Association between dental status and incident disability in an older Japanese population

Oral Function, Loneliness, Depression, and Social Participation Among Physically Disabled Middle-Aged and Older Adult Individuals: Insights from a Japanese Cross-Sectional Study

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000-0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals.

Number of teeth and functional disability in community-dwelling older adults

INTRODUCTION

This study determined whether tooth loss was associated with the development of functional disability and estimated the population attributable fraction (PAF) of functional disability due to tooth loss, along with risk factors for functional disability such as physical function and cognitive impairment.

METHODS

The participants were 838 community-dwelling older adults aged ≥70 years living in the Tsurugaya district in Japan in 2003. The exposure variable was the number of remaining teeth (counted by trained dentists). Other variables were age, sex, depressive symptoms, cognitive impairment, educational attainment, physical function and social support. The Cox proportional hazards model was applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of the incidence of functional disability for each risk factor, such as tooth loss. The functional disability PAF due to tooth loss was estimated, and risk factors for functional disability were identified.

RESULTS

In total, 619 (73.9%) participants developed functional disability during follow-up. A multivariable model showed that those with <20 teeth (HR, 1.28; 95% CI, 1.08-1.53) were more likely to develop functional disability than those with 20 teeth or more. PAF estimation for functional disability was shown to have decreasing values in the following order: age, female sex, tooth loss and reduced physical function.

CONCLUSIONS

Tooth loss was associated with the development of functional disability in community-dwelling older Japanese adults. While retaining teeth may be a potential strategy for avoiding functional disability, clinical studies on the effect of dental treatment on preventing functional disability are warranted.

Physical Performance, Body Composition, and Oral Health in Community-Residing Older Adults: A Cross-Sectional Study

Physical activity is essential for healthy aging. This study aimed to identify an association between physical performance, body fat percentage (%BF), and the perception of oral health-related quality of life (OHRQoL) in independent older adults.

METHOD

A group of active older adults was selected from a government-sponsored reunion center in Mexico City. OHRQoL was assessed using the General Oral Health Index (GOHAI), and nutritional status was assessed using the Mini Nutritional Assessment (MNA) tool. A short physical performance battery (SPPB) was applied, and, for body composition, DXA (dual X-ray absorptiometry) was conducted. Data were analyzed using logistic regression models, and marginal probabilities were obtained.

RESULTS

This study involved 366 participants; their mean age was 73.9 (±6.2) years, and 24.9% had type 2 diabetes mellitus (T2DM). OHRQoL information revealed that pain or discomfort in the oral cavity was perceived by 63.9% of the older adults during the previous three months. The SPPB score was low in 159 (43.44%) participants. The logistic regression model revealed that age (OR = 1.13, p < 0.001), T2DM (OR = 2.10, p = 0.009), the risk of malnutrition/malnutrition (OR = 1.76, p = 0.047), high %BF (OR = 1.09, <0.001), and poor OHRQoL (OR = 1.96, p = 0.009) were associated with deteriorated physical performance.

CONCLUSION

OHRQoL self-perception, excess body fat, and nutritional status impacted physical performance. Aging well requires a comprehensive approach.

Association between masticatory function, frailty, and functional disability: an observational study

BACKGROUND

Increase in functional disability in aging societies is an international medical and public health issue. Masticatory function may be a potential risk factor for functional disability, but the role of frailty in the association has not been clarified.

METHODS

Forty thousand five hundred sixty-two community-dwelling older adults aged 65 years and over who were insured by public health insurance as of April 2018 were followed up for a median of 3.0 years. Masticatory function was categorized as good, moderate, or poor based on a self-reported questionnaire. The development of functional disability was defined as a new certification of the need for long-term care. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and their 95% confidence intervals (CIs).

RESULTS

During the follow-up period, 1,397 individuals experienced functional disability. After adjusting for age, sex, comorbidities, medical history, and lifestyle behaviors, the HR for incident functional disability was significantly higher in the moderate and poor groups compared to the good group (moderate, HR 1.21 [95% CI, 1.07-1.37]; poor, HR 1.64 [95% CI, 1.03-2.62]). However, after additional adjustment for frailty-related factors-namely, underweight, regular exercise, and gait speed-the association was attenuated in both the moderate group (HR 1.06 [95% CI, 0.94-1.21]) and the poor group (HR 1.51 [95% CI, 0.94-2.41]).

CONCLUSIONS

Masticatory dysfunction was significantly associated with incident functional disability in a community-dwelling older Japanese population. Our findings suggest that masticatory dysfunction may be a surrogate of frailty rather than a direct cause of functional disability.

Functional dentition and well-being among Chilean 80-year-olds

BACKGROUND

The Decade of Healthy Aging 2021-2030 calls for a strengthening of the policies for older people in Latin America. An example of successful oral aging is the Japanese "8020" campaign, which achieved 50% of people aged 80 years having ≥20 teeth by 2016.

OBJECTIVE

To evaluate the association between having a functional dentition (≥20 teeth) and cognitive health, social participation, and quality of life in people aged ≥80 years.

METHODS

Cross-sectional data from 299 complete observations (weighted N = 436 981) of individuals aged ≥80 years from Chile's National Health Survey 2016-2017 were included (3% of the population; total = 5520 clinical observations/weighted N = 14 518 969). Generalised structural equation models (GSEM) evaluated the association between having a functional dentition and cognitive health, measured with the Mini-mental score, between having a functional dentition and social participation, and between having a functional dentition and quality of life, measured with the EQ-5D-3L. Models included the effect of mediators (daily fruit and vegetable consumption; oral health-related quality of life score) and controlled for the exposure-induced mediator-outcome variables: sex, educational level, and location. Data were analysed using the STATA-17 survey module. Statistical significance was set at P < .05 (95% confidence interval [CI]).

RESULTS

The sample was mostly female, had <8 years of education, and lived in urban areas. The prevalence of a functional dentition was 9.2% (95% CI 3.6,21.3/n = 21). GSEM demonstrated that the association between functional dentition and cognitive health was mediated by daily fruits and vegetables consumption (β = 0.12/95% CI 0.02,0.21/P = .015), with moderate strength of evidence. Additionally, there was strong evidence of an association between functional dentition and social participation frequency (β = 2.76/95% CI 0.60,4.73/P = .009). Finally, the association between functional dentition and quality of life was mediated by cognitive health (β =0.05/95% CI 0.02,0.09/P = .002) and oral health-related quality of life (β = -0.04/95% CI -0.08 to -0.01/P = .025), with strong and moderate evidence, respectively.

CONCLUSION

Given the beneficial implications of functional dentition in social participation, nutritional benefits and quality of life and well-being of individuals aged ≥80 years.

Association between shortened dental configurations and health outcomes: a scoping review

This study mapped definitions of shortened dental configurations and health outcomes employed in association studies. A scoping review was conducted using the PubMed/Medline, Scopus, Web of Science, SciELO and Cochrane databases. Two trained researchers selected studies and extracted data. Studies that investigated the association between shortened dental configurations (exposure) and person-centered outcomes (general and oral health) related to health behavior (dietary patterns). Clinical outcomes were classified according to the International Classification of Functioning, Disability and Health and the International Classification of Diseases of the World Health Organization (WHO). Shortened dental configurations were defined as at least 20/21 teeth or the position of the teeth, including esthetics, dental occlusion and periodontal status (Eichner Index, Shortened Dental Arches, Functional Dentition Classification System, Posterior Occluding Pairs, Functional Tooth Units). The initial search resulted in 12,525 records in English, Portuguese and Spanish, 432 of which addressed the association of interest. General health (n = 203) and oral health (n = 201) were addressed in a similar number of studies. Most outcomes were related to general health (n = 184), the most frequent of which were endocrine, nutritional or metabolic diseases (n = 57) and mental functions (n = 26). Person-centered measures were addressed in 153 studies, most of which were about oral health and oral health-related quality of life (n = 62). Oral health outcomes were predominantly related to intake functions (n = 44) and diseases or disorders of the orofacial complex (n = 24). Dietary patterns (n = 43) and mortality (n = 38) were also studied. The cross-sectional design (n = 257) and non-probabilistic sampling (n = 218) were more frequent. The shortened dental configurations defined by the WHO were the most frequent in the studies (n = 206). The effects of shortened dental configurations have been investigated mainly in relation to endocrine, nutritional or metabolic diseases and measures of oral health-related quality of life. The findings point to a diversity of health outcomes assessed and substantial methodological variability.

