吉田 光由

BACKGROUND: Measurement of bite force is important for understanding oral function. OBJECTIVES: We aimed to clarify the relationship between the values of a newly developed one-sided measurement-type bite force meter (OBM-01 Prototype, JMS, Hiroshima) and those of a full-dentition bite force meter (Dental Prescale II, GC, Tokyo). Furthermore, we examined the intra- and inter-rater reliability (intraclass correlation coefficients; ICCs) using the OBM-01 Prototype. METHODS: Three studies were conducted. The first examined the ICC of the OBM-01 Prototype in 22 healthy adults; the second evaluated the relationship between the habitual chewing side bite force measured by the OBM-01 Prototype in 343 older adults, with or without dentures; and the third assessed the relationship between measurements obtained from the OBM-01 Prototype and Dental Prescale II in 201 older adults. RESULTS: The ICCs showed good reliability. A moderate correlation was observed between the OBM-01 Prototype and Dental Prescale II, regardless of sex or denture presence on the habitual chewing side (Spearman's Rho; men 0.65, women 0.51 in non-denture group, men 0.51, women 0.55 in denture group). In both men and women, compared with the non-habitual chewing side, the habitual chewing side had significantly greater bite force. Additionally, the bite forces on the habitual and non-habitual chewing sides were strongly and positively correlated with the total bite force measured using the Dental Prescale II (Spearman's Rho; men: habitual 0.676, non-habitual 0.746, women: habitual 0.705, non-habitual 0.640). CONCLUSIONS: A correlation was observed between the measurements obtained from the OBM-01 Prototype and Dental Prescale II.

Background/Objectives: Providing an appropriate diet to older adults with dysphagia can prevent aspiration, choking, and nutritional deficiencies and help preserve their quality of life. Therefore, assessments for determining the appropriateness of food types are required. This multicenter study aimed to determine the reliability and validity of the Meal Rounds Observation Form (MROF), which was developed to identify food forms that can be safely consumed by older adults with dysphagia. Methods: We analyzed 532 food-texture observations obtained from 155 participants (114 men and 41 women). The reliability and validity of the MROF were compared with those of videofluoroscopic (VF) or videoendoscopic (VE) examinations of swallowing. Results: The food-form categories were water (108 pairs), 0j (54 pairs), 0t (118 pairs), 1j (20 pairs), 2-1 (28 pairs), 2-2 (37 pairs), 3 (68 pairs), 4 (67 pairs), and normal food (32 pairs) based on JDD 2021 codes. The AUC was lowest for the water (0.568) category and highest for food forms requiring chewing, such as those of the 4 and normal food (0.678) categories. The sensitivity and specificity of the Gugging Swallowing Screen were 60.1% and 69.1%, respectively (p < 0.001). The agreement between the Gugging Swallowing Screen and the MROF evaluation for food types requiring mastication was 73.2%. Logistic regression analysis revealed asymmetric movement of the corners of the mouth and coughing as important indicators when evaluating food types requiring mastication. Conclusions: The MROF is useful for determining food intake safety when VF or VE tests cannot be performed in medical and nursing care settings and can guide clinical decision-making. However, caution is required in applying it clinically because of its relatively low specificity.

Objectives: Malnutrition can influence perioperative complications and long-term survival in patients with gastrointestinal (GI) cancers. Oral functional decline is associated with decreased food intake, and a reduced number of remaining teeth contributes to malnutrition. However, the impact of preoperative oral conditions on perioperative nutritional status remains unclear. This study investigated the relationship between the number of remaining teeth and the prognostic nutritional index (PNI) in patients undergoing surgery for gastrointestinal malignancies. Methods: In total, 178 patients who underwent gastrointestinal surgery with perioperative oral management at our hospital between January and December 2022 were retrospectively analyzed. Data, including age, sex, tumor site, number of remaining teeth, blood test results, skeletal muscle index, and body mass index (BMI), were extracted from electronic medical records. The PNI and CRP-albumin ratio (CAR) were calculated. Correlations between the number of remaining teeth and nutritional indicators were examined. Results: The number of remaining teeth showed a significant correlation with the PNI in the upper gastrointestinal group (r = 0.336, p = 0.015) and with BMI in the hepatobiliary-pancreatic group (r = -0.519, p = 0.001), after adjusting for age using partial correlation analysis. No significant correlations were observed in the lower GI group. Conclusions: Among patients with upper GI cancer, a lower number of remaining teeth was associated with a lower PNI, influencing postoperative outcomes. Impaired oral function may affect the prognosis of patients with upper GI tumors, emphasizing the need for careful, comprehensive nutritional and oral management as part of perioperative support.

