New method for evaluation of tongue-coating status

Relationship Between Blood Test Results and Oral Function Tests in Individuals Undergoing Regular Physical Examinations

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 < 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.

Volatile sulfur compounds, biofilm, and salivary parameters in patients with periodontal disease: a cross-sectional study

This cross-sectional study aimed to evaluate the interplay between volatile sulfur compounds (VSC), biofilm, salivary parameters, and periodontal status in patients with and without periodontal disease. Sixty-four subjects diagnosed with periodontitis and 60 periodontally healthy individuals were included. Probing depth, clinical attachment level, bleeding on probing, tongue coating index, plaque index, number of teeth, spinnability of unstimulated whole saliva, and salivary flow rate were evaluated. The concentrations of VSC were quantified using a portable gas chromatograph. The mean differences in hydrogen sulfide, methyl mercaptan, salivary flow, spinnability, and plaque index did not exhibit statistically significant variances between the two groups. However, a pronounced tongue coating index and a diminished tooth count showed statistical significance in the periodontitis group (p = 0.039; p < 0.001). Unstimulated salivary flow rate less than 0.25 mL/min was statistically significant in the periodontitis group (p = 0.032). After controlling for confounding factors, bleeding on probing remained significant. A positive correlation between periodontal parameters and VSC concentration was found. An inverse correlation was also noted between the spinnability of saliva and tongue coating index (-0.34; p < 0.001). Salivary parameters may contribute to the formation of tongue coating and are correlated with periodontal status. Bleeding on probing, clinical attachment level, and probing depth were identified as potential contributors to VSC formation.

Diagnostic accuracy of tongue coating in identifying acute appendicitis: a prospective cohort study

BACKGROUND

Acute appendicitis requires timely diagnosis. The diagnostic efficacy of tongue examination in making this diagnosis has not been established. This study investigates whether the Tongue Coating Index (TCI), a validated measure of tongue coating, can aid in diagnosing acute appendicitis.

METHODS

We conducted a prospective cohort study (1 September 2018-31 December 2020) at a single Japanese hospital. Adults (≥20 years) with suspected acute appendicitis, presenting to either the emergency department or general outpatient clinic, were enrolled. Tongue images were taken at presentation; two independent examiners-unrelated to clinical care and blinded to patient data-later scored these images using the TCI. A composite reference standard (clinical findings, imaging, histopathology, follow-up) was used to confirm appendicitis. We compared the TCI's diagnostic performance with the Alvarado score and its components using C-index, area under the curve (AUC), sensitivity and specificity.

RESULTS

Of 145 included patients, 69 (47.6%) were diagnosed with acute appendicitis. The TCI demonstrated comparable discriminative ability (C-index AUC 0.62; 95% CI, 0.53 to 0.71) to that of the Alvarado score (0.66; 95% CI, 0.57 to 0.75). Of Alvarado score components, migration of pain had an AUC of 0.63 (95% CI, 0.55 to 0.71), anorexia 0.58 (95% CI, 0.50 to 0.66) and tenderness in the right lower quadrant 0.55 (95% CI, 0.50 to 0.60). At a cut-off of 3, the TCI demonstrated high sensitivity of 96% (95% CI, 88% to 98%) but low specificity of 21% (95% CI, 13% to 32%). Conversely, at a cut-off of 10, the TCI showed increased specificity of 83% (95% CI, 73% to 90%) but reduced sensitivity of 29% (95% CI, 20% to 41%).

CONCLUSION

The TCI showed comparable diagnostic performance to the Alvarado score and its individual components. TCI may potentially serve as an additional non-invasive indicator for diagnosing or ruling out acute appendicitis. Further research is essential to validate its clinical utility.

Comparison of the inhibitory effects of tooth brushing and povidone-iodine mouthwash on salivary bacterial counts in patients undergoing surgery for malignant solid tumors other than head and neck cancers

Background/purpose

Infectious complications after invasive surgeries may originate from oral sources through either hematogenous infection or direct exposure to salivary bacteria. Perioperative oral management aims to remove oral foci of infection. However, the type of oral care that can reduce the salivary bacterial load remains unclear. This study aimed to identify factors influencing salivary bacterial counts during the perioperative period in patients with malignant tumors and to evaluate the effectiveness of tooth brushing and povidone-iodine mouthwash in reducing oral bacterial counts.

Materials and methods

Patients aged ≥18 years who underwent surgery under general anesthesia for malignant solid tumors other than head and neck cancer were included. Participants were randomly assigned to the brushing or povidone-iodine mouthwash groups. Factors such as sex, age, primary disease, preoperative blood-test results, oral functional metrics, and salivary bacterial counts were analyzed. Saliva samples were collected before and on the day after surgery, both before and after oral-care interventions. The total bacterial and streptococcal counts were determined using real-time polymerase chain reaction (PCR), and delayed real-time PCR was used to determine the viable bacterial count.

Results

Postoperatively, the salivary bacterial counts increased slightly. Significant factors affecting postoperative bacterial counts included high preoperative counts and postoperative fasting status. Brushing increased salivary bacterial counts, whereas the povidone-iodine mouthwash decreased them.

Conclusion

Poor preoperative oral hygiene and postoperative fasting were significantly associated with increased salivary bacterial counts. The povidone-iodine mouthwash reduced postoperative bacterial counts, indicating its effectiveness as a perioperative oral-care method.

Association Between Cognitive Impairment and Poor Oral Function in Community-Dwelling Older People: A Cross-Sectional Study

BACKGROUND/OBJECTIVES

The population of Japan has a high life expectancy, but there is room for improvement in terms of the country's healthy life expectancy. The long period of care dependency among Japan's elderly is also a major economic health challenge. Dementia is a major factor in the need for care, and its prevention is a crucial and urgent challenge. There are recent reports of a possible association between changes in oral function and cognitive impairment, but the details of this association remain unclear. To clarify the relationship between poor oral function and cognitive impairment, we conducted an exploratory investigation using a cognitive function assessment (Mini-Cog) administered in a large-scale study and its relevance to oral function.

METHODS

The study population was 678 community-dwelling individuals aged ≥65 years living in Tarumizu city, Japan, in 2019. Cognitive function was assessed using the Mini-Cog test, and the oral survey was a modification of the content of the Oral Hypofunction Examination as defined by the Japanese Society of Gerodontology.

RESULTS

The participants' median age was 73 years. The oral function results revealed median scores below the oral hypofunction criterion for occlusal force, tongue pressure, oral diadochokinesis, and swallowing function. The results of a binomial logistic regression analysis indicated that tongue-lip motor function was independently associated with oral function in relation to cognitive impairment.

CONCLUSIONS

The oral function associated with cognitive impairment in this study was tongue-lip motor function. Aiming to improve this function may prevent the exacerbation of cognitive impairment.

Associations of sex, age, and number of remaining teeth with performance on oral hypofunction tests

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.

Development of a novel tongue biofilm index using bacterial biofluorescence

Conventional methods for assessing tongue bacterial biofilms have low inter-examiner reliability due to visualization challenges. This study aimed to develop and assess a novel Tongue Biofilm Fluorescence Index (TBFI) for the accurate detection and objective evaluation of the quantitative and qualitative characteristics of tongue biofilms at the chairside. Data were collected from 81 elderly individuals (n = 162 images). Qraycam captured white-light and fluorescence images of the dorsal tongue, and two examiners assessed tongue coating (TC) using the TBFI. The TBFI was calculated based on biofilm intensity and coverage (0-2 scale). Inter-examiner agreement (Kappa) was compared with the Winkel's Tongue Coating Index (WTCI) and the Oho Index. Validity was evaluated through correlations with hydrogen sulfide (H₂S) and methyl mercaptan (CH₃SH) levels. TBFI demonstrated the highest inter-examiner reliability (TBFI, κ = 0.752; WTCI, κ = 0.317; Oho Index, κ = 0.496), particularly for thickness rating (agreement rate: TBFI, 96.3%; WTCI, 76.5%; Oho Index, 79.6%). H₂S and CH₃SH concentrations showed significant positive correlations with all three indices, with the highest correlation observed between H₂S and TBFI (TBFI, r = 0.369; WTCI, r = 0.304; Oho Index, r = 0.308; p < 0.01). Furthermore, H₂S levels increased significantly with higher TBFI scores (p < 0.0001). TBFI shows enhanced reliability and validity, supporting its clinical potential.

