구강건조증 증상 평가를 위한 설문지의 신뢰도에 관한 연구

Reliability of a Questionnaire for Evaluation of Dry Mouth Symptoms

  • 이정윤 (서울대학교 치과대학 구강내과진단학 교실) ;
  • 이영옥 (서울대학교 치과대학 구강내과진단학 교실) ;
  • 고홍섭 (서울대학교 치과대학 구강내과진단학 교실)
  • Lee, Jeong-Yun (Dept. of Oral Medicine and Oral Diagnosis, School of Dentisty, Seoul National University) ;
  • Lee, Young-Ok (Dept. of Oral Medicine and Oral Diagnosis, School of Dentisty, Seoul National University) ;
  • Kho, Hong-Seop (Dept. of Oral Medicine and Oral Diagnosis, School of Dentisty, Seoul National University)
  • 발행 : 2005.12.30

초록

구강건조증은 입안이 마르는 느낌의 주관적 증상을 의미하는 것으로 타액분비의 감소에 따른 불충분한 구강점막의 습윤도에 의해 발생할 수 있다. 그러나 구강건조증의 정도는 실제 측정된 객관적인 타액분비율과 상관관계를 보이지 않는 경우도 있어 그 진단과 치료에 어려움을 야기한다. 본 연구에서는 이러한 구강건조증의 진단과 평가를 위해 구강건조증 환자의 문제 해결을 위한 설문지를 개발하고 설문지의 문항들이 갖는 신뢰도를 분석하여 향후 구강건조증의 연구 및 진단 도구로서의 활용가능성을 알아보고자 하였다. 이를 위하여 구강건조감의 정도를 Visual Analogue Scale(VAS) 척도로 답하는 6 가지 문항과 구강건조감에 따른 행동을 파악하기 위한 4 가지 문항을 개발하고 문항들이 갖는 신뢰도를 평가하기 위하여 구강건조증의 증상을 호소하지 않는 건강한 성인 남녀 88 명(남자 44 명, 평균 $25.6{\pm}3.1$세, 여자 44 명, 평균 $24.3{\pm}2.1$세)을 대상으로 2 회에 걸쳐 질문에 답하도록 하여 다음과 같은 결과를 얻었다. 1. 구강건조감의 정도를 묻는 6 가지 문항의 급내상관계수(intraclass correlation coefficient; ICC) 값은 낮 시간의 구강건조감의 정도(Dry-day)가 0.767, 입안에 침이 적다고 느끼는 정도(Am-sal)가 0.850, 구강건조감으로 인한 일상 생활의 불편감 정도(Eff-life)가 0.791로 매우 높은 신뢰도를 나타내었고, 밤 또는 아침 기상시의 구강건조감의 정도(Dry-PM)가 0.563, 식사시의 구강건조감의 정도(Dry-eat)가 0.674, 음식물을 삼키기 힘든 정도(Dif-swal)가 0.641로 높은 급내상관계수 값을 나타내었다. 2. 6 개의 문항들의 내적 일치도를 평가하는 크론바흐의 알파(Cronbach's alpha) 값은 0.928로 매우 높게 나타났다. 3. 구강건조감에 따른 행동을 파악하기 위한 4 가지 문항들의 코헨의 카파(Cohen's kappa) 값은 잠자리 옆에 물을 준비하게 되는 빈도($H_2O$-bed)는 0.850으로 매우 높은 신뢰도를 나타내었고, 입이 말라 잠을 깨는 빈도(Night-awake)가 0.506, 마른 음식 섭취시에 물을 마시게 되는 빈도(Sip-liq)가 0.419, 껌이나 사탕을 먹게 되는 빈도(Gum-candy)가 0.407로 높은 신뢰도를 나타내었다. 이러한 결과로부터 VAS 척도로 답변하는 주관적 구강건조감의 정도를 묻는 6 가지 질문과 주어진 보기를 선택하여 답변하는 구강건조증에 따른 행동을 묻는 4 가지 질문으로 구성된 설문은 중등도 이상의 신뢰도를 가지고 있고 VAS 척도로 답변하는 6 가지 질문은 매우 높은 내적 일치도를 가지고 있음을 알 수 있었다.

