한국 소아치과의 현재와 전망 - 치아우식증관리 분야를 중심으로 -

이상호,Lee, Sang-Ho 대한소아치과학회 2012 大韓小兒齒科學會誌 Vol.39 No.2

General status of pediatric dentistry in Korea is to conduct vigorous academic activities and specialized medical care centering the Korean Association of Pediatric Dentistry (KAPD) that has about 1,000 pediatric dentists as members, pediatric dentistry departments of 11 Colleges of Dentistry, numbers of pediatric dentistry training institutions and private clinics specialized in children. From 1996, the accredited pediatric dentists were produced by the KAPD and from 2008, the state began to produce the accredited pediatric dentists. Since then, doctors with expertise in pediatric care had opened private clinics in addition to the university hospitals, it became the basis of a momentum to deepen the specialty of pediatric dentistry. The Dentistry community of Korea is going through rapid and profound changes recently, and the underlying reasons for such changes can be classified largely into a few categories: (1) Decreasing population and structural changes in population (2) Increase in numbers of dentists, (3) Changes in the pattern of dental diseases and (4) Changes in medical environment. In Korea, the children population in the age range of 0 ~ 14 years old had been decreased by 2 million in 2010 compared to that of 2000 due to reduction of birth rate. The current population of children in the age range of 0 ~ 4 years old in 2010 takes up 16.2% of the total population, but it is estimated that such percentage would decrease to 8.0% by 2050. Such percentage is largely behind the estimated mean global population of 19.6% by 2050. On the other hand, the number of dentists had been largely increased from 18,000 in 2000 to 25,000 in 2010. And it is estimated that the number will be increased to 41,000 by 2030. In addition, the specialized personnel of Pediatric dentistry had been shown as increased by 2.5 times during past 10 years. For the changes in the pattern of dental diseases, including dental caries, each df rate of 5 years old children and 12 years old children had been decreased by 21.9% and 16.7% respectively in 2010 compared to 2000. Each df Index also had been decreased by 2.5 teeth and 1.2 teeth respectively. The medical expenditure of Korea is less than that of OECD and more specifically, the expenditure from the National Health Plan is less than OECD but the expenditure covered by households is larger than OECD. These facts indicate that it is considered as requiring the coverage of the national health plan to be reinforced more in the future and as such reinforcement needs continuous promotion. In medical examination pattern of Pediatric dentistry, the preventive and corrective treatment were increased whereas the restorative treatment was decreased. It is considered that such change is caused from decrease of dental caries from activation of the prevention project at national level. For the restorative treatment, the restorations in use of dental amalgam, pre-existing gold crowning and endodontic treatment had been decreased in their proportion while the restorative treatment in use of composite resin had been increased. It is considered that such changes is caused by the change of demands from patients and family or guardians as they desired more aesthetic improvement along with socio-economic growth of Korean society. Due to such changes in dentistry, the pediatric dentistry in Korea also attempts to have changes in the patterns of medical examination as follows; It tends to implement early stage treatment through early diagnosis utilizing various diagnostic tools such as FOTI or QLF. The early stage dental caries so called white spot had been included in the subjects for dental care or management and in order to do so, the medical care guidelines essentially accompanied with remineralization treatment as well as minimally invasive treatment is being generalized gradually. Also, centering the Pediatric dentists, the importance of caries risk assessment is being recognized, in addition that the management of

