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Takeda C, Yoshida M, Nakamori M, Hosomi N, Nagasaki T, Yoshikawa M, Kayashita J, Masuda S, Maruyama H, Tsuga K. Delayed Swallowing Reflex is Overlooked in Swallowing Screening Among Acute Stroke Patients. J Stroke Cerebrovasc Dis 2020; 29:105303. [PMID: 33039771 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Dysphagia in the acute phase of stroke contributes significantly to poor outcomes and is associated with the development of aspiration pneumonia and malnutrition. Therefore, an accurate evaluation of swallowing is necessary before initiating oral food intake. The modified water swallow test (MWST) and the repetitive saliva swallow test (RSST) are commonly used as bedside screening methods for swallowing dysfunction, but it is unclear whether other factors contribute to dysphagia and consequent aspiration. The purpose of this study was to identify characteristics that might be overlooked in screening tests. METHODS Participants were prospectively selected from patients hospitalized for stroke at the Suiseikai Kajikawa Hospital between August 1, 2016 and June 30, 2018. Inclusion criteria were conscious and stable medical condition, and patients who were diagnosed with dementia were excluded. A videofluoroscopic (VF) swallowing study was carried out on all patients who met the inclusion/exclusion criteria and who passed both the MWST and the RSST. RESULTS Aspiration was observed in 16 of 172 patients (9.3%) when swallowing 3 ml of water. These aspirated patients showed significantly delayed swallowing reflex on VF. CONCLUSIONS Swallowing evaluation using a combination of the MWST and the RSST is reasonably effective. However, patients who show a delayed swallowing reflex might be overlooked by this screening procedure.
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Affiliation(s)
- Chiho Takeda
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Mitsuyoshi Yoshida
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan.
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Neurology, Chikamori Hospital, Kochi, Japan
| | - Naohisa Hosomi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan; Department of Health Sciences, Faculty of Human Culture and Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Toshikazu Nagasaki
- Department of Oral and Maxillofacial Radiology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Mineka Yoshikawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
| | - Jun Kayashita
- Department of Health Sciences, Faculty of Human Culture and Sciences, Prefectural University of Hiroshima, Hiroshima, Japan
| | - Shin Masuda
- Department of children Sensory, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima 734-8553, Japan
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Suzuki A, Ito M, Kawai Y. Utility of the luminance standard deviation to quantify magnetic resonance imaging motion artifact induced by tongue movement. J Oral Sci 2018; 60:399-404. [PMID: 30146535 DOI: 10.2334/josnusd.17-0322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Clear magnetic resonance imaging (MRI) is required to diagnose tongue cancer. However, the absence of occlusal support may cause tongue movements which are known to introduce artifacts on the MR image. This pilot study compared the manifest of artifacts from the tongue at rest and during motion using luminance standard deviation (LSD) to quantify the artifacts, in dentulous subjects. Participants were ten dentulous participants (5 males, 5 females; age 31.50 ± 8.38 years) with occlusal support. MRI was conducted with the tongue at rest and during lateral movement. The LSD was measured in the regions of interest (ROI) in the axial and sagittal planes. Tongue movement evoked unclear MR images, compared with the images taken at rest. Statistical analysis revealed that the LSD significantly differed between the tongue at rest and in motion in the axial (P = 0.004) and sagittal planes (ROI-A: P = 0.002, ROI-P: P = 0.006). These findings suggest that tongue movement introduces motion artifact and the LSD responds quantitatively to the magnitude of artifacts. Future studies will evaluate whether a prosthetic device used to provide occlusive support can decrease these artifacts when analyzed using LSD.
