• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제48권6호
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• pp.331-341
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• 2022

This systematic review evaluates current evidence regarding the feasibility of using needleless jet injection instead of a conventional local anesthetic needle. EBSCO, ProQuest, PubMed, and Scopus databases were used to identify relevant literature published in English from 2005 to 2020. Ten studies were selected. Five of them were randomized clinical trials, 3 case-control studies, and 2 equivalence trials. Using the Critical Appraisal Skills Program checklist, 6 studies scored between 67% and 100%, and 4 studies scored between 34% and 66%. According to Jadad's scale, 2 studies were considered strong, and 8 studies were considered moderate in quality. The results of the 10 studies showed differences in patient preference for needleless jet injection. Needleless injection technique has been found to be particularly useful in uncooperative patients with anxiety and needle phobia. Needleless jet injection is not technique sensitive. However, with needleless jet anesthesia, most treatments require additional anesthesia. Conventional needle anesthesia is less costly, has a longer duration of action, and has better pain control during dental extraction. Needleless jet anesthesia has been shown to be moderately accepted by patients with a fear of needles, has a faster onset of action, and is an efficient alternative to conventional infiltration anesthesia technique.

• Journal of Dental Anesthesia and Pain Medicine
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• 제15권3호
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• pp.161-165
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• 2015

Long QT syndrome (LQTs) is a rare congenital disorder of the heart's electrical activity. Patients with LQTs are at increased risk of developing fatal ventricular arrhythmias. Elevated levels of sympathetic stimulation can exacerbate this risk. Successful behavior management is indispensable in the treatment of patients with LQTs. However, many drugs involved in pharmacologic behavior management are known to adversely affect the QT interval. Therefore, careful selection of a sedative drug is essential in avoiding such incidences. A 10-year-old boy with a known diagnosis of LQTs required restorative treatment due to dental caries at the permanent molar. He required sedation since treatment was painful and dental phobia can trigger sympathetic stimulation, creating a dangerous situation for patients with LQTs. Therefore, the treatment was performed over two sessions under moderate sedation involving propofol combined with nitrous oxide. Restorative treatment was successful without any complications under sedation with a target-controlled infusion (TCI) of propofol. There was no significant QT prolongation during pulpal treatment. Propofol TCI may be a good candidate for sedation in patients with LQTs.

• 대한치과마취과학회지
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• 제12권2호
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• pp.75-91
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• 2012

Background: Dental sedation reduces fear and phobia during dental treatment and helps patients get quality treatment by inducing adequate consciousness control. Propofol has recently grabbed the spotlight, but no meta-analysis for efficacy and safety of propofol in dentistry has yet been performed. Thus, the purpose of this study was to perform meta-analysis to verify the efficacy and safety of propofol for use in dental sedation. Methods: Articles published between 1980 and 2010 were searched in the web sites, journals and medical database including The Cochrane Library, MEDLINE and EMBASE. And a total of 22 studies were selected among the randomized controlled trials (RCTs) that compared the use of propofol with other sedatives (control group). The data was collected from these studies and meta-analysis for efficacy and safety was performed using Comprehensive Meta-Analysis 5.0 (CMA 5.0). Results: The patient recovered significantly faster and discharged significantly earlier in the propofol group (SMD = -1.442, P < 0.001). The satisfaction of patient and that of operator was higher in the propofol group (P < 0.05). The incidence of arrhythmia and apnea/ hypoventilation was significantly lower in the propofol group (OR = 0.071, P < 0.05), and there was no significant difference in the other side effects. On the level of sedation, although the sedation score was significantly lower in the propofol group (SMD = -0.430, P < 0.05). Conclusions: The present analysis showed that the use of propofol resulted in high satisfaction levels on the part of the patients and operators, a shorter recovery time, and faster hospital discharge. The incidence of complications, however, was lower in the propofol groups or not much different between the propofol and control groups. Thus, the adequate use of propofol in dentistry is believed to be helpful for the effective and safe sedation of the patients.

