.96개, 사용하지않는집단에서골밀도정상 24.16개, 골감소증 22.60개, 골다공증 19.60개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 1년간구강검진을하는집단에서골밀도정상 24.57개, 골감소증 23.29 개, 골다공증 21.26개로나타났으며, 구강검진을하지않는 집단에서골밀도정상 24.49개, 골감소증 22.81개, 골다공증 19.78개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01)(p<0.05)<table 3>. 4. 남성의잔존치아수에대한영향요인 남성에서잔존치아수에대한영향요인을분석하기위하여 t-test or ANOVA에서유의하였던항목을변수로하고잔존치아수를종속변수로해서다중회귀분석을실시한결과모형의설명력은 17.2% 이었고, 잔존치아수에영향을미치는변수는골밀도에서는정상, 연령은 50대와 60대, 직업은사무직, 흡연은비흡연과과거흡연, 당뇨는있는경우가유의하게나타났다. 골밀도는정상이골다공증보다잔존치아
송혜정 이덕희 / 성인의골밀도와잔존치아수와의관련성 67 Table 3. Remaining teeth according to bone mineral density and oral health behavior by gender Characteristic Divisions Male p-value * Female N Mean±SD N Mean±SD p-value * Brushing 1 Normal 77 22.03±7.10 0.352 20 21.10±5.428 0.022 Osteopenia 101 21.13±6.11 71 21.96±6.008 Osteoporosis 28 19.96±7.38 57 18.19±8.286 2 Normal 191 23.06±6.59 0.067 97 24.45±4.655 <0.001 Osteopenia 211 22.10±6.02 323 22.84±6.082 Osteoporosis 25 20.24±6.74 166 20.16±6.688 3 Normal 127 23.83±5.88 <0.001 59 25.75±3.003 <0.001 Osteopenia 111 20.84±6.93 205 23.37±6.082 Osteoporosis 12 16.75±7.23 104 20.69±7.330 Secondary oral hygiene Yes Normal 72 23.79±6.28 0.190 47 25.45±3.482 0.004 Osteopenia 67 22.16±5.65 154 23.82±5.413 Osteoporosis 9 21.00±8.06 53 21.96±7.261 No Normal 323 22.95±6.53 <0.001 129 24.16±4.736 <0.001 Osteopenia 356 21.42±6.42 445 22.60±6.267 Osteoporosis 56 19.23±7.01 274 19.60±7.164 Oral examination Yes Normal 91 23.45±6.21 0.282 35 24.57±3.681 0.026 Osteopenia 71 22.48±4.67 131 23.29±6.236 Osteoporosis 11 20.91±7.66 46 21.26±7.132 No Normal 304 23.00±6.58 <0.001 141 24.49±4.649 <0.001 Osteopenia 352 21.35±6.57 468 22.81±6.036 Osteoporosis 54 19.19±7.05 281 19.78±7.227 * by one-way ANOVA 수가 1.71개높았고, 연령에서 50대는 70대이상보다잔존치아수가 4.09개높고 60대는 1.99개높았다. 직업에서사무직은무직보다 1.78개높았으며, 비흡연은현재흡연보다 3.60개, 과거흡연은현재흡연보다 1.92개높았다. 전신질환은당뇨가있는경우에없는경우보다 1.48개낮은것으로나타났다 (p<0.01)(p<0.05)<table 4>. 5. 여성의잔존치아수에대한영향요인 여성에서잔존치아수에대한영향요인을분석하기위하여 t-test or ANOVA 에서유의하였던항목을변수로하고잔존치아수를종속변수로해서다중회귀분석을실시한결과모형의설명력은 24.5% 이었고, 잔존치아수에영향을미치는변수는골밀도에서는골감소증, 연령은 50대와 60대, 지역은동, 교육은초졸이하, 흡연은비흡연, 체질량지수는저체중, 전신질환은고지혈증이있는경우가유의하게나타났다. 골밀도는골감소증이골다공증보다 0.85개높았고, 연령에서 50대는 70대이상보다잔존치아수가 5.50개높고 60대는 2.81개높았다. 지역은동이읍 면보다 1.00개높았고, 교육은초졸이하가대졸이상보다 2.76개낮았다. 비흡연은현재흡연보다 1.96개높았고, 저체중은비만보다 3.22개낮았다. 전신질환에서고지혈증이있는 경우없는경우보다 1.00개높은것으로나타났다 (p<0.01) (p<0.05)<table 5>. 총괄및고안 골다공증은가장흔한대사성골질환의하나로골절위험이높은골격계질환이며처음엔자각없이진행하다가방치하면충격등에의해골절을일으켜와병생활의원인이된다. 골다공증으로인한골절은의료비상승등여러면에서사회적문제로대두되고있으며 22), 움직임의제한, 자존감저하, 우울등으로인한삶의질저하를초래하게된다. 골다공증증가율을살펴보면고령인구가급증하면서 2007 년에비해 2011년에는 50대이상증가율이높게나타났으며특히, 70대이상에서는 75.2% 가증가하여최고수치를기록하였다 3). 골다공증은호르몬의원인이커주로폐경기여성에서한정적으로연구가많이되어왔다. 하지만남성의골다공증유병률또한매년증가하는추세이고 18,19) 생리적으로구조가다른남성과여성을비교해서연구한다면성별에따라관리및예방하는방법을달리하여좀더효과적이고세부적으로접근할수있는방안이될것이다.
