• 제목/요약/키워드: Surgery, Oral

검색결과 5,575건 처리시간 0.033초

서울시 치과의원의 진료실 감염관리 및 폐기물 처리 실태 조사연구 (Study on the Infection Control and Dental waste Disposal in Dental Clinic Located in Seoul City)

  • 강재경;김은숙;김경미
    • 치위생과학회지
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    • 제2권2호
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    • pp.105-113
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    • 2002
  • 치과 진료실에서 병원성 미생물의 근원이 되는 곳은 환자의 구강이다. 구강 내에서 행하여지는 모든 진료행위는 타액과 혈액에 노출되고 그 안에 존재하는 병원성 미생물들은 다양한 경로를 통해 전파되어 감염성 질환이 쉽게 발생될 수 있다. 따라서 환자와 치과 종사자들의 감염방지를 위해 주위를 환기시키고 실천적 계기를 마련하기 위해 서울시 치과의원 100곳을 추출하여 진료실 감염관리와 폐기물 처리실태를 조사한 결과 다음과 같은 결론을 얻었다. 1 멸균준비를 위한 기구세척시 대부분 고무장갑을 착용하고 있으나(95%), 기구건조(56%), 기구포장(57%), 멸균지시테이프를 부착(24%)하는 기관은 적었으며, 대부분의 기관이 멸균기(가압증기멸균기 또는 불포화화학증기멸균기 또는 건열멸균기)를 보유하고 있으나(97%), 멸균기의 성능점검이 나 관리는 소홀한 것으로 나타났다. 3. mirror, pincette, explorer 등의 기본기구, 외과기구, 그리고 치주기구는 90% 이상 멸균하였다. 3 표면관리에 있어서 표면소독제로 알콜을 사용하는 경우가 94.0% 이었다. 4. 폐기물 처리의 경우 사용한 주사바늘, 수술용 칼, 봉합용 바늘은 97~98%가 별도의 밀폐용기에 모아서 별도로 처리하고 있으나, 아말감 찌꺼기를 올바르게 보관하는 기관은 65% 수은 찌꺼기를 올바르게 보관하는 기관은 74% 이었다. 5. scaling 시(수술용 고무장갑+구강 마스크+보안경)을 착용하거나(수술용 고무장갑+안면 보호대)를 착용하는 사람은 37% 이었고, 보철물 연마시(구강 마스트+보안경)을 착용하거나 안면 보호대를 착용하는 사람은 25% 이었다. 6. 간염예방주사를 맞았거나 면역되어 있는 사람은 90% 이었다. 7. 마취주사바늘 제거시 손으로 뚜껑을 닫고 제거하는 경우(84%)와 주사바늘에 찔린 경험(62%) 사이에 통계적으로 유의한 차이는 없으나, 많은 사람이 부주의 하고 있는 것으로 나타났다. 8. 환자의 안전관리에 대한 인식과 환자에게 납방어복을 입히는 것과 통계적으로 유의한 차이를 보이지 않으므로 환자의 안전관리를 주의한다고 생각하고 있지만(98%) 실제로 환자를 보호(37%)하는 것은 아니며, 본인의 안전관리에 대한 인식과 술자의 방어방법에서도 통계적으로 유의한 차이가 없으므로 주의한다고 인식(95%)하는 만큼 술자의 보호(88%)를 하지 않는 것으로 나타났다. 이상의 결과 기구의 소독과 멸균의 단계와 절차를 올바르게 적용하는 것과 표면소독제로 알콜 대체재료의 보급이 필요하고, 폐기물 처리 방법에 대한 교육을 더욱 확산시켜야 하며, 개인의 안전관리에 대한 인식에 비해 실천이 부족하므로 특히 환자보호와 더불어 술자 등 개인보호를 위한 실천이 필요하다고 검토되었다.

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치과위생사의 전문직 자아개념과 업무수행과의 관계연구 (A Study of the Relation between the Professional Self-Concept and the Practice Performance as Dental Hygienist)