Pilot study on the relationship between oral function or subjective symptoms and appetite

OBJECTIVE

This pilot study evaluated the relationships between appetite and oral function, and between appetite and the subjective symptoms of decreased oral function.

METHODS

Seventy-one adult dental clinic patients (22 males, 66.0 ± 14.0 years) participated in this study. A Council on Nutrition Appetite Questionnaire score of ≤28 indicated anorexia, and the Mini Nutritional Assessment Short-form, body mass index and skeletal muscle mass index were used to define subject characteristics. Seven oral function tests and seven subjective symptoms related to oral function were evaluated. The relationship between subject characteristics, oral function tests, subjective symptoms and anorexia was analysed using the chi-square test and univariate and multivariate logistic regression.

RESULT

There were significant differences between the normal appetite group and the anorexia group for the 10-item Eating Assessment Tool (EAT-10) survey and the question 'Food remains in the oral cavity after eating' (p < .05). Univariate logistic regression found significant differences in the items of masticatory function, the EAT-10 survey and the question 'Food remains in the oral cavity after eating'. Multivariate logistic regression revealed significant differences in masticatory function (AOR 4.35; 95% CI: 1.03-18.35; p = .045) and EAT-10 (AOR 6.27; 95% CI: 1.40-24.02; p = .016).

CONCLUSION

This pilot study investigated the influence of factors related to oral function on appetite. Relationships were found among poor masticatory function, poor swallowing function and anorexia.

Comparison of masticatory performance and oral hygiene status using cream-type denture adhesives and home liners: A cross-sectional study using propensity-score matching

BACKGROUND

Differences in the effects of cream-type denture adhesives and home liners remain unclear.

OBJECTIVE

This cross-sectional study aimed to clarify the differences in the oral-hygiene status and masticatory performance between participants using cream-type denture adhesives and those using home liners.

METHODS

Masticatory performance with and without cream-type denture adhesives and home liners was evaluated using colour-changeable chewing gum. Oral hygiene was assessed using the tongue coating index (TCI). Propensity-score matching was performed using oral moisture, presence of palatal or mandibular protuberances, type of residual ridge, denture type (complete or partial denture), and denture retention as background factors. Wilcoxon signed-rank test was used to examine the differences in masticatory performance with and without cream-type denture adhesives and home liners and differences in masticatory performance and TCI between the cream-type denture adhesive and home-liner groups.

RESULTS

This study included 38 and 40 cream-type adhesive and home-liner users, respectively, and 17 pairs were obtained after propensity-score matching. The Wilcoxon signed-rank tests showed that masticatory performance was significantly different with and without the use of home liners, and higher values were obtained with the use of home-liners. However, the cream-type denture adhesive and home-liner groups showed no significant differences in terms of the change in masticatory performance with the use of them. Furthermore, Wilcoxon signed-rank tests showed that TCI values were significantly high in the cream-type adhesive group.

CONCLUSION

The findings in this study suggest that home liners improve masticatory performance and that participants regularly using cream-type denture adhesives have poorer oral hygiene.

Oral hypofunction and social aspects in older adults visiting frailty outpatient clinic

BACKGROUND

Oral and social problems can exacerbate long-term care. Understanding the relationship between social aspects and oral hypofunction can help identify high-risk factors for long-term care.

OBJECTIVE

This study aimed to investigate the social aspects of oral hypofunction among medical outpatients.

METHODS

This retrospective cross-sectional study included patients who visited an outpatient clinic for frailty. The oral function was assessed using seven items: oral hygiene, occlusal force, masticatory function, tongue-lip motor function, tongue pressure, oral dryness and swallowing function. Participants with three or more functional declines were classified as having 'oral hypofunction'. Social aspects were assessed using 21 items in four categories: general resources, basic social needs, social resources and social behaviours/activities. We analysed the relationship between oral hypofunction and each social aspect.

RESULTS

A total of 316 participants (age 78.5 ± 6.4 years) were included, and 128 (41%) had oral hypofunction. Participants with oral hypofunction were significantly more likely to have limited education, require long-term care, not use transportation, depend on others for shopping, not participate in events, lack association membership and not engage in charity or volunteer work. After logistic regression analysis, 'long-term care' and 'no association membership' remained significantly associated with oral hypofunction (odds ratios 2.3, 2.3; 95% CI 1.1-5.0, 1.1-4.7, respectively).

CONCLUSION

Participants with oral hypofunction faced challenges in 'general resources' and 'social behaviour/activities', which were linked to oral function issues. Future longitudinal studies are necessary to further investigate this relationship.

Assessment of photodynamic therapy with annatto and led for the treatment of halitosis in mouth-breathing children: Randomized controlled clinical trial

OBJECTIVE

To assess the effectiveness of antimicrobial photodynamic therapy (aPDT) employing an annatto-based (20%) dye combined with blue LED for the treatment of halitosis in mouth-breathing children.

MATERIALS AND METHODS

Fifty-two children six to twelve years of age with diagnoses of mouth breathing and halitosis (score of ≥ 3 on portable breath meter) Breath Alert™ (Tanita Corporation®-Japan), were randomly allocated to two groups (n = 26). Group 1: brushing, dental floss and aPDT applied to middle third of the dorsum of the tongue. Group 2: brushing, dental floss and tongue scraper. Breath meter results before, immediately after treatment as well as seven and 30 days after treatment were compared. The hypothesis of normality in the data was discarded by the Shapiro-Wilk test (p < 0.05) and for statistical analysis the Wilcoxon and Mann-Whitney tests were used.

RESULTS

A significant difference was found between the pre-treatment reading and all other readings (p < 0.05) in both groups, suggesting the effectiveness of the proposed treatments. No significant difference was found between the post-treatment reading and two follow-up readings, suggesting the maintenance of the effect of treatment over time (p > 0.05). However, significant differences were found between groups for all post-treatment assessments (p < 0.0001 for all comparisons), indicating greater effectiveness with aPDT. No association was found between the initial reading and the presence of coated tongue.

CONCLUSION

Antimicrobial photodynamic therapy using annatto and blue LED proved to be a viable therapeutic option for the treatment of halitosis in mouth-breathing children.

Tongue brushing enhances the myoelectric activity of the suprahyoid muscles in older adults: a six-week randomized controlled trial

Tongue brushing improves respiratory function in older adults. Considering connection between the respiratory-related and suprahyoid muscles, this study aimed to investigate whether tongue-brushing interventions can improve myoelectric activity during respiration. A six-week randomized controlled trial was conducted in Kitakyushu, Japan, with 50 participants aged ≥ 65 years. The participants were allocated to the intervention (tongue brushing with routine oral hygiene) or control (routine oral hygiene alone) groups. Surface electromyography (sEMG) was used to assess the myoelectric activity of the suprahyoid muscles during inhalation, exhalation, and forced vital capacity (FVC). A survey was conducted at baseline and the end of the follow-up period. Thirty-six participants were recruited for the analysis. The root mean squares (RMS) of sEMG during exhalation increased significantly at the end of the follow-up period compared with that at baseline in the intervention group [48.7 (18.0-177.5) vs. 64.9 (21.6-163.0), p = 0.001], but not in the control group. The generalized linear model revealed that the ratio of change in FVC was correlated with the change in the RMS of sEMG of the suprahyoid muscles during exhalation after adjusting for potential confounders. Tongue brushing enhances the myoelectric activity of the suprahyoid muscle.

Association between intrinsic capacity and oral health in older patients in a frailty clinic

PURPOSE

This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline.

METHODS

This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were established within each domain, and the number of IC deficit domains was calculated for each patient. Oral function assessment included oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Patients who met three or more criteria were classified into the oral hypofunction (OHF) group. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between IC deficit and OHF.

RESULTS

Of 222 included patients (mean age 78.3 ± 6.3 years; 39.6% men), 105 (47.3%) met the criteria for OHF. This OHF group showed a significantly higher prevalence of locomotion, cognition, psychology, and sensory domain deficits than the normal oral function group. Multivariate analysis adjusted for age and sex revealed a significant association between IC deficits and OHF (odds ratio [OR], 1.33; 95% confidence interval [CI] 1.04-1.70). A significant association was also observed between the locomotion domain and OHF (OR, 2.06; 95% CI 1.13-3.76).

CONCLUSION

This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function.

Association between oral frailty and sarcopenia among frailty clinic outpatients: A cross-sectional study

OBJECTIVES

In this study, we aimed to investigate the prevalence of oral frailty and explore its relationship with oral function and sarcopenia among older outpatients.

