吉田 光由

BACKGROUND: Although oral frailty is independently associated with an increased risk of mortality, evidence for the usefulness of screening tools for oral frailty is less than that for physical frailty screening tools. We aimed to investigate the relationship between oral frailty and mortality in older adults. METHODS: This prospective cohort study included 11,374 adults aged ≥65 years, who provided valid responses to a baseline mail survey questionnaire from the Kyoto-Kameoka study. Oral frailty status was evaluated using the Oral Frailty Index-8 (range, 0 [best] to 10 [worst]). Participants were classified into four categories according to the Oral Frailty Index-8: robust (score, 0-2), oral pre-frailty (score, 3), oral frailty (score, 4-6), and oral severe frailty (score ≥ 7). Physical and psychological frailty were evaluated using the validated frailty-screening index and defined as a score of ≥3 out of a possible 5 points. Mortality data were collected from 30 July 2011 to 30 November 2016. Hazard ratios (HR) for all-cause mortality were calculated using a multivariable Cox proportional hazards model. RESULTS: During the 5.3-year median follow-up period (57,157 person-years), 1184 deaths were recorded. After adjusting for confounders, including physical and psychological frailty, medical history, and lifestyle, in comparison with a robust oral status, oral pre-frailty (HR, 1.29; 95 % confidence interval [CI], 1.02-1.63), oral frailty (HR, 1.22; 95 % CI, 1.01-1.48), and oral severe frailty (HR, 1.43; 95 % CI, 1.16-1.76) were associated with higher HRs of mortality (p for trend = 0.002). CONCLUSION: Oral frailty is associated with mortality independent of physical and psychological frailty in older adults. The Oral Frailty Index-8 may be useful for identifying individuals at high risk of mortality.

This one-year multicenter longitudinal study aimed to assess whether older adult residents of long-term care facilities should switch from a normal to a dysphagia diet. Using the results of our previous cross-sectional study as baseline, older adults were subdivided into those who maintained a normal diet and those who switched to a dysphagia diet. The explanatory variables were age, sex, body mass index (BMI), Barthel Index, clinical dementia rating (CDR), and 13 simple and 5 objective oral assessments (remaining teeth, functional teeth, oral diadochokinesis, modified water swallowing test, and repetitive saliva swallowing test), which were used in binomial logistic regression analysis. Between-group comparison showed a significantly different BMI, Barthel Index, and CDR. Significant differences were also observed in simple assessments for language, drooling, tongue movement, perioral muscle function, and rinsing and in objective assessments. In multi-level analysis, switching from a normal to a dysphagia diet was significantly associated with simple assessments of tongue movement, perioral muscle function, and rinsing and with the objective assessment of the number of functional teeth. The results suggest that simple assessments can be performed regularly to screen for early signs of discrepancies between food form and eating/swallowing functions, which could lead to the provision of more appropriate food forms.

PURPOSE: This study aimed to determine the association between home visits by a dentist and regular oral hygiene management by a dental hygienist (regular dental management: RDM) and weight loss among older adults in long-term care facilities. METHODS: A total of 468 older residents from 26 Japanese long-term care facilities participated in two surveys in 2018 and 2019. Participants were divided into two groups based on their diet during the baseline survey (regular diet, n = 256; dysphagia diet, n = 212). Participants with a regular diet were further divided into those who exhibited a weight loss ≥ 5% over 1 year (weight loss group: n = 77) and those with a weight loss < 5% (consistent weight group: n = 179). The explanatory variables were age, sex, baseline weight, Barthel index, and clinical dementia rating, as well as the patients' medical history of pneumonia, stroke, diabetes, and depression (which is reportedly associated with weight). Additionally, a Poisson regression with robust standard error, was carried out to analyze the explanatory variables, namely the prevalence of RDM noted during the study and functional teeth (which seemed to affect weight loss). RESULTS: A multivariate analysis revealed that older residents' lack of RDM, clinical dementia assessment, and their history of pneumonia (prevalence rate ratio: 0.35, 95% confidence interval 0.24-0.95) were all significantly associated with weight loss when on a regular diet. CONCLUSION: Thus, weight loss and RDM were related to each other. Weight loss may be suppressed by incorporating RDMs during the early nursing care for older residents on regular diets.

OBJECTIVE: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention. BACKGROUND: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents. MATERIALS AND METHODS: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables. RESULTS: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665). CONCLUSION: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.

