[Show abstract][Hide abstract] ABSTRACT: Aim:
To clarify whether the number of present teeth, independent of other well-known factors, was associated with the total bacterial count in the saliva of older people requiring care at nursing homes in a multicentered epidemiological survey.
The participants were 618 older people (mean age 86.8 ± 6.9 years; 122 men, 496 women) residing in 14 nursing homes across Japan. The dependent variable was the participant's salivary bacterial count, and the independent variables were basic demographic data, oral conditions and activity of daily living (measured by Barthel Index). Statistical analysis was first carried out by Student's t-test, Pearson's correlation coefficient analysis and Spearman's rank correlation coefficient analysis. Independent variables found to have a significant relationship to their salivary bacterial count by the univariate analyses were further examined by stepwise multivariate analysis.
The independent variables shown by univariate analysis to have a significant positive relationship with higher salivary bacterial count were presence of food residue (P = 0.001), absence of mouth dryness (P = 0.001), need of oral care assistance (P = 0.001), inability to keep the mouth opened (P = 0.009), inability to gargle (P = 0.002), denture use (P = 0.004), higher number of present teeth (P = 0.006) and lower Barthel Index (P = 0.001). Subsequent multivariate analysis identified presence of food residue (P = 0.031), higher number of present teeth (P = 0.043) and lower Barthel Index (P = 0.001) as independent associated factors for higher salivary bacterial count.
The present study found that presence of food residue, higher number of present teeth and decreased activity of daily living were significantly related to higher bacterial count in the saliva of older people requiring care. Geriatr Gerontol Int 2016; ●●: ●●-●●.
Full-text · Article · Jan 2016 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: It is important for the elderly to maintain their skeletal muscle mass, which in turn helps to maintain physical functions. This study aimed to clarify factors related to skeletal muscle mass maintenance. Home-bound elderly (94 men and 216 women), at least 75 years of age, attending a day-care center in Tokyo, were enrolled in this study. Dentists specializing in dysphagia rehabilitation evaluated skeletal muscle mass, occlusal status and swallowing function. Physical function, cognitive function and nutritional status were also evaluated by interviewing caregivers. Correlations of skeletal muscle mass with various factors were determined in each gender group. Multiple regression analysis revealed that skeletal muscle mass was significantly related to nutritional status in both men and women. In men, there was a significant difference in skeletal muscle mass between those with and without occlusion of the natural teeth. Our results suggest that dental treatments and dentures would be useful for maintaining skeletal muscle mass, especially in men.
[Show abstract][Hide abstract] ABSTRACT: Considering the high incidence of oral complications in terminally ill cancer patients, dental services are necessary for high-quality palliative care. However, to our knowledge, there have been no nationwide studies examining the need and availability of dental services in palliative care. In this study, a nationwide survey was conducted to clarify the need and availability of dental services for physicians and nurses engaged in palliative care in Japan.
A questionnaire was distributed to 436 certified palliative care units and palliative care teams registered with Hospice Palliative Care Japan. The questionnaire consisted of questions related to (1) background, (2) need of dental services, and (3) availability of dental services.
The response rate was 48.2 % (n = 210). As a whole, 93 % of all respondents indicated that dental services were absolutely necessary, highly necessary, or necessary. In addition, 94 % of respondents thought dental treatment by dentists was often or sometimes necessary; 96 % of respondents thought oral care provided by specialists was often or sometimes necessary. As a whole, 71 % of the respondents reported that dental services were always available, but 28 % reported that dental services were available only sometimes. In actuality, in 31 % of the institutions, dental services were available 1 day/week or less, and in 39 %, dental services were dispatched from outside the institution.
The results of this study revealed that Japanese palliative care units and teams have a markedly high need of dental services, but there is insufficient availability. To improve oral complications of terminally ill cancer patients, dentistry professionals should be more available in palliative care.
No preview · Article · Apr 2015 · Supportive Care in Cancer
[Show abstract][Hide abstract] ABSTRACT: This study aimed to develop a simultaneously swallowing provocation test for dysphagia patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES), as well as to evaluate its efficacy.
In this test, 0·4 and 2·0 mL volumes of water were dripped into the pharynx under endoscopic examination of swallowing, and determine the latency time (LT) of the swallowing reflex elicited by water. The subjects were 51 bed-bound patients with dysphagia and could be divided into two groups as 35 tube feeding and 16 oral intake subjects. Among the tube feeding subjects, 20 patients who started dysphagia rehabilitation were followed-up to 3 months.
