노인성 구강점막 질환

고홍섭 대한노년치의학회 2023 대한노년치의학회지 Vol.19 No.2

The rapid increase in the elderly population is causing an increase in the number of patients visiting clinics for oral mucosal diseases. There are no oral mucosal diseases that are limited to the elderly, but oral candidiasis, oral leukoplakia and erythroplakia, oral lichen planus and lichenoid lesion, and oral pemphigus and pemphigoid are common in the middle-aged and elderly. Fibrous inflammatory hyperplasia (epulis fissuratum) in patients wearing dentures can often be seen. Oral candidiasis is an oral mucosal disease whose prevalence is increasing most rapidly in the elderly. This is due to the increase in the elderly population with reduced immune function, multimorbidity, and polypharmacy. Therefore, knowledge about the various forms of oral candidiasis and the use of antifungals is very important. Knowledge about the standardization of diagnostic criteria for oral leukoplakia and oral lichen planus is being updated. In addition, scientific evidence is accumulating about the malignant transformation rates of oral leukoplakia, oral lichen planus, and oral lichenoid lesions. Therefore, it is very important to acquire knowledge about these fields for accurate diagnosis and prognosis prediction. Although the prevalence of oral pemphigus and pemphigoid is relatively low, the severity of the symptoms is significant especially in the elderly. For efficient management of oral mucosal diseases in elderly patients, accurate diagnosis of oral mucosal diseases and appropriate choice of medications are important. To this end, it is necessary to be familiar with the updated knowledge of the pathophysiology, diagnostic criteria, and medications related with these diseases.

파노라마방사선사진상의 이공에 관한 연구

최갑식,배용철,김동윤,손정익,CHOI Karp-Shik,BAE Yong-Chul,KIM Dong-Youn,SOHN Jeong-Ick 대한영상치의학회 1997 Imaging Science in Dentistry Vol.27 No.1

22세에서 25세의 남녀 각각 100명씩 200명을 대상으로 표준 위치에서 촬영된 파노라마 방사선사진상에서 이공의 정상적 형태 및 위치를 분석하고, 다시 남녀 각각 50명씩 100명을 선별하여 두부를 10mm 전방 이동, 10mm 후방 이동, 10° 하방 이동, 그리고 10° 상방 이동시킨 후 촬영된 각각의 파노라마 방사선사진상에서 피사체의 위치 변화에 따른 이공의 형태 및 수평, 수직적 위치의 변화를 평가하여 다음과 같은 결과를 얻었다. 1. 이 공의 형 태 는 elliptic질형 (43.3%), round 또는 oval형 (42.5%), unidentified형 (7.5%), diffuse형(6.7%)의 순으로 관찰되었다. 2. 이공이 치아에 대한 수평적 위치는 제2소구치 부위(54.2%)와 제1소구치와 제2소구치 사이 (43.1%)에서 대부분 관찰되었으며, 제2소구치와 제1대구치 사이(2.7%)의 순으로 관찰되었고, 제1소구치 부위, 견치와 제1소구치 사이, 제1대구치 부위에서는 관찰되지 않았다. 3. 이공의 수직적 위치는 치근단 하방(88.2%)에서 대부분 관찰되었으며, 치근단에 접하는 경우(9.7%), 치근단과 겹쳐 나타난 경우(1.9%), 치근단에 비해 상방에 위치하는 경우(0.2%)의 순으로 관찰되었다. 4. 피사체 두부 위치의 변화에 따른 이공의 형태 변화는 표준 위치에서 나타난 결과와 비교해 볼 때 표준 위치에서 두부를 10mm전방 이동시킨 위치에서 unidentified형(9.0%)이 증가하였고, 두부를 10mm 후방 이동시 킨 위치와 피사체의 턱을 10° 상방 이동시킨 위치에서는round 또는 oval형(57.5%, 52.5%)이 각각 증가하였으며, 피사체의 턱을 10° 하방 이동시킨 위치에서는 diffuse형(3.5%)이 감소한 것 외에는 표준 위치에서 나타난 결과와 유사하였다. 5. 피사체 두부 위치의 변화에 따른 이공의 수평적 위치의 변화는 표준 위치에서 두부를 10mm 전방 이동시킨 위치에서 제1소구치와 제2소구치 사이에 위치한 경우(35.2%)가 감소한 반면 제2소구치와 제1대구치 사이에 위치한 경우(8.8%)는 더 많이 관찰되었으며, 두부를 10mm후방 이동시킨 위치와 피사체의 턱을 10° 상방 이동시킨 위치에서는 제2소구치와 제1대구치 사이에 위치한 경우(6.1%, 7.5%)가 더 많이 관찰되었으며, 피사체의 턱을 10° 하방 이동시킨 위치에서는 표준 위치에서 나타난 결과와 유사하였다. 6. 피사체 두부 위치의 변화에 따른 이공의 수직적 위치 변화는 치근단에 비해 하방에 위치한 경우가 약 90%로 대부분이었으며, 치근단에 접하는 경우, 치근단과 겹쳐 나타난 경우의 순으로 관찰되었으며, 치근단에 비해 상방에 위치하는 경우는 관찰되지 않았다. The purpose of this study was to evaluate the position and shape of mental foramen in panoramic radiographs. For this study, panoramic radiographs were obtained from the 200 adults and evaluated the position and shape of mental foramen. According to various positional changes in panoramic radiographs of the patients, the author also obtained panoramic radiographs from the 100 adults and then evaluated the positional and shape changes of mental foramen. The following results were obtained: 1. Shapes of mental foramen were observed elliptical(43.3%), round or oval(42.5%), unidentified(7.5%) and diffuse (6.7%) type in descending order of frequency. 2. Horiwntal position of mental foramen were most frequently observed at the 2nd premolar area(54.2%), and area between the 1st premolar and 2nd premolar(43.1%), area between the 2nd premolar and 1st molar(2.7%) in descending order of frequency. 3. Vertical position of mental foramen were most frequently observed at the inferior of apex(88.2%), and at apex (9.7%), overlap with apex(1.9%), superior of apex(0.2%) in descending order of frequency. 4. According to various positional changes in panoramic radiographs of the patients, shape changes of mental foramen were more obviously observed at the forward 10mm and chin down 100 positioned panoramic radiographs. And changes of horiwntal and vertical position were observed in similar to compared with normal positioned panoramic radiographs.