OBJECTIVE: The purpose of this study was to examine the frequency of oral hypofunction in community-dwelling older people and determine its relationship with frailty and sarcopenia. BACKGROUND: Previous studies have shown that frailty and sarcopenia are associated with decreased oral function. However, these studies have only evaluated frailty or sarcopenia alone and have not evaluated their relationship with each other. MATERIALS AND METHODS: The participants were community-dwelling independent older people in Kyoto. Their oral function evaluation included seven items (oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function). Oral hypofunction was defined as abnormalities in at least three of these items. The frailty status was classified into three categories (robust, pre-frail and frail) according to the frailty phenotype and deficit-accumulation models. Sarcopenia was defined according to the Asian Working Group for Sarcopenia (AWGS) Consensus. The relationships between oral function and frailty were analysed using logistic regression analyses, after adjusting for sarcopenia. RESULTS: Among the 340 participants that were analysed (69 men, 271 women; average age: 75.0 years), 182 (53.5%) had oral hypofunction (40 men, 142 women; average age: 76.8 years). There was a significant relationship between oral hypofunction and deficit-accumulation model-assessed frailty, after adjusting for sarcopenia. CONCLUSION: Almost half of the community-dwelling older people have oral hypofunction, which is significantly related to comprehensive frailty and sarcopenia.

Although better diet quality is inversely related to the risk of geriatric disorders, the association of adherence to dietary guidelines with oral health-related quality of life (OHRQoL) is unclear. We aimed to investigate this association in older Japanese adults. This cross-sectional study included 7,984 Japanese participants aged ≥65 years from the population-based Kyoto-Kameoka study. Dietary intake was estimated using a validated self-administered food frequency questionnaire. The scores for adherence to the Japanese Food Guide Spinning Top (range: 0 [worst] to 80 [best]) were calculated. These scores were stratified into quartiles (Qs). Poor OHRQoL was defined as a score ≤ 50 using a 12-item Geriatric Oral Health Assessment Index. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariable logistic regression and the spline model. Higher adherence score was associated with a lower prevalence of poor OHRQoL (Q1-Q4: 36.0%, 32.1%, 27.9%, and 25.1%, respectively). An inverse association was found between the score for adherence to the food-based Japanese dietary guidelines and the ORs of poor OHRQoL among all the participants (Q1: reference; Q2: OR, 0.87 [95% CI: 0.75-1.00]; Q3: OR, 0.77 [95% CI: 0.66-0.90]; Q4: OR, 0.72 [95% CI: 0.62-0.85]; p for trend < 0.001). These relationships were similar to the results in the spline model. Higher adherence to the food-based Japanese dietary guidelines is inversely associated with the prevalence of poor OHRQoL in older adults. Our results may provide useful insights to improve and maintain oral health.

Although the life expectancy of women is over 80 years in many countries, oral sensation has scarcely been compared between adults ≥ 80 years and younger age groups. The purpose of this study was to clarify age-related changes in oral sensation throughout adulthood. After exclusion of individuals with factors that might have confounded somatosensory performance, 123 female participants were divided into four age groups: 20-39 years, 40-59 years, 60-79 years, and 80-96 years. Perceptions of tactile and thermal sensations were examined at points on the anterior and posterior palate, anterior and posterior tongue, lower labial-attached gingiva, lower lip, and buccal mucosa; two-point discrimination was examined only on the tongue. The tactile and two-point discrimination thresholds for the anterior and posterior tongue were significantly higher in the 80-96-year-old group than in any other age group (p < 0.05). The tactile threshold for the buccal mucosa was significantly higher in the 80-96-year-old group than in the 60-79-year-old group (p < 0.05). The percentage of participants able to perceive a warm stimulus (50 °C) in the buccal mucosa was significantly lower in the 80-96-year-old group than in the 20-39-year-old group (p < 0.05). Only the topography of the warm sensation perception changed with age. This cross-sectional study suggests that oral tactile and thermal sensation for warm stimuli deteriorates with age in a site-specific manner, especially after the age of 80 years, but the same does not occur with cool stimuli.

BACKGROUND AND PURPOSE: We aimed to assess stroke lesions, which play a key role in determining swallowing dysfunction, and findings of videofluoroscopy (VF), which provides the most accurate instrumental assessment for evaluating swallowing function, in patients with acute stroke. METHODS: We enrolled 342 patients with first-time acute stroke (age 70.4 ± 12.6 years, 142 female). Patients with dementia and altered mental status due to severe stroke were excluded. All patients underwent cranial magnetic resonance imaging to identify the location of stroke lesion, VF, and tongue pressure measurement. RESULTS: Aspiration was detected in 45 (13.2%) patients. Multivariate analysis identified parietal lobe lesion and the National Institutes of Health Stroke Scale (NIHSS) score as independent significant factors for aspiration (odds ratio 6.33, 95% confidence interval [CI] 2.25-17.84, p < 0.001; odds ratio 1.12, 95% CI 1.03-1.20, p = 0.004, respectively). Swallowing reflex delay was detected in 58 (17.0%) patients. Multivariate analysis identified habitual drinking, basal ganglia lesion, and the NIHSS score as independent significant factors for swallowing reflex delay (odds ratio 0.51, 95% CI 0.26-0.99, p = 0.047; odds ratio 1.91, 95% CI 1.09-3.67, p = 0.041; odds ratio 1.12, 95% CI 1.05-1.20, p < 0.001, respectively). Additionally, oral cavity and pharyngeal residues were independently associated with tongue pressure. CONCLUSION: Parietal lobe lesions are associated with aspiration and basal ganglia lesions with swallowing reflex delay.

