吉田 光由

It is important for the elderly to maintain their skeletal muscle mass, which in turn helps to maintain physical functions. This study aimed to clarify factors related to skeletal muscle mass maintenance. Home-bound elderly (94 men and 216 women), at least 75 years of age, attending a day-care center in Tokyo, were enrolled in this study. Dentists specializing in dysphagia rehabilitation evaluated skeletal muscle mass, occlusal status and swallowing function. Physical function, cognitive function and nutritional status were also evaluated by interviewing caregivers. Correlations of skeletal muscle mass with various factors were determined in each gender group. Multiple regression analysis revealed that skeletal muscle mass was significantly related to nutritional status in both men and women. In men, there was a significant difference in skeletal muscle mass between those with and without occlusion of the natural teeth. Our results suggest that dental treatments and dentures would be useful for maintaining skeletal muscle mass, especially in men.

It is important for the elderly to maintain their skeletal muscle mass, which in turn helps to maintain physical functions. This study aimed to clarify factors related to skeletal muscle mass maintenance. Home-bound elderly (94 men and 216 women), at least 75 years of age, attending a day-care center in Tokyo, were enrolled in this study. Dentists specializing in dysphagia rehabilitation evaluated skeletal muscle mass, occlusal status and swallowing function. Physical function, cognitive function and nutritional status were also evaluated by interviewing caregivers. Correlations of skeletal muscle mass with various factors were determined in each gender group. Multiple regression analysis revealed that skeletal muscle mass was significantly related to nutritional status in both men and women. In men, there was a significant difference in skeletal muscle mass between those with and without occlusion of the natural teeth. Our results suggest that dental treatments and dentures would be useful for maintaining skeletal muscle mass, especially in men.

Purpose: This study aimed to clarify whether the absence of occlusal support would lead to a decline in the activities of daily living (ADL) in elderly people receiving home care. Methods: The subjects of this study were 322 elderly individual aged 65 and older who were receiving home care during a one-year observation period. The subjects were divided into two groups according to the change in the total score of the Barthel Index (BI) during the prospective cohort study period (the dependent variable): the maintained/improved activities of daily living group, in which the score was unchanged or improved, and the worsened activities of daily living group, in which the score decreased. The relationship between occlusal status (the presence or absence of occlusal support) at the baseline measurement and each BI score change was evaluated in the slightly, moderately and totally dependent ADL subgroups. Results: The number of subjects in the maintained/improved and the worsened ADL groups was 152 and 170, respectively. The baseline characteristics of cognitive function and occlusal support were significantly different between the maintained/improved and the worsened ADL groups (p < 0.05). Among the ADL subgroups, significantly reduced scores in mobility and toilet use were observed only in the slightly dependent group (p < 0.05). Conclusions: Our results suggest that the loss of occlusal support may be an important factor in the decline of ADL in elderly people receiving home care, especially slightly dependent people. (C) 2015 Japan Prosthodontic Society. Published by Elsevier Ireland. All rights reserved.

PurposeThe present study examined the relationship between oral function, such as eating/swallowing, and life prognosis among a homebound elderly population, considering physical and mental function. MethodsThe participants were 511 homebound older adults aged 65 years or older living in four Japanese prefectures. Sex, age, activities of daily living (ADL), cognitive function, underlying disease, nutritional status as Mini-Nutritional Assessment-Short Form (MNA((R))-SF), swallowing function, dietary modification and occlusal status were examined at baseline. Participants were categorized into poor outcome (died or admitted to hospital or nursing home) and good outcome (still under home care) groups at 1-year follow up, and significant related baseline factors were analyzed. In addition, these groups were compared by the ADL subgroup divided into <60 (lower) and 60 (higher) by Barthel Index. ResultsIn total, 473 participants were followed up (poor outcome group 177 [37.4%], good outcome group 296 [62.6%]). Sex, age, ADL, MNA((R))-SF, swallowing function, dietary modification and occlusal support were significantly different between these groups. Logistic regression analysis showed that sex and MNA((R))-SF score were significantly related to prognosis in the lower ADL group, and sex, age, Charlson Comorbidity Index and occlusal support were significantly related in the higher ADL group. ConclusionsADL was strongly correlated with life prognosis in homebound older adults. Within the higher ADL participants, occlusal support was related to this outcome. Geriatr Gerontol Int 2015; 15: 1001-1006.

AimOral bacteria, which are a source of infection for aspiration pneumonia, were examined in frail older adults with the aim of establishing a standard bacteria count that indicates the risk of pneumonia onset in this group. MethodsA survey of bacteria count in the saliva using a simple instrument for measurement of the number of oral bacteria, along with factors including swallowing function and nutritional status, was carried out in 691 elderly individuals requiring care (137 men; mean age 82.68.3years; 554 women; mean age 88.07.1years; total mean age 86.7 +/- 7.8years) at 16 nursing homes in Japan. All participants gave their consent for inclusion in the present study. During a 6-month follow-up period, participants who developed pneumonia were identified, and relationships between the factors measured at the start of the period and pneumonia onset were examined. ResultsDuring the 6-month follow-up period, 33 participants (4.8%; 5 men, 28 women; mean age 88.3 +/- 7.4years) developed pneumonia. Pneumonia onset was significantly associated with reduced activities of daily living, swallowing dysfunction and undernourishment. Logistic regression analysis identified a saliva bacteria count of 10(8.5)colony-forming units/mL as an independent explanatory factor for pneumonia onset (P=0.012, RR=3.759). ConclusionsOral bacteria count of 10(8.5)colony-forming units/mL saliva in an elderly person requiring care was identified as a risk factor for pneumonia onset. Geriatr Gerontol Int 2015; 15: 417-421.