골형태분석법과 micro-CT를 이용한 골소주 특성에 대한 연구

송영한,이완,이창진,지정현,이병도,Song, Young-Han,Lee, Wan,Lee, Chang-Jin,Ji, Jung-Hyun,Lee, Byung-Do 대한영상치의학회 2007 Imaging Science in Dentistry Vol.37 No.1

Purpose : The research was done to investigate the effectiveness of 2D bony morphometry and microstructure of micro-computed tomography (micro-CT) on the osteoporotic bony change. We performed the bone morphometric analysis of proximal femur in ovariectomized rabbits with BMD and micro-CT examination. Materials and Methods : Twenty-one female (Newzealand, about 16 weeks old, 2.9-3.4kg) rabbits were used. Three rabbits were sacrificed on the day when experiment began (Baseline). The remaining 18 rabbits were divided into two groups. One group was ovariectomized bilaterally (OVX) and the other animals were subjected to sham operation (Sham). Bone specimens were obtained from the right and left femur of sacrificed rabbits. At intervals of 1, 2, 3, 5, 6 months respectively, BMD tests were performed on the proximal femur by using PIXlmus 2 (GE Lunar Co. USA), 2-dimensional bone morphometric analysis by custome computer program and 2D/3D bone structure analysis by micro-CT (Skyscan 1072, Antwerpen, Belgium). Statistical analysis was carried out for the correlation between bone morphometry, micro-CT and BMD Result : BV/TV, Tb.Th, Tb.N of micro-CT parameters showed higher values in sham group than OVX group. N.Nd/Ar.RI, N.NdNd, N.NdTm, N. TmTm, PmB/Ar.RI, 3-D BoxSlope of 2D morphometric parameters showed higher values in Sham group than OVX group. The micro-CT parameters of Tb.Sp, Tb.N were statistically significant correlated with BMD respectively. Several 2D morphometric parameters were statistically significant correlated with BMD respectively. Conclusion : Several parameters of 2D bony morphometry and micro-CT showed effective aspects on the osteoporotic bony change.

지역사회 구강돌봄진료제도 도입 제안 - 돌봄(의존성) 노인의 구강건강관리 시스템 -

이성근,고홍섭,소종섭,곽정민,박인임,이지나,정회인,김태완,강경리 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.1

Oral care and dental services for the dependent older people of Korea is still extremely limited and not easily provided. Depending on where the dependent older people resides, such as the nursing facilities, individual homes, and nursing hospitals, access to dental personnel and the scope of oral care and dental treatment can be quite different due to disparities in rules and regulations for different institutions. In this study, the term ‘community oral care/palliative treatment system (COCS)’ for the dependent older people was introduced, and implementation of ‘The integrated community oral care/palliative treatment system’ (ICOCS) for the dependent older people was recommended. Oral care/treatment for the dependent older people could be categorized into four areas as follows 1) Oral care; Oral hygiene care and oral function care, 2) Basic dental treatment; non-invasive or minimally invasive dental treatment such as dry mouth management, pain management, adjusting and repairing of dentures, 3) General dental treatment, 4) Emergency dental treatment. Oral care and basic dental treatment should be available to all dependent older people wherever they are. For general dental treatment and emergency dental treatment the dependent older people should be transported to dental facilities. The criteria for selecting subjects for COCS were as follows, the remaining life expectancy and the rate of physical decline, ambulatory of the older people for dental visit, the ability of self-oral hygiene care, and the ability of cooperating during general dental treatment. For establishing ICOCS for the entire Korea, it was proposed to set-up an organization called the Korean Community Oral Care Promotion Agency (tentative name) in the central government level and supporting organizations at the municipal level. It is proper time to establish oral care/treatment system for the dependent older people in the community when the nationwide system of care welfare system is actively implemented. This study will lay the foundation for a policy that can provide oral care for the dependent older people in the community and is expected to prevent deterioration, or even improve general health.