Oral frailty indicators to target major adverse health-related outcomes in older age: a systematic review

A well-preserved oral function is key to accomplishing essential daily tasks. However, in geriatric medicine and gerodontology, as age-related physiological decline disrupts several biological systems pathways, achieving this objective may pose a challenge. We aimed to make a systematic review of the existing literature on the relationships between poor oral health indicators contributing to the oral frailty phenotype, defined as an age-related gradual loss of oral function together with a decline in cognitive and physical functions, and a cluster of major adverse health-related outcomes in older age, including mortality, physical frailty, functional disability, quality of life, hospitalization, and falls. Six different electronic databases were consulted by two independent researchers, who found 68 eligible studies published from database inception to September 10, 2022. The risk of bias was evaluated using the National Institutes of Health Quality Assessment Toolkits for Observational Cohort and Cross-Sectional Studies. The study is registered on PROSPERO (CRD42021241075). Eleven different indicators of oral health were found to be related to adverse outcomes, which we grouped into four different categories: oral health status deterioration; decline in oral motor skills; chewing, swallowing, and saliva disorders; and oral pain. Oral health status deterioration, mostly number of teeth, was most frequently associated with all six adverse health-related outcomes, followed by chewing, swallowing, and saliva disorders associated with mortality, physical frailty, functional disability, hospitalization, and falls, then decline in oral motor skills associated with mortality, physical frailty, functional disability, hospitalization, and quality of life, and finally oral pain was associated only with physical frailty. The present findings could help to assess the contribution of each oral health indicator to the development of major adverse health-related outcomes in older age. These have important implications for prevention, given the potential reversibility of all these factors.

Oral status and homebound status: A 6-year bidirectional exploratory prospective cohort study

OBJECTIVES

Little is known about the association between oral status and homebound status, and there is a possibility of a bidirectional relationship between them. In this exploratory prospective cohort study, we examined the association between four oral status measurements and being homebound bidirectionally.

METHODS

We used 2010-2016 panel data gathered from the Japan Gerontological Evaluation Study. All functionally independent participants aged 65 years or older (n = 26,579) were included in this study. Multiple imputation and Poisson regression were used for analyses. We adjusted for age, sex, education, comorbidity, and depressive symptoms.

RESULTS

In the fully adjusted model, the prevalence ratio (PR) of being homebound at follow-up was 1.42 for having <20 remaining teeth, 1.28 for having chewing difficulty, 0.99 for having choking experience, and 0.94 for having dry mouth at baseline. Reversely, being homebound at baseline predicted having chewing difficulty at follow-up (PR = 1.17), while no significant association was demonstrated with having <20 teeth (PR = 1.00), choking experience (PR = 1.06), and dry mouth (PR = 1.02).

CONCLUSION

Chewing difficulty and having <20 remaining teeth predicted homebound status after 6 years. Reversely, homebound status at baseline only predicted having chewing difficulty at follow-up. These findings may help to determine the oral frailty assessment measures for older people.

Oral status and incident functional disability: a 9-year prospective cohort study from the JAGES

INTRODUCTION

The population-attributable risk of oral status for incident functional disability remains unknown. We investigated the impact of a range of oral statuses (number of remaining teeth, chewing difficulty, dry mouth, and choking) on incident functional disability.

METHODS

Participants (n = 44,083) aged ≥ 65 years from the Japan Gerontological Evaluation Study were evaluated. The outcome variable was incident functional disability, and the explanatory variables were four select oral statuses. The possible confounders were included as covariates. Using the Cox proportional hazards model, we calculated hazard ratios (HRs), 95% confidence intervals (CIs), and their population-attributable fractions (PAFs).

RESULTS

The mean age of the participants was 73.7 (standard deviation=6.0) years at baseline, and 53.2% were women. A total of 8,091 participants (18.4%) developed functional disabilities during the follow-up period. Among the four oral statuses, the incidence rate of functional disability was the highest in those with chewing difficulty (3.27/100 person-years), followed by those with dry mouth (3.20/100 person-years), choking (3.10/100 person-years), and ≤19 remaining teeth (2.89/100 person-years). After adjusting for all covariates, chewing difficulty showed the highest risk of functional disability (HR=1.22, 95%CI=1.16-1.28), followed by ≤19 remaining teeth (HR=1.18, 95%CI=1.12-1.25), dry mouth (HR=1.18, 95%CI=1.12-1.24), and choking (HR=1.10, 95%CI=1.04-1.17). Regarding PAF, ≤19 remaining teeth (12.0%) were the largest, followed by chewing difficulty (7.2%), dry mouth (4.6%), and choking (1.9%).

CONCLUSIONS

Maintaining a good oral status may reduce the risk of functional disability later in life. Given its population contribution, tooth loss had the largest impact among the four oral conditions.

Maternal disability and prenatal oral health experiences: Findings from Pregnancy Risk Assessment Monitoring System

BACKGROUND

Although disability has associations with poor health and reduced access to health care services, limited research exists on the connection between disability, oral health, and oral health care use. Moreover, to the authors' knowledge, no study has examined the association between disability and oral health around the time of pregnancy. This is an important gap in research, considering that both disability and oral health play a critical role in maternal and infant well-being.

METHODS

The authors obtained cross-sectional data from 15 states from 2019 and 2020 from the Pregnancy Risk Assessment Monitoring System (N = 20,189). The authors used multivariable logistic regression analyses to assess the relationship between cumulative disabilities and specific forms of disability (seeing, hearing, walking, remembering, self-care, and communicating) for 6 indicators of oral health experiences during pregnancy.

RESULTS

Women reporting multiple forms of disabilities around the time of pregnancy (especially ≥ 3 disabilities) reported lower levels of knowledge of appropriate oral health care during pregnancy, were less likely to undergo dental prophylaxis during pregnancy, were more likely to report needing care for dental health problems, and had more unmet oral health care needs than those without disabilities.

CONCLUSIONS

Maternal disability is a risk factor for poorer oral health outcomes and oral health care use during pregnancy.

PRACTICAL IMPLICATIONS

Given the potential harms of poor oral health to maternal and infant well-being, the findings of this study suggest the need for increased health promotion efforts to foster improved oral health for pregnant women living with disabilities.

Oral function and cumulative long-term care costs among older Japanese adults: a prospective 6-year follow-up study of long care receipt data

OBJECTIVES

This study evaluated the relationship between status of oral function and related long-term care service costs.

DESIGN

This was a prospective 6-year follow-up study of previous survey data.

SETTING

The data were obtained from the Japan Gerontological Evaluation Study conducted between 2010 and 2011.

PARTICIPANTS

The participants were functionally independent older adults in 12 municipalities across Japan.

INTERVENTIONS

Care service benefit costs were tracked over 6 years using publicly available claims records (n=46 616) to monitor respondents' cumulative care costs.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome variable was the cumulative cost of long-term care insurance services during the follow-up period. We adjusted for the presence or absence of oral function problems, age, sex, physical function and socioeconomic and lifestyle background at the time of the baseline survey.

RESULTS

Tobit analysis revealed that, compared with those with no oral function problems, cumulative long-term care service benefit costs for those with one, two or three oral function problems were approximately US$4020, US$4775 and US$82 92, respectively, over 6 years. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. With increase in number of oral function problems, there was a concomitant elevation in the cost of long-term care.

CONCLUSIONS

Oral function in older people was associated with cumulative long-term care insurance costs. The oral function of older people should be maintained to reduce future accumulated long-term care insurance costs. Compared with those with maintained oral function, there was a maximum difference of approximately US$8292 in long-term care service costs for those with oral function problems. The cost of long-term care was amplified as oral problems increased.

The association between social isolation and oral health of community-dwelling older adults-A systematic review

AIM

Social isolation and oral health problems commonly exist in older populations and can influence each other. However, evidence on this bidirectional correlation is scarce. This systematic review aimed to provide a comprehensive overview of literature in which social isolation and oral health were associated with each other separately.

METHODS

Electronic searches were performed through six databases. Original cross-sectional and longitudinal prospective studies that evaluated the associations between social isolation and oral health as either exposure or outcome were included.

