Screening for masticatory disorders in older adults (SMDOA): An epidemiological tool

Patient-reported outcome measures for masticatory function in adults: a systematic review

Objective

The aim of this systematic review was to critically evaluate the Patient-Reported Outcome Measures (PROMs) for masticatory function in adults.

Methods

Five electronic databases (Medline, Embase, Web of Science Core Collection, CINAHL Plus and APA PsycINFO) were searched up to March 2021. Studies reporting development or validation of PROMs for masticatory function on adults were identified. Methodological quality of the included studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. Psychometric properties of the PROM in each included study were rated against the criteria for good measurement properties based on the COSMIN guideline.

Results

Twenty-three studies investigating 19 PROMs were included. Methodological qualities of these studies were diverse. Four types of PROMs were identified: questions using food items to assess masticatory function (13 PROMs), questions on chewing problems (3 PROMs), questions using both food items and chewing problems (2 PROMs) and a global question (1 PROM). Only a few of these PROMs, namely chewing function questionnaire-Chinese, Croatian or Albanian, food intake questionnaire-Japanese, new food intake questionnaire-Japanese, screening for masticatory disorders in older adults and perceived difficulty of chewing-Tanzania demonstrated high or moderate level of evidence in several psychometric properties.

Conclusions

Currently, there is no PROM for masticatory function in adults with high-level evidence for all psychometric properties. There are variations in the psychometric properties among the different reported PROMs.

Trial Registration PROSPERO (CRD42020171591).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01949-7.

Consensus on the terminologies and methodologies for masticatory assessment

A large number of methodological procedures and experimental conditions are reported to describe the masticatory process. However, similar terms are sometimes employed to describe different methodologies. Standardisation of terms is essential to allow comparisons among different studies. This article was aimed to provide a consensus concerning the terms, definitions and technical methods generally reported when evaluating masticatory function objectively and subjectively. The consensus is based on the results from discussions and consultations among world‐leading researchers in the related research areas. Advantages, limitations and relevance of each method are also discussed. The present consensus provides a revised framework of standardised terms to improve the consistent use of masticatory terminology and facilitate further investigations on masticatory function analysis. In addition, this article also outlines various methods used to evaluate the masticatory process and their advantages and disadvantages in order to help researchers to design their experiments.

Validity Evidence of an Epidemiological Oropharyngeal Dysphagia Screening Questionnaire for Older Adults

OBJECTIVE

This research aimed to identify evidence of validity of a self-reported Oropharyngeal Dysphagia screening questionnaire for older adults based on test content, response processes, internal structure, relations to other variables, and reliability.

METHOD

This is a nonrandomized, cross-sectional study employing the concepts and principles of the Standards for Educational and Psychological Testing. Data were collected from 644 community-dwelling older adults (both genders, age: ≥60 years) who agreed to participate in some steps of the validation process. Statistical methods obtained the content representation of the construct, internal structure validation, discriminant and convergent evidence, and reliability, using a 5% significance level.

RESULTS

The screening tool was re-specified in nine questions that provided the best fit and robust reliability, with proper discriminant and convergent evidence.

CONCLUSIONS

The screening questionnaire presented valid and reliable results to identify oropharyngeal dysphagia symptoms in older adults, highlighting the importance of the validation process based on the standards to construct an epidemiological instrument.

Did Expanded Dental Insurance Improve Chewing Ability in the Older Korean Population? Results of an Interrupted Time-series Analysis

Background

In 2012, the Korean National Health Insurance extended its coverage to include denture services for older adults. We examined whether the new policy resulted in improved chewing ability in the eligible population.

Methods

We used interrupted time-series (ITS) analysis, a quasi-experimental design, to analyze the effect of the policy. We used data from the Korea National Health and Nutrition Examination Survey conducted from 2007 to 2016–2018. The study population consisted of two groups: the treatment group, aged 65 years or older and eligible for the dental insurance benefit; and the control group, those younger than 65 years and ineligible. The main evaluated outcome was self-reported chewing difficulty.

Results

The ITS analysis showed that chewing difficulty decreased annually by 0.93% (95% CI, −1.30 to −0.55%) and 0.38% (95% CI, −0.59 to −0.16%) after the policy extension in the older than 65 and younger than 65 groups, respectively. However, we could not conclude that the insurance extension affected chewing difficulty because there was a decrease in the control group as well.

Conclusion

Chewing ability improved in both older and younger adults regardless of dental insurance coverage for older adults. Other exogenous factors probably led to the improvements in chewing ability as well as dental insurance benefits.