• 한국치위생학회지
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• 제18권5호
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• pp.607-620
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• 2018

Objectives: The purpose of this study was to investigate the overall research trends and factors influencing dental fears in the last 10 years (2007-2017) and provide recommendations for future research. Methods: The literature review focused on dental fear research in Korea. Inclusion criteria of selected studies were as follows: studies that examined fear in middle school students or older, studies undertaken between 2007-2017, and studies that examined trends and factors relating to dental fears. Results: Findings from this literature review showed that the most commonly used tool for measuring dental fear was the Dental Fear Survey (DFS). A lack of trust towards the dentist increased dental fear among patients. Women managed fear better than men. Past pain experiences increased dental fear. The most frequent intervention for reducing fear was sound (41.7%). Most of the intervention studies demonstrated a reduction of fear, with the exception of interventions using ear plugs. Fear was increased in studies involving ear plugs. Conclusions: Based on the results of the study, specific measures should be taken to alleviate past pain experiences, such as the fear of anesthetic injections and sensations of the dental drill. Continuous research is needed to reduce dental fear.

• 대한소아치과학회지
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• 제36권2호
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• pp.264-269
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• 2009

전신마취하에서의 치과치료는 자발적인 협조가 불가능하거나 전신적인 문제가 있는 경우, 다수의 치료를 한 번에 하고자 하는 경우 등에 행해진다. 이 연구는 서울대학교치과병원 장애인진료실에서 외래 전신마취하에 행해진 환자와 치과치료를 분석함으로써 보다 나은 장애인 진료 시스템을 위한 방안 제시에 도움이 되고자 하였다. 2002년 6월 11일부터 2006년 12월 31일까지 장애인진료실에서 치료 받은 432명의 환자들을 대상으로 조사한 결과 15세 이하의 환자가 50.46%로, 소아 및 청소년 환자가 높은 비율을 차지하고 있었다. 진료과는 보존과, 소아치과, 구강외과, 치주과, 보철과 순으로 나타났으며 치료내용을 보면 보존치료와 발치가 주를 이루고 있었다. 또 2회 이상 전신마취를 시행한 환자가 14.1%나 되었다. 본 연구는 장애인 환자를 위한 보다 포괄적인 치과 치료 및 진료과들 간의 긴밀한 협진 체계를 구축하고 필요한 인력과 설비를 보충함으로써 장애인 환자들에게 보다 보존적 인 치과치료와 편안한 치료 환경을 제공해야 할 필요성을 제시하고 있다.

• 대한소아치과학회지
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• 제37권4호
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• pp.545-550
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• 2010

Freeman-Sheldon Syndrome(FSS)은 드물게 발생하는 선천성 유전 질환으로 휘파람을 부는 듯한 특징적인 안모로 인해 'Whistling face syndrome'으로 불리워진다. 또한 편평한 안모, 긴 인중(philtrum), 낮은 비연골이 나타나 두드러진 안면이상을 보이고, 내반족(club foot, 內反足), 손가락의 관절구축(joint contracture)으로 인한 풍차 모양의 손을 가지며, 지능은 보통 정상이다. 본원에 내원한 환아는 이 질환의 특징적 양상인 구강 주위 근육의 수축으로 소구증 및 개구제한, 높은 구개 및 부정교합, 치열의 심한 총생을 보여 구강위생이 매우 불량하였고 치과치료에 비협조적이었다. 소아치과적 행동조절 및 구강위생관리, 섭식장애의 상담으로 치과적 문제는 다소 개선되었으나, 안과 및 정형외과, 신경정신과, 교정과, 마취과적 문제로 인해 다양한 협진이 필요하며 계속적인 관찰 및 치료가 요구되기에 이를 보고하는 바이다.