Xerostomia is defined as a subjective complaint of dry mouth that may be perceived when there is insufficient mucosal wetting. However, the diagnosis and treatment of xerostomia is not that simple because of the fact that the subjective awareness of dry mouth is not always correlated with a diminution in the flow of saliva and there is always a difference between individuals in salivary flow rates needed for normal oral function. In the present study, the aim was to develop a questionnaire to evaluate the dry mouth symptoms and to analyze its reliability and usability as a diagnostic and analytic tool for xerostomia. The questionnaire which consists of 6 Visual Analogue Scale(VAS) type questions to evaluate the subjective oral dryness and 4 questions to evaluate behavior to avoid oral dryness was developed and administered twice with 1 week's interval to the healthy 88 young adults without dry mouth symptoms(44 males and 44 females; mean age was $25.6{\pm}3.1$ years in male and $24.3{\pm}2.1$ years in female). The results were as follows. 1 The intraclass correlation coefficients of 6 questions to evaluate the subjective oral dryness were as significantly high as 0.767 for the degree of oral dryness at other times of the day, 0.850 for the amount of saliva in the mouth, and 0.791 for the degree of effect on daily life due to oral dryness and as high as 0.563 for the degree of oral dryness at night or on awakening, 0.674 for the degree of oral dryness during eating, and 0.641 for the degree of difficulty in swallowing foods. 2. Cronbach's alpha value of 6 questions was 0.982. It can be concluded that the series of questions to evaluate the subjective oral dryness has high internal consistency. 3. Cohen's kappa values of 4 questions to evaluate behavior to relieve oral dryness were as significantly high as 0.850 for the frequency of keeping a glass of water at the bedside and as high as 0.506 the frequency of awakening during sleeping due to oral dryness, 0.419 for the frequency of sipping liquids to aid in eating dry foods, and 0.407 for the frequency of using a candy or chewing gum due to oral dryness. From the results, it can be concluded that the questionnaire consisting of 6 VAS type questions to evaluate the subjective oral dryness and 4 questions to evaluate behavior to relieve oral dryness has reliability of good to excellent level, and that the series of 6 VAS type questions has significantly high internal consistency to evaluate the subjective oral dryness.