BACKGROUND: Muscle quality, along with muscle mass, deteriorates with disuse, ageing and various disorders, underscoring the need to evaluate the internal characteristics of swallowing-related muscles. Previous studies have reported an association between oral function and echo intensity (EI), but the association between oral function and the stiffness of swallowing-related muscles, as well as the degree of this association, remains insufficiently understood. OBJECTIVE: To examine the association between oral function and the intramuscular characteristics of swallowing-related muscles, focusing on muscle stiffness. MATERIALS AND METHODS: A total of 196 older women (78.1 ± 5.2 years) participated in a physical fitness measurement session in this cross-sectional study. The stiffness and EI of the geniohyoid muscle (GHM) were measured, and oral function was evaluated using oral diadochokinesis (ODK; /pa/, /ta/, /ka/) and tongue pressure. Multiple regression analysis was used to investigate the association between oral function, stiffness and EI. By standardising the variables, we evaluated these associations independently of the units. RESULTS: ODK, /pa/ (β = -0.144, p = 0.002), /ta/ (β = -0.134, p = 0.011) and /ka/ (β = -0.093, p = 0.043) showed a negative association with GHM stiffness. After standardisation, the association between ODK (/pa/, /ta/, /ka/) and GHM stiffness (β: -0.144, -0.134, -0.093) was comparable to that between ODK and EI (β: -0.008, -0.148, -0.075). CONCLUSION: GHM stiffness was associated with oral motor function in older women living in the community. Assessing the stiffness of swallowing-related muscles could be important for evaluating oral function to a degree comparable to EI.

BACKGROUND: Postoperative pneumonia is a serious lung cancer surgery complication. Perioperative oral management can help prevent its development. OBJECTIVES: This study aimed to determine the characteristics of patients who developed postoperative pneumonia despite perioperative oral management. METHODS: This study included 396 consecutive patients who underwent lung cancer surgery under general anesthesia at Fujita Health University Okazaki Medical Center from April 2020, the opening of the hospital, to the end of December 2023. Patient data, including age, gender, body mass index, underlying disease, smoking index, spirogram, operative time, amount of blood loss during operation, and operative procedure, were obtained from medical records. Oral examinations were conducted to determine the number of remaining teeth and whether dental caries are present and to examine tooth mobility and probing pocket depths > 4 mm. Furthermore, the patients were asked whether they had regular dental checkups. The patients were divided into the pneumonia and no-pneumonia groups following lung surgery, and the factors involved in postoperative pneumonia were investigated. RESULTS: A total of 390 patients were analyzed (six were excluded), of whom 33 developed postoperative pneumonia. Among them, 17 were excluded from the analysis due to preoperative interstitial pneumonia. Consequently, the incidence of postoperative pneumonia was 16 of 373 patients (4.3%). Significant differences were observed between the groups in terms of age, sex, chronic obstructive pulmonary disease, smoking index, operative time, number of remaining teeth, and regular dental checkups. Logistic regression analysis using these significant items revealed that fewer than 20 remaining teeth were significantly associated with the development of postoperative pneumonia (p = 0.043). CONCLUSIONS: The results of this study indicated that the incidence of postoperative pneumonia following perioperative oral function management was maintained as low as that reported previously. The importance of dental intervention in the perioperative period was also elucidated. A high number of patients who developed postoperative pneumonia despite these interventions had fewer than 20 remaining teeth, suggesting that more attention should be paid to perioperative oral management, including the prevention of aspiration pneumonia.

BACKGROUND: Denture treatment for unilateral distal extension defects can cause organic and functional asymmetry in the oral cavity, which may be influenced by physical laterality and the preferred chewing side (PCS). However, existing classification systems for dental defects overlook left-right defect distribution, and individual laterality is rarely considered in treatment planning. OBJECTIVE: This study investigated the relationship between dental defect location and laterality. METHODS: This was a cross-sectional study of 176 right-handed elderly participants divided into five groups by denture type: control (n = 87), right distal extension (n = 9), left distal extension (n = 13), bilateral distal extension (n = 43), and complete denture (n = 24). Primary outcomes included masticatory efficiency, bite force, oral health-related quality of life (OHRQoL), and PCS assessed through interviews. RESULTS: The right distal extension group demonstrated significantly reduced masticatory efficiency, bite force and OHRQoL compared to the control group, indicating diminished oral function and quality of life. The left distal extension group showed significant left-right differences in function, with reduced performance on the distal extension defect side. The right side was the PCS in all groups, with no significant differences in distribution observed between the control and denture groups. CONCLUSION: In elderly individuals with unilateral distal extension dentures, right-handed individuals demonstrate different masticatory functions based on whether the defect is on the right or left side. Additionally, when occlusal support is bilaterally maintained through prosthodontic treatment, including dentures, the impact of structural asymmetry on the PCS is limited.

