Predictors of chewing difficulty onset among dentate adults: 24-month incidence

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS

BACKGROUND

Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample.

METHODS

Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors.

RESULTS

The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1).

CONCLUSIONS

One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

The Patient's Denture Assessment (Thai version) is a valid and reliable tool for evaluating the outcome of treatment with complete denture

BACKGROUND

Complete tooth losses are still being major problems which resulted in lesser quality of life especially for elderly patients. However, there are still lack of questionnaire to evaluate the treatment outcome from the patient's aspect. The objective of this study is to evaluate the reliability and validity of the Patient's Denture Assessment-Thai version (PDA-T), then use this questionnaire to assess patient satisfaction with complete denture treatment outcome also investigates the factors involving their satisfaction.

METHODS

The subjects comprised 120 edentulous adult patients (49 men/71 women; average age 70 years-old) from the Prosthodontic and the Geriatric Dentistry and Special Patients Care Clinic at the Faculty of Dentistry, Chulalongkorn University during 2019 March‒2020 March. The patients were divided into two groups: the group experienced (Exper) (n = 54) with wearing complete dentures, and the non-experienced (NonExper) group (n = 66). The patients used the validated PDA-T to self-assess their treatment at different times. The Exper group completed the questionnaire at t0 (during treatment), t0.5 (2‒8-weeks after t0), and t1 (final follow-up). The NonExper group completed the questionnaire only at t1.

RESULTS

In the Exper group, Cronbach's α and average inter-item correlation was 0.95 (range 0.76‒0.95) and 0.47 (range 0.57‒0.83), respectively. The intraclass correlation coefficients (n = 18, 95% confidence interval) were 0.98 overall. The paired t-test (p < 0.05) between t0 and t1 indicated a significant difference between t0 and t1 in every PDA-T topic, and the effect size was 1.71. In the NonExper group, the Pearson correlation analysis indicated no significant correlation between the patients' demographics and masticatory function.

CONCLUSION

The reliability and validity of the PDA-T indicate it is a valuable tool for evaluating complete denture treatment. Treatment success affected the patients' satisfaction but was not associated with the type of doctors, genders, ages, or educational level.

Associations of Food-Chewing Discomfort with Health Behaviors and Cognitive and Physical Health Using Pooled Data from the Korean Health Panel (2010-2013)

Using 4 years of pooled data from the Korean Health Panel (2010-2013), the prevalence of food-chewing discomfort in adults over the age of 19 was investigated and the cross-sectional relationship between food-chewing discomfort and health behaviors and cognitive and physical health was identified. The prevalence of food-chewing discomfort was 31%: young adults (<40 years), 17.9%; middle-aged adults (40-64 years), 28.9%; and older adults (≥65 years), 57.1% (p < 0.0001). When food-chewing discomfort was sometimes, often, or always rather than never, odds ratios (ORs) were analyzed after controlling for sociodemographic characteristics. Significant OR results of target variables were smoking (OR 1.15, 1.37, 1.50), drinking (1.08, 0.87, 0.73), problem drinking (1.87, 1.67, 1.34), abstinence from drinking (1.23, 1.34, 1.42), nonphysical activity (OR 0.87 only significant, 0.94 nonsignificant, 1.10 nonsignificant), memory decline (2.07, 2.56, 3.31), decision-making difficulty (1.76, 2.78, 4.37), limitation of daily life due to illness (2.29, 3.60, 3.92), and the presence of a chronic disease (1.28, 1.62, 1.73), respectively. In conclusion, there were associations of food-chewing discomfort with increased smoking and decreased alcohol consumption, with increased difficulty in decision-making and memory decline, limitations in daily life due to disease, and the presence of chronic diseases. Therefore, it is necessary to investigate the causal relationship between chewing and health behaviors and cognitive and physical health through longitudinal studies.

Relation of dietary preference to masticatory movement and masticatory exercises in Japanese children

OBJECTIVE

Modern Japanese children have decreased masticatory function, which can be explained by the dietary change to soft foods. In earlier studies involving children with mixed dentition, masticatory exercises were shown to improve masticatory function and modify dental arch growth. Grinding type of mastication with a wide path reportedly increases lateral growth of the dental arch. This study aimed to assess the relationship between masticatory movements and dietary preference, and how masticatory exercises affected masticatory movement during Hellman's dental stages IIA to IIC (period of first molar eruption).