Background: This study aimed to develop a simultaneously swallowing provocation test for dysphagia patients undergoing fiberoptic endoscopic evaluation of swallowing (FEES), as well as to evaluate its efficacy. Methods: In this test, 0.4 and 2.0 mL volumes of water were dripped into the pharynx under endoscopic examination of swallowing, and determine the latency time (LT) of the swallowing reflex elicited by water. The subjects were 51 bed-bound patients with dysphagia and could be divided into two groups as 35 tube feeding and 16 oral intake subjects. Among the tube feeding subjects, 20 patients who started dysphagia rehabilitation were followed-up to 3 months. Results: The mean LT was 7.43 +/- 7.19 seconds with 0.4 mL of test water and 5.05 +/- 5.59 sec with 2.0 mL. When 0.4 mL water was dripped, LT was significantly longer in tube feeding (10.49 +/- 7.97 seconds) than oral intake subgroup (5.72 +/- 5.16 seconds) (p < 0.05). After the dietary intervention according to the result of FEES, 5 patients were improved in eating, and 15 patients were unchanged or even got worse among 3-months follow-up investigation. LT with 0.4 ml of test water of the Improved group was 3.16 +/- 2.69 seconds and that of unchanged/worsened group was 22.6 +/- 17.5 seconds, resulting in the significant difference (p < 0.05). Conclusions: The results of this study suggest that our endoscopic swallowing test as swallowing provocation test with FEES is a useful examination for dysphagia rehabilitation.

義歯の装着・使用が高齢者の栄養摂取に及ぼす影響を明らかにする目的で、高齢者の健康状態、身体・精神機能、栄養状態、生活活動状態と義歯の装着・使用状況との関係を多施設で調査した。各研究協力施設からの被験者の合計は378名(平均年齢73.9±6.6歳)であった。歯科項目の診査として、残存歯の有無および数、咬合支持(Eichnerの分類)、欠損状態(Kennedyの分類)、義歯使用の有無および食品摂取状態による咀嚼スコアとグルコース溶出量による咀嚼能力の評価を行った。ついでOHIP-49J、36-Item Short Form Health SurveyからのPhysical Component ScoreとMental Component Score、Profile of Mood States、Mini Nutritional Assessment、Body Mass Index、Barthel Indexによる評価を行った。咬合支持の違いは咀嚼能力に有意な影響を及ぼし、咬合支持域が多くなるほど咀嚼能力が高くなった。統計学的有意差は認められなかったが、咬合支持が多くなるほど、口腔関連QOL、身体的・精神的健康状態、栄養状態も高くなる傾向であった。また咀嚼スコアの評価による咀嚼能力の値が高くなるほど、口腔関連のQOL、身体的・精神的健康状態、栄養状態が良好になる傾向が認められた。今後、高齢者等を対象としたさらなるデータの蓄積が必要である。(著者抄録)

背景:2000年以降の口腔状態と栄養状態に関する論文を系統的に検索した結果、歯の喪失により野菜や果物の摂取が減少しており、栄養摂取の変化が肥満や低体重といった栄養障害を引き起こす可能性があることが示された。とりわけ、要介護高齢者ではこの影響が大きく、栄養障害のリスクの高い要介護高齢者らに対して、形態学的ならびに機能的な評価を加えた口腔に対する総合的なアセスメントが必要であることを示している。目的:本研究の目的は、口腔機能の低下が考えられる要介護高齢者に対して、食事時の咀嚼運動や摂食方法などの外部観察評価による摂食指導が栄養状態の維持・改善につながるかを前向きに調査することで、口腔機能の評価のあり方を検討することにある。方法:都内の某介護保険老人保健施設の入所者31名(平均年齢88.8±6.7歳)に対して、食事時の咀嚼運動や摂食方法などの外部観察ならびに嚥下内視鏡検査(以下VE検査)を行い、その結果に基づいた食事内容や摂食方法などの指導を行った。結果:咀嚼評価票に基づいて食形態の変更が行われた者は22名であった。BMIは有意に増加し、VEにより誤嚥のある者とない者に分けて体重変化をみたところ、誤嚥のあった者でより有意に体重を増加させることができた。考察:咀嚼運動評価票を用いた食事時の外部観察評価とVE検査による摂食嚥下機能評価に基づいて、適切な食形態、食事姿勢、食事介助方法などを個別に指導することができた。これにより、安全で効率的な食事摂取が可能となり、食事摂取量の増加、食事時間の短縮につながり、結果的に平均体重及びBMIの増加につなげることができた。(著者抄録)