ABSTRACT Objective We aimed to examine the effects of oral care in patients with terminal cancer approaching death. Background Patients with terminal‐stage cancer often experience symptoms like oral dryness and candidiasis. Previous studies showed that without professional dental care, oral hygiene significantly worsens within 3 weeks before death. Therefore, oral management is essential for patients with terminal cancer. However, the specific effects of oral hygiene in these patients remain unclear. Material and Methods Twenty patients were admitted to two palliative care units at our institution between June 2022 and May 2023 and received oral care multiple times before death. Oral hygiene was assessed using the Oral Health Assessment Tool (OHAT), and oral dryness was evaluated with an oral moisture checker. The Face Rating Scale (FRS) was assessed before and after professional oral care. Results During the week of death, the number of people who were able to speak and follow instructions decreased, while the number who used sedatives and oxygen increased. There was no significant difference in the degree of oral dryness before oral care between the time of hospitalisation and the week of death. However, oral dryness improved significantly after oral care at admission (before: 21.0 ± 8.3, after: 26.7 ± 3.2) and the week of death (before: 16.8 ± 8.4, after: 25.8 ± 3.7). There was no difference in the time taken for oral care or FRS scores at admission and the week of death. Conclusion Continuous oral care in patients with terminal cancer can prevent worsening oral hygiene and maintain moisture.

BACKGROUND: Ventilator-associated pneumonia (VAP) after tracheal intubation is a major infectious complication in patients in the intensive care unit (ICU), with an incidence of 8-28%. Oral care in the ICU is essential; however, the presence of an intubation tube and restricted mouth opening cause complications. A healthy commensal microflora in the oral cavity resists colonization by respiratory pathogens, and poor oral hygiene may increase the risk for VAP. In this study, we examined the effectiveness of oral care on oral bacterial counts and microbial diversity in patients admitted to the ICU. METHODS: Fifteen ICU patients were included in this study. Oral microbiome samples were collected by swabbing the surface of the tongue. Oral bacterial counts were measured at four time points: before and after oral care, both pre- and post-extubation. Additionally, microbiome analysis was conducted twice: once before oral care pre-extubation, and once before oral care post-extubation. Oral bacterial counts were assessed using a bacterial counter, and microbiome analysis was performed through 16S rRNA gene amplicon sequencing. RESULTS: Oral bacterial counts significantly decreased after oral care at both pre- and post-extubation time points. Microbiome analysis revealed significant differences in alpha diversity pre- and post-extubation samples. Samples post extubation were less diverse. CONCLUSIONS: This study demonstrates that oral care effectively reduces bacterial counts in ICU patients, both pre- and post-extubation. Microbiome analysis revealed shifts in microbial diversity, suggesting that the oral microbiota was disrupted during intubation. Given the risk of VAP, oral care may play an important role to prevent VAP in ICU settings.

This study investigated the swallowing dynamics of jelly, thickened liquid, and thin liquid in selected stroke patients who exhibited near-normal swallowing function with screening tests. Videofluoroscopic examination compared the pharyngeal transit time (PTT), pharyngeal delay time (PDT), and laryngeal elevation delay time (LEDT). Of 175 patients (104 men, 71 women; mean age: 68.6 ± 12.0 years) evaluated, 24 (13.7%) experienced aspiration, significantly prolonging LEDT in swallowing thin liquid. PTT did not differ in swallowing jelly, thickened liquid, or thin liquid among the patients who did not aspirate. However, in two-phase analysis of PTT, performed before and after the jelly passed the epiglottis, the former was significantly prolonged, whereas the latter was significantly shortened. PDT was significantly longer with jelly than with thickened and thin liquids. LEDT was significantly longer in swallowing thin liquids. Apparently, the thin liquid reached the pyriform sinus before maximum laryngeal elevation, posing a risk of laryngeal penetration and aspiration during swallowing. A thicker liquid prolonged the time taken to reach the pyriform sinus, reducing aspiration risk. Moreover, oropharyngeal passage of jelly took longer, triggering the swallowing reflex around the vallecula and allowing the jelly to pass through the hypopharynx after laryngeal closure.

OBJECTIVE: Dysarthria negatively affects quality of life and social communication. This study focused on dysarthria in patients with acute-phase stroke and analyzed the association between lesion locations and oral/swallowing functions. METHODS: Patients with first-ever acute stroke were analyzed. Speech assessments included diadochokinesis rates for "pa," "ta," and "ka," along with reading aloud passages. All patients underwent head magnetic resonance imaging, videofluoroscopic (VF) examinations, and tongue pressure measurements to identify stroke lesions. RESULTS: We analyzed 82 patients with acute stroke excluding those with bilateral or multi-regional lesions (mean age 67.6 ± 11.5 years, 32 women, NIHSS median 1.5). Dysarthria was diagnosed in 16 patients (19.5 %). The National Institutes of Health Stroke Scale (NIHSS) score (odds ratio [OR] 1.289, 95 % confidence interval [CI] 1.050-1.616) and lesions in the corona radiata (OR 9.981, 95 % CI 1.871 - 60.092) were significant risk factors for dysarthria. Tongue pressure was significantly lower in patients with dysarthria, with a cutoff value of 28.4 kPa for predicting dysarthria (area under of the receiver operating characteristic curve 0.688, p = 0.006). Swallowing assessments via VF examinations showed no significant differences between patients with and without dysarthria. CONCLUSION: Lesions in the corona radiata are associated with dysarthria in patients with stroke. Reduced tongue pressure is also linked to dysarthria. These findings underscore the importance of evaluating dysarthria independently of dysphagia.