The mean LT was 7·43 ± 7·19 seconds with 0·4 mL of test water and 5·05 ± 5·59 sec with 2·0 mL. When 0·4 mL water was dripped, LT was significantly longer in tube feeding (10·49 ± 7·97 seconds) than oral intake subgroup (5·72 ± 5·16 seconds) (p < 0·05). After the dietary intervention according to the result of FEES, 5 patients were improved in eating, and 15 patients were unchanged or even got worse among 3-months follow-up investigation. LT with 0.4 ml of test water of the Improved group was 3·16 ± 2·69 seconds and that of unchanged/worsened group was 22·6 ± 17·5 seconds, resulting in the significant difference (p < 0·05).
The results of this study suggest that our endoscopic swallowing test as swallowing provocation test with FEES is a useful examination for dysphagia rehabilitation.
[Show abstract][Hide abstract] ABSTRACT: Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions.
The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions.
The one-leg standing time was significantly shorter with the mouth opened (21·1±19·1 seconds) than with the mouth closed (25·1±21·4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth.
The vertical mandibular position may affect body balance.
Full-text · Article · Jan 2015 · Cranio: the journal of craniomandibular practice
[Show abstract][Hide abstract] ABSTRACT: PurposeThe present study examined the relationship between oral function, such as eating/swallowing, and life prognosis among a homebound elderly population, considering physical and mental function.Methods
The participants were 511 homebound older adults aged 65 years or older living in four Japanese prefectures. Sex, age, activities of daily living (ADL), cognitive function, underlying disease, nutritional status as Mini-Nutritional Assessment-Short Form (MNA®-SF), swallowing function, dietary modification and occlusal status were examined at baseline. Participants were categorized into poor outcome (died or admitted to hospital or nursing home) and good outcome (still under home care) groups at 1-year follow up, and significant related baseline factors were analyzed. In addition, these groups were compared by the ADL subgroup divided into <60 (lower) and ≥60 (higher) by Barthel Index.ResultsIn total, 473 participants were followed up (poor outcome group 177 [37.4%], good outcome group 296 [62.6%]). Sex, age, ADL, MNA®-SF, swallowing function, dietary modification and occlusal support were significantly different between these groups. Logistic regression analysis showed that sex and MNA®-SF score were significantly related to prognosis in the lower ADL group, and sex, age, Charlson Comorbidity Index and occlusal support were significantly related in the higher ADL group.ConclusionsADL was strongly correlated with life prognosis in homebound older adults. Within the higher ADL participants, occlusal support was related to this outcome. Geriatr Gerontol Int 2014; ●●: ●●–●●.
Full-text · Article · Nov 2014 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: AimOral bacteria, which are a source of infection for aspiration pneumonia, were examined in frail older adults with the aim of establishing a standard bacteria count that indicates the risk of pneumonia onset in this group.MethodsA survey of bacteria count in the saliva using a simple instrument for measurement of the number of oral bacteria, along with factors including swallowing function and nutritional status, was carried out in 691 elderly individuals requiring care (137 men; mean age 82.6 ± 8.3 years; 554 women; mean age 88.0 ± 7.1 years; total mean age 86.7 ± 7.8 years) at 16 nursing homes in Japan. All participants gave their consent for inclusion in the present study. During a 6-month follow-up period, participants who developed pneumonia were identified, and relationships between the factors measured at the start of the period and pneumonia onset were examined.ResultsDuring the 6-month follow-up period, 33 participants (4.8%; 5 men, 28 women; mean age 88.3 ± 7.4 years) developed pneumonia. Pneumonia onset was significantly associated with reduced activities of daily living, swallowing dysfunction and undernourishment. Logistic regression analysis identified a saliva bacteria count of 108.5 colony-forming units/mL as an independent explanatory factor for pneumonia onset (P = 0.012, RR = 3.759).Conclusions
Oral bacteria count of 108.5 colony-forming units/mL saliva in an elderly person requiring care was identified as a risk factor for pneumonia onset. Geriatr Gerontol Int 2014; ●●: ●●–●●.
[Show abstract][Hide abstract] ABSTRACT: To develop a simple screening test to identify older adults at high risk for sarcopenia.
We studied 1971 functionally independent, community-dwelling adults aged 65 years or older randomly selected from the resident register of Kashiwa city, Chiba, Japan. Data collection was carried out between September and November 2012. Sarcopenia was defined based on low muscle mass measured by bioimpedance analysis and either low muscle strength characterized by handgrip or low physical performance characterized by slow gait speed.
