위장관으로 흡인된 치과기구의 처치

방난심,이강희,김영진,정복영,Pang, Nan-Sim,Lee, Kang-Hee,Kim, Young Jin,Jung, Bock-Young 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.2

Foreign body indigestion during dental procedures is uncommon but sometimes associated with severe and life threatening morbidity. The dentist should decide whether multidisciplinary intervention is necessary and how urgently it has to be done. The active removal of foreign bodies depends on the size, shape, type and duration of impaction, along with the location in the gastrointestinal tract. In this report, we presented how to manage gastric foreign body related swallowing during dental procedure and investigated the predictive risk factors, precaution, and prompt management in foreign body ingestion.

Assessment of decontamination of gutta-percha cone and the change of surface texture after rapid chemical disinfection

방난심,정일영,유윤정,금기연,Pang, Nan-Sim,Jung, Il-Young,Yu, Yoon-Jung,Kum, Kee-Yeon The Korean Academy of Conservative Dentistry 2006 Restorative Dentistry & Endodontics Vol.31 No.2

본 연구의 목적은 첫째 임상에서 진료실에 노출된 가타파차 콘 표면의 오염 균종을 중합효소연쇄반응법 (polymerase chain reaction, PCR)을 이용해 동정하고, 둘째 이들 세균으로 오염시킨 가타파차 콘에 대해 2종의 소독제의 rapid sterilization 효과를 비교하였다. 또한 이들 소독제에 5분간 처리된 가타파차 콘 표면 성상의 변화를 주사전자현미경으로 관찰하였다. 진료실에 수 개월간 노출된 가타파차 콘 100개를 수거하여 배양지에 넣어 배양 후 universial primer를 사용한 PCR assay 를 통해 오염 균종을 동정하였다. 실험실 상에서 이 균종을 다시 배양하여 소독된 가타파차 콘에 접종하고 1주일간 배양한 후 2종의 소독제(5% NaOCl, 2% Chlorhexidine)에 1, 3, 5, 10 분간 담근 후 각 소독제의 종류와 적용시간에 따른 멸균 효과를 turbidity test 와 subculture 를 이용하여 평가하였다. 또한 각 소독제에 5분간 처리된 가타파차 콘 표면 성상의 변화를 주사전자현미경으로 관찰하였다. 중합효소연쇄반응법의 분석결과 17개의 가타 파차 콘이 오염된 것으로 나타났고 대부분이 Staphylococcus 계통이었으며, 2종의 소독제 모두 이들 균종에 대해 1분내에 멸균 효과를 나타냈다. 주사전자현미경상 NaOCl로 소독된 가타파차 콘 표면에는 cuboidal crystal 의 침전물이 전반적으로 관찰되었다. 본 연구 결과 2종의 소독제 모두 근관충전 전 가타파차 콘의 rapid sterilization 을 위해 유용하였으나 클로헥시딘으로 처리된 가타파차 콘이 크리스탈 침전물이 없는 좀더 깨끗한 표면을 갖는 것으로 나타났다. The purposes of this study were firstly to identify the microbial species on gutta-percha (GP) cones exposed at outpatient clinics using polymerase chain reaction, and secondly to evaluate the rapid sterilization effect of two chemical disinfectants at chair side. It also evaluated the alteration of surface texture of GP cones after 5-min soaking into two chemical disinfectants. A total of 100 GP cones from two endodontic departments were randomly selected for microbial detection using PCR assay with universal primer. After inoculation on the sterilized GP cones with the same microorganism identified by PCR assay, they were soaked in two chemical disinfectants: 5% NaOCl and 2% chlorhexidine for 1, 3, 5, and 10 minutes. The sterilization effect was evaluated by turbidity and subculture. The change of surface textures using a scanning electron microscope was also examined after 5 min-soaking in two chemical disinfectants. Results showed that four bacterial species were detected in 17 GP cones, and all the species belonged to the genus Staphylococcus. Two chemical disinfectants were effective in sterilization with just 1 minute soaking. On the SEM picture of NaOCl-soaked GP cone, a cluster of cuboidal crystals was seen on the cone surface. Present data demonstrate that two chemical disinfectants are useful for rapid sterilization of GP cone just before obturation at chair side, while CHX-soaked GP cone has cleaner surface without crystal precipitation than that of NaOCl-treated cone.