RESULTS

In total, 282 articles were retrieved. Of these, 10 cross-sectional studies and one longitudinal study were included in the analysis. The level of evidence reported was generally moderate to strong. Most studies found that both stronger objective and perceived social isolation were associated with worse oral health in both directions. The frequency of meeting friends had an inconsistent association with oral health.

CONCLUSIONS

The results of our systematic review showed a bidirectional association between social isolation and oral health in independent community-dwelling older adults. Both objective and perceived social isolation are associated with oral health. As objective social isolation indicators, quality of social connectedness appears to play a more important role in the association with oral health.

Dietary Problems Are Associated with Frailty Status in Older People with Fewer Teeth in Japan

This study aimed to investigate the association between dietary problems and frailty according to tooth loss in older Japanese people. This cross-sectional study included 160 older people (mean age 82.6 years) from Japan. Frailty status was assessed using the Study of Osteoporotic Fractures (SOF) criteria, which consists of (i) weight loss > 5% in the past year, (ii) inability to perform five chair stands, and (iii) self-perceived reduced energy level. Frailty was defined as the presence of ≥2 items of SOF criteria. Multivariate logistic regression analyses were performed with frailty as the dependent variable and dietary problems as the independent variable, stratified according to having <20 teeth. Low appetite and no enjoyment of eating were associated with frailty after adjusting for covariates in participants with <20 teeth. Dietary problems, including low appetite, eating alone, and negative attitudes toward enjoyment of eating were associated with a self-perceived reduced energy level in participants with <20 teeth. However, this association was not observed in participants with ≥20 teeth. In older people with fewer teeth, dietary problems have been suggested to be associated with frailty. Therefore, it may be necessary to pay attention to dietary problems, especially in older people with tooth loss.

Tooth Loss Trajectories and Their Association with Functional Disability among Older Chinese Adults: Results from the Chinese Longitudinal Healthy Longevity Survey

BACKGROUND

Tooth loss becomes more prevalent with age and increases risk of functional disability. However, the strength of tooth loss varies between individuals rather than a uniform loss with age. We aimed to evaluate tooth loss trajectories and their association with functional disability among older Chinese adults.

METHODS

We included 16,209 participants aged ≥65 years from five waves of the Chinese Longitudinal Healthy Longevity Survey 2002-2014. The number of teeth, Activities of Daily Living (ADL), and Instrumental ADL (IADL) were assessed at baseline and subsequently every three years. ADL disability and IADL disability were defined as needing any help in any item of the Katz scale and a modified Lawton's scale, respectively. A group-based trajectory model was used to determine tooth loss trajectories based on the self-reported number of teeth and generalized estimating equation models were used to explore associations of tooth loss trajectories with ADL disability and IADL disability.

RESULTS

This study identified four tooth loss trajectories, including Progressively Mild Loss (14.4%), Progressively Severe Loss (21.5%), Persistently Severe Loss (45.1%), and Edentulism (19.0%) among older Chinese adults. Compared with the Progressively Mild Loss trajectory, the Progressively Severe Loss (ADL disability: OR=1.45, 95% CI: 1.15-1.84; IADL disability: OR=1.71, 95% CI: 1.47-1.99), Persistently Severe Loss (ADL disability: OR=2.33, 95% CI:1.93-2.82; IADL disability: OR=3.29, 95% CI: 2.82-3.84) and Edentulism (ADL disability: OR=3.25, 95% CI: 2.58-4.09; IADL disability: OR=3.60, 95% CI: 2.93-4.42) trajectories were significantly associated with an increased risk of functional disability with adjustment for potential confounders.

CONCLUSION

Four distinct tooth loss trajectories were identified among older adults and those with severe tooth loss trajectories had an increased risk of functional disability than those with a mild loss trajectory.

Association between Bone-Related Physiological Substances and Oral Function in Community-Dwelling Older People

BACKGROUND

Oral dysfunction is related to long-term cares including activities of daily living. The objective of this study was to determine the association between oral function and the bone-related physiological substances osteocalcin (OC) and insulin-like growth factor-1 (IGF-1).

METHODS

The study participants were 139 community-dwelling older people in Japan. Evaluation of oral dysfunction was based on subjective judgment by each participant. Blood analysis included OC, IGF-1, and albumin.

RESULTS

Univariate and multiple logistic analyses showed that IGF-1 was significantly associated with a "decline in masticatory function" (p = 0.0074 and p = 0.0308, respectively). Receiver operating characteristic curve analysis of IGF-1 levels revealed a threshold score of 108 ng/mL (p < 0.01) for discriminating a "decline in masticatory function". Logistic regression analysis revealed that participants with an IGF-1 level ≤108 ng/mL had an odds ratio of 4.31 (p < 0.05) for a "decline in masticatory function". No significant association was found between the OC level and oral dysfunction.

CONCLUSIONS

These results suggest a possible relationship between lower serum IGF-1 levels and a decline in masticatory dysfunction in community-dwelling older people.

Is the Number of Missing Teeth Associated With Mortality? A Longitudinal Study Using a National Health Screening Cohort

This study aimed to estimate the risk of mortality related to the number of missing teeth in a South Korean population. The ≥ 40-year-old population of the Korean National Health Insurance Service-Health Screening Cohort 2002–2003 was analyzed. Participants were selected from a total of 220,189 participants and included in groups of 0 teeth lost, 1–2 teeth lost, and ≥ 3 teeth lost. Among the total population, 17,211 participants were included in no missing teeth, 1–2 missing teeth, and ≥ 3 missing teeth and were randomly matched 1:1:1 for age and sex. Mortality from specific causes and all-cause mortality were compared among the groups. The hazard ratio (HR) of the number of missing teeth for all-cause mortality or each cause of mortality was analyzed using Cox proportional hazard models. According to the cause of death, the HRs for metabolic disease, digestive disease, and trauma were greater in the group with ≥ 3 missing teeth than in the no missing teeth group. The group with ≥ 3 missing teeth indicated a 1.19-fold higher HR for all-cause mortality than the no missing teeth group [95% confidence intervals (95% CIs) = 1.12–1.27, P &lt; 0.001]. The group with 1- 2 missing teeth did not show a higher HR for all-cause mortality. In the group with 1–2 missing teeth, the HRs for mortality from mental disease and digestive disease were higher than those in the no missing teeth group. The group with 1–2 missing teeth did not show a higher HR for all-cause mortality. The number of missing teeth was linked with a higher risk of mortality. For specific causes of mortality, mortality from metabolic disease, digestive disease, and trauma was higher in the participants with the number of missing teeth.

Community intervention programs prolong the onset of functional disability among older Japanese

Aim

This study examined the effects of a “community‐based center” intervention to prevent the onset of functional disability among residents in disaster‐affected areas.

Methods

We used data from a prospective cohort study conducted from 2010 to 2016 in Iwanuma City, Japan. Participants were community‐dwelling independent adults aged ≥65 years. The exposure variable was the experience of using a community‐based center. The outcome variable was functional disability onset. The average treatment effect on the treated (ATET) was estimated by adjusting for possible confounders. Additional analysis stratified by sex was conducted considering the sex differences in social participation rates.

Results

Among 3794 participants (mean ± SD age = 72.9 ±5.3 years, 46.0% men), 196 (5.2%) used the community‐based center, and 849 (22.4%) exhibited disability onset. Of those with functional disabilities, 40 (20.4%) used the community‐based center, while 809 (22.5%) did not. The ATET for functional disability onset with community‐based center activities across all participants were not significant (ATET: 0.51 years [95% confidence interval [CI] = −0.23; 1.27]). However, the direction of the effect of community‐based center activities differed by sex (ATET: −0.14, 95% CI = −2.59; 2.31 for men [n = 18], and 0.66, 95% CI = 0.18; 1.16 for women [n = 178]). Women exhibited a 15.63% (95% CI = 3.58; 27.68) increase in the time until functional disability onset.

Conclusions

The use of community‐based centers was associated with a longer period without functional disability in women. Geriatr Gerontol Int 2022; 22: 465–470.

Tooth retention, health, and quality of life in older adults: a scoping review

OBJECTIVE

This scoping review describes the relationship between tooth retention, health, and quality of life in older adults.

METHODS

Seven databases were searched for English language articles for subjects ≥ 65 y from 1981 to 2021. Exposure was tooth retention (≥ 20), and outcomes were general/systemic health and quality of life. Methodological quality was assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias 2.0 tool.