Objective: The purpose of this study was to assess the distinction in oral features/symptoms and occlusal function between young dentate individuals with and without buccal mucosa ridging (BMR). Methods: This cross-sectional study included 200 young adults. The outcome variable was BMR state. The predictor variables were oral features/symptoms (torus palatinus, torus mandibularis, temporomandibular joint noise, bruxism, tongue thrusting habit, number of teeth present, and occlusal vertical dimension) and oral function (occlusal force, occlusal contact area, occlusal pressure, tongue pressure). These variables were compared among participants with and without BMR using univariate and multiple logistic regression analysis. Results: There were 119 participants with BMR and 81 without BMR. Multiple logistic regression analysis revealed that BMR was closely associated with bruxism, occlusal vertical dimension, and occlusal pressure. Discussion: Oral/occlusal changes of increased bruxism, lower occlusal vertical dimension, and lower occlusal pressure constitute the major causes of BMR.

Background/purpose: Tongue pressure measurement conveys important information about eating and swallowing function. The Iowa Oral Performance Instrument® (IOPI) and KAY Swallowing Workstation® are internationally used for tongue pressure measurement, but for legal reasons cannot be used in Japan; rather the JMS tongue pressure measurement device® has been approved for use in Japan. However, it is not clear whether measurement obtained with these devices are directly comparable. Materials and methods: This study investigated the correlation between the maximum tongue pressure data measured by the IOPI and the JMS tongue pressure measurement device in young healthy participants (34 males; 23.2 ± 2.0 years old, and 40 females; 21.4 ± 1.3 years old). Results: Measurements obtained with these two devices showed significant correlations in the total cohort, and in male and female participants, separately (P < 0.05). Conclusion: These findings demonstrate that the measurements obtained with the JMS device is comparable to those obtained with the IOPI. In Japan, JMS tongue pressure measurement device is used not only in dysphagia research field, but also geriatrics field, and extensive and detailed investigations has been carried out.

Background/purpose: Although many studies have examined the efficacy of neck and trunk positioning during eating, few studies have examined how the positioning of the lower extremities affects swallowing function. The purpose of this study was to examine how tongue pressure, which is an important factor during swallowing, is affected by eating postures in bed and wheelchair. Materials and methods: A total of 43 healthy adults (13 men and 30 women; 29.0 ± 5.9 years) and 33 elderly individuals requiring long-term care (14 men and 19 women; 83.6 ± 7.8 years) participated.In both healthy and elderly participants, tongue pressure was measured in four different postures: a good and poor postures in bed (postures 1 and 2, respectively), and a good and poor postures in a reclining wheelchair (posture 3 and 4, respectively). Results: Among the healthy participants, the mean tongue pressure was significantly higher in posture 1 (40.2 ± 7.24 kPa) than in posture 2 (37.6 ± 8.68 kPa) or posture 4 (38.2 ± 8.14 kPa) (P < 0.05). Tongue pressure was also significantly higher in posture 3 (41.3 ± 7.75 kPa) than in either posture 2 or 4 (P < 0.05).Among the elderly participants, the median tongue pressure in posture 1 (16.9 kPa; interquartile range [IQR], 9.4-21.6 kPa) was significantly higher than that in posture 2 (14.1 kPa; IQR, 9.2-21.6 kPa). Tongue pressure in posture 3 (18.5 kPa; IQR, 14.2-26.0 kPa) was significantly higher than that in either posture 1 or 2, and posture 4 (15.9 kPa; IQR, 10.6-22.9 kPa). Conclusion: Posture during eating can potentially affect tongue pressure.

BACKGROUND AND PURPOSE: Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests. METHODS: Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST. RESULTS: Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF. CONCLUSIONS: Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure.

Background: Mastication is the process of breaking ingested food with the teeth and mixing it with saliva to form a mass that is easy to swallow. However, few studies have reported on oral functions, such as occlusal force, tongue pressure, and mastication. The purpose of this study was to evaluate the association between masticatory function and oral functions, such as occlusal force and tongue pressure. Material and Methods: In this study, there were 113 patients (41 men and 72 women; mean age, 68.4 ± 11.3 years) who visited dentists at the Hiroshima University Hospital, Hiroshima, Japan between April 2015 and November 2018. Masticatory function of the patients was evaluated using a masticatory ability test system. In addition, occlusal force was measured using a pressure-sensitive film and the maximum tongue pressure was measured with a tongue pressure measuring device according to a conventional method. The relationship of masticatory ability with occlusal force and tongue pressure was examined using multivariate analysis while considering patients' age, gender, and the number of remaining teeth. Results: Masticatory ability was significantly related to occlusal force, maximum tongue pressure, age, body mass index, the number of remaining teeth, and occlusal contact area (p< 0.05). Multiple regression analysis identified that masticatory ability was significantly associated (p< 0.05) with occlusal force and maximum tongue pressure. Conclusions: Masticatory ability was significantly associated with occlusal force and maximum tongue pressure, indicating that the large muscle mass in the oral cavity is indispensable for improving masticatory function. Key words:Mastication, tongue pressure, occlusion force, oral function.