医療の発展に伴う寿命の延長により、全身疾患による障害を持ったまま生活している高齢者が増加している。これらの中には、歯の欠損による咀嚼障害のみでなく、口腔の運動機能や咀嚼制御のメカニズムが中枢性に障害されたことに起因する咀嚼障害を有する患者も増加している。本研究では、この運動障害性咀嚼機能障害(運動性咀嚼障害)の摂食・咀嚼・嚥下評価法を確立するため、近年考案された簡便な検査法の有用性に関する予備的検討として、検査の実施可能性という観点から検討を行った。366名の高齢者(男性94名、女性272名、検査時の年齢83.0±8.5歳)を対象とした。各被検者に対して舌圧測定、口腔移送試験を実施した。また、咀嚼制御のメカニズムに深く関わる認知機能の評価に際して、各被検者の臨床的認知症尺度(CDR)を測定した。なお、口腔機能検査については、各被検者においてその実施に伴う危険性が高いと判断された対象者には実施せず、実施不可能とした。全被検者において、舌圧検査は256名、口腔移送試験は286名が実施可能であった。それらのうち、CDRの結果から認知障害が重度であると判定された被検者では、舌圧検査を実施できたのは38名(30%)であったが、口腔移送試験については65名(52%)が実施可能であり、統計学的にも有意に高い結果となった。以上より、運動性咀嚼障害を判定するために考案された口腔移送試験は、認知機能が低下した患者においても実施可能な場合が多く、検査の実施に伴う被検者への指示が伝わりやすい点、さらには検査に伴う危険性が低い点が優れているものと考えられた。このような研究を積み重ねることにより、運動性咀嚼障害の診断基準を明確にし、診断に基づく食形態の選択ガイドライン策定の一助になれば幸いである。(著者抄録)

Objective: Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. Methods: The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. Results: The one-leg standing time was significantly shorter with the mouth opened (21.1 +/- 19.1 seconds) than with the mouth closed (25.1 +/- 21.4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth. Discussion: The vertical mandibular position may affect body balance.

This study reviewed the relationship between oral status and nutritional disorders such as obesity and sarcopenia. A literature search was performed using PubMed to find articles published in and after 2000 by using the following search terms: elderly, nutrition, tooth, tooth loss, mastication, and oral function. Although the literature search revealed that further well-designed studies are difficult controlling all confounding factors thought to influence nutritional status, it may be concluded that tooth loss leads to decreased vegetable and fruit intake and results in nutritional disturbance. This was especially prominent in elderly people who required nursing care. Moreover, although it is becoming clear that not wearing dentures increases the risk of undernutrition, the effect of denture therapy remains debatable. Elderly people in need of nursing care should be studied in future investigations on the relationship between nutrition and oral status because this population is at risk of malnutrition considering both functional and structural problems. © 2013 Japanese Association for Dental Science.

Aim: This study aimed to determine the risk of malnutrition in some communities where the frail elderly receive public long-term care insurance. We also clarified the dental problems in those at risk of malnutrition. Methods: A total of 716 frail elderly who lived in eight cities in Japan (240 males and 476 females with a mean age of 83.2 +/- 8.6 years) were divided into three groups according to Mini Nutritional Assessment short form results: well nourished, at risk of malnutrition and malnourished. They were also divided into three groups in terms of remaining teeth occlusion and denture occlusion: group A, natural dentition with adequate function; group B, partially or fully edentulous, but maintaining functional occlusion with dentures in either or both jaws; and group C, functionally inadequate occlusion with no dentures. The relationship between nutrition status and dental occlusion was evaluated using logistic regression analysis with sex, age, activities of daily living and cognitive function as covariates. Results: The number of participants in each of the groups was as follows: 251 well nourished, 370 at risk of malnutrition and 95 malnourished. When they were divided into just two groups, (i) well nourished and (ii) at risk of malnutrition plus malnourished, in order to study malnutrition risk factors, there were significant relationships between their nutritious status and sex, Barthel index, and occlusion. Conclusion: This large-scale cross-sectional survey showed that loss of natural teeth occlusion was a risk factor for malnutrition among community-dwelling frail elderly. Geriatr Gerontol Int 2013; 13: 50-54.

Many elderly people under long-term care suffer from malnutrition caused by dysphagia, frequently leading to sarcopenia. Our hypothesis is that sarcopenia may compromise oral function, resulting in dysphagia. The objectives of this study were to evaluate sarcopenia of the lingual muscles by measuring the tongue thickness, and elucidate its relationship with nutritional status. We examined 104 elderly subjects (mean age = 80.3 +/- A 7.9 years). Anthropometric data, such as triceps skinfold thickness and midarm muscle area (AMA), were obtained. The tongue thickness of the central part was determined using ultrasonography. Measurement was performed twice and the mean value was obtained. The relationship between tongue thickness and nutritional status was analyzed by Pearson's correlation coefficient and Spearman's rank correlation coefficient. AMA and age were identified by multiple-regression analysis as factors influencing tongue thickness. The results of this study suggest that malnutrition may induce sarcopenia not only in the skeletal muscles but also in the tongue.

Maximal voluntary tongue pressure is decreased in Japanese frail elderly persons Background and objective: To quantitatively estimate tongue function, we developed a handy device for intraoral pressure measurement. The objective of this study was to assess maximum voluntary tongue pressure (MVTP) in Japanese frail elderly persons receiving nursing care services. Materials and methods: The study included 42 men and 87 women, aged 58-100 years. To record MVTP, the participants were asked to compress the balloon (diameter: 18 mm) of the disposable intraoral pressure probe onto their palates for 7 s using the maximum voluntary effort of the tongue. Pressures were recorded three times at 1 min intervals. Results: Maximum voluntary tongue pressure was successfully measured in 111 persons. Mean (standard deviation) MVTP was 18 (12) kPa, with a range of 0-63 kPa. The remaining 18 persons could not accurately follow our instructions and MVTP could not be measured. Conclusion: In comparison with the reported standard value using the same device, the frail elderly persons included in our study were found to exert less MVTP than healthy dentate individuals. These results suggest the need for proper quantitative evaluation of oral function, including tongue capacity, at nursing care facilities.