• 대한치과마취과학회지
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• 제14권1호
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• pp.29-39
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• 2014

Background: Dental phobia or anxiety of patients is the serious impediment to appropriate and effective dental treatment. Sedative technique helps to mitigate patients' fear and anxiety thus make them more cooperative and familiar to dental practices. With increasing attention to sedative dentistry in dentists, educational requirements and technical qualification also become stricter but actual survey on recent sedative dentistry has not been reported yet. Especially there is insufficient study reporting the survey of sedative dentistry subjected to Korean adults. In this paper, we conducted a survey study on the actual condition and practice related to sedation with a questionnaire to dentists in South Korea. Methods: The survey was done for members of The Korean Dental Society of Anesthesiology (KDSA), who had great interest in sedation and for whom survey-by-mail was convenient. 472 members of The KDSA having dental license and solid address and contact information were subjected to the survey by sending them survey questions about their sedative techniques and knowledge. In order to increase the response rate, small gifts were presented to those who accurately responded to the survey questions and text messages and phone calls were made to encourage their participation. We collected their responses over two months and examined the returned surveys. Statistical analysis was performed using IBM SPSS Statistics 21 for each question. Results: Out of 472 dentists, 181 responded (38.4% response rate). 63.0% (114 dentists; 77 male and 37 female) of respondents had experience on sedative technique and their average age was $39.8{\pm}7.6$ year. 74 of them were private practitioners, 17 of them were professors (14.9%), 11 of them were dentists-in-service (9.6%), 11 of them were residents (specialist training) (9.6%) and 1 of them was military doctors (0.9%). There were 89 dentists (78.1%) who were specialists or receiving trainings to be specialist, most of whom were pediatric dentists (55, 48.2%) and oral surgeon (31, 27.2%). The most popular route for drug medications was orderly oral, inhalational, intravenous medication. Combination of oral and inhalational medications or single use of intravenous medication was the most common. The most preferred sedative drug was pocral in oral sedation and midazolam in intravenous sedation. 48.2% of practitioners responded that they experienced side effects and emergency situations. Airway obstruction was the most frequent. Conclusions: Results from the survey show that the protocol and system for sedative dentistry have been improved compared to the past. Nevertheless, quality of emergency protocol, monitoring devices and preparation of sedative drugs was still insufficient to achieve safe sedative procedure. This study acquires novelty since actual survey on recent sedative dentistry for adult patients has not been reported yet.

• 치위생과학회지
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• 제17권1호
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• pp.20-29
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• 2017

본 연구는 $IDAF-4C^+$를 국내 실정에 적절하게 적용할 수 있도록 수정 보완하여, 치과 방문 환자의 치과 불안 정도를 평가할 수 있는 도구를 개발하고 타당도와 신뢰도를 평가하고자 시행하였다. 치과 불안 및 공포 원 도구 23문항을 번역한 후 번역 정확도, 내용분석 및 내용타당도 검증을 통하여 3문항을 삭제하고 14문항을 수정하여 총 20문항을 분석하였다. 연구 결과 탐색적 요인분석에 의한 요인 적재량이 0.4 이하인 1개의 문항이 삭제되었으며, 선행연구의 이론구조에 맞지 않게 적재된 1개의 문항이 삭제된 결과 18문항들이 추출되었다. 치과 불안 및 공포 측정 도구의 하위요인으로는 치과 불안, 공포, 자극으로 구분되었다. 또한 확인적 요인분석을 통한 측정 도구의 각 하위별 적합지수를 충족시키기 위해 4개 문항이 삭제되어, 최종 3개의 하위요인의 14문항으로 구성된 측정 모델의 적합도는 기준을 충족하였다. 모든 요인의 개념신뢰도, 표준화 회귀 계수값이 일반적 기준을 충족시켜 집중타당도가 입증되었다. 모든 요인의 평균분산추출값은 각 요인 간 상관관계 제곱값보다 크게 나타나 판별타당도도 입증되었다. 내적일관성을 검증한 결과 Cronbach's ${\alpha}$는 치과 불안 항목 0.920, 공포 항목 0.613, 자극 항목 0.866으로 나타나 신뢰할 만한 수준의 측정도구임을 나타냈다. 한국어판 $IDAF-4C^+$의 타당도와 신뢰도는 적합하다고 검증되었다. 향후 국내 환자의 치과 불안 및 공포 조절 도구로 임상과 연구에 활용되어 구강건강 증진에 도움을 줄 수 있을 것으로 생각된다.