The prevalence of sarcopenia was 14.2% in men and 22.1% in women. After the variable selection procedure, the final model to estimate the probability of sarcopenia included three variables: age, grip strength and calf circumference. The area under the receiver operating characteristic curve, a measure of discrimination, of the final model was 0.939 with 95% confidence interval (CI) of 0.918-0.958 for men, and 0.909 with 95% CI of 0.887-0.931 for women. We created a score chart for each sex based on the final model. When the sum of sensitivity and specificity was maximized, sensitivity, specificity, and positive and negative predictive values for sarcopenia were 84.9%, 88.2%, 54.4%, and 97.2% for men, 75.5%, 92.0%, 72.8%, and 93.0% for women, respectively.
The presence of sarcopenia could be detected using three easily obtainable variables with high accuracy. The screening test we developed could help identify functionally independent older adults with sarcopenia who are good candidates for intervention. Geriatr Gerontol Int 2014; 14 (Suppl. 1): 93-101.
Full-text · Article · Feb 2014 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: Primitive reflexes can reappear with diseases of the brain, particularly those affecting the frontal lobes. Most studies on primitive reflexes have reported an association between such reflexes and brain damage, and the clinical symptoms of dementia. These reflexes can also be present during eating; however, their effects on eating function are difficult to evaluate. The purpose of the present study was to identify the frequency at which primitive reflexes reappear in elderly people, and to determine the effects that such reflexes have on eating function, nutritional status and prognosis.
We followed 121 nursing home residents for 6 months. All patients required long-term care and were examined for the presence of a sucking reflex, snout reflex and phasic bite reflex for baseline measures. Demographic characteristics, physical and cognitive function, and nutritional status were obtained from chart reviews, interviews with nurses, and a brief physical examination at baseline and incidence of aspiration pneumonia during the study period.
The sucking reflex was confirmed in 31 patients (25.6%), snout reflex in 15 patients (12.3%) and phasic bite reflex in 28 patients (23.1%). One or more of these reflexes was identified in 38 patients (31.4%). A relationship between the presence of a primitive reflex and nutritional status was shown. An association with the presence of these reflexes and the development of aspiration pneumonia during 6 months was also confirmed.
The appearance of primitive reflexes appears to be associated with the risk of malnutrition and developing aspiration pneumonia. Geriatr Gerontol Int 2013; ●●: ●●-●●.
No preview · Article · Aug 2013 · Geriatrics & Gerontology International
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to examine how bottle feeding movements improved as a result of the fitting of Hotz's plates in infants with cleft lip and palate, with a focus on tongue movements.Materials and methodsThe subjects were 11 infants with cleft lip and palate (CLP infants) and 16 healthy infants, and their sucking movements were observed by diagnostic ultrasound in B/M mode. Measurements were made by placing the echo window beneath the infant's jaw and visualizing frontal and sagittal images of the tongue during sucking movements. Tongue movements during sucking by CLP infants with and without Hotz's plates were compared with those of healthy infants in each of the three groups. A t-test was used to compare values with and without Hotz's plates, a Mann–Whitney U-test was used to compare measurements between CLP and healthy infants, and a Kruskal–Wallis test was used to investigate changes in tongue movements with increasing age.Results and conclusionThe results showed that tongue movements during bottle feeding were larger in CLP infants without Hotz's plates than in CLP infants with Hotz's plates and healthy infants, indicating an unphysiological condition in CLP infants without Hotz's plates. When Hotz's plates were fitted, movements were stable and close to those of healthy infants, suggesting that fitting Hotz's plates is useful.
[Show abstract][Hide abstract] ABSTRACT: This study reviewed the relationship between oral status and nutritional disorders such as obesity and sarcopenia. A literature search was performed using PubMed to find articles published in and after 2000 by using the following search terms: elderly, nutrition, tooth, tooth loss, mastication, and oral function. Although the literature search revealed that further well-designed studies are difficult controlling all confounding factors thought to influence nutritional status, it may be concluded that tooth loss leads to decreased vegetable and fruit intake and results in nutritional disturbance. This was especially prominent in elderly people who required nursing care. Moreover, although it is becoming clear that not wearing dentures increases the risk of undernutrition, the effect of denture therapy remains debatable. Elderly people in need of nursing care should be studied in future investigations on the relationship between nutrition and oral status because this population is at risk of malnutrition considering both functional and structural problems.