Objective: As tooth loss has been suggested as a potential risk factor for stroke, oral examinations were carried out on stroke patients to review the oral condition of those patients. Method: The subjects were patients consecutively discharged from the recovery rehabilitation unit of Hiroshima City General Rehabilitation Center between April 2008 and December 2009. All patients were offered oral examination and 358 of 443 patients accepted. Patients receiving dental examination were divided into two groups: one group comprising stroke patients and the second, patients with other disorders. These two groups were then compared for the number of remaining teeth by age group. Results: Among the examined patients, the number of remaining teeth in stroke patients in their 50s and 60s was significantly lower than for patients in corresponding age groups (18.4 +/- 9.4 vs. 24.5 +/- 5.4 and 18.3 +/- 9.2 vs. 22.2 +/- 7.2, respectively, with p < 0.05 for both age groups) who were hospitalised for other conditions. In addition, the number of remaining teeth in stroke patients in their 50s was also significantly lower than the number reported in the Survey of Dental Diseases (24.1 +/- 6.1; p < 0.05). Conclusion: The results of this study suggest an association between tooth loss and early occurrence of stroke.

Tongue pressure measured with a disposable hand-held balloon probe has been used for assessing tongue function; however, no diagnostic standard for assessing other oral functions exists currently. In this study, to develop a method for multifactorial manometric evaluation of oral functions, 20 men and 20 women (21-32 years of age) were instructed to apply 7 s maximal voluntary muscular effort on a hand-held balloon probe placed against the anterior and lateral parts of the palate, buccal surface of the molars on the habitual chewing side and labial surface of the anterior teeth for measuring anterior and posterior tongue, cheek and lip pressures (LPs), respectively. Intra-session reproducibility was determined by three repeated measurements, and associations between the obtained and the conventional data on oral diadochokinesis were tested. The men exhibited higher values of all the pressure types. Further, both genders showed a positive correlation between anterior and posterior tongue pressures (PTPs) (P < 0.05), but only the women exhibited positive correlations between anterior tongue and cheek pressures, cheek and PTPs, anterior tongue and LPs, and cheek and LPs (P < 0.05). No

A new tongue pressure device consisting of a simple and safe disposable probe and manometer has been developed. This report describes a study that examined the validity of the new device, comparing it to a widely used tongue pressure manometer, the Iowa Oral Performance Instrument (IOPI), and to the stable adhered three air-filled bulbs manometry system. The first test compared maximum tongue pressure measured with the new device and the IOPI (13 male, 9 female, 25.0 years). The second test compared maximum tongue pressure and swallowing tongue pressure measured with the new device and the three-bulb device (13 male, 9 female, 31.0 years). Significant correlations of maximum tongue pressure were found between the new device and the IOPI in the first test (p < 0.05). In the second test, significant correlations of maximum tongue pressure were found between the new device at the anterior and middle sensors (p < 0.05) but not at the posterior sensor of the three-bulb device. Significant correlations of swallowing tongue pressure between the new device and the three-bulb device were found (p < 0.05). These findings demonstrate that the measurements by the new simple tongue pressure device are closely equivalent to those of the IOPI and three-bulb devices, demonstrating that the new device is capable of accurately measuring the pressure generated by the whole tongue.

Objective: Tooth loss has been suggested as a potential risk factor for cerebral stroke. This report reviews prospective studies investigating the association between tooth loss and stroke. Method: The PubMed database was used to identify studies about the relationship between tooth loss and stroke including prospective, cohort, and follow-up studies reported from 2000 to 2010. Results: Four prospective follow-up studies have been conducted on the relationship between tooth loss and stroke and three of four reports have suggested that tooth loss is related to incidence of both ischemic and hemorrhagic stroke. Conclusion: The results of this review study support the hypothesis that there is an association between early tooth loss and the occurrence of stroke. © 2011 Japanese Association for Dental Science.

Aim: The purpose of this study was to clarify the correlation between dental and nutritional status among community-dwelling elderly Japanese people. Methods: The subjects were 182 elderly individuals, aged 65-85 years, who voluntarily participated in a health seminar at Kyoto Prefectural University of Medicine. These subjects were divided into two groups according to the occlusion. The subjects in the retained contact group were those who had retained molar occlusion with natural teeth. The lost contact group were those who retained molar occlusion with removable partial dentures. Anthropometric variables such as body mass index (BMI) were collected and dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ). Results: No statistical difference in BMI or intake of macronutrients was found between these two occlusal groups. The lost contact group reported significantly lower consumption of vegetables and higher consumption of confectionaries (foods rich in sugar) than did the retained contact group (P < 0.05), and therefore had significantly lower intake of vitamin C and dietary fiber (P < 0.05). Conclusion: It can be concluded that natural tooth contact loss in the posterior region affect the intake of vitamins and dietary fiber. Geriatr Gerontol Int 2011; 11: 315-319.

Aim: The purpose of this study was to clarify the correlation between dental and nutritional status among community-dwelling elderly Japanese people. Methods: The subjects were 182 elderly individuals, aged 65-85 years, who voluntarily participated in a health seminar at Kyoto Prefectural University of Medicine. These subjects were divided into two groups according to the occlusion. The subjects in the retained contact group were those who had retained molar occlusion with natural teeth. The lost contact group were those who retained molar occlusion with removable partial dentures. Anthropometric variables such as body mass index (BMI) were collected and dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ). Results: No statistical difference in BMI or intake of macronutrients was found between these two occlusal groups. The lost contact group reported significantly lower consumption of vegetables and higher consumption of confectionaries (foods rich in sugar) than did the retained contact group (P < 0.05), and therefore had significantly lower intake of vitamin C and dietary fiber (P < 0.05). Conclusion: It can be concluded that natural tooth contact loss in the posterior region affect the intake of vitamins and dietary fiber. Geriatr Gerontol Int 2011; 11: 315-319.