68 J Korean Soc Dent Hyg 2015; 15(1): 63-71 Table 4. Influencing Factors on the number of remaining teeth of the male Variables B t p-value * Constant 15.350 9.345 <0.001 BMD Normal 1.718 0.131 2.024 0.043 (Based on: Osteoporosis) Osteopenia 1.097 0.084 1.332 0.183 General Characteristics Age 50 4.093 0.304 6.145 <0.001 (Based on: 70 ) 60 1.994 0.148 3.421 0.001 Region (Based on: Eup) Dong 0.853 0.059 1.709 0.088 Education Elementary -0.409-0.029-0.578 0.564 (Based on: College ) Junior 0.035 0.002 0.050 0.960 Monthly income (Based on: High) high school 0.187 0.013 0.293 0.770 Low -0.082-0.005-0.120 0.905 Average, Low 0.115 0.008 0.186 0.853 Average, High 0.229 0.015 0.378 0.706 Occupation Office 1.785 0.088 2.254 0.024 (Based on: Unemployed) Non-office workers 0.532 0.041 0.992 0.321 Health Behavior Smoking Non-smoking 3.603 0.199 5.539 <0.001 (Based on: Current smoker) Smoking history 1.924 0.147 4.058 <0.001 Calcium <0.001 0.009 0.276 0.782 Strength training days Not at all -0.216-0.016-0.318 0.750 (Based on: five days ) 1-2 day -0.681-0.035-0.803 0.422 Moderate activity days (Based on: five days ) Oral health behaviors oral examination Systemic disease Diabetes 3-4 day 0.038 0.002 0.044 0.965 Not at all -0.427-0.031-0.636 0.525 1-2 day 0.361 0.020 0.441 0.660 3-4 day -0.345-0.015-0.377 0.706 Yes Yes * by multiple linear regression analysis Adjusted R 2 =0.146(R 2 =0.172), F=6.6(p<0.001) 0.154 0.009 0.294 0.769-1.487-0.086-2.703 0.007 한편치주질환은전세계범발성질환으로연령과함께증가하며치조골흡수와치주낭형성으로성인에있어치아를상실할수있는첫번째원인질환으로성인기이후부터는중점적으로치주질환예방에관심을가지고구강건강관리를하여야한다. 이에본연구에서는 2010년국민건강영양조사제5기 1차년도 (2010년) 자료를이용하여 50대이후의성인을대상으로치조골흡수에따른잔존치아수를구강건강지표로설정하고골밀도와의관계를파악하고자한다. 성별골밀도에따른잔존치아수에서남 여모두골밀도가높을수록잔존치아수가유의하게증가하는것으로나타났다. Yoshihara 등 23) 은골밀도와치아상실의유의한관련성이있다고하였는데본연구와일치하는것으로나타났다. 따라서, 연령이증가할수록골밀도를유지하고골다공증을예방하기위하여적극적인실천이필요할것으로사료된다. Papaioannou 등 24) 은골밀도유지를위하여골밀도에영향을주는인자를살펴보면신체활동부족, 마른체형, 과도한음주, 흡연, 칼슘, 비타민 D의섭취부족이라하였고, 전신질환과는당뇨와관련이있었으며, 칼슘섭취를위하여카페인을삼가고우유섭취를중요하게강조하였다. Lau 등 25) 은골밀도증진을위하여충분한식품섭취를통한적절한열량, 단백질, 칼슘, 철분등다양한식품의섭취가필요하다고하였다. 성별골밀도와구강건강행태에따른잔존치아수에서남 여모두칫솔질횟수 3회집단에서골밀도가높을수록잔존치아수가유의하게증가하는것으로나타났다. 남성에서는구강위생용품을사용하지않는집단과 1년간구강검진을받지않는집단에서유의하게나왔고, 여성에서구강위생용품을사용집단과사용하지않는집단, 1년간구강검진을받는집단과받지않는집단모두에서골밀도가높을수록잔존치아수가많은것으로나타났다. 치주질환을예방하는방법으로가장기본적이고효율적인방법은잇솔질이지만, 칫솔질만으로는완벽하게치면세균막을관리할수없어다양한구강위생용품을사용하는것이중요하며 16) 계속구강건강관리를위한정기적인구강검진이필요하다고할수있겠다.