Background/purpose: To identify age-related changes in maximum tongue pressure (MTP), it is necessary to determine individual biological age. The fitness age score (FAS) is used to calculate the biological age, based on the one-leg standing time with eyes open, vertical jump height, grip strength, functional reach, and 10-m walk time. Materials and methods: The study included 112 community-dwelling elderly adults (42 males and 70 females). We investigated MTP, FAS, and body mass index (BMI) at baseline and 5 years later. MTP was determined with a pressure measurement device. Results: A significant reduction in MTP, FAS, and BMI in both male and female subjects was observed at 5 years. A negative correlation between change in MTP and baseline MTP was observed, but there was no correlation between MTP change and baseline FAS, BMI, and change in FAS and BMI. Conclusion: Age-related decline in MTP might be associated with high MTP, reflecting decreased reserve. Additionally, age-related decline in tongue function might be different from that of physical function.

Background/purpose: Stress in the elderly is caused by loss of physical and psychological health. Although there have been many reports on the intraoral environment affecting physical health, few reports exist on stress and the intraoral environment in the elderly. The aim of this study was to investigate the relationship between salivary α-amylase as an index of stress value and the intraoral environment. Materials and methods: Three hundred and nineteen participants were community-dwelling independent individuals over 65 years old. The outcome variable was salivary α-amylase. After measurement, salivary α-amylase was classified into four groups (0 = 0-30, 1 = 31-45, 2 = 46-60, 3 = 61-200). The predictor variables were physical status (which includes age and male body-mass index) and subjective and objective symptoms (which include present teeth, torus palatinus, torus mandibularis, temporomandibular joint noise, bruxism, and dental attrition). These variables were compared among participants using univariate analysis and multiple logistic regression analysis. Results: The participants included 77 men and 242 women, with a mean age of 75.8 ± 5.4 years (65-94 years). Although temporomandibular joint noise and dental attrition were significantly positively correlated with salivary α-amylase, bruxism was significantly negatively correlated with salivary α-amylase (p < 0.05). Stepwise regression analysis revealed a significant relationship between salivary α-amylase and temporomandibular joint noise, bruxism, and dental attrition. Conclusion: High salivary α-amylase is associated with a high rate of temporomandibular joint noise and dental attrition, and a low rate of bruxism among elderly participants.

The relationship between mixing ability of masticatory functions and frailty has not been well evaluated. This study investigated the prevalence of physical and comprehensive frailty and its association with mixing ability in 1106 older adults aged ≥65 years who underwent physical examination as part of the Japanese Kyoto-Kameoka Study. Mixing ability was assessed using color-changing chewing gum (1-5 points, 5 representing the best mixing ability). Participants were divided into four groups (5 points, 4 points, 3 points, and 1 or 2 points). The modified Japanese versions of the Cardiovascular Health Study (mJ-CHS) criteria and the validated Kihon Checklist (KCL) were used to assess physical and comprehensive frailty, respectively. Multivariate logistic regression was used to evaluate the association between frailty and mixing ability. The prevalence of physical and comprehensive frailty was 11.8% and 27.9%, respectively. After adjusting for confounders, the odds ratios of physical and comprehensive frailty comparing the highest to the lowest chewing gum score groups were 3.64 (95% confidence interval (CI): 1.62 to 8.18; p for trend = 0.001) and 2.09 (95% CI: 1.09 to 4.03; p for trend = 0.009), respectively. Mixing-ability tests involving chewing gum may be an indicator associated with both physical and comprehensive frailty.

目的:舌接触補助床(PAP)装着前後の舌圧の変化を明らかにすること。方法:全国の17施設においてPAPによる治療を行った摂食嚥下障害患者を後方視的に調査した。PAP装着前後ならびに再評価時の3回最大舌圧が測定されていたのは51例であり、これらを口腔腫瘍などの器質的障害群23例と脳血管疾患などの機能的障害群28例に分類した。PAP装着前後ならびに再評価時の最大舌圧の比較、PAP装着直後の即時的舌圧変化量と再評価時までの長期的舌圧変化量の関係を検討した。また、29例で測定されていた嚥下時舌圧の装着前後の変化についても検討した。結果:器質的障害群の最大舌圧は、装着前9.6±8.8kPa、装着直後16.4±10.3kPa、再評価時20.7±11.2kPaと増加した(p&lt;0.01)。また、即時的舌圧変化量と長期的舌圧変化量には強い正の相関を認めた(r=0.81、p&lt;0.01)。機能的障害群の最大舌圧は、装着前12.1±7.0kPa、装着直後15.5±8.0kPa、再評価時18.7±7.7kPaと増加しており(p&lt;0.01)、即時的舌圧変化量と長期的舌圧変化量には中等度の正の相関を認めた(r=0.51、p&lt;0.01)。嚥下時舌圧もPAP装着前の3.0±3.5kPaから装着直後の11.8±9.2kPaに増加していた(p&lt;0.01)。結論:最大舌圧は、PAP装着後に即時的および長期的に増加し、即時的効果が得られた者ほど長期的な効果も期待できる傾向を認めた。また、嚥下時舌圧もPAP装着により増加することが示された。(著者抄録)