MATERIALS AND METHODS

In this cross-sectional study, we retrospectively included older patients who visited a frailty outpatient clinic. We assessed total oral frailty employing, among other measures, oral diadochokinesis (/ta/ sound) for tongue-lip movement and tongue pressure. Patients who did not meet the cut-off values for three or more of these were classified as having oral frailty. Sarcopenia was assessed according to Asian Working Group for Sarcopenia 2019 criteria and analyzed for the relationship with oral function.

RESULTS

The mean ± standard deviation age of the 111 patients was 77.2 ± 5.7 y; 63 were women (57%). Fifteen patients (14%) had either sarcopenia or dynapenia. The overall prevalence of oral frailty was 38%, with no significant difference in its prevalence between the sarcopenia/dynapenia group (44%) and the robust (no sarcopenia/dynapenia) group (35%). The following oral function assessments significantly differed between the sarcopenia/dynapenia group and the robust group: median (interquartile range) total oral frailty score, 2 (2-4) and 2 (1-3) (P = 0.019); tongue-lip motor function, 5.4 ± 1.2 and 5.9 ± 1.2 times/s (P = 0.049); and tongue pressure, 27.3 ± 8.5 kPa and 31.7 ± 8.0 kPa (P = 0.009).

CONCLUSIONS

Approximately 40% of patients exhibited a decline in oral function regardless of the presence of sarcopenia. Sarcopenia and dynapenia may particularly affect tongue function. Although assessing patients for sarcopenia is crucial, separate evaluations of oral function should also be considered.

Side effects and short effects of using three common mouthwashes on oral health and quality of life: A quasi-experimental study

BACKGROUND

Antiseptic mouthwashes are useful adjuncts to daily brushing and flossing for the control of dental plaque and gingivitis. The objective of the present study was to compare the effect of three mouthwashes: chlorhexidine, essential oils and cetylpyridinium chloride on oral health-related quality of life, gingival health, tongue coating and also to compare their potential side effects after 2-week consumption.

METHODS

Sixty participants were enrolled in this study and were divided into four groups (three mouthwash groups plus no mouthwash group). At the beginning, scaling and cleaning were performed and the following parameters were recorded: oral health impact profile (OHIP-5) questionnaire, tongue coating index, modified gingival index, calculus surface index, modified Lobene stain index and a questionnaire for side effects. Each group has followed up in 2 weeks. Data were analysed using paired t-test, ANOVA, Fisher's exact test and Pearson chi-square.

RESULTS

At the end of second week, all three mouthwashes significantly improved OHIP-5 score and reduced modified gingival index whereas essential oils and cetylpyridinium chloride significantly reduced tongue coating index when compared to control group (p < 0.05). The differences between four groups were significant for calculus formation, dental staining and reported burning sensation and changes of taste sensation and perception (p < 0.05).

CONCLUSION

The use of all three mouthwashes has been effective in controlling and reducing gingivitis and tongue coating; however, it appeared that essential oils has the minimum and Chlorhexidine has the maximum side effects. Moreover, the use of all three mouthwashes has been examined to improve the quality of life. Overall, essential oils mouthwash has the best performance among these three mouthwashes.

Developing tongue coating status assessment using image recognition with deep learning

PURPOSE

To build an image recognition network to evaluate tongue coating status.

METHODS

Two image recognition networks were built: one for tongue detection and another for tongue coating classification. Digital tongue photographs were used to develop both networks; images from 251 (178 women, 74.7±6.6 years) and 144 older adults (83 women, 73.8±7.3 years) who volunteered to participate were used for the tongue detection network and coating classification network, respectively. The learning objective of the tongue detection network is to extract a rectangular region that includes the tongue. You-Only-Look-Once (YOLO) v2 was used as the detection network, and transfer learning was performed using ResNet-50. The accuracy was evaluated by calculating the intersection over the union. For tongue coating classification, the rectangular area including the tongue was divided into a grid of 7×7. Five experienced panelists scored the tongue coating in each area using one of five grades, and the tongue coating index (TCI) was calculated. Transfer learning for tongue coating grades was performed using ResNet-18, and the TCI was calculated. Agreement between the panelists and network for the tongue coating grades in each area and TCI was evaluated using the kappa coefficient and intraclass correlation, respectively.

RESULTS

The tongue detection network recognized the tongue with a high intersection over union (0.885±0.081). The tongue coating classification network showed high agreement with tongue coating grades and TCI, with a kappa coefficient of 0.826 and an intraclass correlation coefficient of 0.807, respectively.

CONCLUSIONS

Image recognition enables simple and detailed assessment of tongue coating status.

Short term effect of antimicrobial photodynamic therapy and probiotic L. salivarius WB21 on halitosis: A controlled and randomized clinical trial

OBJECTIVE

This study aimed to evaluate the effect of antimicrobial photodynamic therapy (aPDT) and the use of probiotics on the treatment of halitosis.

METHODS

Fifty-two participants, aged from 18 to 25 years, exhaling sulfhydride (H2S) ≥ 112 ppb were selected. They were allocated into 4 groups (n = 13): Group 1: tongue scraper; Group 2: treated once with aPDT; Group 3: probiotic capsule containing Lactobacillus salivarius WB21 (6.7 x 108 CFU) and xylitol (280mg), 3 times a day after meals, for 14 days; Group 4: treated once with aPDT and with the probiotic capsule for 14 days. Halimetry with gas chromatography (clinical evaluation) and microbiological samples were collected from the dorsum of the tongue before and after aPDT, as well as after 7, 14, and 30 days. The clinical data failed to follow a normal distribution; therefore, comparisons were made using the Kruskal-Wallis test (independent measures) and Friedman ANOVA (dependent measures) followed by appropriate posthoc tests, when necessary. For the microbiological data, seeing as the data failed to follow a normal distribution, the Kruskal-Wallis rank sum test was performed with Dunn's post-test. The significance level was α = 0.05.

RESULTS

Clinical results (halimetry) showed an immediate significant reduction in halitosis with aPDT (p = 0.0008) and/or tongue scraper (p = 0.0006). Probiotics showed no difference in relation to the initial levels (p = 0.7530). No significant differences were found in the control appointments. The amount of Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola were not altered throughout the analysis (p = 0.1616, p = 0.2829 and p = 0.2882, respectively).

CONCLUSION

There was an immediate clinical reduction of halitosis with aPDT and tongue scraping, but there was no reduction in the number of bacteria throughout the study, or differences in the control times, both in the clinical and microbiological results. New clinical trials are necessary to better assess the tested therapies.

TRIAL REGISTRATION

Clinical Trials NCT03996044.

Evaluation of the Oral Microbiome before and after Treatments for Halitosis with Photodynamic Therapy and Probiotics-Pilot Study

BACKGROUND

To compare photodynamic therapy and the use of probiotics in reducing halitosis assessed through gas chromatography and microbiome analysis.

METHODS

Participants aged from 18 to 25 years showing sulfide (SH2) ≥ 112 ppb on gas chromatography were selected. They were divided into four treatment groups: Group 1-Tongue Scraping; Group 2-Antimicrobial Photodynamic Therapy (aPDT); Group 3-Probiotics; and Group 4-Antimicrobial Photodynamic Therapy (aPDT) and Probiotics. The halimetry process was performed before, immediately after the treatments, and 7 days, 14 days, and 30 days after the initial collection. The collections for later microbiological analysis were made along with the halimetry for microbiome analysis.

RESULTS

Treatment with aPDT or probiotics under these experimental conditions was not able to change the bacteria present in the biofilm of the tongue.

CONCLUSIONS

More research is needed to know the behavior of the oral microbiome in the presence of halitosis and the effectiveness of new treatments.

Association between oral health and nutritional status among older patients requiring long-term care who received home-visit dental care

PURPOSE

This study examined the association between oral health and nutritional status among older patients receiving home-visit dental care.

METHODS

This study enrolled 110 older patients (age ≥65 years) requiring long-term care who received home-visit dental care. The oral health indicators evaluated included number of teeth, occlusal support, number of functional teeth, tongue pressure, tongue coating index (TCI), and rinsing ability. Nutritional indicators included skeletal muscle mass index (SMI) and the mini-nutritional assessment short-form (MNA-SF). A multivariate modified Poisson regression analysis (adjusted for age, sex, medical history, care level, and housing type) was used to calculate prevalence ratios and 95% confidence intervals (CIs).