키워드

참고문헌

  1. Fox PC, van der Ven PF, Sonies BC, Weiffenbach JM, Baum BJ. Xerostomia: evaluation of a symptom with increasing significance. J Am Dent Assoc 1985;110(4):519-525 https://doi.org/10.14219/jada.archive.1985.0384
  2. Osterberg T, Landahl S, Hedegard B. Salivary flow, saliva pH and buffering capacity in 70-year-old men and women. Correlation to dental health, dryness in the mouth, disease and drug treatment. J Oral Rehabil 1984;11:157170
  3. Sreebny LM. Xerostomia (Dry Mouth). In Sreebny LM. Ed. The Salivary System, Boca Raton, 1988, CRC Press, Inc., pp. 179-202
  4. Ericsson Y, Hardwick L. Individual diagnosis, prognosis and counseling for caries prevention. Caries Res 1978;12(Suppl.1):94-102 https://doi.org/10.1159/000260369
  5. Sreebny LM, Valdini A. Xerostomia: Part I: Relationship to other oral symptoms and salivary gland hypofunction. Oral Surg Oral Med Oral Pathol 1988;66:451-458 https://doi.org/10.1016/0030-4220(88)90268-X
  6. DiSabato-Mordarski T, Kleinberg I. Measurement and comparison of the residual saliva on various oral mucosal and dentition surfaces in humans. Arch Oral Biol 1996;41:655-665 https://doi.org/10.1016/S0003-9969(96)00055-6
  7. Wolff M, Kleinberg I. Oral mucosal wetness in hypoand normosalivators. Arch Oral Biol 1998;43:455-462 https://doi.org/10.1016/S0003-9969(98)00022-3
  8. Lee SK, Lee SW, Chung SC, Kim YK, Kho HS. Analysis of residual saliva and minor salivary gland secretions in patients with dry mouth. Arch Oral Biol 2002;47:637-641 https://doi.org/10.1016/S0003-9969(02)00053-5
  9. Atkinson JC, Wu A. Salivary gland dysfunction: causes, symptoms, treatment. J Am Dent Assoc 1994; 125:409-416 https://doi.org/10.14219/jada.archive.1994.0059
  10. Guggenheimer J, Moore PA. Xerostomia: etiology, recognition and treatment. J Am Dent Assoc 2003;134 (1):61-69 https://doi.org/10.14219/jada.archive.2003.0018
  11. Loesche WJ, Bromberg J, Terpenning MS, et al. Xerostomia, xerostomic medications and food avoidances in selected geriatric groups. J Am Geriatr Soc 1995;43:401-407 https://doi.org/10.1111/j.1532-5415.1995.tb05815.x
  12. Niedermeier WH, Kramer R. Salivary secretion and denture retention. J Prosthet Dent 1992;67:211-216 https://doi.org/10.1016/0022-3913(92)90455-J
  13. Locker D. Subjective reports of oral dryness in an older adult populations. Community Dent Oral Epidemiol 1993;21:165-168 https://doi.org/10.1111/j.1600-0528.1993.tb00744.x
  14. Samaranayake LP. Host factors and oral candidosis. In Samaranayake LP, MacFarlane TW. Ed. Oral candidosis. London, 1990, Wright, pp. 66-103
  15. Spielman A, Ben-Aryeh H, Gutman D, Szargel R, Deutsch E. Xerostomia diagnosis and treatment. Oral Surg Oral Med Oral Pathol 1981;51:144-147 https://doi.org/10.1016/0030-4220(81)90031-1
  16. von Knorring L, Mornstad H. Qualitative changes in saliva composition after short-term administration of imipramine and zimelidine in healthy volunteers. Scand J Dent Res 1981;89:313-320
  17. Donatsky O, Johnsen T, Holmstrup P, Bertram U. Effect of 'Saliment' on parotid salivary gland secretion and on xerostomia caused by Sjogren's syndrome. Scand J Dent Res 1982;90:157-162
  18. Bergdahl M, Bergdahl J. Low unstimulate salivary flow and subjective oral dryness: association with medication, anxiety, depression, and stress. J Dent Res 2000;79(9):1652-1658 https://doi.org/10.1177/00220345000790090301
  19. Sreebny LM, Valdini A. Xerostomia: a neglected symptom. Arch Intern Med 1987;147:1333-1337 https://doi.org/10.1001/archinte.147.7.1333
  20. Fox PC, Busch K, Baum BJ. Subjective reports of xerostomia and objective measures of salivary gland performance. J Am Dent Assoc 1987;115:581-584 https://doi.org/10.1016/S0002-8177(87)54012-0
  21. Nederfors T. Xerostomia: Prevalence and pharmacotherapy. With special reference to -adrenoreceptor antagonists. Swed Dent J 1996;Suppl.116:1-70
  22. Thomson WM, Chalmers JM, Spencers AJ, Ketabi M. The occurrence of xerostmia and salivary gland hypofunction in a population-based sample of older South Australians. Spec Care Dent 1999;19:20-23 https://doi.org/10.1111/j.1754-4505.1999.tb01363.x
  23. Pai S, Ghezzi EM, Ship JA. Development of a Visual Analog Scale questionnaire for subjective assessment of salivary dysfunction. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:311-316 https://doi.org/10.1067/moe.2001.111551
  24. Valdez IH, Fox PC. Diagnosis and management of salivary dysfunction. Crit Rev Oral Biol Med 1993;4:271-277 https://doi.org/10.1177/10454411930040030301