DESIGN

In 64 Japanese pre-school children, we measured masticatory movements with foods of five different levels of hardness and investigated the dietary preference for hard foods through a questionnaire. Participants were also required to perform masticatory exercises. Masticatory movements and dietary preference for hard foods were assessed at the start (T1), conclusion (T2), and after six months of exercises (T3). Participants were allocated to Wide and Narrow groups at T1 based on their masticatory path width.

RESULTS

Baguettes and bananas resulted in the widest and narrowest masticatory paths, respectively, at T1. Results of questionnaire indicated that those eating hard foods had a broad grinding type of masticatory path. Masticatory exercises significantly widened the masticatory path in the Narrow group demonstrating that masticatory exercises help children learn to chew with grinding strokes. Moreover, the masticatory path remained stable on assessment at T3 (six-month follow-up).

CONCLUSIONS

Masticatory exercises are effective in children who are unable to grind hard foods, affecting their dietary preferences.

Prevalence of chewing difficulty among adults and associated factors

The aim of this study was to estimate the prevalence of chewing difficulty and associated factors in adults aged 20 to 59 years in Patos, in the State of Paraiba in the Northeast Region of Brazil. A cross-sectional study was conducted with a random sample of 532 participants. The outcome chewing impairment was assessed using the question "How often do you have difficulty eating due to problems with your teeth or dentures?". Crude and adjusted prevalence ratios were estimated using Poisson regression. The prevalence of chewing difficulty was 30.5%. An association remained between the following variables and chewing difficulty in the final multivariate models: age group, schooling, being a smoker/non-smoker, length of time since last visit to the dentist, severe tooth loss, absence of functional dentitions, dental prosthesis use, need for a dental prosthesis, oral pain, and signs and symptoms of TMJ dysfunction. The magnitude of the associations between the variables and chewing difficulty, notably tooth loss and the need for a dental prosthesis, emphasize the importance of subjective indicators for assessing the oral health status of adults and shows that chewing difficulty is associated with a range of multi-dimensional factors.

Association between occlusal force and physical functions in preschool children: a comparison of males and females

[Purpose] To determine and compare changes over time in the physical strength of male and female children aged 4–5 years by measuring physical functions such as occlusal forces. [Subjects and Methods] The occlusal force, weight, height, grip strength, standing long jump, ball throwing, timed up and go (TUG), and the 25-m run time were measured of 331 children to determine their physical strength. All the children understood and were capable of completing all tests. [Results] Occlusal force among male infants significantly correlated with all items except ball throwing. Stepwise multiple regression analysis independently associated occlusal force with grip strength. In contrast, occlusal force of female infants significantly correlated with all the tested items. Stepwise multiple regression analysis also independently associated occlusal force with grip strength and TUG in females. [Conclusion] Grip strength indicating upper-limb muscle strength correlated with occlusal forces in both male and female children, whereas TUG, balance and walking ability indicating muscle strength of the lower limbs, correlated with items relevant to everyday functions in female infants. These findings show that different factors are involved in the occlusal forces of male and female children.

Chewing ability in an urban and rural population over 40 years in Shandong Province, China

Objectives

This study aimed to assess chewing ability related to dental status.

Material and methods

One thousand four hundred sixty-two Chinese subjects over 40 years, dentate in both jaws, were categorized in a hierarchical functional classification system with and without tooth replacements. Chewing ability was analyzed using multivariable logistic regression including five dental conditions (≥10 teeth in each jaw’; ‘complete anterior regions’; “sufficient premolar regions’ (≥3 posterior occluding pairs (POPs)); ‘sufficient molar regions’ (bilaterally ≥1 POP); and tooth replacement), adjusted for six background variables. Likelihood ratios for chewing problems were assessed at each level of the hierarchical classification system based on these dental conditions.

Results

Seventy-eight to 91 % of subjects reported no or minor chewing problems. The conditions ‘≥10 teeth in each jaw’, and ‘complete anterior regions’ were not associated, whereas ‘sufficient’ premolar regions’ and ‘sufficient molar regions’ were associated with chewing problems (Ors, 0.33–0.58). If classified hierarchically, the condition ‘≥10 teeth in each jaw’ was relevant for chewing problems (likelihood ratios 3.3–3.7). ‘Sufficient premolar region’ and ‘sufficient molar region’ were relevant to reduce the likelihood ratios for having chewing problems (both approximately with a factor 2), both for soft and for hard foods. Subjects with artificial teeth added had similar chance for chewing problems compared to counterparts with natural teeth only. However, if comparing replaced teeth with natural teeth, subjects with tooth replacement showed higher chance for chewing problems.