  • 김경선;유미선
    • 치위생과학회지
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    • 제4권3호
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    • pp.111-115
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    • 2004
  • 치과위생사의 전문직 자아개념의 중요성을 인식하게 하고, 전문직 자아개념 정립과 치위생직 전문직 발전에 도움이 되기 위한 기초 자료를 제공하고자 전라북도 전주시 치과진료기관에 종사하는 110명의 치과위생사를 대상으로 2002년 3월 11일부터 3월 25일까지 설문조사를 실시하였다. 본 연구의 결과는 다음과 같다. 1. 일반적 특성에 따른 전문직 자아개념 분석결과 종교(p<.05)와 최종학력(p<.01)에서 유의한 차이가 나타났다. 2. 일반적 특성에 따른 업무수행 분석결과 종교에서 유의한 차이가 나타났다(p<.05). 3. 전문직 자아개념과 업무수행과의 상관관계는 순상관성(F=.663, p<.001)을 보여 자아개념이 높을수록 업무수행 정도가 높은 것으로 나타났다. 1) 전문직 자아개념은 업무수행 영역의 독자적업무(F=.683, p<.001), 대인관계업무(F=.648, p<.001), 일반관리업무(F=.573, p<.001), 협동적업무(F=.478, p<.001)순으로 모두 높은 상관성을 보였다. 2) 업무수행은 전문직 자아개념 영역의 전문적 실무(F=.637, p<.001)와 만족감(F=.337, p=.000)에서 높은 상관성을 보였다. 이상의 연구결과를 근거로 하여 다음과 같이 제언하고자 한다. 첫째, 치과위생사의 전문직 자아개념과 업무수행 정도를 높이기 위해 전문성 신장을 위한 교육의 기회가 확대, 유지되어야한다. 둘째, 치과위생사의 전문직 자아개념과 업무수행에 영향을 주는 요인을 규명하기 위한 계속적인 연구가 이루어져야한다. 연구의 제한점으로는 전주시 치과의료기관에 국한된 것이므로 연구결과를 확대 해석하는데 신중을 기해야 하고 설문도구 작성에 있어 주로 간호사를 중심으로 개발된 문항을 사용하였기 때문에 치과위생사에 적합한 표준문항이 없어 타당도에 문제가 있을 수 있다.

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골연하 결손부에서 조직유도재생술의 장기적 방사선학적 변화 관찰 (Long-term radiographic evaluation of GTR treatment in intrabony defect)

  • 최미혜;박진우;서조영;이재목
    • Journal of Periodontal and Implant Science
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    • 제37권2호
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    • pp.181-192
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    • 2007
  • Periodontal surgery as part of the treatment of periodontal disease is mainly performed 1) to gain access to diseased areas for adequate cleaning; 2) to achieve pocket reduction or elimination; and 3) to restore the periodontal tissues lost through the disease; i.e., a new attachment formation of periodontal regeneration. To accomplish the latter, often referred to as the ultimate goal of periodontal therapy, a number of surgical procedures have been advocated throughout the years. Clinical studies have demonstrated that considerable gain of clinical attachment and bone can be achieved following guided tissue regeneration (GTR) therapy of intrabony defects. The aim of this study was to analyse the radiographic bone changes 2-year after GTR using a bone graft material and nonresorbable membrane. Patients attending the department of periodontics of Kyungpook National University Hospital were studied. Patients had clinical and radiographic evidence of intrabony defect(s), 33 sites of 30 patients aged 32 to 56 (mean age 45.6) were treated by GTR with a bone graft material and nonresorbable membrane. Baseline and 2-year follow-up radiographs were collected and evaluated for this study. Radiographic assessment includes a bone fill, bone crest change, defect resolution, and % of defect resolution. Pre- and post-treatment differences between variables (maxilla and mandible, defect depth, defect angle, bone graft materials) using the paired t-test were examined. We observed $2.86{\pm}1,87mm$ of bone fill, $065{\pm}0.79mm$ of crestal resorption, $3.49{\pm}2.11mm$ of defect resolution, and $44.42{\pm}19.51%$ of percentage of defect resolution. Mandible, deeper initial defect depth, narrower initial defect angle showed greater bone fill, defect resolution, and % of defect resolution. But no difference was observed between xenograft and allograft. Outcome of GTR as a therapy of intrabony defect was better than other therapy, but herein, good oral hygiene maintenance as a anti-infective treatment and periodic recall check of patients are essential.