Objectives: The aim of this study was to examine the relation between the degree of tongue-coating and oral function. Background: Tongue-coating is a moss-like deposit which forms over the tongue surface, and includes micro-organisms, food residues, and abrasive epithelia. It is considered that motor function of the tongue and lips and saliva secretion decrease in the aged and have some effect on the accumulation of tongue-coating. Although saliva secretion has been reported as a factor amongst these oral functions in contributing to tongue-coating, the correlation with the motor function of oral structures is unknown. Subjects and methods: The factors that contribute to the accumulation of tongue-coating were examined in 48 subjects of advanced age (mean age 80.8 +/- 7.8 years) with no severe levels of periodontal disease. Changes in the degree of tongue-coating were also examined after oral functional training in these subjects. The frequency of oral cleaning, status of oral hygiene, motor function of the tongue, and masticatory performance were examined as potential factors associated with the degree of coating. Results: The results showed that tongue pressure and the frequency of oral diadochokinesis measured by pronouncing the single syllable 'ka' as an indicator were statistically significantly correlated with the degree of tongue-coating. Several factors in oral function improved with training, and also the degree of tongue-coating decreased in 27 subjects. Conclusion: These results suggest a correlation between the degree of tongue-coating and a reduction in lingual motor function and, in addition, possible improvement in level of coating by functional training of the tongue.

Objectives: An important purpose of denture treatment is the improvement of nutritional intake. This is especially important for the dependent elderly who have a high risk of protein-energy malnutrition. To evaluate the impact of denture treatment on such a population, we compared body weight as an indicator of nutritional status before and 6 months after prosthodontic treatment. Methods: This study was conducted in a long-term care geriatric hospital in Hiroshima, Japan from October 2004 to September 2006. One hundred and four patients received complete or partial denture treatment in both jaws. Nineteen patients were lost to the study because of the development of severe physical conditions or death. Among the remaining 85 patients, 66 used their new prostheses and 19 did not. Body weight and serum albumin levels were examined at prosthesis insertion and 6 months after treatment. Results: Six months after prosthodontic treatment body weight changes were significantly different between users and non-users regardless of denture type and, in addition, serum albumin level were significantly increased among individuals using partial denture in either or both jaws (P < 0.05). Conclusion: It can be concluded that prosthodontic treatment may improve the nutritional status of institutionalized elderly.

In this study the relationship between the functional vertical labial pressure and aging during ingestion in the elderly is examined. The subjects were 84 community-dwelling elderly (mean: 79.4 years old), 109 elderly needing long term care (mean: 81.3 years old), and 59 healthy young adults (mean: 32.0 years old) as control. Labial pressure was measured with a pressure sensor embedded in acrylic plate. There was no correlation between age and labial pressure or the coefficient of variation of labial pressure during ingestion. In people with a history of "choking on food", labial pressure was, however, significantly lower (p < 0.01) than people without a history of "choking on food", while the coefficient of variation of labial pressure was significantly higher (p < 0.05). Poor labial pressure and movement were noted in subjects who experienced "choking on food", suggesting that lip-closing function also plays an important role in the pharyngeal stage of feeding/swallowing. On the other hand, the coefficient of variation of labial pressure during ingestion was not changed in the elderly group in comparison to the control group. These results showed that skilled movement of lip-closing might be compensated by labial pressure. Labial pressure and skilled movement were, however, decreased in the elderly needing care because of "choking on food".

口腔ケア・マネジメントを確立していくうえで, 肺炎リスクを疑うべき口腔の問題を明確にしておくことは必須の課題である。そこで今回, 全国19カ所の介護施設入所者172名 (男性46名, 女性126名, 平均年齢84.0歳) を対象に肺炎リスク群を選定し, それらの口腔にかかわる問題点を検討した。その結果, スクリーニングにより選別された肺炎リスク群は56名 (男性18名, 女性38名, 平均年齢84.0歳) であり, これらの者では, 要介護度が有意に高く, 開口保持, 咀嚼運動が困難やできない者が有意に多いことが示された (p<0.05) 。以上のことは, 口腔機能の低下した者で肺炎リスクが高まることを示唆しており, 歯科医療者との連携による口腔機能の評価が効果的で効率的な口腔ケア提供体制の確立には重要であることを示している。

本調査は, 介護老人福祉施設における歯科衛生士による口腔ケア・マネジメントの有効性を明らかにすることを目的とした。<BR>対象は, 山梨県にある介護老人福祉施設に入居中の要介護高齢者142名で, A施設は82名 (平均年齢85.9±7.5歳), B施設は60名 (平均年齢85.6±8.3歳) である。調査期間は8ヵ月で, 初回, 4ヵ月後, 8ヵ月後において口腔衛生状態の視診と口腔内細菌数の測定を行った。A施設では, 歯科衛生士による口腔ケアの直接的介入を対象者20名に対して行い, 他の対象者に対しては口腔ケアに関する情報提供と相談のみ行った。B施設では, 歯科衛生士が口腔ケア・マネジメントの手法を用い, すべての対象者に対して個々のスクリーニング, アセスメントに応じたケアプランをたて, 施設職員とともに口腔ケアの介入を行った。また今回の口腔ケア介入終了時に各施設職員へ意識調査のアンケートを行い, 施設間の比較を行った。<BR>その結果, A施設では, 施設全体において口腔内総細菌数には変化はなかった。B施設では, 介入期間中に有意に減少を示した (p<0.05) 。職員の意識調査の結果では, A施設よりもB施設のほうが, 口腔ケアに自分でも積極的に参加したいという意識や, 今回の事業があまり負担ではなかったという意識がうかがわれた。<BR>本研究の結果より, 口腔ケア・マネジメントは, 施設の状況, 歯科衛生士の介入方法などを含めて全員に対してプランをたてていくことで効果があることが示され, 本介入調査により口腔ケア・マネジメントの重要性が確認された。