항응고제 복용 환자에서 저분자량 헤파린을 사용한 구강 내 소수술

황세영,윤희정,방난심,정복영,김기덕,김형준,박원서,Hwang, Se-Young,Yun, Hee-Jung,Pang, Nan-Sim,Jung, Bock-Young,Kim, Kee-Deog,Kim, Hyung-Jun,Park, Wonse 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.2

Anticoagulation therapy with warfarin sodium is used to reduce the risk of thromboembolic events in patients with valvular heart disease, prosthetic heart valve, recurrent myocardiac infarction, etc. To keep anticoagulation state and minimize bleeding risk, patients with high risk of thromboembolism have been usually hospitalized for heparinization before oral surgery like extraction. However, this protocol requires time and high expense because of the long period of hospitalization and this is why low-molecular-weight heparin (LMWH) therapy is receiving attention in medical field as well as dentistry. LMWH has several advantages over unfractionated heparin (UFH) including predictable anticoagulant response which makes coagulation monitoring unnecessary in most patients and longer half-life than heparin which enables the patients to give themselves a subcutaneous injection once or twice daily. These advantages of LMWH make patients get oral surgery on an outpatient basis so that they can save time and cost. This case report introduces the use of LMWH in dental surgery and suggests proper use of LMWH. Though LMWH bridging therapy is widely used most of the previous studies are observational studies. Therefore randomized controlled trials are necessary to evaluate the safety and efficacy of LMWH bridging therapy.

하악공 전달마취 후 발생한 일시적인 시력 저하

임지영,윤희정,방난심,정복영,김기덕,박원서,Lim, Gee-Young,Yun, Hee-Jung,Pang, Nan-Sim,Jung, Bock-Young,Kim, Kee-Deog,Park, Won-Se 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.1

One of the most common procedures in dentistry is the inferior alveolar nerve block anesthesia but visual problem can occur during this procedure. Transient visual acuity decrease after inferior alveolar nerve block anesthesia can result from unintended intravascular injection. In this case report, we present ocular complication that has rarely been reported. The understanding of anatomy related to this case is discussed with suggestions for proper management of the patients. The dental management for ocular complications includes a correct diagnosis, management by understanding of patient's anatomic variations. This will prevent intravascular injection.

간이식 환자의 출혈 경향과 치과적 고려 사항

박원서,백윤재,도레미,김기덕,정복영,방난심,윤희정,유태민,Park, Wonse,Baik, Yoon-Jae,Doh, Re-Mee,Kim, Kee-Deog,Jung, Bock-Young,Pang, Nan-Sim,Yun, Hee-Jung,You, Tae-Min 대한치과마취과학회 2012 Journal of Dental Anesthesia and Pain Medicine Vol.12 No.3

Background: The major goal of dental management before and after liver transplantation is the prevention of bacteremia from an oral source that could lead to systemic infection. However dental treatment in liver transplant patients have the risk of infection and bleeding. so it is needed special dental consideration. Methods: 42 liver transplant candidates who visited department of Advanced General Dentistry in Yonsei University College of dentistry from March 1, 2010 to February 29, 2012 were selected. The clinical data of those patients were analyzed; coagulation status such as PT, INR, aPTT, platelet count before and 6 months after liver transplantation, dental infectious foci, time interval between dental visit and operation date of liver transplantation. Results: Before liver transplant, the patient's PT and INR was prolonged, and the platelet count was lower than normal range. But 6 months later from liver transplantation, most of the figures turned into a normal range. The dental infection foci were chronic periodontitis, dental caries, chronic apical periodontitis, root rest et al but we did extraction of 6 root rest before liver transplantation and postponed other treatment after liver transplantation due to bleeding and infection risk of patients. Because of insufficient interval between dental visit and operation date, 64.3% of patients could not finish the dental treatment. Conclusions: The patients before liver transplantation have the risk of bleeding. The treatment of those patient should be removal of only factors that can cause dental infections after transplantation and other treatment must be postponed until the stable period of the transplant that patient's condition has improved.