Characterization of Primary Epithelial Cells Derived from Human Salivary Gland Contributing to in vivo Formation of Acini-like Structures

  • Nam, Hyun;Kim, Ji-Hye;Hwang, Ji-Yoon;Kim, Gee-Hye;Kim, Jae-Won;Jang, Mi;Lee, Jong-Ho;Park, Kyungpyo;Lee, Gene
    • Molecules and Cells
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    • 제41권6호
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    • pp.515-522
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    • 2018
  • Patients with head and neck cancer are treated with therapeutic irradiation, which can result in irreversible salivary gland dysfunction. Because there is no complete cure for such patients, stem cell therapy is an emerging alternative for functional restoration of salivary glands. In this study, we investigated in vitro characteristics of primarily isolated epithelial cells from human salivary gland (Epi-SGs) and in vivo formation of acini-like structures by Epi-SGs. Primarily isolated Epi-SGs showed typical epithelial cell-like morphology and expressed E-cadherin but not N-cadherin. Epi-SGs expressed epithelial stem cell (EpiSC) and embryonic stem cell (ESC) markers. During long-term culture, the expression of EpiSC and ESC markers was highly detected and maintained within the core population with small size and low cytoplasmic complexity. The core population expressed cytokeratin 7 and cytokeratin 14, known as duct markers indicating that Epi-SGs might be originated from the duct. When Epi-SGs were transplanted in vivo with Matrigel, acini-like structures were readily formed at 4 days after transplantation and they were maintained at 7 days after transplantation. Taken together, our data suggested that Epi-SGs might contain stem cells which were positive for EpiSC and ESC markers, and Epi-SGs might contribute to the regeneration of acini-like structures in vivo. We expect that Epi-SGs will be useful source for the functional restoration of damaged salivary gland.

양극산화에 의한 티타늄 산화피막의 전기화학적 거동과 형상 (Electrochemical Behavior and Morphology of Anodic Titanium Oxide Films)

  • 변기정;김진수;;김교한
    • 대한의용생체공학회:의공학회지
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    • 제21권3호
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    • pp.273-277
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    • 2000
  • 순 티타늄(공업용 순 티타늄, 2급)의 0.5M에서 0.7M 농도의 $H_3PO_4$ 용액에서 $0.3\~l.0 A/dm^2$의 정전류 밀도변화에 따른 anodizing 거동을 관찰하였다. 이때 형성된 산화피막을 SEM과 XRD로 관찰, 분석하였다. 실험결과 0.05M $H_3PO_4$ 용액의 조건에서 전압-시간 (V-T)곡선의 초기에는 직선적인 관계를 보였고, 전류밀도가 증가함에 따라 포물선의 형태를 나타내었다. 그리고 V-T곡선의 형태는 전해질의 농도의 증가에 따라 큰 변화가 없었지만, 최종적인 전압은 감소하였다. 티타늄의 산화피막은 전해질 농도와 전류밀도가 증가할수록 미세한 입자 형태에서 눈꽃과 같고 층을 이룬 입자들로 구성된 구조를 나타내었다. 산화막과 전해질의 계면에서의 방전에 의해 산화피막의 국소적인 침착과 용해를 동반하였다. 산화피막의 결정성은 anodizing 전압이 증가할수록 증가하였고 전해질의 농도가 증가할수록 감소하는 경향을 보였다.

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광중합 복합레진에 대한 가열처리 피로내성 및 중합수축에 미치는 영향 (A Fatigue Toughness and Polymerization Shrinkage of Post-cure Heat Treated Composite Resins)

  • 오원만;류선열;손호현;리이치 오쿠다;다쓰오 엔도;요시유키 쿠도
    • Restorative Dentistry and Endodontics
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    • 제19권1호
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    • pp.135-147
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    • 1994
  • This study was conducted to evaluate whether the fatigue toughness of visible light cured composite resins could be improved and how much percentage of polymerzation shrinkage could be affected by additional heat treatment. 7 materials were investigated for this study: P-50, Lite-fil CR inlay, Pekafil, Clearfil CR inlay, Clearfil photo posterior, Z -100 and Progress. Diametral tensile strengths and linear shrinkages of composite resins were taken under visible light cured and additional post-cure heated condition and compared each other. A fatigue toughness of above materials was evaluated by measuring diametral tensile strength after they were repeatedly loaded with 120kgf/$cm^2$ up to 3000 cycles. The results obtained were as follows : 1. When composite resins were cured just by visible light, Lite fil CR inlay, Z -100 and Progress showed respectively higher diametral tensile strength than the other materials. Clearfil CR inlay, Clearfil photo posterior and Progress exhibited strong fatigue toughness compared to P-50 and Pekafil. 2. Post-cure heat treated composite resins had higher diametral tensile strengths than visible light cured composite resins at fatigue toughness test as well as no fatigue toughness test. 3. When Composite resins were additionally polymerized by post-cure heat treatment, P-50 showed weak fatigue toughness, on the contrary, Clearfil CR inlay, Z-100, Progress showed strong one. 4. When composite resins were cured just by visible light, percentage of polymerization linear shrinkage was the lowerest in Clearfil CR inlay, followed by, in ascending order, Clearfil photo posterior, Lite-fil CR inlay, Progress, Pekafil, P-50, and Z-100. In the case of post- cure heat treated composite resins, percentage of linear shrinkage was the lowest in Clearfil photo posterior, followed by, in ascending order, Lite-til CR inlay, Clearfil CR inlay, Progress, P-50, Pekafil and Z-100. 5. Percentage of polymerization linear shrinkage was greater in the post-cure heat treated composite resins than in the visible light cured composite resins and linear shrinkage increased significantly in Pekafil, Clearfil CR inlay, and Clearfil photo posterior between at the visible light cured and at the post-cure heat treated condition. The above results is saying that additional post-cure heat treatment on the composite resins for posterior restoration is able to affect on improvement of strength and fatigue toughness and lead to increase polymerization of composite resins.