하악골 골절에 대한 파노라마방사선사진의 진단능

이지현,정연화,조봉혜,황대석,Lee, Ji-Hyun,Jung, Yun-Hoa,Cho, Bong-Hae,Hwang, Dae-Seok 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.1

Purpose : The purpose of this study was to evaluate the diagnostic efficacy of panoramic radiographs for detection of mandibular fractures. Materials and Methods : The sample was comprised of 65 patients (55 fractured, 10 non-fractured) with 92 fracture sites confirmed by multi-detector computed tomography (CT). Panoramic radiographs were evaluated for mandibular fractures by six examiners; two oral & maxillofacial radiologists (observer A&B), two oral & maxillofacial surgeons (observer C&D), and two general dentists (observer E&F). Results : Sensitivity of panoramic radiography for mandibular fractures was 95.7% in observer A&B, 93.5% in observer C&D and 80.4% in observer E&F. The lowest sensitivity was shown in symphyseal/parasymphyseal areas, followed by subcondylar/condylar regions. Conclusion : Panoramic radiography is adequate for detection of mandibular fractures. However, additional multidetector CT is recommended to ascertain some indecisive fractures of symphysis and condyle, and in complicated fractures.

노인치의학 커리큘럼 가이드라인 제안: 교육주제와 표준역량 항목 중심으로

소종섭,고홍섭,강경리,강명신,고석민,하승룡,황지영,이상구,이성근 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.1

This study was conducted to propose guidelines for Korean geriatric dentistry education in response to changes in society in which the number of older persons is rapidly increasing. By referring to the American, European, and Japanese geriatric dentistry curriculum, the same or highly related items were integrated and reorganized, and new items were added considering the need for education. Through inter-researcher discussion, geriatric dentistry education topics and educational competency items were composed. A survey was conducted on the proposed items among educational experts at dental schools and executives of the Korean Academy of Geriatric Dentistry. After classifying the level of education required into basic or expert curriculum, educational guidelines based on education topics and educational competencies were presented. Educational topics consist of 54 didactic items and 2 practice items in 7 areas including <Public health issues> <Aging> <Aspects of Geriatric medicine> <Communication skills> <Logistic aspects> <Diagnosis & Treatment planning> <Therapy & Prevention>. The core competencies consisted of 83 items in 7 areas including <Understanding of aging> <Medical aspects> <Communication> <Logistic aspects> <Diagnosis, Treatment planning and Treatment> <Prevention and Care> <Public health aspects>. The subjects of socioeconomic aspects, aging, medical and pharmacological aspects in older people, and educational contents for functionally independent older people are mostly classified into the basic educational level. On the other hand, the topics of oral care and treatments, oral and maxillofacial functional rehabilitation, and management areas for frail and dependent older people mostly with sensory or cognitive problems were classified into the expert level. Currently, geriatric dentistry in Korea has been limited to the category of dental treatment for the functionally independent older adults who can visit outpatient clinics. The results of this study had significance in that it presents educational topics and competencies for the functionally frail and dependent older adults. The results of this study can be used for improving not only education curriculum for geriatric dentistry at each and every dental school but also continuing education programs, and will serve as basic and essential data for future research.

비정형 치통 및 삼차 신경통 환자의 임상 특징과 치료 반응의 관계

최서영,정성희,주혜민,옥수민,안용우 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.1

Unexplained toothache is likely to be neuralgia that appears in the teeth. Atypical odontalgia(AO) and trigeminal neuralgia(TN), which are commonly seen in types of neuralgia, can be distinguished by identifying their clinical characteristics. The purpose of this study is to provide information for differential diagnosis by analyzing clinical features of patients suffering from these two diseases. From 2013 to 2022, medical records of 124 patients diagnosed with AO or TN who visited the Department of Oral Medicine at Pusan National University Dental Hospital were analyzed. Analysis was performed on 12 factors related to the patient’s clinical features. Patients with AO are generally younger than those with TN, and few patients show complete improvement (p<0.05). Compared to TN patients who showed sharp pain, AO patients mainly complained of dull pain, which lasted all day (p<0.05). In both diseases, unilateral pain predominantly appeared and the appearance of increased pain during contact stimulation was higher in patients with TN (p<0.05).Patients with AO often developed symptoms after dental treatment and responded relatively well to antidepressants. In contrast, TN patients were less associated with dental treatment, and antiepileptic drugs could reduce pain. In conclusion, the age of patients, pain duration, increased pain to stimulation, pain related to dental treatment, and type of medication indicating the therapeutic effect are important factors that differentiate between AO and TN.