BACKGROUND/OBJECTIVES: The consumption of both green tea and coffee is known to induce positive health effects; however, it remains unclear whether there is an association between the consumption of these beverages and oral health-related quality of life (OHRQoL). Thus, the present study investigated the relationship between the consumption of green tea and coffee and OHRQoL. SUBJECTS/METHODS: We analyzed cross-sectional baseline data in 2012. The subjects were 7514 Japanese participants (3563 men, 3951 women; ≥65 years of age). Each subject completed a validated self-administered questionnaire that included items on the frequency of the consumption of green tea and coffee. OHRQoL was evaluated using the self-reported General Oral Health Assessment Index (GOHAI), which assesses oral health problems in older adults. A GOHAI score <50 points was defined as a poor OHRQoL. RESULTS: Following adjustment for age, body mass index, total energy intake, alcohol, smoking, medication use, coffee, and fruit and vegetable consumption, increased consumption of green tea showed a strong positive association with the GOHAI score in both men and women (Ptrend < 0.001 in both). In contrast, after adjusting for all factors, no statistically significant association was observed between coffee consumption and the GOHAI score in men (Ptrend = 0.538) or women (Ptrend = 0.607). The respective multivariate-odds ratios (95% confidence intervals) for a poor OHRQoL associated with green tea consumption frequencies of none, <1 cup/day, 1-2 cups/day, and ≥3 cups/day were 1.00, 1.01 (0.80-1.27), 0.95 (0.74-1.21), and 0.78 (0.61-0.99) (Ptrend = 0.024) in men, and 1.00, 1.19 (0.90-1.57), 0.98 (0.74-1.29), and 0.86 (0.67-1.12) (Ptrend = 0.014) in women. CONCLUSIONS: Regardless of sex, green tea consumption was positively associated with the GOHAI score. Therefore, ≥3 cups/day of green tea may reduce the risk of a poor OHRQoL, especially in men.

Purpose: The aim of this study was to clarify the effects of fitting palatal augmentation prosthesis (PAP) on the swallowing function for the patients in rehabilitation hospital. Methods: The subjects included 18 elderly hospitalized patients whose body mass index was <18.5 kg/m(2). All subjects wore maxillary complete denture. During a videofluoroscopic examination in which the patients were asked to swallow, post-swallowing pyriform sinus residue was detected. The subjects' maxillary dentures were then modified into PAPs by recording tongue movement in the palatal region. The resulting swallowing dynamics were evaluated qualitatively and quantitatively before and after fitting the PAP. Results: We found that fitting the PAP resulted in the resolution of aspiration in two patients and disappearance of pharyngeal residue in three. The pharyngeal delay and transit times were significantly shortened. Conclusions: These results demonstrated that PAPs could be beneficial treatment devices that may reduce post-swallowing pharyngeal residue formation due to decreased muscle strength. (C) 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Purpose: The aim of this study was to determine the influences of oral motor function such as tongue function and bite force on masticatory performance in the elderly. Methods: We randomly selected 245 subjects who has 28 natural teeth among community-dwelling elderly. We evaluated masticatory performance using a gummy jelly, and also measured bite force, tongue muscle force, and the speed of tongue movement. Results: We found that reduced masticatory performance to be associated with decreased the speed of tongue movement and/or tongue muscle force, indicating that reduced oral motor function also influences masticatory performance. Conclusions: These results suggest that keeping oral motor function, as well as maintenance of occlusal support, to be important for maintaining masticatory function in the elderly. (c) 2018 Japan Prosthodontic Society. Published by Elsevier Ltd. All rights reserved.

Objectives: This study aimed to evaluate the association between buccal mucosa ridging and oral or occlusal statuses among older people. Subjects and Methods: This cross-sectional study examined 262 independent older people (mean age, 74.2 ± 5.9 years) who participated in the Kyoto Elderly Physical Fitness Measurement Research Project. The predictor variables were oral statuses (number of present teeth and torus palatinus, torus mandibularis, temporomandibular joint noise, clenching, or grinding) and oral functions (occlusal pressure, cheek pressure, oral diadochokinesis, and tongue pressure). The outcome variable was the buccal mucosa ridging status (presence or absence). Additional variables were age, sex, body mass index, grip strength, and wearing dentures. We compared these variables between participants with and without buccal mucosa ridging using a univariate analysis and multiple logistic regression analysis. Results: Buccal mucosa ridging was present in 177 (67.6%) people. Multiple logistic regression analysis revealed a close association of buccal mucosa ridging with torus mandibularis, tooth clenching and grinding and occlusal pressure, and cheek pressure. Conclusions: Over 50% of the participants showed buccal mucosa ridging this was significantly associated with higher cheek pressure, lower occlusal pressure, torus mandibularis, and tooth clenching and grinding.