RESULTS

The prevalence ratio for low SMI was not significantly higher for patients with ≥20 teeth than for those with 1-19 or no teeth. Number of teeth was not significantly associated with MNA-SF score. A high TCI score (2.15, 95% CI: 1.07-4.32) and poor rinsing ability (2.32, 95% CI: 1.25-4.30) were significantly associated with low SMI. High TCI scores were associated with low scores in MNA-SF categories (1.25, 95% CI: 1.01-1.55).

CONCLUSION

TCI and rinsing ability, rather than number of teeth, were associated with nutritional status in older patients requiring long-term care.

Concordance in oral frailty five-item checklist and oral hypofunction: Examining their respective characteristics

OBJECTIVES

This study examined the diagnostic concordance and characteristics of the oral frailty five-item checklist (OF-5) and oral hypofunction (OHF).

MATERIALS AND METHODS

In this extensive cross-sectional study, older adults were enrolled at a research hospital frailty clinic between July 2021 and July 2023. The diagnosis of OF-5 and OHF was conducted using the proposed assessment methods. The concordance rate of these criteria was determined by evaluating each patient and calculating the number of patients meeting each diagnosis's criteria. Patients who tested negative for the OF-5 and OHF criteria and those who met only one criterion were included in the OF-5 and OHF characteristic analysis.

RESULTS

A total of 248 patients were included in the analysis (mean age 77.6 ± 6.8 years; 36.7 % men). Among the patients, 114 (46.0 %) and 116 (46.8 %) met the OF-5 and OHF criteria, respectively. Furthermore, 78 (31.5 %) participants met both the OF-5 and OHF criteria, whereas 96 (38.7 %) did not meet either criterion. Moreover, 36 (14.5 %) and 38 (15.3 %) patients tested exclusively positive for OF-5 and OHF, respectively. The OF-5-positive and OHF-negative group showed an older age, lower Mini Nutritional Assessment Short Form score, and higher fall risk than the OF-5-negative and OHF-negative group. However, no significant differences were observed between the OF-5-negative and OHF-positive and OF-5-negative and OHF-negative groups.

CONCLUSION

The concordance rate of OF-5 and OHF diagnoses was 70.2 %. OF-5 showed a potential association with nutritional status and fall risk. Further longitudinal analyses are warranted to explore our study results.

Low tongue pressure and depression using Kihon Checklist for assessing frailty status among community-dwelling Japanese older adults: A pilot study

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.

Oral Function for Diagnosing Oral Hypofunction in Healthy Young Adults: A Comparison with the Literature

This study investigated decline in oral function in healthy young adults and compared it with that observed in an earlier studies employing older adults. The participants comprised 130 young healthy adults (mean age 24.1±2.9 yr), all with complete dentition. All participants underwent the oral hypofunction test established by the Japanese Society of Gerodontology, which evaluates oral hygiene, oral dryness, occlusal force, tongue-lip motor function (oral diadochokinetic rate; ODK), tongue pressure, and masticatory and swallowing function. The average value for and rate of hypofunction of each parameter were calculated. In healthy young adults, the scores were 28.9±17.1% for oral hygiene; 28.8±2.2 for oral dryness; 959.9±499.8 N for occlusal force; 7.0±0.8 times/sec for ODK /pa/, 7.6±0.8 times/sec for /ta/, and 6.9±0.9 times/sec for /ka/; 41.8±8.4 kPa for tongue pressure; 249.8±94.1 mg/dl for masticatory function; and 0.2±0.7 for swallowing function. No sign or symptom of change in oral function was observed at a high rate in young adults. Occlusal force, tongue-lip motor function, and tongue pressure showed a large difference in the rate of hypofunction between younger and older adults, however.

Changes in oral microflora following 0.3% cetylpyridinium chloride-containing mouth spray intervention in adult volunteers after professional oral care: Randomized clinical study

OBJECTIVES

This study explored the changes in bacterial flora composition and total bacterial count in the saliva and tongue coating, along with the change in the tongue coating index (TCI) following an intervention with 0.3% cetylpyridinium chloride (CPC) mouth spray after professional oral care.

MATERIALS AND METHODS

Fifty-two adult volunteers aged 30-60 years were equally divided into CPC spray (n = 26) and control (n = 26) groups. All subjects underwent scaling and polishing. The CPC spray group was administered four puffs of CPC spray to the tongue dorsum four times a day for 3 weeks. The control group performed only routine daily oral care (brushing) and did not use any other spray. Bacteriological evaluation of saliva and tongue coating was performed using 16S ribosomal RNA gene sequencing and quantitative polymerase chain reaction. The tongue coating was evaluated to calculate the TCI. A per-protocol analysis was conducted for 44 subjects (CPC spray group, n = 23; control group, n = 21).

RESULTS

At 1 and 3 weeks after CPC spray use, the flora of the saliva and tongue coating changed; the genus Haemophilus was dominant in the CPC spray group, whereas the genus Saccharibacteria was dominant in the control group. The sampling time differed among individual participants, which may have affected the bacterial counts. There was no significant intragroup change in TCI in either group.

CONCLUSIONS

CPC spray affected the bacterial flora in the saliva and tongue coating, particularly with respect to an increase in the abundance of Haemophilus. However, CPC spray did not change the TCI. These results suggest that it may be optimal to combine CPC spray with a physical cleaning method such as using a tongue brush or scraper. Clinical Trial Registration: University Hospital Medical Information Network UMIN000041140.

Factors affecting the number of bacteria in saliva and oral care methods for the recovery of bacteria in contaminated saliva after brushing: a randomized controlled trial

BACKGROUND

Oral care is important in preventing aspiration pneumonia in older adults. However, it is not clear what kind of oral care can reduce the number of bacteria in saliva. The purposes of this study are to clarify whether there is a relationship between plaque amounts and salivary bacterial counts, and how bacteria dispersed into the oral cavity by brushing can be reduced.

METHODS

First, saliva samples were collected from 10 healthy adult volunteers after 30 h of unbrushing and after thorough brushing, and the total bacterial count was determined by real-time PCR. Next, 40 older adults attending an outpatient dental clinic were randomly assigned into two groups: a wiping group (20 patients) and a mouthwashing group (20 patients). Saliva was collected before and after brushing, and after wiping in the wiping group and after mouthwashing in the mouthwashing group, and the total bacterial count was quantified by real-time PCR.

RESULTS

In a study of volunteers, there was no association between plaque amounts and salivary bacterial counts. In a study of older adult patients, salivary bacterial counts were significantly higher in patients with higher oral hygiene index and fewer remaining teeth. Brushing increased salivary bacterial counts. Wiping did not significantly reduce the number of bacteria, while mouthwash returned the increased number of bacteria after brushing to the pre-brushing level.

CONCLUSIONS

There is no direct relationship between the amount of plaque and the number of bacteria in saliva. Brushing disperses bacteria into the oral cavity, resulting in a marked increase in the number of bacteria in saliva. Wiping does not collect the dispersed bacteria, and it seems essential to rinse the mouth after brushing.

TRIAL REGISTRATION

UMIN000045854.

Associations of oral health status and swallowing function with cognitive impairment in the aging population: a cross-sectional study

BACKGROUND

The purpose of this study was to investigate the relationships of oral health status and swallowing function with cognitive impairment in community-dwelling older adults from Changsha, Hunan Province, China.

METHODS

In this cross-sectional study, we analyzed the data of 215 participants aged ≥ 50 years which were retrieved from the Xiangya and Panasonic mild cognitive impairment (MCI) Study, a community-based study conducted among the residents of the urban areas of Hunan province in China. Demographic information of all participants was collected. We determined oral function by evaluating oral hygiene, oral dryness, occlusal force, tongue pressure, chewing function, swallowing function, remaining teeth number, and other indicators. The mini-mental state examination (MMSE) was used to screen for cognitive function. The relationship between each oral function evaluation item and cognitive function was investigated using correlation analysis. The associations between oral health status and swallowing function with cognitive impairment were inferred using multiple regression analysis.

RESULTS

The general characteristics of participants showed statistically significant correlation coefficients in number of teeth remaining (p = 0.003) and number of teeth lost (p < 0.0001). Almost half of the 25 participants (48%) were aged from 70-80 years. Only 25 older adults (11.6% of the participants) were determined to have cognitive impairment by MMSE sores less than 24. Tongue pressure in male participants was the only significant independent variable that was associated with cognitive impairment (p = 0.01971). The results indicate that male participants with lower MMSE scores had a relative deficiency in tongue pressure.