RESULTS

140 articles were included, only four were randomized trials. Inter-rater agreement (κ) regarding study inclusion was 0.924. Most were assessed with low risk of bias (n = 103) and of good quality (n = 96). Most studies were conducted in Japan (n = 60) and Europe (n = 51) and only nine in the US. Tooth retention was referred to as "functional dentition" in 132 studies and "shortened dental arch" in 19 studies. Study outcomes were broadly synthesized as (1) cognitive decline/functional dependence, (2) health status/chronic diseases, (3) nutrition, and (4) quality of life.

DISCUSSION

There is a positive relationship between tooth retention, overall health, and quality of life. Older adults retaining ≥ 20 teeth are less likely to experience poorer health. Having < 20 teeth increases the likelihood for functional dependence and onset of disability, and may affect successful ageing. This review supports the general finding that the more teeth older adults retain as they age, the less likely they are to have adverse health outcomes. However, significant knowledge gaps remain which can limit decision-making affecting successful ageing for many older adults. This review highlights the need to consider, as an important marker of oral health and function, the retention of a functional minimum of a natural dentition, rather than a simple numeric score of missing teeth.

Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke

Oishi K, Nishioka S, Okazaki Y, Hirakawa K, Nakamura M, Ichinose A, Kurihara M. Relationship between oral hygiene and function and activities of daily living at discharge in convalescent patients with stroke. Jpn J Compr Rehabil Sci 2022; 13: 17-25.

Objective

This study was designed to examine the relationship between improvement in oral hygiene and function and activities of daily living (ADLs) at discharge in patients admitted to convalescent rehabilitation wards.

Methods

Eligible criteria were patients with stroke with a score of 13 or higher (i.e., severe oral problems) on the Revised Oral Assessment Guide (ROAG) at admission. Age, gender, primary diseases, rehabilitation dose, dentist visits and denture status, Eichner classification, eating status at admission and discharge, and body mass index at admission were collected. The patients were classified into two groups: those with ROAG scores of less than 9 points at discharge (good ROAG group) and those with scores of 9 points or more (poor ROAG group), and Functional Independence Measure (FIM) gain and total FIM discharge scores were compared using univariate and multivariate analyses.

Results

The good and poor ROAG groups comprised 126 and 366 patients, respectively. The good ROAG group had significantly higher total FIM score, FIM efficiency, and FIM gain at discharge than the poor ROAG group (112 vs. 82; P < 0.001). The ROAG scores at discharge were independently associated with FIM gain (partial regression coefficient = -9.889, 95% confidence interval = -13.499 to -6.279) and total FIM score at discharge.

Conclusion

Improvement in oral hygiene and function in convalescent patients with stroke was associated with ADLs at hospital discharge.

Parks/sports facilities in local communities and the onset of functional disability among older adults in Japan: The J-shaped spatial spillover effects

We examined the associations between parks/sports facilities in local communities and the onset of functional disability among Japanese older adults. We further investigated the spatial spillover effects of parks/sports facilities in 1st-, 2nd-, and 3rd-degree neighboring communities. Data on the onset of functional disability, including date of onset, sex, age, and address (school district) of all older adults aged 65 years and older living in Kobe City were obtained from the public long-term care insurance database (163,348 men [190,831 person-year] and 200,443 women [230,464 person-year]). Multilevel proportional hazard regression analyses showed that the number of parks and sports facilities were negatively associated with the onset of functional disability among men. In particular, these associations were stronger for the adjacent district than for individuals' living districts. Our results imply that involving multiple neighboring communities as the intervention unit is effective when utilizing community built environments for long-term care prevention in men.

Socioeconomics, health-related factors, and tooth loss among the population aged over 80 years in China

Background

The prevalence of tooth loss varies across the globe among oldest-old individuals. The presence of fewer than 20 teeth in old age was associated with a decrease in people’s health and quality of life. This paper explored the association between socioeconomics, health-related factors, and tooth loss among the population over the age of 80 in China.

Methods

The tooth loss status of older Chinese adults was collected with a structured questionnaire from the 8^th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 6716 individuals aged 80 years and above were included. Logistic regression was used to assess the association between socioeconomic statuses, dietary intake at approximately 60 years old, health-related factors, and tooth loss.

Results

Of the 6716 individuals aged 80 years and above, the composition of the group with fewer teeth for both men and women was statistically significant in many ways. Multivariate logistic regression analyses show that for men, being older than 90 years and being ADL disabled (adjusted OR: 1.71, 95% CI: 1.01–2.89) are factors that are significantly and consistently associated with a higher risk of having fewer than 20 teeth, while having a higher household income per capita (adjusted OR: 0.56, 95% CI: 0.32–0.99) decreases the risk. For women, an age of above 95 years, brushing teeth less than once per day (adjusted OR: 1.96, 95% CI: 1.26–3.03), consuming sugar some of the time as opposed to less than once per month at approximately 60 years old (adjusted OR = 1.74, 95% CI: 1.15–2.62), and being ADL disabled (adjusted OR: 1.70, 95% CI: 1.04–2.77) are factors that are significantly associated with the risk of having fewer than 20 teeth.

Conclusion

The analysis suggests that socioeconomic status, dietary intake in early old age, and ADL capacity are associated with the risk of having fewer teeth for the population aged 80 years and above, and the risk factors vary between sexes.

Risk Factors of Long-Term Care Insurance Certification in Japan: A Scoping Review

This study aimed to review evidence on future long-term care associated with pre-existing factors among community-dwelling Japanese older adults. We systematically searched cohort and nested case–control studies published between 2000 and 2019 that assessed long-term care certification using the PubMed, CINAHL, and EMBASE databases. The relationship between long-term care insurance information and risk factors was investigated. The protocol was registered with the Open Science Framework. We extracted 91 studies for synthesis, including 84 prospective cohort studies, 1 retrospective cohort study, and 6 nested case–control studies. Certification for long-term care was classified into two endpoints: onset of functional disability and dementia. There were 72 studies that used long-term care certification as a proxy for functional disability, and 22 used long-term care information to indicate the onset of dementia. Common risk factors related to functional disability were physical function, frailty, and oral condition. Motor function and nutritional status were common risk factors for dementia. We found consistent associations between premorbid risk factors and functional disability and dementia. The accumulation of evidence on the incidence of long-term care and associated factors can aid the development of preventive measures. Future studies should aim to integrate this evidence.

Association between number of remaining teeth and healthy aging in Japanese older people: The Ohsaki Cohort 2006 Study

Aim

Maintaining ≥20 teeth is a public health goal worldwide. Healthy aging, which includes psychological and social well‐being, as well as physical indicators, has attracted a great deal of attention with the progression of aging societies. However, no studies have examined the association between the number of remaining teeth and healthy aging. This study aimed to investigate the association between the number of remaining teeth and healthy aging.

Methods

This community‐based longitudinal cohort study included 8300 Japanese people aged ≥65 years who were free of disability and depression in the baseline survey in 2006. The participants were categorized into four groups according to the number of remaining teeth at baseline: 0–9, 10–19, 20–24 and ≥25. The primary outcome was healthy aging (defined as meeting all four of the following criteria: free of disability, free of depression, high health‐related quality of life and high life satisfaction), as assessed by a questionnaire survey carried out in 2017. Multiple logistic regression was used to calculate the corresponding odds ratios and 95% confidence intervals.

Results

During about 11 years of follow‐up, 621 (7.5%) participants attained healthy aging. Participants with ≥20 remaining teeth showed a higher healthy aging rate. Compared with participants with 0–9 teeth, the multivariate‐adjusted odds ratios (95% confidence intervals) for 10–19, 20–24 and ≥25 teeth were 0.98 (0.77–1.26), 1.28 (1.01–1.63) and 1.59 (1.24–2.03), respectively.

Conclusions

These findings suggest that maintaining ≥20 teeth was associated with healthy aging. Geriatr Gerontol Int 2022; 22: 68–74.

Prognostic significance of subjective oral dysfunction on the all-cause mortality

BACKGROUND

As the proportion of elderly population grows, it raises concern about impaired oral health which has been reported to be associated with increased risk of numerous adverse health events. Emerging study defined oral frailty as poor oral health accumulation and demonstrated that oral frailty was a risk factor of disability, physical frailty and mortality. In this study, we examined the association between subjective oral dysfunction and all-cause mortality in the United States.