연세대학교 세브란스 병원 내 입원한 환자의 소아치과 의뢰 현황

주기훈,이제호,송제선,이효설 大韓小兒齒科學會 2014 大韓小兒齒科學會誌 Vol.41 No.2

본 연구의 목적은 전신질환으로 입원한 환자의 소아치과 협진 의뢰 현황에 대한 통계분석을 실시하여 소아치과로 의뢰되는전신질환 환자 실태를 파악하는 것이다. 2012년 한 해 동안 연세대학교 세브란스 병원에 전신질환으로 입원한 소아환자 중소아치과에 의뢰되어 실제 진료를 받았으며 그 기록이 온전한 391건을 대상으로 하였다. 환자의 나이, 성별, 전신질환명, 협진의뢰과, 협진주소, 치과적 진단명, 치과적 치료 내용, 사망여부로 분류하여 통계 분석하였으며 환자 정보의 수집은 연세의료원의 Clinical Data Retrieval System을 이용하였다. 총 288명의 환자(M:F=166:122)가 소아치과로 의뢰되었으며 평균 연령은 5.9세였다. 재활의학과에서 129건(33.1%), 소아혈액종양내과에서 80건(20.5%), 소아심장과에서 51건(13.0%), 소아신경과에서 44건(11.3%)이 의뢰되었다. 협진주소는 기본 구강검진(156cases, 39.7%), 치아우식증(55cases, 14.0%), 수술 전 검진(50cases, 12.8%)순으로 많았으며 이 외에도 구강통증, 외상, 치아동요도, 교정치료, 자해로 인한 외상, obturator 제작 등 다양한 주소로 의뢰되었음이 확인되었다. 협진 의뢰된 환자의 절반 가량은 특별한 치료없이 구강검사만을 시행하였으며(193건, 49%), 보존치료 및 예방치료는 각각 63건, 60건으로 비슷한 것으로 나타났다. 전신질환으로 입원한 환자의 소아치과 의뢰 현황을 분석한 결과 구강검진을 포함한 다양한 주소로 의뢰됨이 확인되었으며 재활의학과 및 소아혈액종양내과에서 가장 많은 의뢰가 이루어졌다. 의뢰된 환자의 치과적 진단명은 치아우식증이 가장 많았고이에 대한 비침습적이고 예방적 치과치료가 주로 이루어졌다. 입원환자의 전신건강관리와도 밀접한 구강질환 예방 및 처치를위하여 치과협진이 독려되어야 할 것이며 이를 위한 의사 및 보호자의 인식 개선이 요구된다. The goal of this study was to describe dental consultation of pediatric inpatients to the department of pediatricdentistry at Yonsei University Severance Hospital. 391 dental consultations at Yonsei University SeveranceHospital referred to pediatric dentistry in the year 2012 were included in this study. Consultations were categorizedaccording to patients’gender, age, chief complaint, referred department and diagnosis. 288 patients (166males and 122 females) with an average age of 5.9 were referred to the Department of Pediatric Dentistry. 129cases (33.1%) from Department of Rehabilitation Medicine, 80 cases (20.5%) from Pediatric Hematology-Oncology, 51 cases (13.0%) from Pediatric Cardiology, and 44 cases (11.3%) from Pediatric Neurology. Chiefcomplaints were ranked from oral examination (39.7%), dental caries (14.0%), pre-operative evaluation(12.8%) and others (33.5%); including oral pain, trauma, tooth mobility, orthodontic treatment, self-injury,fabrication of obturator and etc. Dental consultations should be encouraged as dental care and treatment couldaffect the control of systemic diseases of admitted patients. Pediatric inpatients have been referred to pediatricdentistry for not only comprehensive oral exam but also various chief complaints. The most frequent dental diagnosismade and treatment performed were dental caries and non-invasive/preventive care respectively.

소아 치과의원의 공간구성과 면적산정에 관한 연구

김민철,박재승 대한건축학회 2003 대한건축학회논문집 Vol.19 No.1

Today, medical system in Korea faces to two major flows of change. The first one is the change in size from large size general hospital to small-to-middle size special hospital. The second one is the change on a point of view from function-oriented hospital to patient-focused hospital. Un these two flows of change, the pediatric dentistry is a typical small-to-middle size special hospital. This study represents the standards for the spatial composition and area calculation in the pediatric dentistry according to domestic situation. The present conditions and the space programs in the pediatric dentistry are investigated and analyzed for this purpose. This study suggests a basic study on the architectural planning of the pediatric dentistry.