BACKGROUND/AIM: Obese individuals are often said to eat fast. Given that obese individuals are often reported to consume fast food more frequently, we hypothesized that fast food can be eaten more quickly. This study aimed to examine the effects of meal type on meal duration, considering meal sequence. METHODS: Meal duration, number of chews and bites, and chewing tempo were measured among 41 participants (18 males, 23 females; average age, 41.1 years) using two meals: pizza (301 kcal) and hamburger steak bento (hamburger, rice and broccoli, 304 kcal; two eating sequences: vegetables first or last). RESULTS: Compared with pizza, bento meals (vegetables first or last) were associated with longer meal durations (sec) (mean differences in pizza-bento (vegetable first): -182 [-245.6, -118.9], p < 0.0001; pizza-bento (vegetables last): -216.0 [-273.3, -158.7], p < 0.0001). In contrast, no differences in meal duration (sec) were observed regardless of the order of vegetable consumption (p = 0.14). These findings were consistent with the number of chews and chewing tempos across both sexes. The number of bites was similar among pizza, bento (vegetable fast), and bento (vegetable last). Meal duration was positively associated with the number of chews and bites and meal type and negatively associated with age and sex. BMI was not associated with meal duration. CONCLUSIONS: Meal type affected meal duration, the number of chews, and the chewing tempo, independent of meal sequence. To eat more slowly, it is important to pay attention to the meal type.

ABSTRACT Background There is growing interest in the relationship between oral function and lifestyle‐related diseases. Objectives This study aimed to investigate the associations between the results of oral function tests and those of blood tests for lipid abnormalities, glucose metabolism and kidney function. Methods A total of 118 individuals aged ≥ 50 years (80 men and 38 women) who had undergone health check‐ups at our hospital in 2021 and 2023 were examined. Based on the fasting blood glucose (GLU), HbA1c, high‐density lipoproteins (HDL), low‐density lipoproteins (LDL), urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) values obtained from the health check‐up results; the subjects were divided into two groups: those with test values outside the reference range in 2021 and/or 2023 and those with test values within the reference range. The results of seven oral function tests were compared between the groups using the Mann–Whitney U test. p &lt; 0.05 was considered significant. Results The group with GLU and HbA1c values outside the reference ranges had significantly lower numbers of remaining teeth (RTN) and oral diadochokinesis (OD) values compared to the group within the reference range. The groups with HDL and LDL values outside the standard ranges had a significantly higher tongue coat index (TCI) and significantly lower OD. Significant differences in TCI and OD/ta/ /ka/ were observed between BUN groups within and outside the reference range. Likewise, significant differences in TCI, RTN and OD/ta/ /ka/ were observed between eGFR groups within and outside the reference range. Conclusions Subjects with blood test values outside the reference range exhibited a decline in oral function, indicating that a decline in oral function might increase the risk of lifestyle‐related diseases and facilitate the progression of frailty.

Background/Aim: Slow eating is recommended for obese individuals. We aimed to determine the associations between meal duration and various factors (sex, numbers of chews and bites, eating tempo (including forced rhythm with a metronome) and BMI). Methods: Using a test meal (a quarter slice of pizza), we tested the sex difference of the meal duration, numbers of chews and bites, and eating tempo for thirty three healthy subjects (M: 15; F: 18) aged 37.2 ± 11.1 years via unpaired t tests. Next, factors influencing meal duration were identified via multivariate analysis (adjusted for sex), with meal duration as the dependent variable. Results: The meal duration and numbers of chews and bites differed significantly between sexes (63.1 ± 20.7 vs. 87.4 ± 22.8, p = 0.003; 80.3 ± 28.7 vs. 107.0 ± 36.1, p = 0.02; 2.1 ± 1.1 vs. 4.5 ± 2.6, p = 0.001, respectively), but the chewing tempo was similar (p = 0.32). Meal duration was associated with the number of chews (β = 0.6 [0.4, 0.7], p &lt; 0.001) and bites (5.8 [2.5, 9.2], p = 0.001) but not with BMI (p = 0.52) or chewing tempo (p = 0.99). Finally, when a metronome was used to force rhythmic stimulation (0/40/80/160 bpm), compared with 0 bpm, slow stimulation (40 bpm) resulted in increased meal duration (mean difference [95% CI] = −47.0 [−66.4, −27.7], p &lt; 0.0001), chews (−28.6 [−44.5, 12.8], p = 0.0003), and bites (−4.9 [−7.9, 1.9] p = 0.001) and delayed tempo (10.4 [4.5, 16.3], p = 0.0004). Conclusions: Meal duration was positively associated with the numbers of chews and bites and negatively associated with chewing tempo. Thus, increasing the numbers of bites and chews and slowing the eating tempo may prolong meal duration.