METHODS

In this cross-sectional observational study, a total of 7827 participants who completed oral functions data from 1999 to 2002 NHANES database were recruited. Subjective oral dysfunction included 3 components: limited eating ability, dry mouth and difficult swallowing, which were obtained from self-reported questionnaire. For primary outcome, all-cause mortality was followed from baseline to death or 2006. The relationship of subjective oral dysfunction and all-cause mortality was assessed by Cox regression model.

RESULTS

A statistically significant relationship between subjective oral dysfunction and all-cause mortality was observed in fully adjusted model. Participants with more components of subjective oral dysfunction had worse risk of all-cause mortality. Limited eating ability was inversely associated with muscle strength.

CONCLUSION

Subjective oral dysfunction which was obtained from an easy self-assessment survey might be a potential risk factor for all-cause mortality and could be used for initial screening during general health examination.

Tooth retention predicts good physical performance in older adults

BACKGROUND

Oral health is closely related to both physical and psychological well-being, as it enables individuals to eat, speak, and socialize. The number of teeth is the most used indicator of oral health. Several reports document a relationship of dental status with a variety of indicators of general health but longitudinal studies employing standardized physical performance tests are infrequent in the scientific literature.

SUBJECTS AND METHODS

The Italian elderly participating in the Pro.V.A. longitudinal Study (3099 subjects aged 65+ at baseline, 2196 at the 5-year follow-up 1 and 1641 at the 7-year follow- up 2) underwent detailed interview and extensive clinical and instrumental examination that included validated physical performance measures. Participants were classified into 4 groups according to the number of remaining teeth: 0, 1-7, 8-19, and 20+. To explore the association of the number of remaining teeth with physical function and disability, we performed logistic regression analyses with models progressively adjusted for a wide number of covariates, namely anthropometric (gender, age, BMI), comorbidity (cardio-vascular, osteoarticular, and neurological diseases including depression), muscle strength (assessed for upper and lower limbs), lifestyle (smoking status, alcohol use, leisure time activities) and socioeconomical status (education, income, marital status, loneliness).

RESULTS

Dental status correlated with most comorbidities, lifestyle, and socio-economic variables at the univariate analysis at baseline and at follow-ups. A good dental status was significantly associated with better physical functioning and lower disability. The presence of 20+ teeth resulted significantly protective (reference group: 0 teeth) versus mobility-related disability (OR = 0.67), disability (OR = 0.54) and inability to perform heavy duties (OR = 0.62), at follow up 1 and low physical performance score (OR = 0.59) at follow up 2. Conversely, the detrimental effect of edentulism, explored in subjects with or without dentures, was present but not as straightforward. Conclusion. The assessment of a geriatric patient should include an oral evaluation as a good dental status is a crucial component of successful aging.

Association between subjective oral dysfunction and locomotive syndrome in community-dwelling older adults

The need for support and care is a major problem facing societies around the world. Locomotive syndrome (LS) refers to a condition in which people require healthcare services because of problems associated with locomotion. Oral dysfunction is also associated with various long-term care factors including activities of daily living. The purpose of this study was to determine the association between oral dysfunction and LS. The study participants were 407 elderly people living in a rural area in Japan. Evaluation of oral dysfunction was based on subjective judgment by each participant. LS was assessed using Locomo-25, which is a self-administered questionnaire and was defined by a Locomo-25 score ≥ 7 points. Those with a “decline in masticatory function” and “difficulty swallowing” had higher odds of LS than those without these dysfunctions (odds ratio (OR) = 2.134, 2.007, respectively). Furthermore, participants with a Locomo-25 score ≥ 11 had higher odds of a “decline in masticatory function” (OR = 2.657) than those with a Locomo-25 score < 11, and those with a Locomo-25 score ≥ 9 had higher odds of “difficulty swallowing” (OR = 2.411) than those with a Locomo-25 score < 9. These findings suggest that a strong relationship exists between oral dysfunction and LS.

Associations of poor oral health with frailty and physical functioning in the oldest old: results from two studies in England and Japan

BACKGROUND

Very few studies have examined the relationship of oral health with physical functioning and frailty in the oldest old (> 85 years). We examined the association of poor oral health with markers of disability, physical function and frailty in studies of oldest old in England and Japan.

METHODS

The Newcastle 85+ Study in England (n = 853) and the Tokyo Oldest Old Survey on Total Health (TOOTH; n = 542) comprise random samples of people aged > 85 years. Oral health markers included tooth loss, dryness of mouth, difficulty swallowing and difficulty eating due to dental problems. Physical functioning was based on grip strength and gait speed; disability was assessed as mobility limitations. Frailty was ascertained using the Fried frailty phenotype. Cross-sectional analyses were undertaken using logistic regression.

RESULTS

In the Newcastle 85+ Study, dry mouth symptoms, difficulty swallowing, difficulty eating, and tooth loss were associated with increased risks of mobility limitations after adjustment for sex, socioeconomic position, behavioural factors and co-morbidities [odds ratios (95%CIs) were 1.76 (1.26-2.46); 2.52 (1.56-4.08); 2.89 (1.52-5.50); 2.59 (1.44-4.65) respectively]. Similar results were observed for slow gait speed. Difficulty eating was associated with weak grip strength and frailty on full adjustment. In the TOOTH Study, difficulty eating was associated with increased risks of frailty, mobility limitations and slow gait speed; and complete tooth loss was associated with increased risk of frailty.

CONCLUSION

Different markers of poor oral health are independently associated with worse physical functioning and frailty in the oldest old age groups. Research to understand the underlying pathways is needed.

Oral frailty and gait performance in community-dwelling older adults: findings from the Takashimadaira study

PURPOSE

This cross-sectional study compared gait performance between community-dwelling older adults with and without accumulated deficits in oral health, defined as oral frailty.

METHODS

A total of 1,082 individuals (439 men and 643 women; mean age, 77.1 years) from the Takashimadaira study were included in the current analysis. Based on a multifaceted oral health assessment, oral frailty was defined as having three or more of the following six components: (i) fewer teeth, (ii) low masticatory performance, (iii) low articulatory oral motor skills, (iv) low tongue pressure, (v) difficulties in eating, and (vi) swallowing. Eight gait parameters were assessed using an electronic walkway. Gait characteristics comparison between groups with and without oral frailty was performed using multiple linear regression models. Models were adjusted for age, sex, educational status, income, smoking, drinking, physical activity level, height, body mass index, comorbidities, and the presence of chronic pain.

RESULTS

Oral frailty was observed in 227 (21.0%) participants. After adjusting for potential confounders, the participants with oral frailty had slower gait speed, shorter stride and step length, wider step width, and longer double support duration as well as higher variability of stride length and step length.

CONCLUSIONS

Oral frailty was associated with poor gait performance among community-dwelling older adults.

Relationship between Mortality and Oral Function of Older People Requiring Long-Term Care in Rural Areas of Japan: A Four-Year Prospective Cohort Study

Oral ingestion influences the life sustenance, quality of life, and dignity of older adults. Thus, it is an important issue in medical care and the welfare of older adults. The purpose of this four-year prospective cohort study was to investigate the relationship between mortality and oral function among older adults who required long-term care and were living in different settings in a rural area of Japan. This study included 289 participants aged 65 and older who required long-term care and lived in the former Omorimachi area in Yokote City, Akita Prefecture, located in northern Japan. Following the baseline survey, mortality data were collected over four years; 102 participants (35.3%) died during that time. A significant difference was noted in the overall survival rates between the groups with good and deterioration of oral function such as oral dryness, rinsing ability, swallowing function, and articulation, based on Log-rank test results. After adjusting for various potential confounders using Cox proportional-hazards regression, oral dryness (HR: 1.83, 95% confidence interval: 1.12−3.00) was significantly associated with mortality within four years. This study revealed that oral dryness influences the life prognosis of older adults who receive long-term care in different settings.