국민건강보험에 대한 소아치과 의사들의 요구와 인식 조사

김윤형,채용권,이고은,김미선,남옥형,최성철,이효설 대한소아치과학회 2022 大韓小兒齒科學會誌 Vol.49 No.3

The aim of this study is to investigate the awareness and perception of pediatric dentists regarding dental health insurance (DHI) system in Korea. Online surveys were sent to the members of the Korean Academy of Pediatric Dentistry (KAPD), and the responses were collected. The survey, consisting of 41 questions, was subdivided into ‘general background of the respondents’, ‘the awareness on national health insurance (NHI) and DHI’, ‘the awareness on DHI pertaining to pediatric dentistry’, ‘issues that need improvement on DHI pertaining to pediatric dentistry’, ‘DHI claims’, and ‘the roles of KAPD in DHI’. In total, 302 responded, with a response rate of 28.9%. Excluding 2 questionnaires with insufficient answers, a total of 300 survey results were analyzed. According to the analysis, pediatric dentists thought that the coverage of DHI was not as sufficient compared to that of NHI, but were expecting its scope to broaden in the future. The satisfaction rate was higher in pit and fissure sealant and composite resin filling than in caries-detecting quantitative light-induced fluorescence. Pediatric dentists considered permanent tooth composite resin filling (65.7%) needed an increase in insurance copayment, while topical fluoride application (74.7%) to require insurance coverage. DHI claims were generally handled by dental hygienists and/or nursing assistants. Approximately half of the respondents answered that they have had experiences on appealing for insurance denials. Lastly, pediatric dentists generally had a positive attitude towards providing information for the DHI. This study is expected to be used as a sound dataset for the DHI policy development concerning pediatric dentistry. 이 연구의 목적은 치과건강보험에 대한 소아치과 의사의 인식과 견해를 조사하는 것이다. 대한소아치과학회 회원들을 대상으로 온라인 설문조사를 실시하였다. 총 문항 수는 41문항이며, 문항은 6개의 항목 ‘설문 응답자의 일반적인 특성’, ‘국민건강 보험과 치과건강보험’, ‘소아치과 영역의 치과건강보험’, ‘소아치과와 관련된 치과건강보험 제도 개선점’, ‘치과건강보험청구’, ‘치과건강보험과 관련한 대한소아치과학회 역할’으로 이루어졌다. 총 302명이 응답하였고, 응답률은 28.9%였다. 기록이 미비한 2명을 제외하고, 총 300명을 분석대상으로 하였다. 소아치과 의사들은 치면열구전색술, 광중합형 복합레진 충전에 정량광형광기 치아우식검사에 비해 높은 만족도를 보였다(p < 0.017). 소아치과 의사들은 보험수가 인상이 가장 필요한 항목은 영구치 복합레진 충전(65.7%), 보험급여가 가장 필요한 항목은 불소도포(74.7%)라 생각하였다. 치과건강보험 청구는 대체로 치과위생사 또는 간호조무사가 담당하였다. 소아치과 의사들은 학회에서 치과건강보험에 대한 정보를 제공하는 것에 대해 긍정적으로 생각하였다. 이 연구는 향후, 소아치과 영역 치과건강보험제도의 정책적 발전을 위한 기초자료로 활용될 수 있을 것이라 사료된다.

최근 10년간(2011-2020) 전남대학교 치과병원 소아치과의 진료 현황에 대한 실태조사

김보람(Boram Kim),김선미(Seonmi Kim),최남기(Namki Choi) 대한치과의사협회 2021 대한치과의사협회지 Vol.59 No.10

The distribution of patients and practice patterns in pediatric dentistry are constantly changing. This study aimed to analyze the changing trends of patient distribution and treatment patterns in pediatric dentistry. Patient distribution and practice patterns from 2011 to 2020 at the Department of Pediatric Dentistry at Chonnam National University Dental Hospital were collected and reviewed. The total number of outpatients showed a tendency to increase until 2019; however, this value decreased slightly in 2020 owing to the impact of the coronavirus disease pandemic. From 2011 to 2020, the proportion of new patients decreased from 12.18% to 8.98%. In 2011, restorative treatment was the most common, followed by preventive, surgical, endodontic, and orthodontic treatments. After 2012, preventive treatment showed the highest proportion, follwed by restorative, surgical, orthodontic, and endodontic treatments in 2020. The frequency of sedation and the proportion of insured treatments tended to increase over the 10-year study periods.