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Affiliation(s)
- Asako Suzuki
- Nihon University Graduate School of Dentistry at Matsudo, Removable Prosthodontics
| | - Masayasu Ito
- Department of Removable Prosthodontics, Nihon University School of Dentistry at Matsudo
| | - Yasuhiko Kawai
- Department of Removable Prosthodontics, Nihon University School of Dentistry at Matsudo
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Suzuki A, Ito M, Kawai Y. Dentures wearing reduce motion artifacts related to tongue movement in magnetic resonance imaging. J Prosthodont Res 2018; 62:303-308. [DOI: 10.1016/j.jpor.2017.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/06/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022]
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Yamanashi H, Shimizu Y, Higashi M, Koyamatsu J, Sato S, Nagayoshi M, Kadota K, Kawashiri S, Tamai M, Takamura N, Maeda T. Validity of maximum isometric tongue pressure as a screening test for physical frailty: Cross-sectional study of Japanese community-dwelling older adults. Geriatr Gerontol Int 2017; 18:240-249. [DOI: 10.1111/ggi.13166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 06/15/2017] [Accepted: 07/18/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Hirotomo Yamanashi
- Department of Island and Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Goto Japan
- Department of Clinical Medicine, Institute of Tropical Medicine; Nagasaki University; Nagasaki Japan
| | - Yuji Shimizu
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Miho Higashi
- Department of Global Health, Medicine and Welfare; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Jun Koyamatsu
- Department of Island and Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Goto Japan
| | - Shimpei Sato
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Mako Nagayoshi
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Koichiro Kadota
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Shinya Kawashiri
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Mami Tamai
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Noboru Takamura
- Department of Global Health, Medicine and Welfare; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takahiro Maeda
- Department of Island and Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Goto Japan
- Department of Community Medicine; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
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Furuya J, Tamada Y, Sato T, Hara A, Nomura T, Kobayashi T, Sakai M, Kondo H. Wearing complete dentures is associated with changes in the three-dimensional shape of the oropharynx in edentulous older people that affect swallowing. Gerodontology 2016; 33:513-521. [PMID: 25939853 DOI: 10.1111/ger.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the effects of wearing complete dentures on pharyngeal shape for swallowing in edentulous older people. BACKGROUND In the absence of complete dentures, edentulous older people often lose the occlusal support necessary to position the mandible, which leads to an anterosuperior shift of the mandible during swallowing. This may result in pharyngeal shape changes effecting swallowing function in older people. However, the details of this phenomenon are currently unclear. MATERIALS AND METHODS Participants were 17 older edentulous volunteers. Cone-beam computed tomography imaging was performed with the participant in the seated position and wearing (i) both maxillary and mandibular dentures, (ii) maxillary dentures only and (iii) no dentures. During imaging, participants were instructed to keep their mouth closed to the mandibular position determined in advance during swallowing for each denture-wearing condition. The volume, height and average cross-sectional area of the velopharynx and oropharynx were measured, and the positions of the epiglottis and mandible were recorded. RESULTS While the vertical height of the oral cavity and pharynx significantly decreased, the volume and average cross-sectional area of the oropharynx significantly increased when dentures were not worn (p < 0.01). The absence of dentures caused an anterosuperior shift of the mandible when swallowing and drew the epiglottis forward, resulting in expansion of the oropharynx where the tongue base forms the anterior wall. CONCLUSION The absence of dentures results in anatomical changes in oropharyngeal shape that may exacerbate the pharyngeal expansion caused by ageing and reduce the swallowing reserve.
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Affiliation(s)
- Junichi Furuya
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan.