송혜정 이덕희 / 성인의골밀도와잔존치아수와의관련성 69 Table 5. Influencing Factors on the number of remaining teeth of the female Variables B t p-value * Constant 17.164 9.543 <0.001 BMD Normal 0.901 0.051 1.483 0.138 (Based on: osteoporosis) Osteopenia 0.857 0.066 2.005 0.045 General Characteristics Age (Based on: 70) Region (Based on: Eup) Education (Based on: College ) Marital status (Based on: Widowed, Divorced, Separated) Monthly income (Based on: High) Occupation (Based on: Unemployed) Health Behavior Smoking (Based on: Current smoker) Drinking (Based on: Yes) BMI (Based on: Obesity) Sleep (Based on: 9 hours ) Milk (Based on: At least once a day) 50 5.507 0.425 9.485 <0.001 60 2.819 0.212 5.592 <0.001 Dong 1.002 0.069 2.354 0.019 Elementary -2.768-0.211-2.893 0.004 Junior -1.725-0.101-1.785 0.074 High school -1.338-0.080-1.433 0.152 Married 0.530 0.037 1.282 0.200 Low -0.243-0.018-0.457 0.647 Average, Low 0.078 0.005 0.147 0.883 Average, High -0.014-0.001-0.025 0.980 Office -1.189-0.034-1.176 0.240 Non-office workers -0.706-0.053-1.782 0.075 Non-smoking 1.964 0.074 2.013 0.044 Smoking history -0.465-0.012-0.333 0.740 No -0.427-0.031-1.156 0.248 Underweight -3.220-0.075-2.648 0.008 Normal 0.065 0.005 0.171 0.864 6 hours 0.259 0.020 0.316 0.752 7-8 hours 0.866 0.067 1.046 0.296 Almost not eating 0.103 0.008 0.215 0.830 Once a month or more -0.837-0.045-1.397 0.163 More than once a week -0.357-0.024-0.704 0.482 Calcium 0.001 0.026 0.917 0.360 Oral health behaviors Secondary oral hygiene Systemic disease Hypertension Yes -0.077-0.005-0.176 0.860 Yes 0.411 0.032 1.087 0.277 Diabetes Yes -0.907-0.046-1.619 0.106 Hyperlipidemia Yes 1.004 0.065 2.294 0.022 * by multiple linear regression analysis Adjusted R 2 =0.223(R 2 =0.245), F=11.208(p<0.001) 천 26) 의연구를살펴보면칫솔질횟수가많고구강위생용품사용을잘하고치과진료검진을잘받는군에서치주질환유병율이낮게나왔다. 소등 27) 은칫솔을제외한나머지구강위생용품은거의사용하지않아구강상태에적합한구강위생용품의사용을강조하였고남 28) 은다양한매체를통한구강위생용품을소개하여효율적인실천을강조하였다. 본연구의결과와같이남 여간차이가있어남성들에게는 좀더적극적이고세부적인구강보건교육과실천이이루어져야될것으로사료된다. 남성에서잔존치아수에영향을미치는변수는골밀도에서는정상, 연령은 50대와 60대, 직업은사무직, 흡연은비흡연과과거흡연, 당뇨는있는경우가유의하게나타났다. 골밀도는정상이골다공증보다잔존치아수가 1.71개높았고, 연령에서 50대는 70대이상보다잔존치아수가 4.09개
