Relationship between masticatory performance using a gummy jelly and food intake ability in Japanese complete denture wearers

Influence of denture-bearing conditions on masticatory function and patient-reported outcomes measures

PURPOSE

To investigate the influence of different denture-bearing conditions on the masticatory function and patient-reported outcome measures (PROMs) of complete denture wearers.

METHODS

Sixty edentulous patients were selected and allocated into two groups according to the American College of Prosthodontics' (ACP) classification: non-atrophic (NAT) (Classes I and II) (n = 24) and atrophic (AT) (Classes III and IV) (n = 36). All patients received new complete dentures (CDs). The objective variables (masticatory performance and swallowing threshold) were assessed as well as the PROMs (oral health-related quality of life (OHIP-EDENT), patient satisfaction) and quality of the prosthesis, at baseline (using the old CD) and after 4 months new prostheses use. Data were analyzed by Mann-Whitney test followed by the Generalized Equations Estimation (GEE), linear regression and Chi-square test.

RESULTS

Higher masticatory performance was observed in the NAT group (p < .05) for both time points, baseline and after 4 months. However, compared to baseline, both groups showed significant masticatory improvement after 4 months (p < .05). Satisfaction and overall quality of life improved after 4 months with no difference between groups (p > .05). Regarding the quality of the CD, baseline results were significantly (p < .05) lower in the AT group, but after 4 months, no significant differences were found between groups and in intragroup analysis (p > .05).

CONCLUSIONS

The denture-bearing conditions seems to impact masticatory function, but the PROMs are barely affected.

Development of the Food Acceptance Questionnaire for Thai Partial and Complete Edentulism

This study aimed to develop the Food Acceptance Questionnaire (FAQ) to assess the masticatory ability of Thai older adults (≥60 years). Fifty participants were interviewed using open-ended questions about food they regularly consumed and avoided due to difficulty chewing. From a list of 140 items, 100 were recruited for a trial version of the FAQ. A total of 154 participants responded to the 5-point Likert scale on their chewing perception of each food item (1, impossible to chew; 5, most easily eaten). The average response of each food item was used as the chewing index (CI). The 100 food items were ranked and divided into five grades based on their CIs. Masticatory performance (MP) was objectively assessed by a visual scoring method using gummy jelly (UHA Mikakuto). Two foods from each grade that demonstrated the highest correlation with MP were selected to form the final 10-item FAQ. The FAQ score was calculated by summarizing the responses of 10 items. MP correlated strongly with the FAQ score (r = 0.57, p < 0.001), indicating its predictive validity. Furthermore, the FAQ indicates strong internal consistency (Cronbach's alpha coefficient = 0.90), indicating high reliability. In conclusion, this newly developed 10-item FAQ is valid and reliable for assessing the masticatory ability of Thai older adults.

Effect of digital complete dentures manufactured using the custom disk method on masticatory function

Statement of problem

The effect of using the custom disk method (CDM) for fabricating digital dentures on patients' masticatory function should be studied to support its use in clinical practice.

Purpose

To investigate the effect of digital dentures fabricated using CDM on patients' masticatory function.

Material and methods

This single-center prospective clinical study included 20 patients with edentulous maxillary and mandibular arches who used a complete denture. The digital impression and complete denture manufacturing procedures using CDM have already been reported by Kanazawa et al. (2018) [32] and Soeda et al. (2022) [18] Thedigital dentures fabricated with CDM were delivered to the participants, and periodic adjustments were made until the patient could use the denture without pain. A color-changeable chewing gum, two types of gummy jellies that can evaluate the masticatory function, and pressure-sensitive sheets were used to evaluate the participants' masticatory function at baseline, 1 month, and 6 months following adjustment of the new digital complete dentures fabricated with CDM. These masticatory function values had already been measured in the previous conventional dentures and were recorded as baseline values.

Results

The study participants included 8 women and 12 men (mean age, 77.6 years). The color-changeable chewing gum analysis indicated that there was no significant improvement of masticatory function from baseline to 1 M (P = .083) and 6 M (P = .157).The gummy jelly analysis indicated no significant differences between the masticatory function baseline and 1 month (P = .387); however, a significant improvement was observed from baseline to 6 months (P = .020). Tests with Glucolum indicated a significant improvement from baseline to 1 month (P = .012) and 6 months (P = .003). The maximum bite force and occlusal contact area showed no significant difference at any time point.