CONCLUSIONS

In this cross-sectional study, the oral health status and swallowing function of participants were in relatively good condition and showed low correlations with cognitive impairment. However, lower tongue pressures were associated with lower MMSE scores in males, indicating it could serve as a novel oral function index for evaluating cognitive impairment.

Quantification of tongue coating using quantitative light-induced fluorescence-digital image analysis and its correlation with visual evaluation

BACKGROUND

The tongue coating is a grayish-white deposit that quickly reflects the state of health or disease of the human body. Quantitative light-induced fluorescence (QLF) is a novel digital imaging system that objectively quantifies tongue coating.

AIMS

The present study aims to evaluate the correlation between the visual assessment of tongue coating and tongue coating by analysis of QLF-digital (QLF-D) images.

SETTINGS AND DESIGN

This was an in vivo explorative study.

MATERIALS AND METHODS

Fifty children aged 11-13 years with clinically visible tongue coating were selected for the study. Tongue coating was assessed clinically by the Tongue Coating Index (Shimizu et al., 2007) and digitally by QLF-D Biluminator™ 2, C3 software.

STATISTICAL ANALYSIS

Data obtained were subjected to statistical analysis using SPSS 23.0 software. Spearman's rho correlation test was done, and P < 0.05 was considered statistically significant.

RESULTS

A statistically significant correlation was found between the visual assessment scoring and the QLF image analysis for the evaluation of tongue coating.

CONCLUSION

The Digital QLF tongue imaging system was found to be reliable due to its correlation with the clinical score and objective nature.

Evaluating the effect of management on patients with oral hypofunction: A longitudinal study

INTRODUCTION

Declining oral function may affect subsequent physical frailty in the older population. The aim of this longitudinal study was to summarise data on patients who underwent functional oral examination and evaluate the impact of management on patients with oral hypofunction (OHF).

METHODS

Dental outpatients aged over 65 years at their initial visit to the Niigata University Hospital received detailed assessment of seven oral function items to diagnose oral hypofunction using diagnostic criteria defined by the Japanese Society of Gerodontology. Patients with OHF at the first assessment received management including oral health guidance for low function and dental treatment. They were re-evaluated approximately 6 months later and the two assessments were compared. According to the results of the second assessment, the patients were divided into two groups: OHF improved and OHF re-diagnosed.

RESULTS

Of the 273 patients who underwent the first assessment, 86 (31.5%) were diagnosed with OHF and received management. Of those, 42 (48.8%) completed the second assessment. Comparing the first and second assessment, significant improvement was observed in oral hygiene, occlusal force, tongue-lip motor function of /pa/, mastication and swallowing. The change in values from the first assessment demonstrated a significant difference between the OHF improved and re-diagnosed groups only in occlusal force.

CONCLUSION

Management for patients with OHF can contribute to the improvement of poor oral function, and an increase in occlusal force was notable in the recovery from OHF.

Frequency tongue coating in patients referred to Kerman Dental School and its relationship with relative factors

OBJECTIVE

There has been shown a relationship between "tongue coating" and "Simplified Oral Health Index, periodontal status, modified mallampati classification (MMC) of the oropharynx and oral malodor". The purpose of this study is to assess the frequency of tongue coating and relative factors (sex, age, smoking, systemic disease and oral health indices) among patients referred to Dental School of Kerman University.

METHODS

In this cross sectional study 250 patients referred to dental school of Kerman university of medical sciences were examined. The data collection form was included demographic data (gender, age, history of systemic disease and smoking) and Oral health indices such as TCI (Tongue coating index), OHI-S (Simplified Oral Hygiene Index), MGI (Modified Gingival Index), MMC and lost teeth. The analysis have been done using SPSS21, T-test, Pearson correlation coefficient and linear regression analysis (significance level was set at less than 0.05).

RESULTS

Tongue coating has been shown in 96% of patients with the mean percent of 45.83 ± 19.16%. Men had higher percent of TCI though it was not statistically significant. Smoking was the strongest determinant factor in people with higher TCI scores (P = 0.013). There was a positive significant correlation between OHI-S and TCI [(Pearson's coefficient(r) = 0.134, P = 0.034)].

CONCLUSION

TCI appears to be related to smoking and Simplified Oral Health Index. The evaluation of tongue coating is necessary to assess its impact on oral health status and also to motivate patients to clean their tongue as a part of their oral health care routine.

Relationship of preoperative oral hypofunction with prognostic nutritional index in gastric cancer: A case-control retrospective study

Preoperative nutritional status is an important prognostic factor in gastric cancer patients. This study will evaluate whether preoperative oral dysfunction is associated with prognostic nutrition index (PNI). This case-control study analyzed 95 patients who underwent oral function management. We assessed the following parameters: body mass index, stage of gastric cancer, C-reactive protein, total lymphocyte count, albumin, and prognostic nutritional index. The patients were divided into groups with prognostic nutritional indexes <45 and >45. Logistic regression analysis was used to assess the association between the measurements of oral function and the prognostic nutritional index. Univariate analysis of factors associated with decreased oral function and prognostic nutritional index showed significant differences between the two groups in C-reactive protein, neutrophils, and tongue pressure (p<0.01). However, oral hygiene, oral dryness, occlusal force, tongue-lip motor function, masticatory function, and swallowing function were not significantly different. Multivariate analysis showed that C-reactive protein (odds ratio: 0.12, 95% confidence interval: 0.30-0.45, p<0.01) and tongue pressure (odds ratio: 3.62, 95% confidence interval: 1.04-12.60, p<0.05) were independent risk factors for oral hypofunction. Oral function decreased in perioperative patients with gastric cancer, and decreased tongue pressure is associated with a decreased prognostic nutritional index.

Comparative study between photodynamic therapy and the use of probiotics in the reduction of halitosis in mouth breathing children: Study protocol for a randomized controlled clinical trial

INTRODUCTION

Halitosis is a term that defines any odor or foul smell the emanates from the oral cavity, the origin of which may be local or systemic. One of the causes of local or oral halitosis is low salivary flow and dry mouth, which is also one of the complaints of individuals with the mouth-breathing habit. The aim of this study is to determine the effectiveness of antimicrobial photodynamic therapy (aPDT) and the use of probiotics for the treatment of halitosis in mouth-breathing children.

METHODS

Fifty-two children between 7 and 12 years of age with a diagnosis of mouth breathing and halitosis determined through an interview and clinical examination will be selected. The participants will be divided into 4 groups: Group 1-treatment with brushing, dental floss and tongue scraper; Group 2-brushing, dental floss and aPDT applied to the dorsum and middle third of the tongue; Group 3-brushing, dental floss and probiotics; Group 4-brushing, dental floss, aPDT and probiotics. The use of a breath meter and microbiological analysis of the tongue coating will be performed before, immediately after treatment and 7 days after treatment. The quantitative analysis will involve counts of colony-forming bacteria per milliliter and real-time polymerase chain reaction. The normality of the data will be determined using the Shapiro-Wilk test. Parametric data will be submitted to analysis of variance and nonparametric data will be compared using the Kruskal-Wallis test. The results of each treatment in the different periods of the study will be compared using the Wilcoxon test.

DISCUSSION

Due to the low level of evidence, studies are needed to determine whether treatment with aPDT using annatto as the photosensitizer and blue led as the light source is effective at diminishing halitosis in mouth-breathing children.

Objective evaluation of tongue diagnosis ability using a tongue diagnosis e-learning/e-assessment system based on a standardized tongue image database

Background

In Kampo medicine, tongue examination is used to diagnose the pathological condition "Sho," but an objective evaluation method for its diagnostic ability has not been established. We constructed a tongue diagnosis electronic learning and evaluation system based on a standardized tongue image database.

Purpose

This study aims to verify the practicality of this assessment system by evaluating the tongue diagnosis ability of Kampo specialists (KSs), medical professionals, and students.

Methods

In the first study, we analyzed the answer data of 15 KSs in an 80-question tongue diagnosis test that assesses eight aspects of tongue findings and evaluated the (i) test score, (ii) test difficulty and discrimination index, (iii) diagnostic consistency, and (iv) diagnostic match rate between KSs. In the second study, we administered a 20-question common Kampo test and analyzed the answer data of 107 medical professionals and 56 students that assessed the tongue color discrimination ability and evaluated the (v) correct answer rate, (vi) test difficulty, and (vii) factors related to the correct answer rate.