70 J Korean Soc Dent Hyg 2015; 15(1): 63-71 높고 60대는 1.99개높았다. 직업에서사무직은무직보다 1.78개높았으며, 비흡연은현재흡연보다 3.60개, 과거흡연은현재흡연보다 1.92개높았다. 전신질환은당뇨가있는경우에없는경우보다 1.48개낮은것으로나타났다. 여성에서골밀도에서는골감소증, 연령은 50대와 60대, 지역은동, 교육은초졸이하, 흡연은비흡연, 체질량지수는저체중, 전신질환은고지혈증이있는경우가유의하게나타났다. 골밀도는골감소증이골다공증보다 0.85개높았고, 연령에서 50대는 70대이상보다잔존치아수가 5.50개높고 60대는 2.81개높았다. 지역은동이읍 면보다 1.00개높았고, 교육은초졸이하가대졸이상보다 2.76개낮았다. 비흡연은현재흡연보다 1.96개높았고, 저체중은비만보다 3.22개낮았다. 전신질환에서고지혈증이있는경우없는경우보다 1.00개높은것으로나타났다. 이러한결과로남 여모두에서공통적으로영향을미치는변수는골밀도, 연령, 흡연이었다. 골밀도가높을수록, 연령이낮을수록, 흡연을안할수록잔존치아수가유의하게증가하였다. 임과이 29), 최등 30) 의연구결과와같이남 여모두에서연령이증가할수록잔존치아수는감소하는것으로나타나본연구와일치하였으며, 주된원인이연령증가와함께치조골소실의결과라사료되어남 여모두치주질환예방위주의진료가확대보강되어져야될것으로본다. 흡연에서이번연구와같이박등 31) 은흡연자의경우비흡연자보다잔존치아수가감소한다고하였다. 장과남 32), 천 26), 한 33) 은흡연과치주질환과의연관성을입증하였는데흡연은치주질환의유력한위험지표로치주질환유병율을높이며, 외과적또는비외과적치주치료모두의예후에나쁜영향을미친다고하였다. 이에따라흡연자에대해서는금연의절대성을강조하고숙지할수있는체계적인교육과적극적인치주질환예방을위한교육이철저히이루어져야될것으로본다. 체질량지수에서는여성에서저체중인경우잔존치아수가 3.22개더낮게나타난반면천 26) 의연구에서과체중인경우가치주질환의유병률이높게나타나이번결과와일치하지않았다. 저체중방지를위해영양소를질적이고규칙적으로섭취하고, 근육생성을위한적절한운동과함께적정체중유지가필요할것으로본다. 한국성인들의치주질환과골다공증의관계는골다공증위험이있을수록만성적으로진행하는치주질환이증가하는데 34) 치주질환은치아상실의주된원인으로치주질환예방을위한계속구강건강관리를체계적으로운영하여노인이되더라도본인치아로음식을저작할수있는행복을만끽할수있도록구강건강관리가적극적으로되어져야될것으로생각된다. 이번연구는연구대상자수가많은대규모연구라는장점을지니고지금까지연구는주로폐경기여성을대상으로이루어졌는데반해본연구는 50대이상성인남 여를대상으로골밀도와잔존치아수와의관계를연구함으로써성별에따른구강건강관리방법을강구한다는점에서다 른연구와차별성을지닌다. 본연구의제한점은국민건강영양조사자료를이용한단면연구이므로골밀도와잔존치아수와의연관성에서인과관계를구체적으로제시하지못한점과이전에골밀도와잔존치아수에영향을미치는혼란변수를미리통제하지않고분석한점에서본연구를해석하는데제약이따른다. 결론 본연구는질병관리본부에서시행하는국민건강영양조사 (KNHANES) 제5기 1차년도 (2010년) 원시자료를이용하여참여한전체대상자중만 19세이상의성인에서골밀도검사를시행받은 50대이상성인남 여 1,985명을최종연구대상으로실시하여다음과같은결론을얻었다. 1. 남성에서는골밀도에따라잔존치아수가골밀도정상 23.11개, 골감소증 21.54 개, 골다공증 19.48개로나타났으며, 여성에서는골밀도정상 24.51개, 골감소증 22.91개, 골다공증 19.98 개로남 여모두에서골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 2. 남성에서는칫솔질횟수가 3회일때, 골밀도정상 23.83 개, 골감소증 20.84개, 골다공증 16.75개로골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 3. 여성에서는칫솔질횟수가 3회일때, 보조구강위생용품을사용하는집단과구강검진을하는집단에서골밀도가높을수록잔존치아수가많은것으로나타났다 (p<0.01). 4. 남 여모두에서잔존치아수에공통적으로영향을미치는변수는골밀도, 연령, 흡연이었다 (p<0.01) (p<0.05). 골밀도가높을수록, 연령이낮을수록, 흡연을안할수록잔존치아수가유의하게증가하였다. 그외남성에서는당뇨가있는경우이며, 여성에서는교육이낮을수록, 저체중일수록잔존치아수가유의하게감소하였다 (p<0.01). References 1. Statistics. 2013 Elderly statistics. Seoul: Statistics; 2013: 1-14. 2. Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. ScienceDirect 2005; 366(9499): 1809 20. 3. Cochran DL. Inflammation and bone loss in periodontal disease. J Periodontol 2008; 79(8): 1569-76. http://dx.doi.org/ 10.1902/jop.2008.080233. 4. Jo GH, Gaq SH. 2010 National survey of oral health status. Seoul: Department of health and human services; 2011: 2-13. 5. Yoshie H, Kō SS. Periodontal disease and seven kinds of