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중추신경계의 Aspergillosis (Aspergillosis of Central Nervous System)

  • 유승훈;이정일;남도현;김종수;홍승철;신형진;박관;어환;김종현
    • Journal of Korean Neurosurgical Society
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    • 제30권7호
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    • pp.896-902
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    • 2001
  • Objectives : Aspergillosis of central nervous system(CNS) is a rare pathologic condition and it has been known to be difficult to diagnose and treat. We analyzed seven cases of central nervous system aspergillosis. The clinical characteristics, and the problems in diagnosis and treatment are discussed with review of previous literatures. Material and Methods : We reviewed the clinical records, radiological findings, and pathologic reports of 7 patients with aspergillosis which involved CNS. Results : Five patients were immunocompetent, and infection was related with previous operation in 4 of them. Two patients were immunocompromised and had no history of operation. Five patients had intracranial lesions and two had spinal lesions. Mean duration from the onset of initial symptom to pathologic diagnosis was 2.4 months. Mean duration from the previous operation to the onset of symptom was 9.3 months, and from the onset of symptom to diagnosis was 2.9 months in the patients who had histories of operation. All of them were treated with surgical procedures and intravenous and oral antifungal agents, resulting in cure in 6 cases. Mean duration of the treatment was 4.9 months. Conclusion : Because aspergillosis of CNS is a rare disease and is difficult to be differentiated from the pyogenic abscess or recurrent tumor, the pathologic diagnosis is very important for adequate treatment. Although the prognosis of aspergillosis of CNS has been known to be poor, adequate surgery for both diagnosis and treatment and antifungal chemotherapy resulted in good outcome.

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인공심장판막 환자를 대상으로 한 Warfarin 치료의 적정성 평가 (The Evaluation of Therapeutic Control with Warfarin in Patients with Mechanical Heart Valve Prostheses)

  • 임영선;장병철;서옥경;이숙향;신현택
    • 한국임상약학회지
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    • 제9권1호
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    • pp.27-34
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    • 1999
  • The goal of oral anticoagulation therapy with warfarin is to maintain INR values within the therapeutic range in order to prevent complications such as bleeding and thrombosis. The purposes of this study were to investigate the current level of anticoagulation control using INR values, to investigate the incidences of thromboembolism and bleeding complications, and to compare the effect of low intensity INR regimen with therapeutic range recommended by ACCP (American College of Chest Physician). Two hundred three patients with mechanical heart valve replacement done at Yonsei University Cardiovascular Center between January 1994 and December 1996 were selected and reviewed retrospectively. The target INR ranges of $2.5\sim3.5$ (ACCP standard) and low intensity INR of $2.0\sim3.5$ were used for evaluation. According to ACCP standard, $51.2\%$ of patients and $31.1\%$ of INR values were within the therapeutic range when average INR and cumulative INR were used, respectively. Applying low intensity INR values of $2.0\sim3.5$, the therapeutic control was achieved in $57.4\%\;and\;90.1\%$, using average INR and total INR, respectively. The incidences of major and minor bleedings were $0.5\%\;and\;26.6\%$, respectively. The incidence of thromboembolism was $0.5\%$. There was no significant difference in terms of complication incidences between INR $2.0\sim2.5\;and\;INR\;2.5\sim3.5$ groups. However, INR values at the time of bleeding were generally high. In conclusion, the evaluation of patients with mechanical heart valve replacement showed low level of therapeutic control with warfarin therapy. This is partially explained by the fact that the physicians at Yonsei University Cardiovascular Center were using lower intensity INR values as a goal than recommended INR. Also, in the near future, systematic anticoagulation service should be implemented at various hospitals in Korea so that patients on anticoagulant therapy can be more closely monitored to be within the recommended INR by ACCP.