Purpose: Since tooth loss may be considered to affect postural control, the aim of this study was to compare body balance control among samples of edentulous and dentate community-dwelling elderly subjects. Materials and Methods: A case control study was conducted using test and control groups matched by age, gender, body fat, and muscle composition. The test group included all participants of the 2006 Kyoto Health Seminar who wore a full denture in either or both arches. The control group was blindly selected from the same population, but only included individuals who retained all of their dentition with either natural teeth or crown prostheses. The results of physical fitness examinations and stabilometer tests were compared between these two groups. Results: The test and control groups both included 12 male and 23 female subjects. Body balance ability, measured by time spent standing on one leg with eyes open (P = .013) and functional reach (P = .037), was significantly less in the test group when compared to the control, as shown by analysis done using the Mann-Whitney U test. The stabilometer examination also indicated that sway area (an accurate indicator of postural balance) and body sway (evidence of energy consumption for postural control) while standing with eyes closed were both significantly higher in the test group (P = .035 and .048, respectively; Wilcoxon signed ranks test) than the control. Conclusion: It is suggested that tooth loss is a risk factor for postural instability, This further suggests that proprioceptive sensation from the periodontal ligament receptor may play a role in body balance control. Int J Prosthodont 2009;22: 136-139

This study was performed to ascertain the relationships between oral motor functions, such as those of the tongue and lips, and age in the community-dwelling elderly, as well as to investigate the effects of these factors on masticatory performance. The subjects were 268 healthy elderly Japanese living in Kyoto. They were divided into four age groups and further classified into the following two groups by the presence or absence of posterior occlusal support: Eichner A or B1-B3 (group A), and Eichner B4 or C (group B). They were wearing removable or fixed dentures if they had missing teeth. Oral function evaluation items included (1) masticatory performance and (2) oral motor skills. Significant differences were noted among the age groups in tongue pressure within group A (P &lt; 0.01) and group B (P &lt; 0.05), and in the number of repetitions of the syllables /ta/ and /ka/ in group B (/ta/: P &lt; 0.05, /ka/; P &lt; 0.01). The number of natural teeth (beta = 0.463, P &lt; 0.001) in group A and tongue pressure (beta = 0.436, P &lt; 0.001) in group B were the only predictors of masticatory performance when the data were analyzed by multiple regression analysis. The tongue may compensate for the missing teeth in masticatory performance of those elderly who have lost their natural teeth. The results of this study highlight the importance of tongue function in masticatory performance.

The purpose of this study was to clarify quantitatively the differences in tongue-tip motion among the dentulous elderly people and also among the elderly edentulous, both with and without their dentures and, to identify the influence of tooth loss and denture wear on tongue-tip motion. Fourteen young dentulous people, 12 elderly dentulous people and 13 elderly edentulous people participated in this study. Subjects were asked to swallow a 10 mL barium sulfate solution three times. The elderly edentulous people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine-film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine-projector, the movements of the tongue surface were traced as dots and lines frame by frame on a single tracing sheet within a definite period of time from the beginning of the oral phase to the end of the pharyngeal phase. With counting the number of &#039;trajectories&#039; of tongue-tip motion, tongue movements were classified as &#039;stable&#039; and &#039;hyperactive&#039; types. The results was that significantly more &#039;hyperactive&#039; type subje

It is clinically important to evaluate tongue function in terms of rehabilitation of swallowing and eating ability. We have developed a disposable tongue pressure measurement device designed for clinical use. In this study we used this device to determine standard values of maximum tongue pressure in adult Japanese. Eight hundred fifty-three subjects (408 male, 445 female; 20-79 years) were selected for this study. All participants had no history of dysphagia and maintained occlusal contact in the premolar and molar regions with their own teeth. A balloon-type disposable oral probe was used to measure tongue pressure by asking subjects to compress it onto the palate for 7 s with maximum voluntary effort. Values were recorded three times for each subject, and the mean values were defined as maximum tongue pressure. Although maximum tongue pressure was higher for males than for females in the 20-49-year age groups, there was no significant difference between males and females in the 50-79-year age groups. The maximum tongue pressure of the seventies age group was significantly lower than that of the twenties to fifties age groups. It may be concluded that maximum tongue pressures were reduced with primary aging. Males may become weaker with age at a faster rate than females; however, further decreases in strength were in parallel for male and female subjects.