Full-text · Article · Jan 2013 · Japanese Dental Science Review
[Show abstract][Hide abstract] ABSTRACT: This educational trial was an eight-day problem-based learning (PBL) course for fourth-year predoctoral students at Okayama University's dental school who interviewed elderly residents living in a nursing home. The purpose of this PBL course was to introduce geriatric dentistry to the students by allowing them, independently, to discover the clinical problems of elderly patients as well as the solutions. The sixty-five students were divided into nine small groups and received patient information (age, gender, degree of care needed, medical history, food type, medications, and oral condition) in datasheets before visiting the nursing home. Each group of students directly interviewed one patient and the caregivers and identified the patient's medical, psychological, and social problems. After the interview, the students participated in a PBL tutorial to delineate a management approach for the patient's problems. To measure the efficacy of this program, the students completed a questionnaire before and after the course regarding their level of understanding of and attitudes toward geriatric dentistry, clinical research, and self-study. The results showed that student's perceptions of their knowledge about and attitudes toward oral health care for the elderly significantly increased after the PBL course, which suggests that such tutorials should be an option for dental curricula.
No preview · Article · Dec 2012 · Journal of dental education
[Show abstract][Hide abstract] ABSTRACT: Objectives:
Malnutrition and cognitive impairment lead to declines in activities of daily living (ADL). Nutritional status and cognitive ability have been shown to correlate with oral health status and swallowing function. However, the complex relationship among the factors that affect decline in ADL is not understood. We examined direct and indirect relationships among oral health status, swallowing function, nutritional status, cognitive ability, and ADL in Japanese elderly people living at home and receiving home care services because of physical disabilities.
Participants were 286 subjects aged 60 years and older (mean age, 84.5±7.9 years) living at home and receiving home care services. Oral health status (the number of teeth and wearing dentures) was assessed, and swallowing function was examined using cervical auscultation. Additionally, ADL, cognitive ability, and nutritional status were assessed using the Barthel Index, the Clinical Dementia Rating Scale, and the Mini Nutritional Assessment-Short Form, respectively. Path analysis was used to test pathways from these factors to ADL.
The mean number of teeth present in the participants was 8.6±9.9 (edentates, 40.6%). Dysphagia, malnutrition, and severe cognitive impairment were found in 31.1%, 14.0%, and 21.3% of the participants, respectively. Path analysis indicated that poor oral health status and cognitive impairment had a direct effect on denture wearing, and the consequent dysphagia, in addition to cognitive impairment, was positively associated with malnutrition. Malnutrition as well as dysphagia and cognitive impairment directly limited ADL.
A lower number of teeth are positively related to swallowing dysfunction, whereas denture wearing contributes to recovery of swallowing function. Dysphagia, cognitive impairment, and malnutrition directly and indirectly decreased ADL in elderly people living at home and receiving home nursing care. The findings suggest that preventing tooth loss and encouraging denture wearing when teeth are lost may indirectly contribute to maintaining or improving ADL, mediated by recovery of swallowing function and nutritional status.
No preview · Article · Aug 2012 · Community Dentistry And Oral Epidemiology
[Show abstract][Hide abstract] ABSTRACT: Many elderly people under long-term care suffer from malnutrition caused by dysphagia, frequently leading to sarcopenia. Our hypothesis is that sarcopenia may compromise oral function, resulting in dysphagia. The objectives of this study were to evaluate sarcopenia of the lingual muscles by measuring the tongue thickness, and elucidate its relationship with nutritional status. We examined 104 elderly subjects (mean age = 80.3 ± 7.9 years). Anthropometric data, such as triceps skinfold thickness and midarm muscle area (AMA), were obtained. The tongue thickness of the central part was determined using ultrasonography. Measurement was performed twice and the mean value was obtained. The relationship between tongue thickness and nutritional status was analyzed by Pearson's correlation coefficient and Spearman's rank correlation coefficient. AMA and age were identified by multiple-regression analysis as factors influencing tongue thickness. The results of this study suggest that malnutrition may induce sarcopenia not only in the skeletal muscles but also in the tongue.
[Show abstract][Hide abstract] ABSTRACT: Aim: This study aimed to determine the risk of malnutrition in some communities where the frail elderly receive public long-term care insurance. We also clarified the dental problems in those at risk of malnutrition. Methods: A total of 716 frail elderly who lived in eight cities in Japan (240 males and 476 females with a mean age of 83.2 ± 8.6 years) were divided into three groups according to Mini Nutritional Assessment short form results: well nourished, at risk of malnutrition and malnourished. They were also divided into three groups in terms of remaining teeth occlusion and denture occlusion: group A, natural dentition with adequate function; group B, partially or fully edentulous, but maintaining functional occlusion with dentures in either or both jaws; and group C, functionally inadequate occlusion with no dentures. The relationship between nutrition status and dental occlusion was evaluated using logistic regression analysis with sex, age, activities of daily living and cognitive function as covariates. Results: The number of participants in each of the groups was as follows: 251 well nourished, 370 at risk of malnutrition and 95 malnourished. When they were divided into just two groups, (i) well nourished and (ii) at risk of malnutrition plus malnourished, in order to study malnutrition risk factors, there were significant relationships between their nutritious status and sex, Barthel index, and occlusion. Conclusion: This large-scale cross-sectional survey showed that loss of natural teeth occlusion was a risk factor for malnutrition among community-dwelling frail elderly. Geriatr Gerontol Int 2012; ••: ••-••.