Impact of Poor Oral Health on Community-Dwelling Seniors: A Scoping Review

The aim of this scoping review was to determine health-related impacts of poor oral health among community-dwelling seniors. Using MeSH terms and keywords such as elderly, general health, geriatrics, 3 electronic databases-Medline, CINAHL, and Age Line were searched. Title and abstracts were independently screened by 3 reviewers, followed by full-texts review. A total of 131 articles met our inclusion criteria, the majority of these studies were prospective cohort (77%, n = 103), and conducted in Japan (42 %, n = 55). These studies were categorized into 16 general health outcomes, with mortality (24%, n = 34), and mental health disorders (21%, n = 30) being the most common outcomes linked with poor oral health. 90% (n = 120) of the included studies reported that poor oral health in seniors can subsequently lead to a higher risk of poor general health outcomes among this population. Improving access to oral healthcare services for elderly can help not only reduce the burden of oral diseases in this population group but also address the morbidity and mortality associated with other general health diseases and conditions caused due to poor oral health. Findings from this study can help identify shortcomings in existing oral healthcare programs for elderly and develop future programs and services to improve access and utilization of oral care services by elderly.

Association between presence of 20 or more natural teeth and all-cause, cancer-related, and cardiovascular disease-related mortality: Yamagata (Takahata) prospective observational study

BACKGROUND

Several studies have surveyed the relationship between the presence of ≥ 20 natural teeth and mortality. However, very few have evaluated this association over a long-term follow-up of more than ten years within a large population in Japan. This study aimed to prospectively confirm the associations between mortality and the presence of ≥ 20 natural teeth within a community-based population in Japan.

METHODS

A prospective observational study including 2208 participants aged ≥ 40 years was conducted in Takahata Town, Japan, between May 2005 and December 2016. All participants answered a self-administered questionnaire to provide their background characteristics, including their number of teeth. The participants were classified into two categories based on their self-reported number of teeth (< 20 and ≥ 20 teeth). Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional-hazards regression model to assess risk factors for all-cause, cancer-, and cardiovascular disease-related mortality.

RESULTS

The total follow-up period was 131.4 ± 24.1 months (mean ± SD). After adjusting for covariates, the risk of all-cause mortality was significantly higher in the group with < 20 teeth than in those with ≥ 20 teeth (HR = 1.604, 95% CI 1.007-2.555, p = 0.047). However, the risk of cancer- and cardiovascular disease-related mortalities was not statistically significant between the two groups.

CONCLUSION

In this study, participants with < 20 teeth had a significantly higher risk of all-cause mortality, although the difference was borderline significant. These results emphasize the importance of having ≥ 20 natural teeth for a healthy life expectancy.

Does Oral Hypofunction Promote Social Withdrawal in the Older Adults? A Longitudinal Survey of Elderly Subjects in Rural Japan

It is often assumed that oral hypofunction is associated with social withdrawal in older adults because decreased motor function is related to decreased oral function. However, few studies have examined the relationship between social withdrawal in older adults and oral function. This longitudinal study aimed to clarify the relationship between changes in the level of social withdrawal and oral function in independent older adults. Participants were 427 older adults aged 65 years or older who took part in a self-administered questionnaire from 2016 to 2017 (baseline), and again two years later (follow-up). At baseline, 17 items related to oral function and confounding factors related to withdrawal, physical condition, physical function, and cognitive function were evaluated. A Cox proportional hazard model was used to examine the oral functions that negatively impact social withdrawal. The following factors were significantly associated with the worsening of social withdrawal: the number of remaining teeth, gingival condition, occlusal force, masticatory efficiency, and items related to swallowing and dry mouth. Older adults with cognitive issues who walk slowly and have a weak knee extension muscle were also significantly more likely to have oral frailty. Those who were found to have oral frailty at baseline were 1.8 times more likely to develop withdrawal compared to those with robust oral function. The results indicated that the worsening of withdrawal was associated with oral hypofunction at baseline. Since oral hypofunction was associated with the worsening of social withdrawal in older adults, it is important to maintain older adults' oral function.

Dentition status and 10-year higher-level functional capacity trajectories in older adults

AIM

The effect of dentition status on higher-level functional capacity patterns over time remains unclear. We aimed to identify distinct higher-level functional capacity trajectories in individuals aged 70-80 years, and examine whether dentition status at 70 years predicted the trajectory.

METHODS

The study included 551 community-dwelling adults aged 70 years at baseline. Higher-level functional capacity was measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) up to the age of 80 years. A higher TMIG-IC score indicated a higher level of competence. Group-based trajectory modeling was used to identify distinct TMIG-IC trajectories. The number of teeth, use of dentures, sex and education were added as baseline group membership predictors. Dental visits, health behaviors, body mass index and comorbidities during observation were added as time-varying covariates.

RESULTS

Three TMIG-IC trajectories were identified: "high/stable" (65.3%), "middle/decline" (24.5%) and "low/decline" (10.2%). A lower number of teeth and non-denture use were associated with increased odds of a low/decline trajectory relative to a high/stable trajectory (odds ratio 1.09, 95% confidence interval 1.04-1.14 [per one decrease] and odds ratio 3.96, 95% confidence interval 1.54-10.16, respectively).

CONCLUSIONS

Older adults with fewer teeth and those without dentures at the age of 70 years were more likely to follow a trajectory toward functional decline with low baseline TMIG-IC scores, which further declines by the age of 80 years. These findings suggest that preserving natural teeth later in life, as well as using dentures, could contribute toward maintaining a higher-level functional competence. Geriatr Gerontol Int 2021; 21: 48-53.

Oral dysfunctions and cognitive impairment/dementia

With global increases in the aging population, the number of patients with dementia is greatly increasing, which has become a big social problem. Many studies have shown strong associations between oral disorders and systemic disorders, such as diabetes, arthritis, sepsis, aspiration pneumonia, arteriosclerosis, bacterial endocarditis, and other cardiovascular diseases. Similarly, numerous cross-sectional studies showed that patients with dementia usually have poor oral conditions and tooth loss. These have long been considered as a result of difficulty with oral care due to impaired cognitive function, memory, and physical ability in patients with dementia. Indeed, even in patients with mild cognitive impairment, oral care becomes insufficient owing to decreases in spontaneity of grooming and finger dexterity. However, recent studies have shown that tooth loss and occlusal dysfunction may affect brain function and trigger the onset of dementia found in neurodegenerative diseases including Alzheimer's disease. In this review, we highlight the relationships among aging, oral dysfunction, and the development of dementia. Increasing evidence suggests that oral dysfunction is not only a result of dementia in the elderly people, but could also be a causative factor for the onset of dementia.

Impact of Oral Health Status on Postoperative Complications and Functional Recovery After Cardiovascular Surgery

Background

Poor oral health status can lead to a deteriorated level of general health and is common among patients undergoing cardiovascular surgery. However, the effect of oral health status on postoperative outcomes in cardiovascular surgery patients remains unclear. Thus, we investigated the effect of preoperative oral health status on postoperative complications and functional recovery after cardiovascular surgery.

Methods

This single-centre retrospective cohort study included 884 inpatients undergoing elective cardiovascular surgery. Oral health status was assessed based on the number of remaining teeth, use of dentures, occlusal support, and periodontal status. We investigated postoperative complications related to surgery and postoperative functional recovery by measuring the reacquisition of walking ability, activities of daily living, and length of postoperative hospital stay.

Results

In this cohort (age 66.9 ± 13.4 years), the mean number of remaining teeth was 18.7 ± 9.4. Patients were grouped based on tertiles of the data distribution of remaining teeth: ≥ 20 teeth (470 patients); 10-19 teeth (137 patients); < 10 teeth (185 patients). The number of missing teeth was associated with age (P < 0.001). The prevalence of postoperative pneumonia and reintubation after surgery was 3.2% and 2.5%, respectively, which was significantly higher in patients with severe tooth loss (P < 0.05 for both). After adjusting for age and other confounding factors, the number of remaining teeth was a statistically significant predictor of functional recovery (P < 0.05).

Conclusions

Preoperative oral health status was related to postoperative respiratory complications and independently associated with functional recovery. Preoperative oral intervention may improve functional recovery after cardiovascular surgery.