최근 10년간(2006 - 2015) 서울대학교 치과병원 소아치과의 진료 현황에 대한 연구

서미경,송지수,신터전,현홍근,김정욱,장기택,이상훈,김영재,Seo, Meekyung,Song, Ji-Soo,Shin, Teo Jeon,Hyun, Hong-Keun,Kim, Jung-Wook,Jang, Ki-Taeg,Lee, Sang-Hoon,Kim, Young-Jae 대한소아치과학회 2018 大韓小兒齒科學會誌 Vol.45 No.2

The practice pattern of pediatric dentistry has been changing for the last several decades. This change might be influenced by several factors such as development in dental materials and socioeconomic changes. The purpose of this study was to analyze the changing trends of patient distribution and treatment pattern of pediatric dentistry. Patient distribution and practice trends from 2006 to 2015 at the department of pediatric dentistry of Seoul National University Dental Hospital were reviewed. From 2006 to 2015, the proportion of new patient increased from 12.49% to 20.56%. The average age of new patients decreased. In 2006, restorative treatment had highest percentage, followed by preventive treatment, orthodontic treatment, surgical treatment, and pulp treatment. In 2015, preventive treatment had highest percentage, followed by restorative treatment, orthodontic treatment, surgical treatment and pulp treatment Frequency of general anesthesia increased more than 5 times for last 10 years. The proportion of insurance treatment decreased until 2009, and after 2010 it increased steadily. 인구통계적 변화 및 사회 경제적 변화 등으로 인해 최근 몇십 년간 소아치과는 환자 분포와 진료 양상에 많은 변화가 있었다. 본 연구는 이러한 변화의 양상을 파악하기 위해 시행되었다. 2006년부터 2015년까지 서울대학교 치과병원 소아치과에 내원한 모든 환자를 대상으로 하여 환자분포 및 진료 현황에 대한 정보를 분석하였다. 조사 결과 전체 환자 중 초진 환자의 비율은 증가하였고, 초진 환자의 평균 연령은 감소하였다. 연도별 진료 현황을 조사한 결과 2006년에는 수복치료, 예방치료, 교정치료, 외과치료, 치수치료 순으로 빈도가 높았다. 이후 예방치료는 크게 증가했고, 수복치료는 감소하였고, 치수치료 및 외과치료는 비슷하게 유지되었다. 교정치료는 2009년까지 증가하였으며 이후로는 감소하였다. 그 결과 2015년에는 예방치료, 수복치료, 교정치료, 외과치료, 치수치료 순으로 많이 시행되었다. 진정법과 전신마취 시행 건수를 년도별로 조사한 결과 2011년 이후 전신마취 시행이 크게 증가하였으며, 진정법은 2010년 크게 증가하였다가 이후 감소하여 매년 200건 정도가 시행되었다. 전체 진료 항목 중 급여 진료는 2009년까지 감소하였으며, 이후 증가하였다.

어린아기들의 구강관리 (아기치과)

이효설(Hyo-Seol Lee) 대한치과의사협회 2022 대한치과의사협회지 Vol.60 No.6

There are two major trends in pediatric dentistry recently. One is the declining treatment of traditional dental caries, and the second is the growing interest in prevention. Therefore, there is a need for a change in the treatment method of pediatric dentistry until now. In Japan, which experienced such social change before Korea, in 2018, the diagnosis and insurance items were added as ‘Children"s Oral Dysfunction". It is based on baby dentistry, which manages the oral health of young children. Baby dentistry is for infants up to 18 months, including newborns. The main content contains the premise, way of thinking, and specific contents of baby dentistry, This article is based on the recently published books of "Early Treatment" and "Baby Dentistry", and I recommend that you refer to the book for more details.