Objectives To develop and assess a dysphagia training method involving lollipop sucking training in older adults with dementia, clarify its effectiveness for improving oral function. Methods Twenty-five older adults with dementia (5 males and 20 females, mean age 90.8 ± 6.7 years) were participated in this study. Participants were trained in lollipop sucking once a day, 3 times a week for 6 months. Mini-Mental State Examination (MMSE), Barthel Index (BI), Candy Sucking Test (CST), and BMI values were measured before and after the training. Participants were grouped into those who achieved &gt 0.1 g/min increase in CTS value after the training (increase group) and those who did not (nonincrease group). Results No significant change was observed after the training. The increase group contained 4 patients and the non-increase group contained 21 patients. There were no significant differences in MMSE, BI, or BMI between the two groups before and after the training. However, the CST values of the increase group before the training (0.31 ± 0.13 g/min) were significantly lower than non-increase group (0.69 ± 0.27 g/min) (p &lt 0.01). Respective changes in BMI before and after training were 1.13 ± 0.85 kg/m² and −0.53 ± 1.76 kg/m² in the increase and non-increase, and the difference in these changes was statistically significant (p = 0.04). Conclusions Our new rehabilitation method was well accepted by older adults with dementia, and there was an improvement in oral function as a result of the rehabilitation, which had some good influence on weight gain.

Purpose: Maintenance of natural dentition and/or prosthodontic rehabilitation is necessary for good masticatory function. Although other factors such as physical and oral functions are also important for masticatory performance, only a few studies have evaluated their roles. The aim of the current study was to assess factors associated with masticatory performance among elderly individuals, while maintaining and/or reconstructing all occlusal support areas. Methods: The present study was designed and implemented as a cross-sectional study, involving a total of 262 participants (mean age: 74.2 ± 5.9 years) who participated in the Kyoto Elders Physical Fitness Measurement Research Project. Individuals with partial or complete edentulousness who did not use dentures were excluded from the study. The predictor variables included physical status (i.e., age, gender, body-mass index, and grip strength), oral conditions (i.e., number of present teeth, temporomandibular joint noise, and denture wearer), and oral functions (i.e., maximum voluntary occlusal force occlusal contact area cheek pressure oral diadochokinesis test /pa/, /ta/, /ka/ and maximum voluntary tongue pressure). The variable outcome was masticatory performance. These variables among the participants using univariate and multivariate analyses were compared. Results: Grip strength, number of present teeth, maximum voluntary occlusal force, occlusal contact area, oral diadochokinesis /ka/ /ta/, and maximum voluntary tongue pressure were significant factors for masticatory performance. Stepwise regression analysis showed that grip strength, maximum voluntary occlusal force, and diadochokinesis /ta/ significantly affected masticatory performance. Conclusions: Masticatory performance was closely associated with grip strength, maximum voluntary occlusal force, and diadochokinesis /ta/ among healthy elderly participants.

Objective: Many previous studies have reported that fruit and vegetable consumption is associated with a reduced risk of various disease, but whether or not their consumption is associated with the oral health-related quality of life (OHRQoL) is unclear. The objective of this study was to examine the association between the frequency of fruit and vegetable consumption and the OHRQoL in elderly subjects by sex. Methods: We analyzed cross-sectional data from a population-based Kyoto-Kameoka Study in 2012 of 3112 men and 3439 women (age 65 years). The frequencies of fruit and vegetable consumption were assessed using a validated food frequency questionnaire. We evaluated the OHRQoL using the General Oral Health Assessment Index (GOHAI), a self-reported measure designed to assess the oral health problems in old adults. Results: After adjusting for age, body mass index, alcohol, smoking, education, socioeconomic status, history of disease, medication use, mobility disability, and total energy intake, a higher frequency of combined fruit and vegetable consumption showed a significant positive association with the GOHAI score in both men and women (p-trend &lt; 0.001 in both sexes). These associations remained significant after adjustment for poor mastication and denture use (p-trend all &lt; 0.05 in both sexes). We observed a significant positive association even when the frequencies of fruit or vegetable consumption were analyzed separately (all p-trend &lt; 0.05 in both sexes). Conclusions: A higher frequency of fruit and/or vegetable consumption independently showed a strong positive association with the OHRQoL in both men and women. Further prospective studies are needed to confirm these findings.

