Journal of Oral Medicine and Pain

Korean Academy of Orofacial Pain and Oral Medicine (대한안면통증구강내과학회)
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Study on Short Term Smoking Cessation Treatment in Dental Hospitals in Korea

국내 치과대학병원에서 시행한 단기 금연진료에 대한 조사

  • Song, Je-Il (Department of Oral Medicine, School of Dentistry and Medical Laser Research Center, Dankook University) ;
  • Lee, Gi-Ho (Department of Oral Medicine, School of Dentistry and Medical Laser Research Center, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, School of Dentistry and Medical Laser Research Center, Dankook University) ;
  • Kim, Ki-Suk (kimks@dankook.ac.kr)
  • 송제일 (단국대학교 치과대학 구강내과학 교실) ;
  • 이기호 (단국대학교 치과대학 구강내과학 교실) ;
  • 김미은 (단국대학교 치과대학 구강내과학 교실) ;
  • 김기석 (단국대학교 치과대학 구강내과학 교실)
  • Received : 2010.09.20
  • Accepted : 2010.10.15
  • Published : 2010.12.30
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Abstract

Smoking has been identified not as a major risk factor for circulatory and respiratory diseases but also as causes of various oral diseases. A number of clinical studies and regional health surveys have found an association between smoking and poor oral health status and between smoking and prognosis of dental treatments. However, there is few studies about status of smoking cessation treatment and policies in dentistry in Korea. The purpose of this study was to investigate the smoking patterns of outpatients and outcomes of short-term smoking cessation treatment in dental hospitals in Korea and, subsequently, to seek further smoking cessation services in dentistry. This study was sponsored by Korean Dental Association (KDA) and department of culture and welfare. 825 dental patients were voluntarily participated in a 4-week smoking cessation program with nicotine patch and 297 participants of them completed on smoking-related questionnaires. All participants were recruited from outpatients of 11 dental university hospitals (primarily in the department of oral medicine, oral surgery and periodontology) in Korea during 3-month period from October 2009 to January 2010. The Questionnaires included demographics, duration of smoking, heavy smoking index (HSI), number of thinking of quit smoking, duration of stop smoking and reasons to smoking, awareness of smoking effects on oral health, and their success rate after 4 weeks of nicotine patch program was investigated. The statistical analysis was carried by SPSS version 18.0 program and Chi-square test. According to the results of this study, male in their 30s to 50s were the most prevalent of all the participants and duration of smoking increased with age. Attempt rate to quit smoking (Quit smoking) was the highest in 30s and 40s with duration of quit smoking ranging 1 to 3 months. Emotional stresswas the most frequently reported reason for smoking, followed by habit and pleasure in order. All age group showed high HIS over 71% and awareness of smoking effects on oral diseases such as oral soft tissue diseases, periodontal diseases and dental caries was found relatively high (50~60%) Periodontal implant was the main reason for participation in the smoking cessation services in dental clinics and the success rate of, 4-week nicotine patch program of all the participants was 29.4%, extremely low compared to that of medical clinics. Systemic education for dentists to be able to provide interventions to quit smoking including counseling with the 5As'and development of available measures for smokers is needed as considered that the low success rate of the smoking cessation services in dentistry could be explained mainly by lack of dentists' strategies, experience and attention. Awareness and attention of dentists should be emphasized and their participation be encouraged by long-term, multidisciplinary policies such as establishment of insurance fee, which would made a considerable progress in preventing smoking-related oral diseases and promoting public oral health.