송혜정 이덕희 / 성인의골밀도와잔존치아수와의관련성 71 diseases. 1st. Seoul: Gentleman publisher; 2009: 98-103. 6. Health insurance review and assessment service. Press release. Seoul: Health insurance review and assessment service; 2013: 1-4. 7. Carr M. The emergence of the metabolic syndrome with menopause. JCEM 2003; 88; 2402-11. 8. Wactawski-Wende J. Periodontal Diseases and Osteoporosis: Association and Mechanisms. J Periodontol 2001; 6(1): 197-208. http://dx.doi.org/10.1902/annals.2001.6.1.197. 9. Wactawski-Wende J, Grossi SG, Trevisan M, Genco RJ, Tezal M, Dunford RG, et al. The role of osteopenia in oral bone loss and periodontal disease. J Periodontol 1996; 67(10): 1076-84. http://dx.doi.org/10.1902/jop.1996.67.10s.1076. 10. Jagelaviciene E, Kubilius R. The relationship between general osteoporosis of the organism and periodontal diseases. J Medicina 2006; 42(8): 613-8. 11. Phipps KR, Chan BKS, Madden TE, Geurs NC, Reddy MS, Lewis CE, et al. Longitudinal study of bone density and periodontal disease in men. J Dent Res 2007; 86(11): 1110-4. 12. Esfahanian V, Shamami MS, Shamami MS. Relationship between osteoporosis and periodontal disease: review of the literature. J Dent Res 2012; 9(4): 256 64. 13. Passos JS, Gomes-Filho IS, Vianna MIP, Cruz SS, Barreto ML, Oliveira TJS, et al. Outcome measurements in studies on the association between osteoporosis and periodontal disease. J Periodontol 2010; 81(12): 1773-80. http://dx.doi. org/ 10.1902/jop.2010.100143. 14. Centers for disease control and prevention(2008). 2007 National Health Statistics. Seoul: Centers for disease control and prevention; 2008: 279. 15. Lee TJ, Jeong JO, Lee GH. Study on the oral health status of the elderly in some areas. J Korean Soc Dent Hyg 2012; 12(4): 801-15. 16. Choi YH. Author and relationship skills of the elderly in Korea and the remaining dimensions. J Khep 2009; 2009(5): 83. 17. Kim JB, Kim GS, Kim YH, Jeong SH, Jin BH, Choi UM, et al. Public oral health. 3rd. Seoul: Gomunsa; 2004: 299-311. 18. Wactawski-Wende J, Hausmann E, Hovey K, Trevisan M, Grossi S, Genco RJ. The association between osteoporosis and alveolar crestal height in postmenopausal women. J Periodontol 2005; 76(11): 2116-24. http://dx.doi.org/10. 1902/jop.2005.76.11-S.2116. 19. Centers for disease control and prevention(2006). 2005 Health behaviors and chronic disease statistics Kit. Seoul: Centers for disease control and prevention; 2006: 135. 