Purpose: There have been only a few reports on the prevalence of torus mandibularis (TM) in young adult patients, and TM can have various adverse effects on oral and occlusal states in middle-age patients. This study was designed to determine the association between TM status and oral and occlusal states in young healthy dentate adults. Materials and Methods: This was a cross-sectional study; the sample population included students at Hiroshima University (Hiroshima, Japan) who participated for practical education. The predictor variables in this study included oral symptoms (temporomandibular joint noise, tooth clenching and grinding, buccal mucosa ridging, dental attrition, and tongue habit), oral anatomy (occlusal vertical dimension), and oral function (average occlusal pressure, occlusal contact area, and maximum voluntary tongue pressure). The outcome variable was TM status (present or absent). Additional variables were demographic in nature and included age, number of residual teeth, body weight, and gender. These variables were compared among participants with and without TM using univariate analysis and multiple logistic regression analysis. Statistical analyses were carried out using SPSS Statistics 19 for Windows (IBM Corp, Armonk, NY); a P value less than .05 was considered significant. Results: Of 204 participants included in the study, 50% were men and 50% were women. The mean age was 22.4 +/- 2.7 years. TM was present in 119 (58.3%). Multiple logistic regression analysis showed that TM status was associated with dental attrition and occlusal contact area (P&lt;.05). Conclusions: This study showed that TM was present in more than half the young healthy dentate participants and was closely associated with dental attrition and occlusal contact area. This study will provide readers with useful information to help prevent the development of TM before middle age. (C) 2017 The Authors. Published by Elsevier Inc. on behalf of American Association of Oral and Maxillofacial Surgeons.

AimTo maintain oral intake in elderly patients with dementia, it is important to evaluate their oral function. However, these patients often have difficulties following instructions during oral function tests, especially with the progression of dementia. The task of sucking a lollipop candy is simple for elderly patients with mild or severe dementia. The present study aimed to develop a new oral function test - the candy sucking test (CST) - for elderly patients with dementia. MethodsWe recruited 23 female elderly patients with dementia (mean age 89.0 6.7 years). First, we determined the number of participants who were able to carry out this new oral function test, compared with other existing tests. Then, swallowing function was evaluated using videofluoroscopy for those who could carry out the CST. ResultsMore participants were able to perform carry out CST than other function tests (P &lt; 0.05). A significant correlation was observed between the CST value, evaluated as the difference in candy weight, and oral transit time ( = -0.62, P &lt; 0.01). ConclusionsThe CST could be useful as a new method for evaluating the oral function of elderly patients with dementia. Geriatr Gerontol Int 2017; 17: 1977-1981.

AimTo maintain oral intake in elderly patients with dementia, it is important to evaluate their oral function. However, these patients often have difficulties following instructions during oral function tests, especially with the progression of dementia. The task of sucking a lollipop candy is simple for elderly patients with mild or severe dementia. The present study aimed to develop a new oral function test - the candy sucking test (CST) - for elderly patients with dementia. MethodsWe recruited 23 female elderly patients with dementia (mean age 89.0 6.7 years). First, we determined the number of participants who were able to carry out this new oral function test, compared with other existing tests. Then, swallowing function was evaluated using videofluoroscopy for those who could carry out the CST. ResultsMore participants were able to perform carry out CST than other function tests (P &lt; 0.05). A significant correlation was observed between the CST value, evaluated as the difference in candy weight, and oral transit time ( = -0.62, P &lt; 0.01). ConclusionsThe CST could be useful as a new method for evaluating the oral function of elderly patients with dementia. Geriatr Gerontol Int 2017; 17: 1977-1981.

Tongue strength is a useful indicator of oral function and has been found to decrease with aging and reduced physical functioning. The present study aimed to assess the relationships of tongue strength with physical function, mental function, and nutritional status, and also between these factors and 1-year outcomes, to determine whether tongue strength is related to life expectancy in elderly people needing nursing care. The subjects were 140 elderly individuals requiring needing nursing care (49 men and 91 women; ae&lt;yen&gt;65 years). The investigated items included sex, age, activities of daily living (ADL), comorbidity, cognitive function, nutritional status, eating function, occlusal support, and tongue strength. Furthermore, a follow-up study was conducted 1 year later, and factors related to death were identified. The mean tongue strength of the total 140 subjects was 20.3 +/- 8.6 kPa. Tongue strength was assessed relative to each of the investigated items, using the t test and one-way analysis of variance. Tongue strength was significantly related to ADL, comorbidity, cognitive function, calf circumference, food intake, and occlusal support. Fifteen subjects were found to have died at the 1-year follow-up study. We assessed the relationships of 1-year outcomes with each of the factors examined, and 1-year outcomes were found to be significantly related to ADL and tongue strength.

Tongue strength is a useful indicator of oral function and has been found to decrease with aging and reduced physical functioning. The present study aimed to assess the relationships of tongue strength with physical function, mental function, and nutritional status, and also between these factors and 1-year outcomes, to determine whether tongue strength is related to life expectancy in elderly people needing nursing care. The subjects were 140 elderly individuals requiring needing nursing care (49 men and 91 women; ae&lt;yen&gt;65 years). The investigated items included sex, age, activities of daily living (ADL), comorbidity, cognitive function, nutritional status, eating function, occlusal support, and tongue strength. Furthermore, a follow-up study was conducted 1 year later, and factors related to death were identified. The mean tongue strength of the total 140 subjects was 20.3 +/- 8.6 kPa. Tongue strength was assessed relative to each of the investigated items, using the t test and one-way analysis of variance. Tongue strength was significantly related to ADL, comorbidity, cognitive function, calf circumference, food intake, and occlusal support. Fifteen subjects were found to have died at the 1-year follow-up study. We assessed the relationships of 1-year outcomes with each of the factors examined, and 1-year outcomes were found to be significantly related to ADL and tongue strength.