흡연은 전신뿐 아니라 구강에서 발생하는 다양한 질병의 중요한 위험 인자이며, 치과의사가 금연 치료에 참여하는 것은 개인의 전신 건강과 치주치료와 임플란트 치료 같은 치과 치료의 예후에도 큰 차이를 보여주는 것으로 알려져 있다. 흡연이 구강암과 같은 생명을 위협하는 비교적 흔치 않은 질병으로부터 경미한 구강 내 증상에 이르기까지 구강 환경에 다양한 영향성과 관련한 많은 근거가 있음에도 불구하고, 흡연과 구강건강의 관련성에 대한 환자들의 인식 수준을 조사한 연구는 적고, 금연진료에 대한 국내 치의학계의 관심과 참여는 더욱 부족하다. 그러므로 본 연구는 국내 치과 외래 환자의 흡연 양상과 치과계의 금연 진료 현황을 파악하여 금연 진료 방향을 모색해 보고자 하였다. 대한치과의사협회 문화복지부의 후원으로 전국 11개 치과대학병원의 구강내과, 구강외과 및 치주과 환자 중 825명이 니코틴 패치를 이용한 4주 금연 프로그램 및 설문에 참여하였고, 297명이 금연 설문에 참여하였다. 각 설문지 분석을 통해 각 치과대학병원의 조사 현황, 치과 외래 환자의 흡연 양상을 분석하였고, 치과에서 시행된 4주간의 금연 치료의 참여목적과 성공률을 조사하였다. 본 연구의 결과에 따르면, 흡연자는 주로 30-50대 중 장년층이 많았고, 흡연기간은 연령 증가에 비례하며, 하루 흡연량은 30대에서 가장 많았다. 금연시도는 30,40대에서 금연시도 비율이 높았고 그 기간은 대부분 1-3개월이었다. 흡연의 이유로는 스트레스 해소와 습관이 가장 높은 빈도를 보였으며 Heavy Smoking Index (HSI)는 20대가 가장 낮고 (71.4%) 60대가 가장 높았다(93.7%). 흡연 경고 문구에 대해 참가자의 68%는 금연을 떠올렸다. 구강질환(구강점막질환, 치주질환, 치아우식증)과 흡연의 관련성에 대한 실험참가자들의 인식도는 비교적 높았지만(50~68%) 금연 성공률은 일반 의과진료실에 비해 아주 낮은 결과를 보였다(22.7%). 흡연관련 질환 예방 업무에서의 치과의사의 중요성을 고려할 때, 금연치료에 치과의사들이 보다 적극적으로 참여할 수 있는 인식의 변화가 필요하다. 낮은 치료 성공율이 체계화되지 못한 진료내용 때문임을 고려할 때, 5As' 방법 등과 같은 금연관련 상담에 대한 지속적인 치과의사 교육과 환자 교육을 위한 다양한 자료의 개발을 통해 금연 성공률을 높일 수 있도록 해야 한다.