AIM: Malnutrition is reportedly associated with the development of delirium. As dental health is essential for nutritional intake, tooth loss may be a risk factor for the development of delirium. This study aimed to investigate the relationship between postoperative delirium and the number of remaining teeth in patients undergoing gastrointestinal surgery. METHODS: This retrospective study included 453 consecutive patients aged ≥65 years who underwent programmed gastrointestinal cancer surgery under general anesthesia at the Department of Surgery, Fujita Health University Hospital, between January 2022 and December 2022. Background factors were prepared between the participants with and without dental intervention. In the dental intervention group, associations between background and surgical factors and the presence of postoperative delirium were explored. Factors with significant associations with postoperative delirium in the univariate analysis were subjected to logistic regression analysis to determine their association with the number of remaining teeth. RESULTS: Overall, 189 participants underwent postoperative management. They had a significantly lower Prognostic Nutritional Index and higher cognitive decline than the 264 patients who underwent no dental intervention during this period. However, no significant difference was observed in the incidence of postoperative delirium between the two groups. In the dental intervention group, logistic regression analyses revealed that postoperative complications and the number of remaining teeth were significantly associated with postoperative delirium development. CONCLUSION: The results revealed that a decrease in the number of remaining teeth is associated with postoperative delirium. The cause of this is not clear, but it is thought to be related to brain fragility. Geriatr Gerontol Int 2025; 25: 90-95.

AIM: Down syndrome (DS) involves an extra chromosome 21 and tongue hypotonicity. This study examined reproducibility of tongue pressure measurement (TPM) in DS patients. METHODS: Thirty patients with DS (13 females) who were able to complete three measurements underwent a tongue pressure test (TPT). Reproducibility was evaluated using intraindividual standard deviation (SD) and coefficient of variation (CV). Patients were divided into two groups based on developmental age (DA): DA ≥ 4 years (over-4 DA) and DA < 4 years (under-4 DA). RESULTS: Thirty DS patients with a mean age of 33.0 ± 11.7 years and mean DA of 3.8 ± 1.2 years were analyzed. Median tongue pressure was 17.6 kPa, SD was 2.0 kPa, and CV was 11.9. Eleven patients were in the under-4 DA group, and 19 were in the over-4 DA group. Significant differences in speech presence and CV values were observed between the groups (p = 0.002, 0.043). CONCLUSIONS: The reproducibility of the TPT in DS patients with a DA ≥ 4 years is comparable to that in normal subjects.

Abstract Introduction Velopharyngeal insufficiency (VPI) in cleft palate patients often requires surgical intervention. This study evaluates the effectiveness of four‐dimensional computed tomography (4D‐CT) in assessing velopharyngeal function (VPF) pre‐ and postoperatively. Case presentation Four pediatric patients with cleft palate underwent 4D‐CT imaging before and after surgery. Velar length, thickness, elevation angle, and minimum cross‐sectional area were measured during sustained phonation. Conclusion 4D‐CT provided detailed imaging without patient discomfort, allowing both qualitative and quantitative analysis. While surgery improved velopharyngeal motion in most cases, further research is needed to understand the relationship between structural changes and hypernasality outcomes.

BACKGROUND/OBJECTIVES: The aim of this study is to investigate the association between physical and chemical digestion and nutrition markers (serum albumin (ALB), prealbumin (PAB), and vitamin B12 (B12) levels). METHODS: During a detailed checkup at Fujita Health University, we examined the associations of physical (occlusal force, masticatory performance, and swallowing ability (via the 10-item Eating Assessment Tool, EAT-10)) and chemical (Helicobacter pylori (HP) eradication history, HP antibody levels, and oral antacid (proton pump inhibitors) use) digestion parameters with serum ALB, PAB, and B12 levels in 92 individuals (M:67, F:25). RESULTS: Forty-eight percent of the participants were older than 65 years of age, 19% had decreased occlusal force, 3.2% had decreased masticatory strength, 3.2% had decreased swallowing function, 24% had a history of HP eradication, 23% were HP antibody positive, and 16% were taking oral antacid medication. Additionally, 14% and 11% of the patients had low serum ALB and PAB levels, respectively, and 14% of the patients had B12 deficiency. Multivariate analysis adjusted for age, sex, body mass index, and C-reactive protein levels revealed that there were no significant associations between the physical digestion parameters and the serum PAB, ALB, or B12 levels. On the other hand, there was a significant association between oral antacid use and PAB levels (β = -3.3, p = 0.04). Independent of physical or chemical digestion parameters, serum PAB and B12 levels were significantly associated with protein and B12 intake, respectively. CONCLUSIONS: Oral antacid use may decrease serum PAB levels, indicating protein synthesis.