Parity and Number of Teeth in Japanese Women: Results from the Japan Nurses' Health Study

Background: Parity is thought to be associated with a decreased number of teeth present in women. However, educational level and social status, which are particularly significant risk factors for loss of teeth, have been heterogeneous in previous observations. This cross-sectional survey aimed to clarify the associations of parity with the risk of having <20 teeth in Japanese female nurses participating in the Japan Nurses' Health Study (JNHS). Methods: In the third follow-up questionnaire of the JNHS, 11,299 women aged 27-82 years participated in this study. The number of participants according to age range was 7,225 (63.9%) aged <50 years and 4,074 (36.1%) aged ≥50 years. Information on parity and risk factors for loss of teeth was collected through a baseline questionnaire and then a follow-up questionnaire. Multivariate logistic regression analysis was used to calculate the adjusted odds ratio (OR) and 95% confidence interval (CI) of having <20 teeth according to parity category. Results: Participants ≥50 years who had experienced three or more deliveries had a significantly higher risk of having <20 teeth than those who had not experienced delivery (OR = 1.59, 95% CI = 1.14-2.20), although this finding was not observed in participants <50 years. In addition to parity, age and current smoking may be independent risk factors for having <20 teeth in Japanese nurses. Conclusions: Higher-parity female nurses ≥50 years may be more likely to lose teeth than those who have not experienced delivery.

Semi-powered exoskeleton that regulates the muscular activity of jaw movement for oral functional rehabilitation/training

The sequential oral functions of mastication and swallowing are well tuned in humans. To prevent oral hypofunction as a risk factor for systemic frailty by oral motor training, semi-powered exoskeleton was developed and evaluated its loading/assist effects by monitoring electromyography signals and saliva secretion in healthy persons. The actuator of the driving unit combined mechanical and powered mechanics and was driven alternatively by an unpowered stainless-steel spring system for jaw-opening training by loading and a powered shape-memory alloy spring system to assist jaw closing. Sequential device movement was controlled by two electronic circuits with two magnetic switching systems to match human jaw movement. This exoskeleton realized a 25% increase of jaw-opening muscular activity for training, 15% saving of jaw-closing muscular activity for assistance, and 15% enhancement of saliva secretion, which could contribute to the prevention of oral frailty by maintenance and strengthening of oral function in the upcoming super-aging society.

Does second-hand smoke associate with tooth loss among older Japanese? JAGES cross-sectional study

OBJECTIVE

Second-hand smoke (SHS) is considered a risk factor for a number of oral diseases. However, its influence on tooth loss, which is the final consequence of periodontal disease and caries, remains unknown. We aimed to evaluate the association between SHS experience and the number of remaining teeth among non-smoking older Japanese individuals.

METHODS

Cross-sectional data from the Japan Gerontological Evaluation Study (JAGES) 2013 were used. From the 27,561 people ≥65 years of age who responded to a self-reported questionnaire (response rate = 71.1%), data of 18,865 respondents who had never smoked were analysed. Multinomial logistic regression with multiple imputations was applied to estimate the odds ratio of the frequency of SHS exposures on the number of remaining teeth.

RESULTS

The prevalence of participants with ≥20 teeth, 10-19 teeth, 5-9 teeth, 1-4 teeth, and no teeth were 53.2%, 20.4%, 9.9%, 6.6%, and 9.9%, respectively. The proportion of participants with SHS was 37.5%. After adjusting for sex, the SHS experience tended to be associated with a lower risk of having the fewer number of remaining teeth (P < 0.05). However, after being adjusted for age and sex, participants with SHS exposure at "a few times a week" and "almost every day" were significantly associated with the fewer number of teeth. After adding all other covariates, compared to the participants without any exposure to SHS, the odds ratio for having no teeth rather than having ≥20 teeth among the participants with daily exposure to SHS was 1.35 (P < 0.01).

CONCLUSION

Daily second-hand smoke was significantly associated with fewer remaining teeth based on the self-reported survey among older Japanese people.

Predictive Validity of a New Instrumental Activities of Daily Living Scale for Detecting the Incidence of Functional Disability among Community-Dwelling Older Japanese Adults: A Prospective Cohort Study

We examined the predictive validity of a newly developed scale-the National Center for Geriatrics and Gerontology Activities of Daily Living (NCGG-ADL)-to measure instrumental activities of daily living (IADL) ability. We tested the scale for detecting new incidences of functional disability among community-dwelling older Japanese adults. Participants were 2708 older adults (mean age = 79.0 years, 51.6% women) living in the community who had no functional decline at baseline. We assessed IADL ability using the NCGG-ADL scale, comprising 13 self-report questions. Next, we assessed their functional disability monthly for 24 months, based on the national long-term care insurance (LTCI) system. Among all participants, 430 (15.9%) had an IADL limitation at baseline, and 289 (10.7%) were newly certified as functionally disabled. Participants scoring ≤ 12 of 13 points in the NCGG-ADL showed a significantly higher risk of functional disability than did those scoring 13 points, even after adjusting for covariates (hazard ratio [95% confidence interval] = 1.58 [1.19-2.09]). We thus validated the NCGG-ADL as a screening tool for assessing the risk of functional disability among community-dwelling older Japanese adults. We conclude that IADL limitations, as measured by the NCGG-ADL, could be useful predictors of functional disability.

Regular dental visits may prevent severe functional disability: A community-based prospective study

BACKGROUND

Previous studies have shown that regular dental visits can affect the relationship of tooth loss with mortality and functional disability. However, the independent association between regular dental visits and incident functional disability is unclear.

METHODS

Our study participants were community-dwelling individuals aged ≥65 years, without disability at baseline. The outcome was the level of incident functional disability, as defined in a new certification of the public long-term care insurance. We defined no disability as no certification at follow-up, mild disability as support levels 1-2 and care level 1 (i.e., independent in basic ADL, but requiring some help in daily activities), and severe disability as care levels 2-5 (i.e., dependent in basic ADL). The exposure variable, based on the questionnaire, was regular dental visits at baseline. Covariates included gender, age, socio-economic status, health status, lifestyle habits, physical and mental functioning, and oral health variables. Using multinomial logistic regression, we calculated adjusted odds ratio (aOR) and 95 % confidence interval (CI) for mild disability and severe disability, with no disability as a reference category.

RESULTS

Among 8,877 participants, the 33-month cumulative incidence of mild and severe disability was 6.0 % and 1.8 %, respectively. After controlling for all covariates, regular dental visits at baseline were significantly associated with a lower risk of incident severe disability (aOR 0.65; 95 % CI, 0.46-0.91) but not the incidence of mild disability (aOR 0.96; 95 % CI, 0.79-1.17).

CONCLUSIONS

Encouraging dental visits may contribute to prevention of severe functional disability and extension of healthy life expectancy among community-dwelling older adults.

Income and education are associated with transitions in health status among community-dwelling older people in Japan: the JAGES cohort study

BACKGROUND

Health inequalities are an emerging issue in ageing societies, but inequalities in pre-frailty, which is suffered by almost half of older people, are mostly unknown.

OBJECTIVE

This study aimed to determine the association between the socio-economic status (SES) and changes across pre-frailty, frailty, disability and all-cause mortality.

METHODS

We conducted a prospective cohort study across 23 Japanese municipalities between 2010 and 2013. Functionally independent community-dwelling older adults aged ≥65 years (n = 65 952) in 2010 were eligible for the study. The baseline survey was conducted from 2010 to 2012, and the self-reporting questionnaires were mailed to 126 438 community-dwelling older adults [64.8% (81 980/126 438) response rate]. The follow-up survey was conducted in 2013. Overall, 65 952 individuals were followed up [80.4% (65 952/81 980) follow-up rate]. The health status was classified into five groups: robust; pre-frailty; frailty; disability and death. We conducted three multinomial logistic regression models stratified by the initial disability status. Educational attainment and equivalized household income were separately added to the models as exposures after adjusting for covariates.

RESULTS

Participants with the lowest educational level were less likely to recover from pre-frailty to robust compared with those with the highest level [odds ratio (OR) (95% confidence interval (CI)) = 0.84 (0.76-0.93)]. The participants with the lowest income level were also less likely to recover from pre-frailty to robust compared with those with the highest level [OR (95% CI) = 0.80 (0.69-0.91)].

CONCLUSIONS

Older individuals with a lower SES were less likely to recover from a pre-frailty status.

Effects of oral environment on frailty: particular relevance of tongue pressure

Purpose

Oral frailty or the loss of oral functionality can be a symptomatic precursor of overall frailty. Previous studies have suggested that decreased tongue pressure causes a decline in ingesting and swallowing function and poor nutrition. This study investigated what factor(s) contribute to tongue pressure, thereby leading to frailty.