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코로나 바이러스 대유행에 따른 치과 의료 관리 가이드라인 (Guidelines for dental clinic infection prevention during COVID-19 pandemic)

  • 김진
    • 대한치과의료관리학회지
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    • 제8권1호
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    • pp.1-7
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    • 2020
  • Dental settings have unique characteristics that warrant specific infection control considerations, including (1) prioritizing the most critical dental services and provide care in a way that minimizes harm to patients due to delayed care, or harm to personnel from potential exposure to persons infected with the COVID-19 disease, and (2) proactively communicate to both personnel and patients the need for them to stay at home if sick. For health care, an interim infection prevention and control recommendation (COVID-19) is recommended for patients suspected of having coronavirus or those whose status has been confirmed. SARS-CoV-2, which is the virus that causes COVID-19, is thought to be spread primarily between people who are in close contact with one another (within 6 feet) through respiratory droplets that are produced when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new disease, and there remain uncertainties about its mode of spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for several hours, and on some surfaces for days under laboratory conditions. COVID-19 may also be spread by people who are asymptomatic. The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers, and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. While KF 94 masks protect the mucous membranes of the mouth and nose from droplet spatter, they do not provide complete protection against the inhalation of airborne infectious agents. If the patient is afebrile (temperature <100.4°F)* and otherwise without symptoms consistent with COVID-19, then dental care may be provided using appropriate engineering and administrative controls, work practices, and infection control considerations. It is necessary to provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub (ABHR) with 60%~95% alcohol, tissues, and no-touch receptacles for disposal, at healthcare facility entrances, waiting rooms, and patient check-ins. There is also the need to install physical barriers (e.g., glass or plastic windows) in reception areas to limit close contact between triage personnel and potentially infectious patients. Ideally, dental treatment should be provided in individual rooms whenever possible, with a spacing of at least 6 feet between the patient chairs. Further, the use of easy-to-clean floor-to-ceiling barriers will enhance the effectiveness of portable HEPA air filtration systems. Before and after all patient contact, contact with potentially infectious material, and before putting on and after removing personal protective equipment, including gloves, hand hygiene after removal is particularly important to remove any pathogens that may have been transferred to the bare hands during the removal process. ABHR with 60~95% alcohol is to be used, or hands should be washed with soap and water for at least 20 s.

치과위생사의 법적업무범위에 관한 인식 조사: 치과위생사와 치과의사를 대상으로 (A survey on the perceptions of dental hygienists and dentists on the legal scope of dental hygienists)

  • 김명희;김설희;김혜성;황영선;김진
    • 대한치과의료관리학회지
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    • 제9권1호
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    • pp.14-24
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    • 2021
  • Dentists and dental hygienists are major collaborators, as expressed by the concept of "Four-handed dentistry." Dentists are guaranteed their legal duties and rights in accordance with the Medical Act, whereas dental hygienists are currently stipulated in the scope of their legal duties under the Act on Medical Technicians. However, there is a difference between the actual work and the legal work performed by dental hygienists; therefore, the work is dependent on many legal controversies and authoritative interpretations. The purpose of this study is, first, to develop a reliable questionnaire tool regarding the actual work performed by dental hygienists in dental hospitals and clinics, and second, to examine the awareness of the appropriateness of legal work based on the developed questionnaire. The target subjects of the survey were dental hygienists and dentists, and the dental hygienists were those who worked in dental hospitals and clinics as license reporters of the Korean Dental Hygienists Association. A total of 1,294 dental hygienists and 39 dentists were included in the final analysis. In the dental hygienist group, 19 items received the response "appropriate for legal work" in over 90% of cases, accounting for 25% of the total 76 items. In addition, in a total of 31 items, more than 80% of the responses were appropriate for legal work. Among them, the highest was 'Scailing' (97.7%), followed by "Extraoral-Panorama" (97.1%). In the dentist group, 10 out of 76 items showed over 90% adequacy for legal work, and among them, "instrument cleaning and sterilization" was the highest at 100%. It was followed by "Intraoral radiography," "Scailing," and "Toothpick method, TPM" with 97.4%. In the case of dentists, 28 out of a total of 76 items showed an appropriateness of more than 80% for legal work. This study comprehensively investigated the actual work of dental hygienists in line with timely and appropriate social issues and provided reliable statistics in evidence-based dentistry.