[Show abstract][Hide abstract] ABSTRACT: Foreign body asphyxiation causes severe medical conditions including pneumonia in the elderly requiring nursing care. The objective of this study was to elucidate the relationships between insufficient occlusal support due to tooth loss and the onset of asphyxiation accidents, and determine preventive measures for such accidents in nursing homes in Japan. The subjects were 437 elderly (110 men and 327 women) requiring nursing care. The frequency and risk factors for asphyxiation accidents and the food causing asphyxiation were examined in these subjects for 2.5 years, from June 2006 to December 2008. During the study period, 51 of the 437 subjects suffered asphyxiation. Self-feeding ability and loss of occlusal support were associated with a covariate-adjusted relative ratio for asphyxiation of 3.1 (95% confidence interval (CI)=1.50-6.44) and 1.7 (95% CI=1.12-2.74), respectively. To prevent asphyxiation in elderly people, it was found that maintaining or restoring occlusal support may be required. It was concluded that self-feeding ability and loss of occlusal support are significant risk factors for foreign-body asphyxiation among elderly people requiring nursing care.
No preview · Article · Feb 2012 · Archives of gerontology and geriatrics
[Show abstract][Hide abstract] ABSTRACT: The purpose of the present study was to examine what dysphagic signs identified by videoendoscopy (VE) could predict the incidence of pneumonia and body weight loss in elderly patients living in nursing homes. This study was performed at six nursing care facilities in Japan from March 2007 to February 2009. The 148 subjects (85·1 ± 8·0 years, male/female: 43/105) were evaluated for their feeding and swallowing movements by clinical and VE examinations during the consumption of a regular meal. The VE examination items included the existence/absence of pharyngeal residue, laryngeal penetration, and aspiration of food and saliva. The patients were followed-up for 3 months with individualized feeding therapy based on the results of the clinical/VE examination at baseline, and the incidence of pneumonia was examined as the primary outcome. In patients without pneumonia, the body weight change was also measured as a secondary outcome. The risk factors for pneumonia and body weight loss (of 3% or more) were identified among the clinical/VE examination items by a Cox proportional hazard analysis. Even with elaborative feeding therapy, 12 (8·1%) of the 148 patients developed pneumonia during the 3 months follow-up period. The existence of signs of 'silent aspiration of saliva' or 'aspiration of saliva' detected by VE examination was a significant risk factor for both pneumonia and a body weight loss of 3% or more. This study shows that 'aspiration of saliva' detected by VE is a significant risk factor for both pneumonia and body weight loss in elderly patients living in nursing homes.
No preview · Article · Feb 2012 · Journal of Oral Rehabilitation
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to clarify the effect of regular professional supra-gingival plaque control over 2 years
on the dental hygiene status and periodontal conditions of elderly in need of care. The subjects were 88 nursing home
elderly (mean age：81.8±9.1 years) in Taito-ku, Tokyo. Thirty nine subjects were excluded because they either
moved away or died. Fifteen residents received weekly supra-gingival plaque control performed by dental hygienists
in addition to habitual tooth brushing methods by themselves and/or helpers (intervention group) for a baseline. In
another 34 subjects, self-performed tooth brushing and/or brushing by helpers were continued (control group).
Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PlI) were
recorded at baseline and 2 years. Reduction of mean PlI in the intervention group was 0.3±0.4 in 2 years, while in the
control group, mean PlI increased by 0.1±0.8. The differences were statistically significant (p＜0.05). There were no
statistically significant differences with respect to mean PPD, mean CAL and mean BOP between the groups. In the
intervention group, 17 out of 199 teeth were lost (8.5%), while 36 out of 311 teeth were lost (11.6%) in the control
group. These results demonstrated that systemic professional oral care performed by dental hygienist improved the
oral hygiene status in elderly residents in nursing homes. A further large-scale study on the introduction of a
meticulous oral hygiene program is necessary