Patients and methods

For the purposes of the present study, 467 residents of Hirosaki city in northern Japan aged≥60 years who completed a questionnaire about frailty and underwent an intraoral assessment, which included number of teeth, presence or absence of periodontitis, tongue pressure, and oral diadochokinesis (ODK) were recruited.

Results

Of the 467 participants with complete data sets, frailty was identified in 13 (7.5%) of 173 males and in 34 (11.6%) of 294 females. Significantly fewer teeth, lower tongue pressure, and a reduced diadochokinetic syllable rate were more prevalent among frail than among healthy residents. Multivariable logistic regression analysis revealed that age, body mass index, number of teeth, and tongue pressure significantly contributed to frailty, whereas ODK did not. Multiple regression analysis showed that tongue pressure was positively associated with muscle index and number of teeth.

Conclusion

The results of the present study suggest that fewer teeth and lower tongue pressure, but not ODK function, are risk factors for developing overall frailty among older residents.

Oral Health, Disability and Physical Function: Results From Studies of Older People in the United Kingdom and United States of America

OBJECTIVES

Studies examining the associations between oral health and disability have limited oral health measures. We investigated the association of a range of objectively and subjectively assessed oral health markers with disability and physical function in older age.

DESIGN, SETTING, AND PARTICIPANTS

Cross-sectional analyses were based on the British Regional Heart Study (BRHS) comprising men aged 71 to 92 years (n = 2147) from 24 British towns, and the Health, Aging, and Body Composition (HABC) Study comprising men and women aged 71 to 80 years (n = 3075) from the United States. Assessments included oral health (periodontal disease, tooth count, dry mouth, and self-rated oral health), disability, and physical function (grip strength, gait speed, and chair stand test).

RESULTS

In the BRHS, dry mouth, tooth loss, and cumulative oral health problems (≥3 problems) were associated with mobility limitations and problems with activities of daily living and instrumental activities of daily living; these remained significant after adjustment for confounding variables (for ≥3 dry mouth symptoms, odds ratio (OR) 2.68, 95% confidence interval (CI) 1.94-3.69; OR 1.76, 95% CI 1.15-2.69; OR 2.90, 95% CI 2.01, 4.18, respectively). Similar results were observed in the HABC Study. Dry mouth was associated with the slowest gait speed in the BRHS, and the weakest grip strength in the HABC Study (OR 1.75, 95% CI 1.22, 2.50; OR 2.43, 95% CI 1.47-4.01, respectively).

CONCLUSIONS AND IMPLICATIONS

Markers of poor oral health, particularly dry mouth, poor self-rated oral health, and the presence of more than 1 oral health problem, were associated with disability and poor physical function in older populations. Prospective investigations of these associations and underlying pathways are needed.

Relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly: a cross-sectional study

Background

Low masticatory ability and the resulting decrease in intake of masticable foods can result in undernutrition. The present study investigated the relationship between tooth loss, low masticatory ability, and nutritional indices in the elderly.

Methods

The data analyzed in this study were retrieved from the baseline data of the 2007 Fujiwara-kyo study, a prospective cohort study of community-dwelling elderly individuals. Subjects included 1591 men and 1543 women, both with a median age of 71 years. The maximum occlusal force was measured as an objective index of masticatory ability. Foods were divided into five groups based on hardness: Group 1 (bananas, etc.), 0.53 kg; Group 2 (boiled rice, etc.), 1.22 kg; Group 3 (raisins, etc.), 2.93 kg; Group 4 (raw carrots, etc.), 4.38 kg; and Group 5 (beef jerky), 6.56 kg. To obtain a subjective index of masticatory ability, a questionnaire-based survey was conducted to determine whether subjects could masticate foods within each group. As nutritional indices, serum albumin levels and body mass index (BMI) data were used.

Results

The median number of teeth was 21. The proportion of subjects for whom all five food groups were masticable showed a significant decrease in the number of teeth in both males and females. Logistic regression analysis showed that, after adjustment for confounders, no significant relationships were observed between the number of teeth and the masticatory ability with nutritional indices in males. In females, a maximum occlusal force of 100 to 300 N (OR = 1.65; 95% CI = 1.06–2.55) or less than 100 N (OR = 1.95; 95% CI = 1.15–3.31) showed a significant correlation with serum albumin levels below 4.4 g/dL (reference: 500 N or more). In addition, the masticability of all five food groups showed a significant correlation with BMI < 21.0 kg/m² (OR = 0.62; 95% CI = 0.46–0.85) in females.

Conclusions

A low number of teeth was associated with low masticatory ability in both males and females. Low masticatory ability was associated with low plasma albumin levels and low BMI in females. Not smoking, maintaining grip strength, preventing cancer, and masticatory ability are important for preventing undernutrition.

Dental Infection and Resistance-Global Health Consequences

Antibiotics are widely used in dental caries and another dental related issues, both for therapeutic and prophylactic reasons. Unfortunately, in recent years the use of antibiotics has been accompanied by the rapid emergence antimicrobial resistance. Dental caries and periodontal diseases are historically known as the top oral health burden in both developing and developed nations affecting around 20⁻50% of the population of this planet and the uppermost reason for tooth loss. Dental surgeons and family practitioners frequently prescribed antimicrobials for their patients as outpatient care. Several studies reported that antibiotics are often irrationally- and overprescribed in dental diseases which is the basis of antimicrobial resistance. The aim of this review is to evaluate the use of antibiotics in dental diseases. Almost certainly the promotion of primary oral health care (POHC) in primary health care program especially among the least and middle-income countries (LMIC) may be the answer to ensure and promote rational dental care.

Dental Status is Associated With Incident Functional Disability in Community-Dwelling Older Japanese: A Prospective Cohort Study Using Propensity Score Matching

Background

A growing number of epidemiology studies have shown that poor oral health is associated with an increased incidence of functional disability. However, there are few studies in which the confounding bias is adjusted appropriately. In this study, we examined whether dental status is associated with functional disability in elderly Japanese using a 13-year prospective cohort study after elimination of confounding factors with propensity score matching.

Methods

Participants were community-dwelling Japanese aged 70 years or older who lived in the Tsurugaya district of Sendai (n = 838). The number of remaining teeth (over 20 teeth vs 0–19 teeth) was defined as the exposure variable. The outcome was the incidence of functional disability, defined as the first certification of long-term care insurance (LTCI) in Japan. The variables that were used to determine propensity score matching were age, sex, body mass index (BMI), medical history (stroke, hypertension, myocardial infarction, cancer, and diabetes), smoking, alcohol consumption, educational attainment, depression symptoms, cognitive impairment, physical function, social support, and marital status.

Results

As a result of the propensity score matching, 574 participants were selected. Participants with 0–19 teeth were more likely to develop functional disability than those with 20 or more teeth (hazard ratio 1.33; 95% confidence interval, 1.01–1.75).

Conclusions

In this prospective cohort study targeting community-dwelling older adults in Japan, having less than 20 teeth was confirmed to be an independent risk factor for functional disability even after conducting propensity score matching. This study supports previous publications showing that oral health is associated with functional disability.

The Causal Effect of Education on Tooth Loss: Evidence From United Kingdom Schooling Reforms

Associations between education and oral health have frequently been reported, but until now there has been no causal evidence. Exploiting exogenous variation in the duration of schooling due to 1947 and 1972 reforms in mandatory schooling in the United Kingdom, we examined the causal relationship between education and tooth loss in older age. We conducted a cross-sectional study using data from waves 3 (2006-2007), 5 (2010-2011), and 7 (2014-2015) of the English Longitudinal Study of Ageing. We used a 2-stage least squares instrumental variable approach and included 5,667 respondents (average age = 67.8 years; 44.4% were men) in the analyses, of whom 819 (14.5%) had no teeth. The schooling reforms increased the duration of education by an average of 0.624 years (95% confidence interval: 0.412, 0.835). For respondents born within ±6 years of the pivotal cohorts, a 1-year increment of education causally reduced the probability of edentulism by 9.1 (95% confidence interval: 1.5, 16.8) percentage points. The effects were stronger for the 1947 reform than for the 1972 reform. Results were robust to broadening of the cohort bandwidth and functional form of the cohort trend. The findings suggest that investment in education produces improved oral health later in life.