악관절 내장증 환자의 최대 개구시 하악과두 운동량에 대한 자기공명영상 평가; 경두개촬영법과의 비교

조봉혜,Cho Bong-Hae 대한영상치의학회 2001 Imaging Science in Dentistry Vol.31 No.4

Purpose: To evaluate the condylar movement at maximal mouth opening on MRI in patients with internal derangement. Materials and Methods: MR images and transcranial views for 102 TMJ s in 51 patients were taken in closed and maximal opening positions, and the amount of condylar movement was analyzed quantitatively and qualitatively. Results: For MR images, the mean condylar movements were 9.4 mm horizontally, 4.6 mm vertically and 10.9 mm totally, while those for transcranial views were 12.5 mm, 4.6 mm, and 13.7 mm respectively. The condyle moved forward beyond the summit of the articular eminence in 41 TMJs (40.2%) for MR images and 56 TMJs (54.9%) for transcranial views. Conclusion: The horizontal and total condylar movements were smaller in MR images than in transcranial views.

실험적 골 병소에 대한 콘빔형전산화단층영상과 초음파영상의 비교

김민성,박철우,김규태,최용석,황의환,Kim, Min-Sung,Park, Cheol-Woo,Kim, Gyu-Tae,Choi, Yong-Suk,Hwang, Eui-Hwan 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.3

Purpose : This study was performed to evaluate the diagnostic ability of ultrasonography in detection of bone defects and new bone formation. Materials and Methods : Experimental bony defects were prepared on the parietal bone samples acquired from 3.5 kg New Zealand male rabbits. The defects were evaluated using ultrasonography and CBCT, and examined histologically at interval of 1, 3, 6, and 8 weeks. Results : Ultrasonograph demonstrated hyperechogenicity in the defect area at 3 weeks and broadened hyperechogenicity from the margin of bone defect at 6 and 8 weeks due to new bone formation. On the CBCT images, new bone formation was first observed at 3 weeks around the margin of the defect, and showed gradually increase at 6 and 8 weeks. Histologic findings revealed existence of the fibroblasts and fibrous connective tissue with abundant capillary vessels only at 1 week, but osteoid tissue and newly formed trabecular bone at 3 weeks. Bone remodeling in the defect area was observed at 6 weeks and increased calcification and dense trabecular bone formation was observed at 8 weeks. Conclusions : Ultrasonograph proved to be a very useful diagnostic tool in detecting the bony defect and new bone formation. Additionally, ultrasonography provided valuable information regarding the blood supply around the defect area.

Cone-beam CT와 multi-detector CT영상에서 측정된 CT number에 대한 비교연구

김동수,한원정,김은경,Kim, Dong-Soo,Han, Won-Jeong,Kim, Eun-Kyung 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.2

Purpose : To compare the CT numbers on 3 cone-beam CT (CBCT) images with those on multi-detector CT (MDCT) image using CT phantom and to develop linear regressive equations using CT numbers to material density for all the CT scanner each. Materials and Methods : Mini CT phantom comprised of five 1 inch thick cylindrical models with 1.125 inches diameter of materials with different densities (polyethylene, polystyrene, plastic water, nylon and acrylic) was used. It was scanned in 3 CBCTs (i-CAT, Alphard VEGA, Implagraphy SC) and 1 MDCT (Somatom Emotion). The images were saved as DICOM format and CT numbers were measured using OnDemand 3D. CT numbers obtained from CBCTs and MDCT images were compared and linear regression analysis was performed for the density, $\rho$ ($g/cm^3$), as the dependent variable in terms of the CT numbers obtained from CBCTs and MDCT images. Results : CT numbers on i-CAT and Implagraphy CBCT images were smaller than those on Somatom Emotion MDCT image (p<0.05). Linear relationship on a range of materials used for this study were $\rho$=0.001H+1.07 with $R^2$ value of 0.999 for Somatom Emotion, $\rho$=0.002H+1.09 with $R^2$ value of 0.991 for Alphard VEGA, $\rho$=0.001H+1.43 with $R^2$ value of 0.980 for i-CAT and $\rho$=0.001H+1.30 with $R^2$ value of 0.975 for Implagraphy. Conclusion: CT numbers on i-CAT and Implagraphy CBCT images were not same as those on Somatom Emotion MDCT image. The linear regressive equations to determine the density from the CT numbers with very high correlation coefficient were obtained on three CBCT and MDCT scan.