Objective: The present study compared surface electromyographic (sEMG) activity obtained from the submental muscle group for a tongue press and a head lift exercise as potential therapeutic exercises for dysphagic elderly. Materials and methods: Fifty-three healthy volunteers with a mean age of 35.3 participated in this study. Subjects were required to perform an isometric task, pressing their tongue against the hard palate, and an isotonic task requiring sustained lingual force against the hard palate. Pressure sensors were used to measure the amount of lingual pressure against the hard palate. Submental sEMG data from these tasks were compared with those obtained from the isometric and isotonic aspects of a head lift exercise. Results: No sEMG differences were identified between the isometric tongue press task and head lift exercise. Isotonic tongue press exercises resulted in significantly higher maximum and mean sEMG values compared with the isotonic head lift exercise (p &lt; 0.05). The submental sEMG activity from the tongue press exercise was equal (isometric) to, or greater (isotonic) than comparable muscle activation obtained during the head lift exercise. Conclusions: The tongue press exercise may be less strenuous than the head lift exercise while achieving the same therapeutic effect.

OBJECTIVES: To clarify the influence of aging and denture use on swallowing in healthy edentulous people aged 75 and older. DESIGN: A cross-sectional research design was used with participants from Hiroshima University Hospital, Hiroshima University, and Hiroshima City. SETTING: Participants were examined in Hiroshima University Hospital, Hiroshima, Japan. PARTICIPANTS: Thirteen edentulous elderly volunteers (7 male, 6 female; aged 75-86, mean age 81.2) and 19 dentulous elderly volunteers (12 male, 7 female; aged 80-87, mean age 81.2) as a control group participated in this study. Participants reported no clinical symptoms relating to dysphagia, neurological impairments, or degenerative diseases. MEASUREMENTS: Participants were asked to swallow a 10-mL barium sulfate solution three times. Edentulous older people were asked to swallow the solution while wearing dentures and with dentures removed. Functional swallowing was recorded on cine-film with a digital subtraction angiography system. Lateral cinefluorography images were obtained from seated subjects. Using a cine-projector, visual images were evaluated qualitatively and quantitatively. RESULTS: No participants exhibited aspiration. The occurrence of laryngeal penetration in the edentulous older people not wearing dentures was the only significant difference (P &lt;.05). CONCLUSION: Only laryngeal penetration differed significantly between edentulous older people not wearing their dentures and dentulous older people.

The tongue plays a key role in oropharyngeal swallowing. It has been reported that maximum isometric tongue pressure decreases with age. The risk for dysphagia resulting from low tongue strength remains unclear. This study was designed to reveal the relationship between tongue pressure and clinical signs of dysphagic tongue movement and cough and to demonstrate the clinical value of tongue pressure measurement in the evaluation of swallowing function. One hundred forty-five institutionalized elderly in five nursing homes participated. Evaluation of physical activity with self-standing up capability and mental condition with Mini Mental Status Examination (MMSE) were recorded. Maximum tongue pressure was determined using a newly developed tongue pressure measurement device. Voluntary tongue movement and signs of dysphagic cough at mealtime were inspected and evaluated by one clinically experienced dentist and speech therapist. The relationship between level of tongue pressure and incidence of cough was evaluated using logistic regression analysis with physical and mental conditions as covariates. Tongue pressure as measured by the newly developed device was significantly related to the voluntary tongue movement and incidence of cough (p &lt; 0.05). The results of this study suggest that tongue pressure measurement reflects clinical signs of dysphagic tongue movement and cough and that measurement of tongue pressure is useful for the bedside evaluation of swallowing.

&lt;b&gt;Purpose:&lt;/b&gt; Multifactorial interventions to prevent falls are relatively less effective in the elderly with dementia. We hypothesize that the primitive posture reflex associated with dental occlusion may play an important role in preventing falls in elderly persons with dementia. To demonstrate this, we compared the incidence of falls in individuals with and without dental occlusion.&lt;br&gt;&lt;b&gt;Methods:&lt;/b&gt; This study was conducted at a special geriatric hospital for patients with severe dementia in Hiroshima, Japan. One hundred and forty-six ambulatory institutionalized elderly subjects (42 male and 104 female; mean age, 82.2 y) were divided into three groups on the basis of oral examinations: Group A, premolar and molar occlusion was maintained by natural dentition; Group B, occlusion was maintained by partial or full denture(s); and Group C, occlusion was not maintained by either natural or prosthetic teeth. Each subject was classified into either the &quot;High Falls&quot; (history of two or more falls during the previous one year) or &quot;Low Falls&quot; (history of one or no fall during the previous one year) category. In addition, a small pilot study was conducted to investi

Background. Although age-related changes resulting in slowing of the swallowing reflex and a decline in the neuromuscular control system have been reported, there have been few reports on swallowing function in dentate elderly persons. The purpose of this study was to clarify the primary influence of aging on swallowing in healthy dentate elderly persons older than 80 years who have more than 20 teeth. Methods. Dentate elderly persons (12 male. 7 female: mean age: 81.2 years) and dentate young participants (9 male, 5 female, mean age: 26.8 years) as a control group participated voluntarily. Participants reported no clinical symptoms relating to dysphagia, neurologic impairments, or degenerative diseases, and were asked to swallow 10 nil of barium sulfate solution (10% w/v) three times. Functional swallowing was recorded on 35 mm cinefilm at 30 frames per second with a digital subtraction angiography system. Lateral images of cinefluorography of seated participants' mouth, pharynx, and larynx were obtained. Visual image analysis for qualitative and quantitative evaluation was made with a cine projector. Results. No participants exhibited aspiration during three trials. Occurrence and frequencies of piecemeal deglutition. premature loss of liquid, oral and pharyngeal residues, and laryngeal penetration were significantly greater in dentate elderly persons (p &lt; .05) than in the dentate young participants. Oral transit time, pharyngeal delay time, and pharyngeal transit time in dentate elderly persons were prolonged significantly compared with those in dentate young participants (p &lt; .01). Conclusion. Physiological swallowing functions deteriorate even in healthy dentate elderly persons. This deterioration may be explained primarily by the influence of aging on swallowing.