Conclusions

Significant improvement in masticatory function was observed upon evaluation with gummy jelly and Glucolum 6 months after delivering the new digital complete dentures. Under limited conditions, the digital denture fabricated using CDM resulted in good recovery of the masticatory function in elderly edentulous patients. The present results combined with the cost-effectiveness and patient satisfaction associated with CDM indicate its clinical utility.

Usefulness of the masticatory score by occlusal support

This study aimed to clarify the usefulness of masticatory score by occlusal support. A total of 605 adults were classified into four groups (A1, A2A3, B, and C) according to the Eichner classification, and the relationship between the amount of glucose eluted and masticatory score was investigated in each group. A significant correlation between the glucose eluted and masticatory score was observed in groups A2A3, B, and C, but not in A1, suggesting that the masticatory score is useful for evaluating the masticatory performance of complete denture wearers, but not adults with natural dentition.

Relationship between body mass index and masticatory factors evaluated with a wearable device

Numerous studies have evaluated the relationship between eating behavior and obesity, however few studies have objectively assessed eating behavior. Additionally, the association of masticatory behaviors with masticatory performance remains unclear. This study aimed to verify the relationship between masticatory performance and behavior measured by a wearable masticatory counter, and BMI. 365 healthy adults participated. Mastication behaviors, i.e. number of chews and bites, chewing rate, and chewing time, were measured using wearable masticatory counter while consuming one rice ball (100 g). Masticatory performance was evaluated using testing gummy jelly. Lifestyle habits including exercise, walking, and breakfast, were surveyed by questionnaire. The correlation coefficients between masticatory behaviors and performance and BMI were analyzed. Furthermore, multiple regression analysis was performed. The number of chews showed positive correlation with chewing rate, number of bites and chewing time, but no correlation with masticatory performance. BMI had weak but significant negative correlation with number of chews, bites, chewing time, and masticatory performance, but had no correlation with chewing rate. Multiple regression analysis revealed that BMI was associated with sex, age, number of chews, bites, masticatory performance, and walking speed. In conclusion, masticatory behavior and performance were not interrelated, but both were independently associated with BMI weakly.

Reference value of masticatory performance by measuring the amount of glucose extraction from chewing gummy jelly

PURPOSE

The purpose of this study was to determine a reference value for masticatory performance (MP) by measuring the amount of glucose extracted(AGE) from chewing gummy jelly.

METHODS

A total of 237 young adults (young group, 20-39 years), 147 middle-aged adults (middle-aged group, 40-59 years), and 177 older adults (old group, 60-87 years) participated in this study. All participants had natural dentition, excluding the third molars. AGE was measured when the participant chewed gummy jelly and used as a parameter of MP. AGE was compared among the three groups. Next, AGE in each group was compared between the habitual chewing side and non-habitual chewing side, and between males and females. The correlation between age and AGE was also investigated.

RESULTS

AGE in the young, middle, and old groups were similar, and no significant differences were observed. AGE was significantly higher in the habitual chewing side compared to the non-habitual chewing side, and in males than that in females. No significant correlations were found between age and AGE. AGE in the habitual chewing side of all ages was 221.9 ± 34.4 mg/dL for males and 206.0 ± 28.7 mg/dL for females. The mean-2SD (standard deviation) value representing the reference value of healthy adults was 153.1 mg/dL for males and 148.6 mg/dL for females, which was close to 150 mg/dL.

CONCLUSION

It was concluded that the reference value of masticatory performance as measured by the amount of glucose extraction after chewing gummy jelly was 150 mg/dL.

Development of the Sakiika Transport Test: A Practical Screening Method for Patients with Oral-phase Dysphagia

PURPOSE

This study aimed to develop a simple screening test for mastication, "the Sakiika (squid jerky) transport test (STT), which evaluates the vertical jaw movement coordinated with the lateral tongue movement during stage I transport, and investigate the possibility of its clinical application.

METHODS

The study included 73 people with dysphagia (mean age, 78.5 ± 7.8 years; median age, 79.0 years; interquartile range, 75.0-84.0). The STT evaluated the ability of a participant to transport a piece of squid jerky placed on the midline of the tongue to the molar region. The STT score was defined as the number of vertical jaw movements occurring as the tongue transported food to the molars. A cutoff value was set by comparing the STT scores with masticatory function evaluated via a videofluoroscopic swallowing study and with food texture evaluated using the Food Intake LEVEL Scale (FILS).

RESULTS

The STT scores counted by the two examiners had a κ coefficient of 0.79, indicating good reliability. The STT score was significantly associated with both the presence of masticatory movement ( p = 0.019) and food texture classified by FILS ( p = 0.032) at cutoff value of "3" (3 vertical movements). The STT showed 62% sensitivity and 75% specificity for masticatory movements.