Result

In the first study, the average test score was 62.2 ± 10.7 points. Twenty-eight questions were difficult (correct answer rate, <50%), 34 were moderate (50%-85%), and 18 were easy (≥85%). Regarding intrarater reliability, the average diagnostic match rate of five KSs involved in database construction was 0.66 ± 0.08, and as for interrater reliability, the diagnostic match rate between the 15 KSs was 0.52 (95% confidence interval, 0.38-0.65) for Gwet's agreement coefficient 1, and the degree of the match rate was moderate. In the second study, the difficulty level of questions was moderate, with a correct rate of 81.3% for medical professionals and 82.1% for students. The discrimination index was good for medical professionals (0.35) and poor for students (0.06). Among medical professionals, the correct answer group of this question had a significantly higher total score on the Kampo common test than the incorrect answer group (85.3 ± 8.4 points vs. 75.8 ± 11.8 points, p < 0.01).

Conclusion

This system can objectively evaluate tongue diagnosis ability and has high practicality. Utilizing this system can be expected to contribute to improving learners' tongue diagnosis ability and standardization of tongue diagnosis.

Association between sarcopenia and oral functions in community-dwelling older adults: A cross-sectional study

BACKGROUND

Few studies have examined the state of oral function in older adults with sarcopenia. We assessed the oral functions of community-dwelling older adults with sarcopenia from multiple perspectives to clarify their potentially low oral function.

METHODS

A total of 1517 (86.2%; 990 women, 527 men; mean age 76.1 ± 7.6 years) participants were included in this study. Grip strength, gait speed and skeletal muscle mass index were assessed, and sarcopenia was evaluated according to the criteria of the Asian Working Group for Sarcopenia 2019. The degree of tongue coating, oral moisture, occlusal force, tongue-lip motor function, tongue pressure, masticatory function and swallowing function were assessed. The criteria for oral hypofunction (a disease that is a combination of multiple low oral functions) were used to assess oral function. Statistical analyses were performed using Kolmogorov-Smirnov test, unpaired t-test, Mann-Whitney U test, χ² test, and univariate and multivariable logistic regression analyses, with each oral function as the dependent variable and sarcopenia as one of the independent variables. The significance level was set at P < 0.05.

RESULTS

The prevalence rates of sarcopenia and severe sarcopenia were 14.2% and 3.8%, respectively. The prevalence of oral hypofunction was 39.9%. Compared with the robust group, the sarcopenia and severe sarcopenia groups tended to have a higher frequency of the following components (all P < 0.01): low occlusal force, low tongue-lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. Univariate logistic regression analysis showed that sarcopenia was associated with low occlusal force, low tongue-lip motor function, low tongue pressure, low masticatory function, low swallowing function and oral hypofunction. The odds ratios and 95% confidence intervals of sarcopenia for each oral function were 2.62 [2.00, 3.43], 2.21 [1.69, 2.89], 3.66 [2.79, 4.81], 3.23 [2.46, 4.25], 1.66 [1.26, 2.20] and 3.59 [2.72, 4.72], respectively. Multivariable logistic regression analysis showed that sarcopenia was associated with low occlusal force (1.63 [1.10, 2.40]), low tongue pressure (2.28 [1.65, 3.15]), low masticatory function, (1.94 [1.27, 2.97]), low swallowing function (1.64 [1.17, 2.28]) and oral hypofunction (2.17 [1.52, 3.09]).

CONCLUSIONS

This study demonstrated that multiple aspects of oral function were low among community-dwelling older adults with sarcopenia. The potential decline in oral functions in older adults with sarcopenia may have been overlooked until now. This study indicates the need for dental perspectives in intervening with older adults with sarcopenia and the need to encourage them to see dental professionals.

Assessment of the Possible Correlation between the Presence of Helicobacter Pylori Infection and Hairy Tongue Lesion in a Group of Patients in Syria: A Cross-Sectional and Pilot Study

BACKGROUND

This study aimed to evaluate the correlation between the presence of hairy tongue and H. pylori infection in patients referring to their blood test based on the serum levels of anti-H pylori IgG antibodies.

METHODS

This cross-sectional study was conducted in the Department of Oral Medicine, University of Damascus Dental School, between February 2021 and January 2022. The sample size of 40 patients (23 males, 17 females), whose ages ranged from 20-79 years with a mean age of 41.5 ± 12 years, was calculated using the G*power 3.1.3, with a statistical power of 80% and a significance level of 0.05. The hairy tongue index was assessed by a visual method based on observing the dorsum tongue appearance. Then, a blood test was performed to detect the presence of H. pylori by Immulite 2000 XPi. Statistical analysis was performed using SPSS software 22.0, Chi-square.

RESULTS

The prevalence of hairy tongue was higher among males (75%) as compared to females (25%) and was found to be statistically significant (p = 0.026). The hairy tongue lesions were found to be least in the 20-39 age group and most prevalent in the 40-59 age group, without statistically significant correlation. H. pylori infection was detected positive in 70% and negative in 30% of hairy tongue patients, compared to the control group, where the rates were 15% and 85%, respectively, with a statistically significant correlation between infection with H. pylori and hairy tongue (p = 0.001).

CONCLUSION

Our results strongly suggest that the hairy tongue might be considered an indicator of H. pylori infection.

Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study

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.

COVID-19-related stress, exercise, and oral health-related quality of life among community-dwelling older adults who participated in the CHEER Iwamizawa project, Japan

This study examined the association between coronavirus disease 2019 (COVID-19)-related stress, exercise habits, and oral health-related quality of life (OHRQoL) in a sample of 215 community-dwelling older adults in Japan (57 men, 158 women; M_age = 74.2 years, SD = 6.0). Data were collected during wellness checkups in October 2020 and included participants' demographic characteristics, measures of instrumental activities of daily living and depressive tendencies, number of teeth, oral hypofunction, OHRQoL, COVID-19-related stress, and exercise habits. Four mutually exclusive groups were created, using the presence or absence of COVID-19-related stress and lack of exercise habits as risk factors for poor OHRQoL (no COVID-19-related stress and no lack of exercise, COVID-19-related stress only, lack of exercise habits only, and both COVID-19-related stress and lack of exercise habits). Poisson regression with robust standard errors provided the prevalence ratio for poor OHRQoL. The presence of both COVID-19-related stress and lack of exercise habits (adjusted prevalence ratio: 2.20, 95% CI: 1.31- 3.69) was associated with poor OHRQoL. The results indicate that COVID-19-related stress and exercise habits should be considered when designing oral health and public health initiatives.

Relationship between Knowledge and Attitude toward Oral Function in Middle-Aged and Older Adults

Oral hypofunction is the stage at which recovery can be expected with proper diagnosis, management, and motivation before oral dysfunction occurs. The knowledge and attitude toward oral function can influence the maintenance and improvement of oral function. However, whether middle-aged and older adults with declining oral function have knowledge of their oral function and how this knowledge and their attitude affect their oral function are unclear. Therefore, we aimed to examine (1) the relationship between knowledge and attitude toward oral function and hypofunction in individuals with suspected oral hypofunction and (2) changes in knowledge and attitude toward oral function through evaluation and education. Participants aged ≥50 years were enrolled during their first community dental clinic visit. A questionnaire assessment of knowledge and attitudes before and after oral function evaluation was performed. The oral function was initially assessed with seven criteria: oral hygiene; oral dryness; occlusal force; tongue pressure; tongue-lip motor, masticatory, and swallowing function. Associations between knowledge and attitudes and their changes were statistically analyzed. Fifty-nine participants (93.7%) were unaware of “oral hypofunction.” Associations between knowledge and attitudes and their changes in the negative to positive response groups, from 86.4% and 61.0% to 6.8% and 25.4%, respectively, after oral function evaluation, indicated that participants understood their oral function and the need for training. Middle-aged and older individuals with poor knowledge and attitudes were more likely to have a worse oral function; however, their knowledge and attitudes toward oral function could be improved through oral function assessment and education.