| | - Yasushi Tamada
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Tomohide Sato
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Atsushi Hara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Taro Nomura
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Takuya Kobayashi
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
| | - Maiko Sakai
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan
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Onodera S, Furuya J, Yamamoto H, Tamada Y, Kondo H. Effects of wearing and removing dentures on oropharyngeal motility during swallowing. J Oral Rehabil 2016; 43:847-854. [DOI: 10.1111/joor.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- S. Onodera
- Department of Prosthodontics and Oral Implantology; School of Dentistry; Iwate Medical University; Morioka Japan
| | - J. Furuya
- Department of Oral Health Care Science for Community and Welfare; Graduate School of Medical and Dental Sciences; Tokyo Medical and Dental University; Bunkyo-ku Japan
| | - H. Yamamoto
- Department of Prosthodontics and Oral Implantology; School of Dentistry; Iwate Medical University; Morioka Japan
| | - Y. Tamada
- Department of Prosthodontics and Oral Implantology; School of Dentistry; Iwate Medical University; Morioka Japan
| | - H. Kondo
- Department of Prosthodontics and Oral Implantology; School of Dentistry; Iwate Medical University; Morioka Japan
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Magalhães Junior HV, Tavares JC, Magalhães AAB, Galvão HC, Ferreira MAF. Caracterização da pressão da língua em idosos. AUDIOLOGY: COMMUNICATION RESEARCH 2014. [DOI: 10.1590/s2317-64312014000400001401] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objetivo Caracterizar a pressão da língua em idosos. Métodos Estudo transversal, com a participação de 45 idosos, de 61 a 96 anos, sendo 34 (75,6%) do gênero feminino e 11 (24,4%) do masculino, sem distúrbios neurológicos e cognitivos, sem histórico de câncer de cabeça e pescoço e de procedimento radioterápico. Consistiu na aplicação de questionário, com registro da presença ou ausência de queixa de problemas na deglutição, seguido da avaliação miofuncional orofacial, enfocando a mobilidade e tensão de língua. Para a mensuração da pressão da língua, foi utilizado o Iowa Oral Performance Instrument (IOPI). A análise dos dados foi descritiva, com nível de significância de 5%. Resultados A média do pico pressórico foi de 44,6 KPa (±16), com os valores mínimo e máximo entre 9 e 88 KPa. Houve correlação moderada negativa entre pico pressórico e idade. Os longevos apresentaram a menor média de pico pressórico e inferior ao padrão de normalidade. Houve diferença entre a média de pico pressórico e uso de próteses, tensão de língua e mobilidade de língua no estalo. Conclusão Houve diminuição moderada do pico pressórico da língua com o aumento da idade e redução pressórica com o decréscimo da tensão da língua e de sua mobilidade no estalo. Em contrapartida, os valores de pico foram maiores nos idosos que utilizam próteses dentárias, quando comparados aos que destas não fazem uso.
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Kondoh J, Ono T, Tamine K, Fujiwara S, Minagi Y, Hori K, Maeda Y, Kreissl M, Nitschke I. Effect of complete denture wearing on tongue motor biomechanics during swallowing in edentulous older adults. Geriatr Gerontol Int 2014; 15:565-71. [DOI: 10.1111/ggi.12315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Jugo Kondoh
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Takahiro Ono
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Kenichi Tamine
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Shigehiro Fujiwara
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Yoshitomo Minagi
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Kazuhiro Hori
- Division of Dysphagia Rehabilitation; Graduate School of Medical and Dental Sciences; Niigata University; Niigata Japan
| | - Yoshinobu Maeda
- Department of Prosthodontics; Gerodontology and Oral Rehabilitation; Graduate School of Dentistry; Osaka University; Osaka Japan
| | - Marion Kreissl
- Clinic for Masticatory Disorders, Removable Prosthodontics and Special Care Dentistry; Center for Oral Medicine, Dental and Maxillo-Facial Surgery; University of Zurich; Zurich Switzerland
| | - Ina Nitschke
- Clinic for Masticatory Disorders, Removable Prosthodontics and Special Care Dentistry; Center for Oral Medicine, Dental and Maxillo-Facial Surgery; University of Zurich; Zurich Switzerland
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Yamamoto H, Furuya J, Tamada Y, Kondo H. Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous. J Oral Rehabil 2013; 40:923-31. [PMID: 24237359 DOI: 10.1111/joor.12107] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 11/30/2022]
Abstract
Prosthetic treatment with dentures is often required for the elderly who have reduced swallowing function. Therefore, it is important to understand the relationship between denture-wearing and feeding function from the perspective of swallowing. To clarify changes in bolus transport during feeding in elderly edentulous patients with or without complete dentures. Subjects were 15 elderly edentulous volunteers who were treated with maxillary and mandibular complete dentures. The test food was 10 g of minced agar jelly containing barium sulphate with a particle diameter of 4·0-5·6 mm. Lateral videofluoroscopy was performed to assess the position of the leading edge of the bolus, the bolus volume in each area at swallow onset, bolus transit time and the mandibular position during pharyngeal swallowing. There were significant changes between the bolus transport with and without dentures. Without dentures, the leading edge of the bolus at swallow onset fell from the valleculae area to the hypopharynx, and the bolus volume in the hypopharynx increased. Bolus transit time increased in the oral cavity, valleculae and hypopharynx. The mandibular position shifted anterosuperior direction. The results arose owing to anatomical changes in the oral and pharyngeal structure and the following functional changes: poor food manipulation, poor bolus formation and delayed swallowing reflex. Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.