症例1:69歳女.左側舌半側切除術で器質性構音障害と嚥下障害が残存した.舌可動域の拡大を目標に,ディスポーザブルの口腔内プローブを口蓋皺襞上に位置させ,最大の舌圧でできる限り口蓋に押しつぶすよう指示した.疼痛で一時訓練を中止したが,7ヵ月後には舌運動改善,発音明瞭化,食生活改善を認めた.症例2:73歳男.下顎歯肉癌に対する下顎区域切除術で器質性構音障害,嚥下障害が残存した.症例1と同様の訓練を行い,3週間後には全量経口摂取可能となった.最大舌圧は訓練開始時4.6kPaから10週目20.0kPaとなり,舌運動改善,発音明瞭化,嚥下機能改善を認めた.症例3:63歳男.口底癌に対する下顎骨区域切除術で器質性構音障害,嚥下障害が残存した.症例1と同様の訓練を行い,9週後には全量経口摂取が可能となったが,舌尖部の発赤を認めたため訓練は中止した.その後言語訓練を継続し,舌の挙上運動の改善,発音の一部明瞭化,嚥下機能改善が得られた

OBJECTIVE:To evaluate the influence of dental occlusion, with or without the use of dentures, on mortality in community-dwelling elderly persons.;SUBJECTS:A total of 1030 randomly selected healthy independent elderly aged 65 and over were surveyed in 1995. For the study reported here, subjects were classified into three groups according to the presence or absence of maxillo-mandibular tooth contacts. Subjects with no maxillo-mandibular tooth contacts were further subdivided into those with and without dentures.;METHODS:Data on mortality were obtained from Kure City Council in September 2003. Cox regression models were used in analysing the risk for death with gender and age as covariates.;RESULTS:Individuals whose teeth had contact in at least the bilateral premolar regions at baseline had 0.78 times (95% CI: 0.60-0.99) smaller risk for death during the succeeding 8 years than those who had no occlusion. Among those who had no occlusion with their own teeth, the risk for mortality among denture non-users was 1.52 times (95% CI: 1.25-1.83) higher than the risk for denture users.;CONCLUSION:These results may support the view that, in the elderly; poor dental occlusion is associated w

This paper reports the case of a 47-year-old woman with dysphagia due to amyotrophic lateral sclerosis (ALS). Swallowing impairment was improved for 9 months by the application of a palatal plate prosthesis. The patient's swallowing condition was evaluated by the swallowing function of ALS severity scale and cinefluoroscopy. The effect on ALS patients of oral prostheses as an aid to swallowing is discussed herein.

歯の喪失は, そこにいたるまでの問題のある食習慣や生活習慣などの結果としての病態であるといえる. その意味から, 無歯顎者は健康でなくなるリスクの高い人たちともいえる. また, 無歯顎という病態そのものが, 咀嚼障害や審美障害をもたらし, 社会的活動性を制限することから, より健康でなくなるリスクを高める可能性がある. これまでの報告から, 歯が20本以上もしくは16本以上残存している高齢者は, そうでない高齢者に比べて有意に長命であることが示されている. さらに, 義歯装着と生命予後との関係について, われわれが行った調査では, 上下顎で残存歯による咬合のない高齢者では, 義歯を装着していない者は装着している者に比べて1.52倍 (95%CI: 1.25-1.83) 有意に死亡率が高いことが示されている. このように, 歯や咬合の有無が生命予後に影響を及ぼす可能性が明らかになったことは, 今後われわれがなすべき研究のひとつの方向性を示しており, ここでは, 考えられるそのいくつかについて, 文献的考察ならびにわれわれの調査結果を含めて提示した. このような疫学的研究に基づいた仮説とその立証が, 超高齢社会における歯科補綴学の意義を明確にしていくうえで重要な取り組みの1つであると考える.

It has been well recognized that geriatric dentistry will become more important in the 21st century because of the increase of the elderly population and their longevity of life. Geriatric dentistry should tackle prevention, medication, and welfare as one. The main theme of prevention is health promotion to obtain high quality of life by maintaining their own teeth and occlusion. The purpose of medication is to enhance the quality of life by repairing masticatory function and esthetics. Moreover, dentists should take part in the care for the elderly with complex medical conditions through oral health care and rehabilitation of eating. Technology assessment is one of the most useful ways to examine the quality of medicine and quality of life. In this paper, technology assessment has been performed to evaluate complete denture treatment using our original scores. The subjects were classified into two groups, one group of 28 persons (12males, 16 females, mean age 71.5 years) who were treated by complete denture treatment at the university hospital and another group of 30 (13 males, 17 females, mean age 72.3 years) who were treated by complete denture treatment at private offices in Kure City. The complete denture score was obtained by examination of quality of medicine, the chewing function and satisfaction scores of complete denture prosthesis defined treatment outcome, and the QOL score was used to identify their own quality of life. As a result, complete denture score in the group at the university hospital was significantly higher than that in the other group. Significant relationship was detected between the complete denture and satisfaction scores (p<0.01). The complete denture score was closely related to the QOL score. Under limited conditions of this study, it could be concluded that high quality of complete denture treatment enhances the edentulous patient's quality of life.