Minimally Invasive Laser-Assisted Biopsy of the Oral Lesions for Oral Graft-Versus-Host Disease after Hematopoietic Stem-Cell Transplantation

김윤미,윤희정,김현실,김기덕,정복영,방난심,박원서,Kim, Yun-Mi,Yun, Hee-Jung,Kim, Hyun-Sil,Kim, Kee-Deog,Jung, Bock-Young,Pang, Nan-Sim,Park, Won-Se The Korean Academy of Orofacial Pain and Oral Medi 2012 Journal of Oral Medicine and Pain Vol.37 No.3

조혈줄기세포이식은 면역 결핍 질환, 자가 면역 질환, 악성 조혈 종양의 주된 치료법이다. 이종 조혈줄기세포이식의 주요한 합병증은 이식편대 숙주질환이다. 구강 점막 생검은 이식편대 숙주 질환의 확진과 치료계획 수립을 위해 필요하나 영양 결핍과 화학 요법으로 인해 전신상태가 불량한 환자에게 출혈과 균혈증을 일으킨다. 본 논문에서는 레이저를 이용한 최소 침습적 조직생검의 효능을 평가하였다. 모두 3개의 증례가 소개되었고 모든 환자의 의료 기록, 임상 사진, 조직병리학적 결과가 레이저를 이용한 조직생검의 효능을 평가하기 위해 검토되었다. 모든 환자는 생검 후 불편감이 없었고 심각한 합병증이 발생하지 않았다. 생검 조직의 질이 이식편대 숙주 질환을 확진하는 데에 적당했다. 구강 점막의 레이저를 이용한 최소 침습적 생검은 통상의 조직병리학적 생검에 비해 출혈을 일으키지 않아 감염과 균혈증, 술 후 흉터 생성을 줄이므로 이식편대 숙주 질환의 확진에 이로울 것이다. Hematopoietic stem-cell transplantation (HSCT) is a treatment for immune deficiency, autoimmune diseases, and hematopoietic malignancies. The main complication of allogenic HSCT is graft-versus-host disease (GVHD). Oral mucosal biopsy is needed for a definitive diagnosis and treatment planning of GVHD, but this procedure causes bleeding and bacteremia in a poor general condition. We evaluated the efficacy of laser-assisted biopsy as a minimally invasive treatment. Three cases were described in this article. All patients' medical records, clinical photographs, and histopathologic findings were reviewed. All patients felt comfortable and no severe complications occurred. The quality of the obtained biopsy material was adequate for a definitive diagnosis of GVHD. Laser-assisted, minimally invasive biopsy of the oral mucosa does not cause bleeding, and it reduces the chances of infection, bacteremia, and postoperative scarring compared to the usual histopathologic biopsy procedure. It would thus be advantageous to use this procedure to biopsy GVHD patients.

컴퓨터를 이용한 속도 조절형 치과 국소마취 기구: 문헌고찰

김영진,이준형,이강희,김기덕,정복영,방난심,박원서,Kim, Young-Jin,Lee, Jun-Hyung,Lee, Kang-Hee,Kim, Kee-Deog,Jung, Bock-Young,Pang, Nan-Sim,Park, Wonse 대한치과마취과학회 2013 Journal of Dental Anesthesia and Pain Medicine Vol.13 No.4

Background: Today, there are computer controlled local anesthesia devices used clinically. The main principle is to control injection speed by computer aided system, and it relieves pain. However, there are few objective data considering this subject. In this literature review, we researched studies about computer controlled anesthetic delivery. We compared pain control effect of computer controlled to conventional local anesthetic syringe system. Methods: A bibliographic search in PubMed was performed and we reviewed original articles. Results: There were 18 publications that compared pain control effect of computer controlled to conventional system. There were 8 articles reported of children, similar pain control effect was found in 7 of them. One study showed superior pain control effect of computer controlled anesthetic delivery. For adults, 10 studies showed superior pain control effect in computer aided system. Conclusions: Computer controlled anesthetic delivery has similar or superior pain control effect compared to conventional local anesthetic syringe system. For both children and adults, computer controlled anesthetic delivery could be clinically useful, still it may be more effective for adults.

통합치과전문임상의 과정 내 건강 보험 교육 실태

권정훈(Jeong-Hoon Kwon),이민혜(Min-Hye Lee),양정강(Joung-Kang Yang),김기덕(Kee-Deog Kim),정복영(Bock-Young Jung),방난심(Nan-Sim Pang),도레미(Re-Mee Doh),박원서(Wonse Park) 대한치과보험학회 2011 대한치과보험학회지 Vol.2 No.1

Objectives : The purpose of this study is to survey the general recognition of dental insurance and the actual condition of insurance education, then to offer the reference for AGD resident education requisite to qualification renewal. Method : 129 questionnaires were sent out to AGD residents and people who completed the AGD course in 20 dental hospital and 49 were returned(return rate: 38.0%). The questionnaires with 21 questions about dental health insurance education were sent by e-mail and fax from 2010.11.15 to 12.4. Results and Conclusion : Most respondents felt the need of insurance education in the course of AGD. However, this study finds out insufficient insurance education in AGD course, caused by inadequate education system of health insurance, lack of education time and impractical contents. In AGD course, expanding the education about health insurance would complement insufficient curriculum in the undergraduate dental college.