CONCLUSION

The STT could be a useful screening test to assess the presence or absence of food transportation to the molars for mastication in older patients with dysphagia. In addition, the STT could be useful in identifying the need to modify food texture to meet functions.

Association between masticatory movement and oral and physical function in healthy older women

PURPOSE

This study examined the association between masticatory movement and oral and physical function in healthy older women using clinical assessments considering central motor control.

METHODS

A total of 107 independent older women (mean age, 74.37 ± 4.46 years; age range, 66-84 years) living in the community participated in this cross-sectional study. The subjects selected were those aged 65 years or older with at least 28 teeth and without oral dysfunction, temporomandibular joint (TMJ) disease, cerebrovascular disease, or neuromuscular disease. The following items of oral and physical function were measured: masticatory path pattern, masticatory perfor-mance, oral diadochokinesis (ODK), tongue pressure, single-leg stance with eyes open (SLS), stepping test, and grip strength. Logistic regression analysis adjusting for age was performed to investigate the association between masticatory movement and other items.

RESULTS

In total, 30.8% of subjects were classified into the abnormal group regarding masticatory path pattern, having a significantly lower value than that of the normal group in masticatory performance (unadjusted p = 0.021). After adjusting for age, the masticatory path pattern was significantly associated with masticatory performance ( p = 0.032); ODK /pa/ ( p < 0.001), /ta/ ( p = 0.022), and /ka/ ( p = 0.016); and stepping test ( p = 0.018). Tongue pressure, SLS, and grip strength were not significantly associated with masticatory path pattern.

CONCLUSION

Masticatory movement in older women was associated with masticatory performance, tongue and lip motor skills, and physical agility, which might be influenced by central motor control.

Masticatory movements and food textures in older patients with eating difficulties

Objectives

To investigate whether masticatory movements in older patients with eating difficulties were associated with oral motor function, physical function, and appropriate food textures.

Background

There are few reports on the association between masticatory movements and food textures in older patients with eating difficulties.

Materials and Methods

This cross‐sectional study involved outpatients at a clinic that specialised in eating and swallowing rehabilitation. Masticatory movements were evaluated as normal or abnormal masticatory path patterns. Oral and physical functions were assessed in terms of oral and physical status, muscle strength and motor skills. The appropriate food texture was determined based on fibreoptic endoscopic evaluation of swallowing and a video fluoroscopic swallowing study. The associations between food texture and masticatory organ, muscle strength and motor skills were analysed.

Results

A total of 126 outpatients (75 men and 51 women; mean age, 78.2 years; SD, 9.6 years) were included in the analysis. 68 participants (54.0%) showed abnormal masticatory movements. Masticatory movement was associated with masticatory performance (odds ratio [OR] = 0.99, 95% confidence interval [CI] = 0.98‐0.99), oral diadochokinesis (OR = 0.55, CI = 0.35‐0.86) and stepping test (OR = 0.92, CI = 0.86‐0.97). Masticatory movement (OR = 2.94, CI = 1.23‐7.01) and the number of natural teeth (OR = 0.94, CI = 0.89‐0.99) were associated with normal food.

Conclusion

Masticatory movements in older patients with eating difficulties may be associated with appropriate food textures whilst being influenced by individual differences in systemic motor control. Masticatory movements may be as important as teeth to enjoy eating.

Inter-measurement variation of masticatory performance test using gummy jelly

The purpose of this study was to clarify the inter-measurement variation of the masticatory performance test. Forty healthy adults were divided into group A (10 males and 10 females), who did not chew the test food before experiment, and group B (10 males and 10 females) who chewed the test food before the experiment. Subjects were asked to chew a gummy jelly for 20 s on the habitual chewing side, and the amount of glucose extraction was measured. The test was repeated three times with an interval of 1 min in both groups (Group A: A1, A2, A3; Group B: B1, B2, B3). In both groups A and B, the difference between the measured values was compared and the reliability between measurements was investigated. In group A, the value of A1 was small, and a statistically significant difference was observed between A1 and other measured values. In group B, the three measured values were similar and no significant difference was observed among the measured values. The intraclass correlation coefficient (ICC) values for determining inter-measurement reliability in group A were 0.758 for A1-A2-A3, 0.708 for A1-A2, and 0.901 for A2-A3. The ICCs in group B were 0.924 for B1-B2-B3, 0.945 for B1-B2, and 0.926 for B2-B3. Based on these results, it can be suggested that high reliability between the measurements can be obtained if the subjects are accustomed to chewing the test food before the experiment, and that the measured values were similar whether it was performed two or three times. Consequently, one measurement was sufficient if subjects were accustomed to chewing the test food before the experiment.