OBJECTIVES: Exploring the effects of swallowing function on sleep quality could provide valuable insights into the potential impact of reduced swallowing function on sleep. However, pertinent studies are limited. Therefore, this study aimed to investigate the relationship between dysphagia risk and sleep health in community-dwelling older adults. METHODS: Data for this cross-sectional study were obtained from the Shizuoka and Daiko studies conducted as part of the Japan Multi-Institutional Collaborative Cohort Study. Information on demographics, overall lifestyle, dysphagia risk, as well as sleep quality, duration, satisfaction, and regularity, was obtained using a self-administered questionnaire. Dysphagia risk and sleep quality were assessed using the Dysphagia Risk Assessment Questionnaire for the Community-dwelling Elderly and the Japanese version of the Pittsburgh Sleep Questionnaire Index, respectively. Multivariate logistic regression, adjusted for covariates, was employed to assess the association between dysphagia risk and sleep health. RESULTS: Among the 3058 participants (1633 males, 1425 females) aged ≥60 years, 28.0 % exhibited dysphagia risk, and 19.1 % reported poor sleep quality. Those with dysphagia risk were more likely to experience poor sleep quality than those without dysphagia risk. In male participants, dysphagia was significantly associated with poor sleep quality, unsatisfactory sleep, and sleep irregularity, but was not significantly associated with unsatisfactory or irregular sleep in female participants. The Japanese version of the Pittsburgh Sleep Questionnaire Index components-subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction-were associated with dysphagia risk in both sexes. CONCLUSIONS: Dysphagia risk is associated with sleep quality in older individuals in Japan. Thus, preserving swallowing function may contribute to enhancing sleep quality.

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.

INTRODUCTION: Oral hypofunction comprises seven aspects of oral condition, including oral hygiene, oral dryness, bite strength, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Each of these seven has a single diagnostic criterion; however, the use of a single indicator without consideration of sex, age, or other factors is controversial. The purpose of this study was to evaluate the association between the oral hypofunction test and sex, age, and number of remaining teeth. METHODS: The study was conducted at 12 facilities by the members of the Japanese Society of Geriatric Dentistry during April to December 2019. The participants comprised 181 healthy older adults aged 65 years and over (56.9% female; age range 65-95 years) who regularly visited these facilities. All tests of oral function and oral status available in Japan were performed on the participants, and the association between these tests and sex, age, and number of remaining teeth was examined. RESULTS: Sex differences were observed in masticatory function, bite force, lip closure force, jaw-opening force, oral diadochokinesis "ka," and tongue coating index (p < .05). In men, age was weakly (r = 0.20-0.40) associated with masticatory function, jaw-opening force, maximum tongue pressure, oral diadochokinesis, and swallowing function. In women, the number of remaining teeth, masticatory function, jaw-opening force, and oral diadochokinesis "ta" and "ka" was also weakly associated with age. CONCLUSIONS: Performance on the oral hypofunction test differs by sex, age, and number of remaining teeth. This means that the current single criterion for evaluation requires caution in its interpretation.

BACKGROUND: Simple, noninvasive, and repeatable screening methods are essential for assessing swallowing disorders. We focused on patients with acute stroke and aimed to assess the characteristics of swallowing screening tests, including the modified Mann Assessment of Swallowing Ability score, tongue pressure, and repetitive saliva swallowing test (RSST), compared with detailed videofluoroscopic swallowing study (VFSS) findings to contribute as a helpful resource for their comprehensive and complementary use. METHODS AND RESULTS: We enrolled first-ever patients with acute stroke conducting simultaneous assessments, including VFSS, modified Mann Assessment of Swallowing Ability score, tongue pressure measurement, and RSST. VFSS assessed aspiration, laryngeal penetration, oral cavity residue, vallecular residue, pharyngeal residue, and swallowing reflex delay. Screening tests were compared with VFSS findings, and multiple logistic analysis determined variable importance. Cutoff values for each abnormal VFSS finding were assessed using receiver operating characteristic analyses. We evaluated 346 patients (70.5±12.6 years of age, 143 women). The modified Mann Assessment of Swallowing Ability score was significantly associated with all findings except aspiration. Tongue pressure was significantly associated with oral cavity and pharyngeal residue. The RSST was significantly associated with all findings except oral cavity residue. Receiver operating characteristic analyses revealed that the minimum cutoff value for all VFSS abnormal findings was RSST ≤2. CONCLUSIONS: The modified Mann Assessment of Swallowing Ability is useful for broadly detecting swallowing disorders but may miss mild issues and aspiration. The RSST, with a score of ≤2, is valuable for indicating abnormal VFSS findings. Tongue pressure, especially in oral and pharyngeal residues, is useful. Combining these tests might enhance accuracy of the swallowing evaluation.

