DOI QR코드

DOI QR Code

연세대학교 치과대학병원 소아치과의 진정법의 변화 양상

The Changes of Sedation in the Department of Pediatric Dentistry, Yonsei University Dental Hospital

  • 이고은 (연세대학교 치과대학 소아치과학교실) ;
  • 송제선 (연세대학교 치과대학 소아치과학교실) ;
  • 김성오 (연세대학교 치과대학 소아치과학교실) ;
  • 이제호 (연세대학교 치과대학 소아치과학교실) ;
  • 최병재 (연세대학교 치과대학 소아치과학교실) ;
  • 최형준 (연세대학교 치과대학 소아치과학교실)
  • Lee, Koeun (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Song, Je Seon (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Kim, Seong-Oh (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Lee, Jaeho (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Byungjai (Department of Pediatric Dentistry, College of Dentistry, Yonsei University) ;
  • Choi, Hyung-Jun (Department of Pediatric Dentistry, College of Dentistry, Yonsei University)
  • 투고 : 2017.08.11
  • 심사 : 2017.10.12
  • 발행 : 2018.05.31

초록

진정작용은 행동조절이 어렵고 광범위한 치료가 필요하거나 의학적 문제가 있는 어린이의 치과 치료에 유용한 행동조절 방식이다. 본 연구의 주된 목적은 연세대학교 치과대학병원 소아치과에서 사용하는 진정제와 진정치료의 경향을 분석하여 진정법의 사용의 변화를 살펴보는데 있다. 본 연구는 2011년 - 2016년까지 연세대학교 치과대학병원 소아치과의 전자의무기록(EMR)을 바탕으로 환자 및 진정법을 검토하였다. 연구 결과에 따르면, 진정법으로 치료받은 환자들의 수가 일반적으로 증가했다. 남자가 여자보다 진정법을 이용한 치과 치료를 더 많이 받았으나 2015년부터는 유사한 비율로 적용되고 있다. 전신질환(ASA II) 환자의 치료 비율은 2013년에 감소했지만, 이후에는 일정하게 유지되었다. 4 - 5세 및 6 - 10세의 진정 치료 비율은 일반적으로 증가하는 반면, 0 - 2세 및 11세 이상은 감소했다. 3세는 비교적 일정한 비율로 유지되고 있다. 가장 자주 사용되는 진정법은 아산화질소 흡입진정법이었으며, chloral hydrate의 사용이 감소하는 동안 benzodiazepine계열의 사용이 증가했다. 최근에는 행동관리 기법으로 진정법이 확대되고 있다. 그러나 안전한 사용을 위하여 다차원적 접근이 요구되고 있으며, 진정제 사용의 안전성과 효능에 대한 추가 연구 역시 동반 수행되어야 한다.

Sedation is a useful behavior management technique for dental patients who may be uncontrollable or have medical problems. The aim of this study is to investigate the changes in patterns of sedative treatments in pediatric dentistry by analyzing the distribution of patients and used sedative agents. Patients and sedative agents were reviewed based on the electronic medical records (EMR) of the department of pediatric dentistry in Yonsei University Dental Hospital from 2011 to 2016. The number of patients who were treated under sedation generally increased. Male received more sedation treatment than female by 2014, and they became similar from 2015. The treatment percentage of patients with systemic disease decreased in 2013, remained constantly afterwards. The ratio of sedative treatment for the age 4 - 5 and age 6 - 10 generally increased, while that of the age 0 - 2 and older than age 11 decreased. The ratio of the age 3 remained steady. Nitrous oxide was the most frequently used sedative agent. The use of benzodiazepine increased while the use of chloral hydrate decreased. Although the use of sedation has expanded, multidimensional approaches for ensuring safety have been less focused. Therefore, it is necessary to explore further studies for the safety and efficacy of the use of sedation.

