Journal of dental hygiene science (치위생과학회지)

The Korean Society of Dental Hygiene Science (한국치위생과학회)
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Dental Hygienist-Led Dental Hygiene Process of Care for Self-Support Program Participants in Gangneung

강릉시 자활근로사업 참여자 대상 치위생 과정 사례보고

  • Yoo, Sang-Hee (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Kwak, Seon-Hui (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Lee, Sue-Hyang (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Song, Ga-In (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Bae, Soo-Myoung (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Shin, Sun-Jung (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry) ;
  • Shin, Bo-Mi (Department of Dental Hygiene, Gangneung-Wonju National Universtity College of Dentistry)
  • 유상희 (강릉원주대학교 치과대학 치위생학과) ;
  • 곽선희 (강릉원주대학교 치과대학 치위생학과) ;
  • 이수향 (강릉원주대학교 치과대학 치위생학과) ;
  • 송가인 (강릉원주대학교 치과대학 치위생학과) ;
  • 배수명 (강릉원주대학교 치과대학 치위생학과) ;
  • 신선정 (강릉원주대학교 치과대학 치위생학과) ;
  • 신보미 (강릉원주대학교 치과대학 치위생학과)
  • Received : 2018.07.11
  • Accepted : 2018.09.14
  • Published : 2018.12.31
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Abstract

This study aimed to provide basic data for establishing the clinical basis for dental hygienist-led dental hygiene process of care by identifying multiple risk factors for self-support program participants in Gangneung city; we also compared oral health status and behavioral changes through customized oral health care. Four dental hygienists who were evaluated for degree of conformity provided dental hygiene process of care to eight self-support program participants who were selected as having an oral health risk among people in the self-support center. The clinical indicators measured during dental hygiene assessment and evaluation and behavioral changes due to dental hygiene intervention were compared and analyzed. With respect to clinical indicators, at the time of probe, the retention rate of patients with gingival bleeding decreased from 61.4% to 14.7% after intervention (p=0.004). Furthermore, the retention rate of patients with a periodontal pocket >4 mm decreased from 15.6% to 5.8% (p=0.001). The average modified O'Leary index of the patients improved from 23 to 40 (p=0.002). Previously, all eight subjects used the vertical or horizontal method of brushing; after dental hygiene care interventions regarding method and frequency of toothbrushing, use of oral care products, and individual interventions, they started using the rolling or Bass method of toothbrushing. Four of eight subjects reported using interdental toothbrushes after intervention. As a result of applying the change model to the transtheoretical behavior change of the subject, the result of strengthening the health behavior was confirmed. For promotion of oral health by the prevention-centered incremental oral health care system, dental hygienist-led dental hygiene management and maintenance is essential. It is thought that continuous research, such as for feasibility evaluation, cost benefit analysis, and preparation of legal systems, is needed to establish and activate dental hygiene management.

본 연구는 강릉시에 소재한 자활센터 자활사업 참여자를 대상으로 하여 대상자의 복합적인 위험요인을 고려한 맞춤형 치위생 과정을 통해 구강건강상태 및 행태의 변화 과정 및 결과의 사례를 분석함으로써, 치과위생사 주도의 치위생 과정에 대한 임상적 근거를 마련하고 임상 현장 및 지역사회사업에서의 치위생 과정 적용 가능성을 검토하고자 수행하였다. 본 연구에서는 전체 모집단 80명 중 연구참여에 동의한 44명을 대상으로 치과위생사 면허를 소지한 교수 3인이 전신질환 여부(당뇨병, 심혈관계질환 등), 치은 상태 및 치석 여부, 구강위생상태 등의 기준으로 구강 내 사정을 실시하였고, 구강건강위험군으로 선발된 21명 중 개인적인 사정과 치과의사 치료 의뢰 등으로 인해 중도 탈락한 13명을 제외하고 치위생계획에 따라 모든 과정을 종료한 8명을 최종 연구대상자로 선정하였다. 본 연구에서는 수행자 간 일치도 평가를 거친 치과위생사 4인이 자활센터 자활사업 참여자 8인을 대상으로 치위생 과정을 수행하였다. 대상자별 전담 치과위생사를 선정하여 대상자 중심의 맞춤형 관리를 제공하였고 모든 치위생 과정 내용은 치위생관리 기록부에 기록하여 치위생 과정 전 후에 따라 회차별로 평가한 임상 지표 및 치위생 중재에 따른 행동 변화 등을 비교 분석하였다. 복합적인 건강위험요인을 동반한 취약계층인 자활사업 참여 대상자의 치위생 과정을 분석한 결과, 인간욕구이론에 기반하여 대상자 중심의 목표를 수립하고, 전담 치과위생사와의 지속적인 신뢰관계 형성에 기반하여 행동 변화를 위한 중재를 실시하며, 회차별 대상자의 구강건강상태에 따른 맞춤형 전문가구강위생관리를 실시함에 따라 긍정적인 행동 변화와 함께 유의미한 임상적 변화를 확인하였다. 범이론 모형에 근거한 행동 변화 중재에 따라 칫솔질 방법 및 빈도의 변화가 나타났고, 치간칫솔을 사용한 치간관리의 변화를 확인하였다. 개인별 치위생 과정에 따른 구강상태를 비교한 결과 치위생 과정을 수행한 후 탐침 시 치은출혈 치아 보유율과 4 mm 이상 치주낭 보유율은 감소하였고, 변형 O'Leary index는 향상되었다. 치위생 과정은 치과의료에서 환자/대상자 중심의 가치를 실현하고 질병의 예방과 구강건강증진을 지향함에 따라 임상 현장 및 지역사회에서 지속적으로 치위생 과정이 적용될 수 있는 시스템을 구축함으로써 구강건강증진을 통한 구강건강 관련 삶의 질 향상과 더불어 구강건강의 사회경제적 불평등을 줄이는 데 기여할 수 있을 것으로 생각된다.

Keywords

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