Decline in Oral Function and Its Management

With the renewed focus on eating abilities in the ageing population, new concepts referred to as oral frailty and oral hypofunction have been introduced in Japan. We aimed to provide an overview of (i) the evaluation and management of oral function in ageing populations according to oral frailty and oral hypofunction and (ii) recent scientific evidence of the associations of poor oral function with physical function and nutritional status. Both oral frailty and oral hypofunction are multidimensional concepts that describe poor oral function. In epidemiologic and/or clinical settings, they are defined as the accumulation of factors leading to poor oral status. Oral hypofunction is a core component of oral frailty. To date, there are no systematic strategies for addressing oral frailty or oral hypofunction. Nevertheless, recent randomised controlled trials revealed that several components of oral function can be improved through appropriate training. On the other hand, multiple observational studies published in recent years have demonstrated that oral frailty and oral hypofunction are associated with physical function (gait performance, frailty, and sarcopenia) and nutritional status (low protein intake, poor dietary diversity, and malnutrition) in community-dwelling older adults. Moreover, studies have reported a significant association between insufficient participation in social networks and poor oral function. However, most of the studies conducted to date have utilised a cross-sectional design, which does not permit assessment of the temporal association between comprehensive oral function and general health. Maintaining good oral function may be key to longevity. However, evidence is limited thus far, and comprehensive oral function has not been studied in detail; thus, additional high-quality studies are needed.

A Cross-Sectional Study on the Relationship between Oral Function and Sarcopenia in Japanese Patients with Regular Dental Maintenance

We aimed to clarify the relationship between oral function assessments regarding oral hypofunction and sarcopenia in patients who had completed treatment for organic dental problems, including oral pain, removable denture fit, and tooth loss. This cross-sectional study included 269 patients aged ≥65 years (mean age 74.9 ± 6.50 years, 133 men, 136 women) who visited a dental clinic between June 2019 and March 2021. We evaluated oral function and sarcopenia and analyzed their relationship using the Jonckheere–Terpstra test, Mantel–Haenszel trend test, and Poisson regression analysis. We diagnosed 132 (49.07%) patients with oral hypofunction, 30 (11.2%) with sarcopenia, and 24 (8.9%) with severe sarcopenia. The number of oral hypofunction items (prevalence rate ratio [PRR] = 1.39, 95%Wald = 0.11 to 0.56) was significantly associated with sarcopenia. For each of the items, tongue-lip motor function [ta] (PRR = 0.80, 95%Wald = −0.44 to −0.02)] [ka] (PRR = 0.76, 95%Wald = −0.53 to −0.03) and tongue pressure (PRR = 0.95, 95%Wald = −0.09 to −0.02) showed a significant association with sarcopenia. However, no significant association was found for other variables. Dentists should not only treat organic dental problems but also consider the relationship between oral function and sarcopenia.

Oral exercises significantly improve oral functions in people with mild and moderate dementia: a randomized controlled study

BACKGROUND

There have been no standard protocols of oral exercises for maintaining and improving oral function for people with dementia.

OBJECTIVE

This study aimed to determine the effects of home-based oral exercises on the oral function of people with mild to moderate dementia.

METHODS

Twenty-two participants at King Chulalongkorn Memorial Hospital were randomly assigned to exercise group (n = 11) or control group (n = 11). The exercise group was instructed to do three home-based oral exercises, consisting of tongue-strengthening, oral diadochokinesis (ODK), and mouth-opening exercises, for 3 months, while the control group received advice on oral health care. The maximum tongue pressure (MTP) was the primary outcome. MTP, ODK rates of /pa/, /ta/, /ka/, modified water swallowing test (MWST), and oral moisture were measured at baseline, and after 1, 2, and 3 months of training. The generalized estimating equation analysis was used to evaluate the effects of oral exercises on the oral function.

RESULTS

The MTP and all ODK rates in the exercise group were significantly increased after 3 months of training. There were significant interaction effects between time and intervention in MTP and all ODK rates. No significant interaction effects between time and intervention in oral moisture were found. The MWST scores in both groups did not change through the end of study and no adverse effects were reported.

CONCLUSION

Home-based oral exercises were found to be effective for improving tongue strength and tongue-lip motor function in people with mild to moderate dementia.

Regular Oral Health Management Improved Oral Function of Outpatients with Oral Hypofunction in Dental Hospital: A Longitudinal Study

This longitudinal study aimed to clarify the impact of regular oral health management for oral hypofunction on the oral function of older dental outpatients. The 68 participants enrolled in this study were older dental outpatients (mean age 78.5 ± 8.1 years). According to the number of declined oral examinations after the first exam, participants were assigned to the oral hypofunction group (Hypo group, ≥3), receiving regular oral health management with a leaflet at the dental clinic, or the pre-oral hypofunction group (Pre-hypo group, ≤2), which served as a control. At the second oral examination, after approximately 6 months to 1 year, the Hypo group showed significant improvement in the tongue-lip motor function (Oral diadochokinesis, ODK) /pa/, /ta/, and masticatory function, while the Pre-hypo group showed significant worsening in oral hygiene and oral wetness. Temporal changes in ODK /pa/, /ta/, and the number of declined examination items were significantly different between the groups. Multiple analysis revealed that the number of improved oral examination items were associated with presence of regular oral health management after adjusting for age, sex, number of visits, measuring period, and dental treatment. Regular comprehensive oral health management for oral hypofunction improves and maintains oral function among older dental outpatients.

Denture wearing is associated with nutritional status among older adults requiring long-term care: A cross-sectional study

Background/purpose

Dentures are important for the reconstruction of occlusal support and masticatory performance for older adults with poor dentition. We aimed to elucidate the oral health factors associated with malnutrition in older adults requiring long-term care, including denture use.

Materials and methods

This cross-sectional study included 322 older adults (63 men, 259 women; mean age, 86.6 ± 6.9 years) who required long-term care in rural Japan. The participant's nutritional status was assessed using the Mini Nutritional Assessment-Short Form (MNA®-SF). Oral health was assessed using participant's dentition and oral function. Barthel Index (BI) and medical history were measured for assessing general health status. Multiple logistic regression analyses were performed to determine the oral health factors associated with malnutrition.

Results

The proportion of participants with malnutrition was 17.2%. The BI score (odds ratio [OR], 0.95; 95% confidence interval [CI] 0.93–0.98, p<0.001), having <20 teeth and dentures (OR 0.42; 95%CI 0.18–0.99; p = 0.047), and poor lip-closure ability (OR 2.86; 95%CI 1.32–6.20; p = 0.008) were significantly associated with malnutrition.

Conclusion

Denture use, lip-closure ability, and activities of daily living were significantly associated with malnutrition in older adults requiring long-term care, suggesting that wearing dentures for tooth loss and maintaining oral function contributes to nutritional status.

Oral function and nutritional status in non-acute hospitalised elders

Introduction

Malnutrition and risk of malnutrition continues to be a common finding in elders, yet its association with oral function in hospitalised patients remains unclear.

Material and methods

Patients aged 70 years or over who had been hospitalised for non‐acute rehabilitation were recruited. Nutritional risk was screened using the Mini‐Nutritional Assessment Short Form (MNA‐SF) and Nutritional Risk Screening (NRS) scores. Malnutrition was assessed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria. All participants underwent the oral hypofunction test battery, evaluating oral hygiene, oral dryness, occlusal force, tongue‐lip motor function, tongue pressure, masticatory and swallowing function. Statistical analyses comprised Mann‐Whitney or Kruskal‐Wallis tests. Bivariate associations between categorical variables were tested using the Pearson chi‐square test; for continuous variables, the Spearman correlation was calculated. A P‐value < .05 was considered statistically significant.

Results

Sixty patients aged a mean 82.5 ± 7.0 years participated. Some 88.3% were diagnosed with oral hypofunction, and this was more common in older patients (P = .020). Analysing the 7 oral hypofunction tests as an interval variable (NiOF) revealed additional correlations with number of teeth (ρ = 0.477) as well as the nutritional risk, evaluated by the MNA‐SF (ρ = −0.284) and NRS (ρ = 0.317) scores. NiOF scores were higher among denture wearers (P = .003). GLIM did not confirm the correlation with NiOF. Biomarkers such as serum albumin and CRP were not associated with the NiOF score.

Conclusion

In this sample, the association between oral function and nutritional state is more obvious in nutritional risk scores than in the malnutrition diagnosis by GLIM.