키워드

참고문헌

  1. Lee SM, Kim JS, Kim YK : The effectiveness of two sedative regimen used for child patient who failed to oral choral hydrate. J Korean Acad Pediatr Dent, 27:505-516, 2000.
  2. Houpt M : Project USAP 2000 - Use of sedative agents by pediatric dentists : A 15-year follow-up survey. Pediatr Dent, 24:289-294, 2002.
  3. Wilson S, Houpt M : Project USAP 2010: Use of sedative agents in pediatric dentistry : A 25-year follow-up survey. Pediatr Dent, 38:127-133, 2016.
  4. Korean Academy of Pediatric Dentistry : Textbook of Pediatric Dentistry, 5th ed. Dental Wisdom; 226-227, 2014.
  5. An SY, Lee JW, Kim JB, et al. : A review of the systemic analysis method on dental sedation for children. J Korean Acad Pediatr Dent, 42:331-339, 2015.
  6. Choi YS, Shim YS : Sedation practices in dental office : A survey of members of the korean adademy of pediatric dentistry. J Korean Acad Pediatr Dent, 26:579-587, 1999.
  7. An SY, Choi BJ, Kwak JY, et al. : A survey of sedation practices in the korean pediatric dental office. J Korean Acad Pediatr Dent, 32:444-453, 2005.
  8. Yang YM, Shin TJ, Jeong TS, et al. : Survey of sedation practices by pediatric dentists. J Korean Acad Pediatr Dent, 41:257-265, 2014.
  9. Creedon RL : Guidelines for the elective use of conscious sedation, deep sedation, and general anesthesia in pediatric patients. Anesth Analg, 33:189, 1985.
  10. Korean statistical information service : Population trend survey - Statistical information report 2016. Available from URL: http://kosis.kr/nsportalStats/nsportalStats_0102Body.jsp?menuId=10&NUM=1037 (Accessed on August 10, 2017).
  11. Klingberg G, Broberg AG : Dental fear/anxiety and dental behaviour management problems in children and adolescents : A review of prevalence and concomitant psychological factors. Int J Paediatr Dent, 17:391-406, 2007. https://doi.org/10.1111/j.1365-263X.2007.00872.x
  12. Leelataweedwud P, Vann WF : Adverse events and outcomes of conscious sedation for pediatric patients : Study of an oral sedation regimen. J Am Dent Assoc, 132:1531-1539, 2001. https://doi.org/10.14219/jada.archive.2001.0086
  13. Park CJ, Jung JM, Yum KW, et al. : Analysis on the outpatiet anesthesia at dental clinic for disabled in seoul national university dental hospital. J Korean Acad Pediatr Dent, 31:19-25, 2004.
  14. Dougherty N : The dental patient with special needs : A review of indications for treatment under general anesthesia. Spec Care Dent, 29:17-20, 2009. https://doi.org/10.1111/j.1754-4505.2008.00057.x
  15. Soldani F, Manton S, Foley J, et al. : A comparison of inhalation sedation agents in the management of children receiving dental treatment : a randomized, controlled, crossover pilot trial. Int J Paediatr Dent, 20:65-75, 2010.
  16. Levering NJ, Welie J : Current status of nitrous oxide as a behavior management practice routine in pediatric dentistry. J Dent Child, 78:24-30, 2011.
  17. Foley J : A prospective study of the use of nitrous oxide inhalation sedation for dental treatment in anxious children. Eur J Paediatr Dent, 6:121-128, 2005.
  18. Cote CJ, Notterman DA, McCloskey C, et al. : Adverse sedation events in pediatrics : A critical incident analysis of contributing factors. Pediatrics, 105:805-814, 2000. https://doi.org/10.1542/peds.105.4.805
  19. Wilson S : A survey of the american academy of pediatric dentistry membership : Nitrous oxide and sedation. Pediatr Dent, 18:287-293, 1996.
  20. Hosey M : Managing anxious children : The use of conscious sedation in pediatric dentistry. Int J Paediatr Dent, 12:359-372, 2002.
  21. Weinstein P, Domoto PK, Holleman E : The use of nitrous oxide in the treatment of children : Results of a controlled study. J Am Dent Assoc, 112:325-331, 1986. https://doi.org/10.1016/S0002-8177(86)23011-1
  22. Kantovitz KR, Puppin-Rontani RM, Gaviao MB : Sedative effect of oral diazepam and chloral hydrate in the dental treatment of children. J Indian Soc Pedod Prev Dent, 25:69-75, 2007. https://doi.org/10.4103/0970-4388.33451
  23. Houpt M, Sheskin R, Koenigsberg S, et al. : Assessing chloral hydrate dosage for young children. ASDC J Dent Child, 52:364-369, 1985.
  24. Dallman JA, Ignelzi M, Briskie D : Comparing the safety, efficacy and recovery of intranasal midazolam vs. oral chloral hydrate and promethazine. Pediatr Dent, 23:424-437, 2001.
  25. Malamed SF : Sedation : A Guide to Patient Management, 5th ed. Mosby, 95-118, 141-150, 495-513, 2010.