전이성 암종의 증상으로 발현된 numb chin syndrome 증례

임현대 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.2

Numb chin syndrome (NCS) is a sensory neuropathy characterized by numbness in the distribution of the inferior alveolar nerve or mental nerve. Benign as well as malignant diseases are known to cause NCS. If a dentist encounters NCS without a history of maxillofacial trauma or dental problems, they should keep in mind the relationship with malignant tumors. This report introduces the case of numbness and pain in chin area caused by metastasis and emphasizes the importance of diagnosis of NCS.

지역사회 거주 노인의 타액선 기능저하 (구강건조) 평가 및 중재

소종섭,정회인,강정현,김지훈 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.2

Salivary gland hypofunction (dry mouth) is the most common dysfunction in older adults. It causes a deterioration in oral health, mastication, and swallowing functions. It can also lead to systemic frailty. Early diagnosis and intervention are required to prevent oral and systemic frailty. This literature review introduced the salivary gland hypofunction assessment methods and interventions applicable in community-dwelling older adults. The study proposed an oral mucosal wetness test. The test uses an oral moisture-checking device as the primary test for assessment considering logistic aspects in application to the elderly in the community. The clinical oral dryness score (CODS) is an alternative test. The assessment method of oral mucosal wetness showed a significant correlation with salivary secretion rate. The CODS system is also significantly correlated with mucosal wettability, salivary secretion rate, and severity of oral dryness. Therefore, they have proven useful as test tools for assessing salivary gland hypofunction and oral mucosal wetting. The subjective questionnaire (xerostomia inventory) is also a useful tool for determining the severity of dry mouth and can be combined with other examination methods for salivary gland hypofunction such as oral mucosal wetness test or CODS. Essential interventions to salivary gland disfunction include drug coordination, prescription of artificial saliva, expert application of fluoride varnish, and salivary gland stimulation exercises. Careful consideration of other oral functions, such as occlusal force, tongue pressure, tongue movement, and oral hygiene management ability, is also required. Comprehensive intervention must be planned. Many studies have shown that the degradation of one function leads to that of another. Conversely, improving each function can improve other oral and integrated functions, such as masticatory and swallowing functions. The ultimate purpose of the intervention for salivary gland hypofunction in community-dwelling older adults is to improve and maintain oral functions—mastication, swallowing, and pronunciation. Therefore, interventions should include complex interventions such as oral exercise, tongue pressure enhancement training, oral hygiene, and interventions to improve salivary gland function. The intervention for individual salivary gland dysfunction should be planned with a comprehensive perspective for maintaining integrated oral function and contributing to the prevention and management of systemic frailty and its complications.

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.

노인에서 턱관절 장애와 골밀도의 관련성에 관한 예비 연구

김문종 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.2

Purpose: The aim of this study is to investigate and compare bone mineral density in patients with temporomandibular disorders (TMD) and healthy controls to confirm the relationship between TMD and osteoporosis. Methods: 107 TMD patients and 50 healthy controls were included in this study. Among the TMD patients, 50 were diagnosed with osteoarthritis in at least one joint. Mandibular cortical width (MCW) and panoramic mandibular index (PMI) were calculated in all participants using panoramic radiographs to evaluate bone mineral density. Results: The mean age was not significantly different between the TMD patients and controls. There were significantly more female subjects in the TMD group than in the controls. The TMD patients with osteoarthritis displayed lower values of MCW and PMI than those without osteoarthritis. However, only the difference in the value of MCW showed statistical significance. Conclusion: The patients with TMD have lower bone mineral density than the healthy controls. Additionally, compared to the TMD patients without osteoarthritis, the TMD patients with osteoarthritis have reduced bone mineral density. These findings suggested that osteoporosis may be related to the pathophysiology of TMD and osteoarthritis.

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.

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.

고령자 삼킴기능저하의 평가와 중재

고석민,이지나 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.2

Korea is on the verge of becoming a super-aged society, and the structure of the disease is changing accordingly. One of the measures to lower the medical and social burden for the elderly is early detection and prevention of elderly frailty. Oral frailty in elderly is reported to be manifested prior to whole body frailty. So, if oral frailty is diagnosed and treated early, independency in mobility and healthy aging of elderly can be effectively promoted. The Korean Academy of Geriatric Dentistry launched establishing a clinical guideline of oral frailty for Korean elderly with diagnostic criteria and treatment modality. If two out of the six criteria, chewing function, occlusal force, tongue force, salivary gland function, swallowing function, and oral hygiene, are checked as not ‘normal’ but ‘at risk’, the patient is diagnosed as having oral frailty. In this paper, evaluation methods and exercise therapies for swallowing function (out of the six criteria for oral frailty) is described in detail.

골다공증 환자에게서 MRONJ(Medication-related osteonecrosis of the jaw)를 유발할 수 있는 국소위험인자에 대한 고찰

김훈민,이진호,손나리,안윤환,정찬우,이재일,성일용,손장호,하진희,조영철 대한노년치의학회 2022 대한노년치의학회지 Vol.18 No.1

Recently, many side effects such as bone necrosis have been reported during dental treatment for patients with osteoporosis as an underlying disease. In particular, osteoporosis is on the rise every year in menopause women and elderly patients, and occurs in connection with bisphosphonate medication. Such medication-related osteonecrosis of the jaw is often caused by surgical dental treatment, and it is difficult to cure when it occurs, so prevention is important. Surgical treatment may be required in the oral Preparation process for extraction or prosthetic repair due to periodontal disease, and for the successful treatment of osteoporosis patients, dentists should fully understand and pay attention to the treatment of osteoporosis patients.