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Affiliation(s)
- H Yamamoto
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Japan
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Fujiki T, Deguchi T, Nagasaki T, Tanimoto K, Yamashiro T, Takano-Yamamoto T. Deglutitive tongue movement after correction of mandibular protrusion. Angle Orthod 2013; 83:591-6. [PMID: 23289734 DOI: 10.2319/060412-464.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To investigate any change in deglutitive tongue movement following the correction of malocclusion by orthognathic surgery. MATERIALS AND METHODS The subjects were nine patients with mandibular protrusion. A control group consisted of 10 individuals with a similar age range and normal occlusion. Swallowing events before and after mandibular setback via sagittal split ramus osteotomy were recorded by cineradiography, and the tongue movement was analyzed. Time and linear measurements were compared before and after surgical treatment by the Wilcoxon signed rank test; control and test subjects were compared with the Mann-Whitney U-test. RESULTS Tongue-palate contact and the tongue-tip position changed after orthognathic surgery and became similar to those of the controls. Movements of the anterior and middorsal regions of the tongue did not change after orthognathic surgery and remained different from those of the controls. CONCLUSION Our findings suggest that tongue-palate contact and tongue-tip position during deglutition adapted to the corrected oral and maxillofacial morphology, but the anterior and middorsal regions of the tongue during deglutition may have been affected by pharyngeal constrictors rather than by the oral and maxillofacial morphology.
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Affiliation(s)
- Tatsuya Fujiki
- Division of Orthodontics, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Chen YF, Yang YH, Lee JH, Chen JH, Lee HE, Chou TM. Tongue support of complete dentures in the elderly. Kaohsiung J Med Sci 2012; 28:273-8. [DOI: 10.1016/j.kjms.2011.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 07/22/2011] [Indexed: 11/29/2022] Open
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Gokce HS, Gokce SM, Akin E, Bulakbasi N, Akyol M. Effect of complete denture wearing on deglutition time: a cine-magnetic resonance imaging study. J Oral Rehabil 2011; 39:198-209. [PMID: 22150643 DOI: 10.1111/j.1365-2842.2011.02272.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose of the study was to evaluate the effect of complete denture wearing on deglutition time (DT), hyoid bone and larynx movements in edentulous patients with real-time balanced turbo field echo cine-magnetic resonance imaging. Subjects were examined by cine-magnetic resonance imaging in supine position during swallowing water. Two sets of images for 23 edentulous (with/without wearing complete dentures) and one for 23 dentulous patients were obtained. Radiographic outputs representing three consecutive deglutition stages (oral, pharyngeal and oesophageal) were provided to perform measurements. Deglutition time significantly increased when edentulous patients wore their dentures (mean 0·75 s increased to 1·17 s), whereas dentulous patients' DT was about 0·91 s (P ≤ 0.05). The duration of deglutition is crucial because prolonged pharyngeal transit times increases the risk of aspiration. Within the limitations of the study, complete denture wearing could increase the shortened DT of the edentulous patients.
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Affiliation(s)
- H S Gokce
- Beytepe Military Hospital, Dental Service, Golbasi, Turkey.
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