Keywords

References

  1. Halbrook JH. Nicotine addiction. In: Harrison's principles of internal medicine. 14th ed., Mc Graw-Hill, 1998;2516-2519.
  2. Gross AJ, Lackland DT, Tu DS. Oral cancer and smokeless tobacco: Literature review and metaanalysis. Environment International 1995;21(4): 381-394. https://doi.org/10.1016/0160-4120(95)00040-R
  3. Sadetzki S, Oberman B, Mandelzweig L et al. Smoking and risk of parotid gland tumors. A nationwide case-control study. Cancer 2008;112(9): 1974-1982. https://doi.org/10.1002/cncr.23393
  4. Banoczy J, Gintner Z, Dombi C. Tobacco use and oral leukoplakia. J Dent Educ 2001;65(4):322-327.
  5. Vellappally S, Fiala Z, Smejkalova J et al. Smoking related systemic and oral disease. Acta Medica 2007;50(3):161-166.
  6. Millar WJ, Locker D. Smoking and oral health status. JCDA 2007;73(2):155-155g.
  7. Klein I, Nagler RM, Toffler R et al. Effect of cigarette smoke on oral peroxidase activity in human saliva: Role of hydrogen cyanide. Free Radical Biology & Medicine 2003;35(11):1448-1452. https://doi.org/10.1016/j.freeradbiomed.2003.08.001
  8. Larrazabal C, Garcia B, Penarrocha M. et al. Influence of oral hygine and smoking on pain and swelling after surgical extraction of impacted mandibular third molars. J Oral Maxillofac Surg 2010;68(1):43-46. https://doi.org/10.1016/j.joms.2009.07.061
  9. Heng CK, Badner VM, Clemens D et al. The relationship of cigarette smoking to postoperative complication from dental extraction among female inmates. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104(6):757-762. https://doi.org/10.1016/j.tripleo.2007.04.020
  10. Takashi H, Miki O, Keiko T et al. Relationship between smoking status and tooth loss: Findings from national database in Japan. Journal of Epidemiology 2007;17(4):125-132. https://doi.org/10.2188/jea.17.125
  11. Chung KC, Kowalski CP, Kim HM et al. Maternal cigarette smoking during pregnancy and the risk of having a child with cleft lip and palate. Plast reconstr surge 2000: 105(2):485-491. https://doi.org/10.1097/00006534-200002000-00001
  12. Kinane DF, Chestnutt IG. Smoking and periodontal disease. Crit Rev Oral Biol Med 2000;11:356-365. https://doi.org/10.1177/10454411000110030501
  13. Calsina G, Ramon JM, Echeverria JJ. Effects of smoking on periodontal tissues. J Clin Periodontol 2002;29:771-776. https://doi.org/10.1034/j.1600-051X.2002.290815.x
  14. Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol 2004;75(2):196-209. https://doi.org/10.1902/jop.2004.75.2.196
  15. Thomson WM, Broadbent JM, Welch D et al. Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort. J Clin Periodontol 2007;34(10):828-834. https://doi.org/10.1111/j.1600-051X.2007.01131.x
  16. 박주희, 김영남, 유자혜 등. 한국 성인에서 흡연과 치주낭 형성의 관련성. 대한구강보건학회지 2005;29(3):293-3y01.
  17. Baig MR, Rajan M. Effects of smoking on the outcome of implant treatment: A literature review. Indian J Dent Res 2007;18(4):190-195. https://doi.org/10.4103/0970-9290.35831
  18. Kan YK, Rungcharassaeng K, Lozada JL et al. Effects of smoking on implant success in grafted maxillary sinuses. J Prosthet Dent 1999;82(3):307-311. https://doi.org/10.1016/S0022-3913(99)70085-5
  19. Haas R, Haimbock W, Mailath G et al. The relationship of smoking on peri-implant tissue: A retrospective study. J Prosthet Dent 1996;76(6): 592-596. https://doi.org/10.1016/S0022-3913(96)90435-7
  20. Strietzel FP, Reichart PA, Kale A et al. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol 2007;34(6):523-544. https://doi.org/10.1111/j.1600-051X.2007.01083.x
  21. Hinode D, Tanabe SI, Yokoyama M et al. Influence of smoking on osseointegrated implant failure: a meta-analysis. Clin Oral Impl Res 2006;17(4):473-478. https://doi.org/10.1111/j.1600-0501.2005.01244.x
  22. Khalaf FA, Mohamed AM, Jassem MA et al. Dental patient awareness of smoking effects on oral health: Comparison of smokers and non-smokers. Journal of Dentistry 2006;34(3):173-178. https://doi.org/10.1016/j.jdent.2005.05.006
  23. Akerberg O: Editorial. FDI World, 1996;5:5-6.
  24. 박용덕, 김지현, 이선경. :치과의사의 흡연 실태 및 인식 조사. 대한구강보건학회지 2007;33(2):288-97.
  25. Burns JC, Williams Jr LN. A survey to determine the knowledge of military members about the hazards of tobacco use, and a resulting tobacco-hazard education project. Journal of Cancer Education 1995; 10(1):37-40.
  26. Humphris GM, Field EA. An oral cancer information leaflet for smokers in primary care: result from two randomized controlled trials. Community Dentistry and Oral Epidemiology 2004;32(2):143-149. https://doi.org/10.1111/j.0301-5661.2004.00129.x
  27. Lawoyin JO, Aderinokun GA, Kolude B, Adekoya SM, Ogundipe BF. Oral cancer awareness and prevalence of risk behaviors among dental patients in Southwestern Nigeria. African Journal of Medical Sciences 2003;32(2):203-207.
  28. Lowry RJ, Craven MA. Smokers and drinkers awareness of oral cancer: a qualitative study using focus groups. British Dental Journal 1999;187:668-670.
  29. Powe BD, Finnie R. Knowledge of oral cancer risk factors among African Americans: do nurses have a role? Oncology Nursing Forum 2004;31(4):785-791. https://doi.org/10.1188/04.ONF.785-791
  30. Telivuo M, Kallio P, Berg MA, Korhonen HJ, Murtomaa H. Smoking and oral health: population survey in Finland. Journal of Public Health Dentistry 1995;55(3):133-138. https://doi.org/10.1111/j.1752-7325.1995.tb02355.x
  31. 조경숙, 송태민. 보건소 금연클리닉의 금연성공률과 비용효과 분석. 보건복지포럼-정책분석 2006;65-77.
  32. 이성기, 권혁중, 임대준 등. 니코틴 의존도 평가검사로서 Heavy smoking index (HIS)의 유용성. 가정의학회지 2008;29:405-411.
  33. Heartherton TF, Kozlowski LT, Fecker RC et al. The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnare. Br J Addict 1991;86(9):1119-1127. https://doi.org/10.1111/j.1360-0443.1991.tb01879.x
  34. Kim CH, Seo HG. The factors associated with success of smoking cessation at smoking-cessation clinic. J Korean Acad Fam Med 2001;22(11):1603-1611.
  35. Kim JS, Lim SH, Lee DU et al. Smoking types and smoking cessation rate. J Korean Acad Farm Med 2004;25:388-391.
  36. American Academy of Family Physicians. http:// familydoctor.org/handouts
  37. 김동기, 김진선, 성진효. 일부 지역사회에서 구강건강관리인력의 금연지도활동에 관한 조사 연구. 대한구강보건학회지 2003;27(4):511-525.
  38. 김혜양, 이선경, 박용덕. 공중보건치과의사의 근무현황과 업무수행에 관한 조사연구. 대한구강보건학회지 2008;32(1):86-95.
  39. Watt R et al. Helping smokers to stop: A guide for the dental team. London, 1999, Health Education Authority.
  40. 서홍관, 조홍준, 김철환 등. 금연진료지침 문헌 고찰 및 근거 요약. 가정의학회지 2005;26(11) Supple:394-406.