BACKGROUND: Evaluation of low tongue pressure is used to diagnose oral hypofunction. The pathophysiology of oral hypofunction is hypothesized to be associated with oral dysfunction related to ageing. Depression in older adults is a major problem and is related to handgrip strength, which is related to tongue pressure. We hypothesized that low tongue pressure could indicate depression mood in community-dwelling older adults. OBJECTIVES: This study aimed to measure maximum tongue pressure and compare it to the responses to the Kihon Checklist (KCL), which is used to check mental and physical deterioration of community-dwelling older adults. METHODS: A total of 49 community-dwelling independent older adults with stable dental condition (23 men, 26 women; median age, 79 years) answered the KCL, which contained questions on frailty status, cognitive function, nutritional and sarcopenia status. Oral function was measured to assess oral hypofunction. The relationship between tongue pressure differences and frailty status, cognitive function, nutritional and sarcopenia status was analysed using logistic regression analyses after adjusting for age and sex. RESULTS: Nine participants (6 men and 3 women; median age, 81 years) had a tongue pressure <23.0 kPa, which was the lowest limit of the standard value of maximum tongue pressure in patients aged ≥70 years. Logistic regression analyses showed that only Question 21, which is related to a lack of fulfilment in daily life, was significantly associated with low tongue pressure (p = .027). CONCLUSION: Low tongue pressure may be associated with sociopsychological factors in older adults.

OBJECTIVES: Teledentistry could be effective in managing oral health through the provision of oral hygiene instruction and diagnostic services. This study aimed to assess the perception and usefulness of teledentistry in Japanese long-term care facilities. METHODS: We conducted a questionnaire survey to compare related factors of the usefulness of teledentistry and identify issues in its implementation. We chose 1000 facilities using a stratified random sampling method. The questionnaires were sent to the facilities in August 2021 and collected in December of the same year. Responses to the questionnaire items regarding the usefulness of teledentistry for oral management were divided into three groups according to the answer: perceiving teledentistry as "useful," "not useful," or "neither," including facilities that do not currently use teledentistry. RESULTS: In total, 26.1% (261) responded to the questionnaire, and among these, 184 facilities answered the question regarding the usefulness of teledentistry. Only two of these facilities implemented teledentistry. Facilities with dental hygienists (p = 0.040) and those that receive insured medical treatment: reimbursement for oral feeding maintenance II (p = 0.040) tended to perceive teledentistry as useful in the management of patients with coronavirus disease. The higher the number of services that responded to the question "what kind of services do you think can be provided via teledentistry?" the higher the percentage of "useful" responses. CONCLUSIONS: Although only a few facilities use teledentistry, many long-term care facilities perceive it as useful even without using it. The presence of dental hygienists and interprofessional work done with reimbursement for oral feeding maintenance II contributed to the perception of the usefulness of teledentistry in long-term care facilities.

BACKGROUND: Many studies have shown deterioration of the oral health environment in palliative care patients; however, most of these studies are cross-sectional. In this longitudinal observational study, we aimed to determine the oral symptoms and how they change in palliative care patients. METHODS: The participants were 82 patients (37 men, 45 women) admitted to two palliative care units in Japan between January 2018 and December 2021. The oral condition was evaluated once a week from the time of admission using the Oral Health Assessment Tool (OHAT) and performance status (PS). Friedman tests were performed on the OHAT and PS scores at 1, 2, and 3 weeks before the week of death. In addition, the Bonferroni method was used to determine how many weeks before death the changes occurred. RESULTS: PS continuously deteriorated from three weeks before death. The total OHAT score 2 weeks before death (3.44±2.10) was significantly different compared to that in the week of death (4.37±2.45). In terms of oral conditions, the properties of the saliva changed, and dry mouth became obvious. CONCLUSIONS: The results of this study revealed that the oral environment of palliative care patients became significantly dry 2 weeks before death, suggesting that it may be useful for predicting the stage of death.

Abstract Background Submental intubation is an airway management technique wherein an endotracheal tube is guided through incisions in the floor of the mouth and the submental skin after normal orotracheal intubation. Case presentation A 20‐year‐old man with a history of pharyngeal flap construction for a cleft palate was planned for orthognathic surgery. Preoperative nasopharyngoscopy showed that the space lateral to the flap was too narrow for nasotracheal intubation; then submental intubation was performed. No intra‐ or postoperative complications were observed. Conclusion Submental intubation is a useful alternative to tracheotomy in patients with difficulty in nasotracheal intubation during surgeries requiring occlusal confirmation.

PURPOSE: This study aimed to determine whether denture use contributes to maintaining and improving food forms in long-term care facility (LTCFs) residents. METHODS: In 888 residents of 37 LTCFs in Japan, the following were investigated: nutritional intake status, food forms, age, sex, Barthel index (BI), clinical dementia rating (CDR), number of teeth present, number of occlusal supports, swallowing function, and use of dentures. Among all residents, those who were well-nourished and had ≤9 occlusal supports were analyzed. Based on standardized criteria, the food forms consumed by the subjects were divided into two groups: dysphagia and normal diet, which were further classified into four levels. Analysis was performed using a generalized estimation equation with the four levels of food forms as dependent variables and age, sex, BI, CDR, presence of dysphagia, number of teeth present, and use of dentures as independent variables. RESULTS: The final analysis included 622 (70.0%) residents. Of these, 380 (61.1%) used dentures. The analyses revealed that food form was significantly associated with age (adjusted odds ratio [OR], 0.98), BI (OR, 1.04), number of teeth present (OR, 1.03), presence of dysphagia (OR, 0.44), and use of dentures (OR, 2.82). CONCLUSIONS: Denture use was associated with food forms among Japanese LTCF residents. This indicates that the use of dentures is related to the maintenance of food forms, even in the elderly who participate in few activities of daily living, have reduced cognitive function, and require long-term care.