세브란스 병원에 입원한 환자들의 소아치과 협진의뢰 내용 및 진료현황

송지혜,이고은,송제선,김성오,이제호,최형준 대한소아치과학회 2019 大韓小兒齒科學會誌 Vol.46 No.2

The purpose of this study was to analyze the dental consultation of pediatric inpatients to the department of pediatric dentistry in Yonsei University Severance Hospital, and to investigate the change in patterns. In 2017, 268 pediatric patients (384 cases) admitted to the Severance Hospital were referred to the department of pediatric dentistry. The mean age was 6.6 years, and most of the patients were referred from the Department of Pediatric Hematology Oncology and Rehabilitation Medicine. The chief complaints were as follows: oral examination (31%), dental caries (20%), oral pain (10%), tooth mobility (10%), pre-operative evaluation (9%) and others (20%). 41% of the patients received only oral examination without treatment. Dental caries were the most frequent dental diagnosis of the patients. 28% (111 cases) of patients received operative treatments, 22 cases were treated under general anesthesia. Oral health is closely related to systemic diseases, especially for hospitalized patients. Dental consultations should be encouraged for prevention and early appropriate treatments. For this purpose, it is necessary to establish a referral system and perform dental treatment under general anesthesia. 이 연구는 연세대학교 세브란스 병원에 입원한 환자의 소아치과 협진의뢰에 대한 정보를 분석하여 소아치과에 의뢰되는 전신질환환자에 대해 파악하고 협진 및 진료 경향에 변화가 있는지 분석하기 위해 시행되었다. 2017년 한 해 동안 연세대학교 세브란스 병원에 전신질환으로 입원한 소아환자 중 소아치과에 의뢰되어 실제로 진료를 받은 384건(268명)에 대한 자료를 조사하였다. 평균연령은6.6세였으며, 소아혈액종양과와 재활의학과에서 가장 많은 의뢰가 있었다. 협진주소는 기본 구강검진(31%), 치아우식증(20%), 구강통증(10%), 치아동요도(10%), 수술 전 검진(9%) 순으로 많았고, 협진의뢰된 환자의 41%는 치료 없이 구강검사만 시행하였다. 의뢰된 환자의 치과적 진단명은 치아우식증이 가장 많았으며, 이에 대한 보존치료 및 예방치료가 시행되었다. 협진의뢰된 환자의 28%(111건)는보존치료를 받았으며 그 중 22건은 전신마취 하에 진행되었다. 구강건강은 입원환자의 전신질환과 밀접한 연관성이 있으므로 구강질환의 예방 및 치료를 위하여 치과협진이 적극적으로 이루어져야 한다. 이를 위해 협진의뢰 체계 확립과 전신마취를 통한 치과치료의활용이 필요하다.

서울대학교치과병원 소아치과에서 시행된 전신마취 하 치료에 대한 연구

한정화,송지수,신터전,현홍근,김영재,김정욱,장기택,이상훈,Han, Jeong-Hwa,Song, Ji-Soo,Shin, Teo Jeon,Hyun, Hong-Keun,Kim, Young-Jae,Kim, Jung-Wook,Jang, Ki-Taeg,Lee, Sang-Hoon 대한소아치과학회 2018 大韓小兒齒科學會誌 Vol.45 No.2