Can masticatory performance be predicted by using food acceptance questionnaire in elderly patients with removable dentures?

BACKGROUND

Although a food acceptance questionnaire is useful for subjective masticatory function assessments, its characteristics and limitations when applied to patients with removable dentures have been unclear. We therefore assessed the relationship between the subjective and objective masticatory function and explored whether or not a decreased masticatory function could be evaluated by food acceptance questionnaire.

METHODS

One hundred and nineteen patients >60 years old with removable partial and/or complete dentures participated. Food acceptance score (FAS) was calculated by using Sato's questionnaire with 20 food items. Masticatory performance (MP) was assessed by a visual scoring method using a test gummy jelly (UHA Mikakuto). Simple/multiple regression analyses were performed to explain the objective masticatory function. The cut-off value of FAS was determined to predict a decreased masticatory function by sensitivity, specificity and receiver operating characteristics curve.

RESULTS

No significant gender differences in MP or FAS were noted. Although both MP and FAS increased with the number of functional teeth, FAS was not significantly affected by age. The number of functional teeth, FAS and age had significant correlations with MP, with the number of functional teeth showing the strongest correlation. Multiple linear regression analyses identified the FAS as a significant explanatory variable for MP, and 70 was the optimal cut-off value for detecting a decreased masticatory function (MP score ≤ 2) in the diagnosis of 'oral hypofunction'.

CONCLUSIONS

Using FAS to assess the MP was deemed appropriate, and a score of 70 was the optimal cut-off value for detecting a decreased masticatory function.

Does Masticatory Ability Contribute to Nutritional Status in Older Individuals?

Mastication plays a primary role in the process of eating. Hence, compromised masticatory ability may affect the nutrition and quality of life, which are particularly important concerns among older individuals. It remains unclear how is the masticatory ability assessed regarding the nutritional status. We examined the effect of various oral factors on three masticatory ability tests conducted among older individuals. A total of 100 older individuals were enrolled in this study. Body mass index (BMI) as an indicator of nutritional status; and age, sex, and the number of occlusal and molar occlusal supports as clinical attributes were recorded. Three masticatory ability tests (masticatory efficiency, masticatory score, and satisfaction with mastication) were conducted, and tongue pressure, cheek pressure, and occlusal force were assessed as oral functions. A significant but weak correlation was found between masticatory efficiency and the masticatory score, but not between masticatory efficiency and satisfaction score. Objective masticatory efficiency was strongly associated with objective oral factors, whereas subjective assessments of masticatory ability (masticatory score and satisfaction score) were not. Furthermore, BMI was significantly associated with subjective assessments of masticatory ability but not with objective masticatory efficiency. Both subjective and objective assessments of masticatory ability, along with considerations of nutritional formulations, are required for the maintenance and improvement of nutritional status in older individuals.

Influences of Masticatory Function Recovery Combined with Health Guidance on Body Composition and Metabolic Parameters

Background:

Tooth loss reduces masticatory function. Insufficient masticatory function causes an increase in carbohydrate intake while decreasing the intake of foods with a low Glycemic Index (GI) and high in protein, antioxidants, dietary fiber, vitamins, and minerals. Protein-energy malnutrition may lead to metabolic syndrome, frailty, and faster onset of Non-Communicable Diseases (NCDs). Individuals with tooth loss resulting in problematic eating habits require behavior modification and health guidance.

Objective:

This report aims to evaluate the influence of dental prostheses combined with health guidance on body composition and metabolic parameters.

Methods:

Data were collected from three subjects: Two with molar loss and one with edentulism. Masticatory function was restored in each subject through prosthodontic treatment. Masticatory performance was evaluated before and after the prosthodontic treatment by having the subjects chew a gummy jelly and measuring the glucose extraction. Questionnaires were used to assess food intake and lifestyle habits. Health guidance based on the results of the questionnaires was conducted simultaneously with the prosthodontic intervention. Body composition and blood pressure were measured and blood tests were performed at baseline and around 90 days after the first health guidance session.

Results:

Masticatory ability, body-mass index, basal metabolism standard value, body-fat percentage, and intake of certain nutrients improved in all cases. Blood pressure and hemoglobin A1c improved in two cases.

Conclusion:

Masticatory function recovery combined with health guidance was effective in preventing the onset or deterioration of NCDs in patients with masticatory dysfunction.