• 대한소아치과학회지
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• 제29권2호
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• pp.189-195
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• 2002

치과진료시 환아는 어느 정도의 공포를 느끼게 되고, 이에 따른 다양한 부정적 반응을 표출하게 된다. 소아환자의 행동조절을 위해 여러 방법들이 시도되어 왔고, 최근 소아치과 분야에서 사용이 증가하고 있는 시청각자료의 이용도 그 중의 하나이다. 본 연구에서는 시청각자료의 사용이 치과진료시 환아의 반응에 미치는 영향과, 환아의 나이, 치과병력, 일일 TV나 비디오 시청시간 등과의 상관관계를 알아보고자 하였다. 삼성서울병원 소아치과를 내원한 만 $3{\sim}6$세의 건강한 아동 30명을 동수의 두 군으로 나누어, 1군에서는 치료시 통상의 tell-show-do만을 시행하였고, 2군에서는 시청각기구의 사용을 병행하였다. 발치를 제외한 통상의 보존적 술식만 실행하였고, 초진시 설문지를 통해 환아의 나이, 치과병력유무, Frankl 행동지수, 일일 TV나 비디오 시청시간을 조사하여 중등도의 협조도를 보이는 환아만을 대상으로 하였다. 치료시 환아의 행동평가에는 Houpt 행동분류 지수를 이용, 수면유도, 움직임, 울음 및 전체적인 반응을 기록하였다. 초진시 조사한 두 군간의 나이와 일일 TV나 비디오 시청시간 사이에는 차이가 없었다. 수면유도에 있어서 시청각군에서 유의성있는 수면유도 효과를 보였으며, 움직임이나 울음에 대하여는 유의성있는 차이를 보이지 않았다. 전체적 반응에 대한 평가에서는 시청각군이 유의성있는 개선된 반응을 보였는데, 치과병력의 존재, 연령의 증가, 시청각매체와의 빈번한 접촉시 시청각자료를 이용한 행동조절에 보다 긍정적으로 반응하였다.

• 대한구강악안면병리학회지
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• 제42권5호
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• pp.145-152
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• 2018

A 57 years old female complained of severe pain on the right temporomandibular joint (TMJ) area. Her right condyle had been partly resected under surgical operation 13 years ago due to condyle hypertrophy, thereafter she felt dull pain on TMJ area and recently the lesion became severely swelled and painful leading to cancer phobia. The present radiological views showed slightly enlarged and sclerosed condyle with increased radiopacity, but its articular sliding function was almost disable during mouth opening. The patient's TMJ lesion was carefully managed with conservative physiotherapy and pain treatment. The microsection of condyle head obtained from the previous operation was re-evaluated histologically, and it was finally diagnosed as osteochondrosis dissecans (OCD), exhibiting hyperplastic proliferation of cartilage in condyle head and marked vascular dilatation in epiphyseal zone. This abnormal cartilage tissue was distinguishable from normal cartilage tissue found in the peripheral cartilaginous cap of the same microsection. The involved cartilage cap showed thick hypertrophic chondrocyte zone with horizontal and vertical clefts accompanying diffuse hyaline degeneration. The superficial fibrous zone of cartilage cap was thickened and frequently peeled off, while lower hypertrophic zone of cartilage cap was highly cellular and proliferative. Consequently, the endochondral ossification became aberrant and resulted pre-mature apoptosis of many hypertrophic chondrocytes, followed by diffuse and mild inflammatory reaction in the underlying marrow tissue. Therefore, it was suggested that this hypertrophic condyle lesion, OCD, be differentiated depending on radiological and histological features from ordinary condyle hyperplasia, osteochondroma, and osteoarthritis, and that the pathological confirmation of OCD may provide a reliable modality for dental and medical treatment of chronic and painful TMJ lesion.