Relationship between Oral Hypofunction, and Protein Intake: A Cross-Sectional Study in Local Community-Dwelling Adults

Few studies have investigated the relationship between nutritional status and comprehensive assessment of oral hypofunction, especially protein intake-related sarcopenia. Thus, we explored these relationships in a large-scale cross-sectional cohort study using the seven-item evaluation for oral hypofunction and Diet History Questionnaire for nutritional assessment. We used the data from 1004 individuals who participated in the 2019 health survey of the residents of Tarumizu City, Kagoshima Prefecture, Japan for analysis. We found that individuals with oral hypofunction were significantly older with a lower skeletal muscle index. Although there were few foods that had a significant difference between the groups with and without oral hypofunction, the consumption of beans and meats was significantly lower in women and men in the oral hypofunction group, respectively. According to the lower limit of the tentative dietary goal defined in Japan, comprehensive evaluation of oral hypofunction was significantly and independently associated with protein intake in both men and women (odds ratio, 1.70; 95% confidence interval, 1.21-2.35). In conclusion, we found that oral hypofunction was associated with targeted protein intake for sarcopenia and frailty prevention in middle-aged and older community-dwelling adults. Comprehensive evaluation of oral function with intervention in cases of hypofunction could inform clinicians to better prevent sarcopenia.

Associations of streptococci and fungi amounts in the oral cavity with nutritional and oral health status in institutionalized elders: a cross sectional study

BACKGROUND

Disruption of the indigenous microbiota is likely related to frailty caused by undernutrition. However, the relationship between undernutrition and the oral microbiota, especially normal bacteria, is not obvious. The aim of this study was to elucidate the associations of nutritional and oral health conditions with prevalence of bacteria and fungi in the oral cavity of older individuals.

METHODS

Forty-one institutionalized older individuals with an average age ± standard deviation of 84.6 ± 8.3 years were enrolled as participants. Body mass index (BMI) and oral health assessment tool (OHAT) scores were used to represent nutritional and oral health status. Amounts of total bacteria, streptococci, and fungi in oral specimens collected from the tongue dorsum were determined by quantitative polymerase chain reaction (PCR) assay results. This study followed the STROBE statement for reports of observational studies.

RESULTS

There was a significant correlation between BMI and streptococcal amount (ρ = 0.526, p < 0.001). The undernutrition group (BMI < 20) showed a significantly lower average number of oral streptococci (p = 0.003). In logistic regression models, streptococcal amount was a significant variable accounting for "not undernutrition" [odds ratio 5.68, 95% confidential interval (CI) 1.64-19.7 (p = 0.06)]. On the other hand, participants with a poor oral health condition (OHAT ≥ 5) harbored significantly higher levels of fungi (p = 0.028).

CONCLUSION

Oral streptococci were found to be associated with systemic nutritional condition and oral fungi with oral health condition. Thus, in order to understand the relationship of frailty with the oral microbiota in older individuals, it is necessary to examine oral indigenous bacteria as well as etiological microorganisms.

Oral hypofunction and its relation to frailty and sarcopenia in community-dwelling older people

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.

Associations between Oral Hypofunction Tests, Age, and Sex

Oral function declines in older individuals due to disease and age-related changes, making them vulnerable to oral and physical frailty. Therefore, it is important to manage the decline in oral function in older outpatients. Oral hypofunction is diagnosed by seven tests related to oral function, oral hygiene, oral moisture, occlusal force, oral diadochokinesis, tongue pressure, masticatory function, and swallowing function. However, sex or age were not factored into the current reference values of these tests. We included subjects attending the dental hospital clinic for maintenance, and recorded and analyzed oral hypofunction and the factors associated with its diagnosis. Of the 134 outpatients (53 males and 81 females, mean age 75.2 ± 11.2 years), 63% were diagnosed with oral hypofunction. Oral hypofunction prevalence increased significantly with age, and significant variations were observed in all tests. Furthermore, oral hygiene and swallowing function were not associated with oral hypofunction diagnosis. All examined factors decreased with increasing age, even after adjusting sex, except for oral hygiene and moisture. Occlusal force and masticatory function were higher in men after adjusting age. This study suggested that older outpatients were likely to be diagnosed with oral hypofunction, and that the test reference value and their selection for oral hypofunction should be reconsidered.

Evaluation of the ability of the trypsin-like peptidase activity assay to detect severe periodontitis

OBJECTIVES

N-benzoyl-DL-arginine peptidase (trypsin-like peptidase) is specifically produced by certain strains of periodontitis-associated bacteria. We aimed to examine the effectiveness of an objectively quantified trypsin-like peptidase activity assay (TLP-AA) for detecting severe periodontitis.

METHODS

The study population included 347 adults (108 men and 239 women; average age, 43.3 years) who underwent a full-mouth periodontal examination. Specimens for the TLP-AA were obtained using tongue swabs. Using a color reader, the TLP-AA results were obtained as a* values, with higher positive a* values indicating an increased intense enzymatic activity. The predictive validity of the TLP-AA results for severe periodontitis was assessed using receiver operating characteristic curve analysis and the periodontitis case definition provided by the Centers for Disease Control and Prevention/American Academy of Periodontology as the gold standard. Furthermore, multivariable logistic regression analyses were performed to predict severe periodontitis using the TLP-AA results and health characteristics, as the exposure variables.

RESULTS

Severe periodontitis was observed in 5.2% of the participants. TLP-AA had high diagnostic accuracy for severe periodontitis, with an area under the curve of 0.83 (95% confidence interval [CI]: 0.75-0.92). The cut-off score for the a* value that best differentiated individuals with severe periodontitis was 0.09, with a sensitivity of 83% and specificity of 77%. Multivariable logistic regression analyses revealed that the TLP-AA results were significantly associated with severe periodontitis after adjusting for health characteristics (adjusted odds ratios: 1.90 [95% CI: 1.37-2.62] for the a* value).

CONCLUSIONS

Objectively quantified TLP-AA results are potentially useful for detecting severe periodontitis in epidemiological surveillance.

Survey of oral hypofunction in older outpatients at a dental hospital

BACKGROUND

Oral hypofunction is defined as the reversible stage preceding oral dysfunction. However, its assessment and management need further examination and consideration.

OBJECTIVE

The present study aimed to examine the current state of oral hypofunction among outpatients at the university hospital.

METHODS

New outpatients underwent medical interviews and detailed assessment of oral hypofunction at their initial visit to our dental department. Oral hypofunction was diagnosed if the results of three of the following seven assessment items were below cut-off values: poor oral hygiene, oral dryness, reduced occlusal force, decreased tongue-lip motor function, decreased tongue pressure, decreased masticatory function and deterioration of swallowing function. The relationships between factors used to diagnose oral hypofunction as well as the distributions of assessment values were clarified.

RESULTS

Seventy-five of 209 patients (35.9%) were finally diagnosed with oral hypofunction. Diagnosis of oral hypofunction was significantly related to patient age, Eichner index, a chief complaint of dental or periodontal disease or ill-fitting dentures and a history of neurodegenerative disease. The lowest quintile values for poor oral hygiene, oral dryness and decreased masticatory performance were all above current cut-off values. Reduced occlusal force contributed strongly to the diagnosis of oral hypofunction.

CONCLUSION

Oral hypofunction in dental outpatients at a university hospital was associated with patient age, medical history and chief complaint at presentation. Diagnosis of oral hypofunction can be closely related to reduced occlusal force. The validity of cut-off values for assessments of oral hypofunction needs further consideration.

Clinical and self-reported oral conditions and quality of life in the 1982 Pelotas birth cohort

AIM

To investigate and compare the effects of clinical and self-perceived oral conditions on oral health-related quality of life (OHRQoL) among young adults.

MATERIALS AND METHODS

Adults enrolled in the 1982 Pelotas birth cohort were included in this study. OHRQoL was assessed by the Oral Health Impact Profile-14 (OHIP-14) instrument. Clinical parameters such as dental caries, periodontitis, aesthetics, and occlusal characteristics, and tongue coating were collected through clinical evaluation, while dental anxiety and halitosis were self-reported. Direct and indirect effects of clinical and self-perceived oral conditions on OHRQoL were assessed using structural equation modelling.

RESULTS

Five-hundred and thirty-nine individuals participated in this study. Dental caries (β = 0.12) and periodontitis (β = 0.11) were directly and indirectly (via halitosis, β = 0.05 for periodontitis only) associated with greater OHIP-14 scores, while the other clinical conditions did not influence the OHIP-14 scores. Dental anxiety and halitosis were also associated with higher OHIP-14 scores (β = 0.31 and β = 0.27, respectively).

CONCLUSIONS

This study found a positive association between clinically diagnosed and self-reported oral conditions and OHRQoL; however, the self-reported conditions had a higher impact on OHRQoL.