Maximum tongue pressure (MTP) measurement is a convenient, less invasive assessment that has been developed to quantify tongue strength; however, it is unclear whether MTP is useful for the detection of swallowing disorders in amyotrophic lateral sclerosis (ALS) patients. The purpose of this study was to clarify the relationship between MTP and the characteristics of swallowing disorders on videofluorography and to determine the usefulness of tongue pressure measurement for the assessment of swallowing function in ALS patients. Twenty-five ALS patients were evaluated according to the ALS functional rating scale-revised (ALSFRS-R), and their ability to swallow yogurt was observed via videofluorography. MTP was measured using a device (TPM-01, JMS, Hiroshima) equipped with a balloon probe. Then, the relationships between the ALSFRS-R score, swallowing function, and MTP were analyzed. MTP was significantly lower in the subjects with reduced tongue function (p = 0.002) or with pharyngeal residue (p = 0.006) than in the subjects with normal characteristics. Bolus formation and oral transit time and pharyngeal transit time were significantly prolonged among those with reduced MTP. MTP at a cut-off value of 21.0 kPa was associated with a full score on the bulbar-related items of the ALSFRS-R. MTP may serve as a new diagnostic tool for the early detection of swallowing dysfunction in ALS patients, because of its good relationship with their swallowing characteristics.

Objective: The Kyoto-Kameoka Study was launched in 2011e2012 to identify the associations among food intake, nutritional status, physical activity, oral function, quality of life or social capital, the use of longterm care insurance (LTCI) system, and healthy lifespan in community-dwelling older people as a part of the World Health Organization Safe Community program. Design: A prospective cohort study, reporting baseline demographics (cross-sectional data). Setting and participants: We conducted 2 mailed self-administered questionnaire surveys; one is a complete population survey with a comprehensive survey of needs in the sphere of daily life (NSDL) that included 2 different frailty indexes, the Kihon Checklist (KCL) and the Fried phenotype, socioeconomic status, general and psychological health, and social relationships; followed by the more detailed Health and Nutrition Survey. A slightly modified NSDL survey was conducted again in 2013. Survival time, LTCI certification, and medical and long-term care costs after the baseline survey will be followed. Results: Of 18,231 NSDL questionnaires distributed, 13,294 people responded (response rate: 72.92%; mean age 73.7 +/- 6.4 and 75.1 +/- 7.2 years for men and women, respectively; 12,054 people without and 1240 with LTCI certification). In people without LTCI, the proportion of robust, prefrail, and frail were 30.3%, 59.8%, and 9.9% in men and 25.3%, 64.7%, and 10.0% in women, according to the Fried index. The proportion of frail people as defined by KCL &gt;= 7 was 30.8% in men and 33.3% in women. Conclusions: The study is the first to document frailty prevalence using both Fried and KCL measures with a complete city population survey among older Japanese in the community as a part of World Health Organization Safe Community program. The study is expected to provide valuable evidence of the effects of lifestyle habits on long-term care prevention and healthy life span. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Some patients with Guillain-Barr, syndrome require respiratory management by tracheotomy and/or nutritional management by tube feeding; however, few studies have reported the follow-up course in these patients. The objective of this study was to investigate the follow-up course of tracheotomy and gastrostomy in patients with Guillain-Barr, syndrome. The study subjects were 50 patients with Guillain-Barr, syndrome (25 males, 25 females; mean age, 51.1 +/- 18.7 years) who were admitted to the Hiroshima City Rehabilitation Hospital during the period from April 2008 to December 2015. We retrospectively reviewed the medical records to determine the presence or absence of tracheotomy and/or feeding tube, and the timing of withdrawal from these treatments. During the acute phase, 15 patients underwent tracheotomy and 14 underwent tube feeding management. A tracheotomy tube was inserted for 110 days or longer in five patients, and four of these five patients also had a gastrostomy tube inserted. Among the 14 patients in the tube feeding group, seven underwent nasal feeding and seven underwent percutaneous endoscopic gastrostomy. All patients had the nasal tube removed (mean duration of nasal tube placement, 62.1 +/- 46.5 days); however, the gastrostomy tube could not be removed in two patients. Our findings indicate that patients in the acute phase of Guillain-Barr, syndrome carry a relevant risk of long-term tube feeding and prolonged need of an artificial airway.

AimTo 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. MethodThe participants were 618 older people (mean age 86.86.9 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. ResultsThe 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. ConclusionsThe 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 2017; 17: 219-225.

AimTo 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. MethodThe participants were 618 older people (mean age 86.86.9 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. ResultsThe 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. ConclusionsThe 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 2017; 17: 219-225.