20. Atalar E, Aydin G, Keles I, Inal E, Zog G, Arslan A, Orkun S. Factors affecting bone mineral density in men. Rheumatology International 2009; 29(9): 1025-30. 21. Charles NS, Alchalabi H. Clues for new therapeutics in osteoporosis and periodontal disease: new roles for lipoxygenases? Infoma Healthcare 2004; 8(6): 643-52. http://dx.doi.org/10.1517/14728222.8.6.643. 22. Kim KS. Osteoporosis. 3rd. Seoul: Society for bone; 2006: 11. 23. Yoshihara A, Seida Y, Hanada N, Miyazaki H. A longitudinal study of the relationship between periodontal disease and bone mineral density in community-dwelling older adults. J Clini Periodontol 2004; 31(8): 680-4. 24. Papaioannou A, Kennedy CC, Cranney A, Hawker G, Brown JP, Kaiser SM, et al. Risk factors for low BMD in healthy men age 50 years or older: a systematic review. J Osteoporosis International 2009; 20(4): 501-18. 25. Lau EM, Suriwongpaisal P, Lee JK, De SD, Festin MR, Saw SM, et al. Risk factors for hip fracture in Asian men and women: the Asian osteoporosis study. J Bone Miner Res 2001; 16(3): 572-80. http://dx.doi.org/10.1359/jbmr. 2001.16.3.572/full. 26. Chen HW. Related factors analysis of oral disease and chronic illness[doctoral dissertation]. Jeonbuk: Univ. of Wonkwang, 2011. 27. Soo MH, Kim SS, Sin SB. Study on the status of some areas using oral hygiene products. J Korean Soc Dent Hyg 2010; 10(6): 1107-19. 28. Nam SM. Use of oral hygiene and oral health status and the presence or absence of dental hygiene and related lab patients. J Korean Soc Dent Hyg 2011; 11(3): 373-81. 29. Im HJ, Lee EK. Affect the oral health of the visiting business target number of factors seniors existing natural teeth. J Korean Soc Dent Hyg 2013; 13(4): 693-700. 30. Choi YH, Sea I, Nam JM, Oh DG, Son HG, Kwon HG. Relationship between dental and general health deficits. J Oral Health 2002; 26(2): 169-77. 31. Park JH, Kim YN, Yoo JH, Kim MY, Kim BI, Kwon HK. Relevance of Smoking in South Korea and probing formed adult. J Oral Health 2005; 29(3): 293-301. 32. Jang BJ, Nam IS. Some of the patients visiting the university center scaling relation of smoking and drinking and probing form. J Dent Hyg Sci 2010; 10(2): 117-22. 33. Han GS, Kim US, Kang JG, Hoang US, Han DH, Bea GH. Association of smoking and periodontal status in a metropolitan area, adults. J Oral Health 2008; 32(2): 250-60. 34. Jang YJ, Kim NS. Community periodontal index and osteoporosis Relevance. J Dent Hyg Sci 2012; 12(5): 943-52.