Assessment of sterilization effect and the alteration of surface texture and physical properties of gutta-percha cone after short-term chemical disinfection

Pang, Nan-Sim,Jung, Il-Young,Yu, Yoon-Jung,Kum, Kee-Yeon 大韓齒科保存學會 2006 Restorative Dentistry & Endodontics Vol.31 No.2

본 연구의 목적은 첫째 임상에서 진료실에 노출된 가타파차 콘 표면의 오염 균종을 중합효소연쇄반응법(polymerase chain reaction, PCR)을 이용해 동정하고, 둘째 이들 세균으로 오염시킨 가타파차 콘에 대해 3 종의 소독제의 short-term sterilization효과를 비교하였다. 또한 이들 소독제에 5 분간 처리된 가타파차 콘 표면 성상의 변화를 주사전자현미경으로 관찰하였고 물성 변화, 특히 인장 강도와 연신률의 변화를 측정, 비교하고자 하였다. 진료실에 수 개월간 노출된 가타파차 콘 150개를 수거하여 배양지에 넣어 배양 후 universial primer를 사용한 PCR assay를 통해 오염 균종을 동정하였다. 실험실 상에서 이 균종을 다시 배양하여 소독된 가타파차 콘에 접종하고 1 주일간 배양한 후 3 종의 소독제 (5% NaOCl, 2% Chlorhexidine, ChloraPrep)에 1, 5, 10, 30 분간 short-term soaking후 각 소독제의 종류의 적용시간에 따른 멸균 효과를 turbidity test와 subculture를 이용하여 평가하였다. 또한 각 소독제에 5 분간 처리된 가타파차 콘 표면 성상의 변화를 주사전자현미경으로 관찰하였으며, 물성 변화를 평가하기 위해 Instron 5500을 이용하여 연신률 및 tensile strength를 측정한 후 통계학적 유의성 여부를 검증하였다. 중합효소연쇄반응법의 분석결과 19.4%의 가타파차 콘 이 오염된 것으로 나타났고 대부분이 Staphylococcus 계통이었으며, 3 종의 소독제 모두 이들 균종에 대해 1 분내에 멸균 효과를 나타냈다. 주사전자현미경상 NaOCl로 소독된 가타파차 콘 표면에는 cuboidal crystal 의 침전물이 전반적으로 관찰되었다. Tensile strength는 NaOCl군에서 다른 군에 비해 유의성 있는 증가를 보였으며 (p <0.05), elongation rate는 3 종의 소독제 모두 대조군에 비해 유의성 있는 증가를 보였으나 (p < 0.05), 특히 ChloraPrep군에서 가장 큰 증가를 보였다. 본 연구 결과 3 종의 소독제 모두 근관충전 전 가타파차 콘의 rapid sterilization을 위해 유용하게 사용할 수 있음을 시사한다. The purposes of this study were firstly to identify the microbial species on gutta-percha (GP) cones exposed at clinics using polymerase chain reaction, and secondly to evaluate the short-term sterilization effect of three chemical disinfectants. It also evaluated the alteration of surface texture and physical properties of GP cones after 5-min soaking into three chemical disinfectants. 150 GP cones from two endodontic departments were randomly selected for microbial detection using PCR assay with universal primer. After inoculation on the sterilized GP cones with the same microorganism identified by PCR assay, they were soaked in three chemical disinfectants : 5% NaOCl, 2% Chlorhexidine, and ChloraPrep for 1, 5, 10, and 30 minutes. The sterilization effect was evaluated by turbidity and subculture. The change of surface textures using a scanning electron microscope and the tensile strength and elongation rate of the GP cones were measured using an Instron 5500 (Canton). Statistical analysis was performed. Four bacterial species were detected in 29 GP cones (19.4%), and all the species belonged to the genus Staphylococcus. All chemical disinfectants were effective in sterilization with just 1 minute soaking. On the SEM picture of NaOCl-soaked GP cone, a cluster of cuboidal crystals was seenon the cone surface. The tensile strenght of NaOCl-soaked group was significantly higher than the other groups (p< 0.05). Alsi, all disinfectants significantly increased the elongation rate of GP cones compared to the fresh GP cone (p < 0.05). Present data demonstrate that three chemical disinfectants are useful for rapid sterilization of GP cone just before obturation.