의학적 관리가 필요하거나 공포로 인해 치과치료를 기피하는 경우 등 다양한 경우에서 소아환자의 치과치료는 일반적인 행동조절만으로는 불가능한 경우가 많다. 이에 최근 전신마취를 이용한 치과치료에 대한 관심이 증가하는 추세이다. 본 연구는 서울대학교치과병원 소아치과에서 시행된 전신마취 하 치과치료에 대한 분석을 위하여 시행되었다. 2011년 10월부터 2015년 12월까지 서울대학교치과병원 소아치과에서 만 18세 미만의 환자를 대상으로 시행한 전신마취 1378례(1322명)에 대한 자료를 조사하였다. 성별은 남자가 805명(60.9%)로 여성보다 더 많았으며, 연령은 5 - 9세(56.0%)가 가장 많았다. 치료 전 전신상태는 ASA 1등급 67.8%, 2등급 이상이 32.2%이었다. 주된 치료는 치아우식증 치료(51.1%)가 가장 많았으며, 다음으로 외과적 치료(42.2%)가 많았다. 전신마취는 행동조절법 중 하나로 다양한 장점이 있으며, 협조가 부족한 환자에서 유용한 방법이 될 수 있다. Behavior management of the child constitutes an important part of pediatric dentistry. The majority of children can be treated with adequate behavior management. However, some children who have extensive dental problems or mental, physical disabilities cannot cooperate. So, the need for general anesthesia as a special method of behavior management has increased recently. This study analyzes the records of patients who received dental treatment under general anesthesia. The 1378 cases of 1322 patients under 18 years of age, who received dental treatment under general anesthesia in department of pediatric dentistry at the Seoul National University dental hospital, from October, 2011 to December, 2015 were included. In this study, male (60.9%) was more than female (39.1%). The mean age of patients was 5.9 years and age from 5 to 9 years was the most frequent (56.0%). The primary dental treatment which patients received was dental caries treatment (51.1%), followed by surgical treatment (42.2%). The dental treatment under general anesthesia has many advantages including of performing a lot of treatments at once, producing good quality of treatment, and reducing the number of visits. General anesthesia may be a useful method of behavior management.

Dental Management in a Child Patient with Glucose-6-phosphate Dehydrogenase Deficiency : A Case Report

전지윤,양선미,최남기,김선미,Jeon, Jiyoon,Yang, Sunmi,Choi, Namki,Kim, Seonmi Korean Academy of Pediatric Dentistry 2021 大韓小兒齒科學會誌 Vol.48 No.3

포도당-6-인산탈수소효소 결핍증은 X 염색체 열성으로 유전되는 세계에서 가장 흔한 효소 결핍증이다. 이 질환은 우리나라에서는 드물게 나타나지만, 다문화 가정의 증가로 유병률이 높아질 가능성이 있다. 이 결핍증의 주된 문제는 소아치과에서 일반적으로 사용되거나 처방되는 일부 약물에 의해 용혈성 빈혈이 유발될 수 있다는 점이다. 소아치과 의사는 환자의 병력에 대한 정확한 지식을 갖고 용혈을 유발할 수 있는 산화 스트레스를 피하기 위해 소아 혈액 전문의와 상담해야 한다. 가장 효과적인 치료는 빈혈을 유발할 수 있는 인자에 노출되지 않도록 예방하는 것이다. 이 질환으로 진단받은 환자들에게 위험인자에 대한 적절한 교육은 필수적이다. 이 증례보고는 G6PD 결핍증 환아에서 주의해야 할 약물과 치과적 관리 방법에 대해 논의하고자 하였다. Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked recessive disorder and is the most common enzyme deficiency worldwide. Although this disease is rare in Korea, its prevalence may increase due to an increase of multicultural families. Patients with this deficiency are prone to hemolytic anemia provoked by specific drugs commonly used or prescribed in pediatric dentistry. It is necessary for pediatric dentists to have accurate knowledge of a patient's medical history and to consult with a pediatric hematologist to avoid oxidative stress that can lead to hemolysis. The most effective treatment is prevention of exposure to factors that may trigger anemia. Appropriate education regarding risk factors is essential for patients diagnosed with this disease. This case report aimed to discuss the drugs and dental management methods that should be cautious in children with G6PD deficiency.