This 1-year multicenter prospective cohort study aimed to determine the association between observable eating and swallowing function factors and outcomes (death/hospitalization or survival) among elderly persons in long-term care insurance facilities in Japan. Baseline assessments of factors, such as language, drooling, halitosis, hypersalivation, tongue movement, perioral muscle function, coughing, respiration after swallowing, rinsing, and oral residue, among others, were conducted. A score of 0 was considered positive, and a score of 1 or 2 was considered negative. Patient age, sex, body mass index, Barthel index, and Clinical Dementia Rating were recorded. The death/hospitalization or survival rates over 1 year were recorded, and patients were allocated into groups depending on the respective outcome (death/hospitalization group or survival group) and baseline characteristics. A total of 986 residents from 32 facilities were included, with 216 in the death/hospitalization group and 770 in the survival group. Language, salivation, halitosis, perioral muscle, coughing, respiration after swallowing, rinsing, and oral residue were significantly associated with the outcomes (p < 0.05). Therefore, routine performance of these simple assessments by caregivers may allow early detection and treatment to prevent death, pneumonia, aspiration, and malnutrition in elderly persons.

Electron ionization (EI) mass spectrum library searching is usually performed to identify a compound in gas chromatography/mass spectrometry. However, compounds whose EI mass spectra are registered in the library are still limited compared to the popular compound databases. This means that there are compounds that cannot be identified by conventional library searching but also may result in false positives. In this report, we report on the development of a machine learning model, which was trained using chemical formulae and EI mass spectra, that can predict the EI mass spectrum from the chemical structure. It allowed us to create a predicted EI mass spectrum database with predicted EI mass spectra for 100 million compounds in PubChem. We also propose a method for improving library searching time and accuracy that includes an extensive mass spectrum library.

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.

We examined factors related to dietary intake status (food form) of long-term care facility (LTCF) residents to identify factors related to proper food form choice for older individuals requiring nursing care. We surveyed 888 residents from 37 LTCFs in Japan. We evaluated basic information (age, sex, body mass index [BMI]), food form (swallowing-adjusted diet class), Barthel Index (BI), Clinical Dementia Rating (CDR), simply evaluated eating and swallowing functions, the number of present/functional teeth, oral diadochokinesis, repetitive saliva swallowing test (RSST), and modified water swallowing test. To clarify factors associated with food form, participants who had good nutrition by oral intake were categorized into the dysphagic diet (DD) and normal diet (ND) groups. Multi-level analyses were used to detect oral functions associated with food form status. Among objective assessments, BMI (odds ratio [OR] 0.979, 95% confidence interval [CI] - 0.022- to 0.006, p = 0.001), BI (OR 0.993, 95% CI - 0.007 to - 0.004, p < 0.001), CDR 3.0 (OR 1.002, 95% CI 0.002‒0.236, p = 0.046), present teeth (OR 0.993, 95% CI - 0.007 to - 0.001, p = 0.011), functional teeth (OR 0.989, 95% CI - 0.011 to - 0.005, p < 0.001), and RSST (OR 0.960, 95% CI - 0.041 to - 0.007, p = 0.006) were significantly associated with DD vs ND discrimination. Simple evaluations of coughing (OR 1.056, 0.054‒0.198, p = 0.001) and rinsing (OR 1.010, 0.010‒0.174, p = 0.029) could also discriminate food form status. These simple evaluations provide insight into the discrepancies between food form status and eating abilities of LTCF residents. Periodic evaluations by the nursing caregiver may help to prevent aspiration by older individuals with dysphagia.

We investigated how jelly is crushed and examined the relationship between tongue pressure and tongue food crushing ability among older adults requiring nursing home care. Seventy-two participants were instructed to freely crush the test foods soft jelly (SJ) and hard jelly (HJ). We visually evaluated the crushability of the test food and identified the intraoral tissues (active sites) used to crush the test food. The active sites were consistent for all participants for both SJ and HJ, and they included the maxillary and mandibular teeth in 41 participants, teeth and residual ridges in 15 participants, maxillary and mandibular residual ridges in 10 participants, and tongue and palate in six participants. Two participants failed to crush the SJ; the active sites in both participants were the tongue and palate. No participant using the tongue and palate as active sites could crush the HJ. Furthermore, 64 participants could crush the SJ and 23 could crush the HJ using the tongue and palate. The cutoff value of the tongue pressure for crushability of the HJ was 22.0 kPa. Assessing tongue pressure and intraoral active sites involved in food crushing could help determine an appropriate diet for older adults requiring nursing home care.

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.

Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.

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.