Conclusions

Chewing ability was strongly associated with dental conditions.

Clinical relevance

The presence of at least 10 teeth in each jaw had highest impact on chewing ability.

Socio-demographic and behavioural inequalities in the impact of dental pain among adults: a population-based study

OBJECTIVES

To assess socio-demographic and behavioural inequalities in the impact of dental pain on daily activities, as well as to estimate the prevalence and intensity of dental pain.

METHODS

A population-based cross-sectional study was carried out in Florianopolis, Southern Brazil, with 1720 adults aged 20-59 years in 2009-2010. Interviews were performed at adults' households, which included socio-demographics and behavioural characteristics, such as smoking status and alcohol abuse, along with mental health, self-reported health, number of retained teeth, dental pain occurrence (including its intensity and its impact on daily life). The association between the impact of dental pain and the covariates was tested using multinomial logistic regression.

RESULTS

The global prevalence of dental pain was 14.8% (95% CI, 12.9-16.7). Adjusted analysis showed that women, those who self-classified as dark-skinned Blacks, those with low family income, current smokers and those with common mental disorders reported a higher impact of dental pain than their counterparts. Among subjects reporting dental pain, 12.7% indicated the maximum intensity, whereas 6.0% had some daily activity disrupted by it, such as difficulties in chewing certain foods (38.0%), sleep disturbance (21.0%), difficulty to work (21.0%) and difficulty in performing household tasks (8.0%). Prevalence ratios of impact of dental pain between the poorest income group and richest income group (2.4), between the highest and lowest schooling group (2.6), and between dark-skinned Blacks and Whites (2.1) were of higher magnitude than the dental pain prevalence ratios among the same groups (1.7, 1.3 and 1.4, respectively).

CONCLUSIONS

The impact of dental pain showed a social gradient. Inequalities between socio-economic groups found in this study should be taken into account, as the impact of dental pain leads to reduced daily activities and poor quality of life.

Quality of life related to oral health: contribution from social factors

Sociodental indicators have been widely used in epidemiological research related to oral health, as they add the dimension of the impact of oral health on the quality of life of individuals and populations. Various studies have been done in order to validate new instruments to assess these subjective perceptions, however, the association between social parameters and impact on oral health-related quality of life (OHRQoL) has not been systematically studied, thus there is still doubt as to the role of the main social variables as OHRQoL impact modulators. This study aims to systematically review the literature in order to evidence the association between six social parameters and OHRQoL. Based on six exclusion criteria, the literature search revealed 40 eligible publications for analyses. The frequency of expected (positive) association between the social parameters and OHRQoL was greater than the non-expected (negative) associations for the six parameters.

CONCLUSIONS

The social conditions most clearly associated with the perception of negative impact on OHRQoL were: women, with poor education and low income, immigrants or people belonging to minority ethnic groups.

Association between perceived chewing ability and oral health-related quality of life in partially dentate patients

Background

One of the most immediate and important functional consequences of many oral disorders is a reduction in chewing ability. The ability to chew is not only an important dimension of oral health, but is increasingly recognized as being associated with general health status. Whether perceived chewing ability and oral health-related quality of life (OHRQoL) are correlated to a similar degree in patient populations has been less investigated. The aim of this study was to examine whether perceived chewing ability was related to OHRQoL in partially dentate patients.

Methods

Consecutive partially dentate patients (N = 489) without signs or symptoms of acute oral disease at Tokyo Medical and Dental University's Prosthodontic Clinic participated in the study (mean age 63.0 ± 11.5, 71.2% female). A 20-item chewing function questionnaire (score range 0 to 20) was used to assess perceived chewing ability, with higher scores indicating better chewing ability. The 14-item Oral Health Impact Profile-Japanese version (OHIP-J14, score range 0 to 56) was used to measure OHRQoL, with higher scores indicating poorer OHRQoL. A Pearson correlation coefficient was calculated to assess the correlation between the two questionnaire summary scores. A linear regression analysis was used to describe how perceived chewing ability scores were related to OHRQoL scores.

Results

The mean chewing function score was 12.1 ± 4.8 units. The mean OHIP-J14 summary score was 13.0 ± 9.1 units. Perceived chewing ability and OHRQoL were significantly correlated (Pearson correlation coefficient: -0.46, 95% confidence interval [CI]: -0.52 to -0.38), indicating that higher chewing ability was correlated with lower OHIP-J14 summary scores (p < 0.001), which indicate better OHRQoL. A 1.0-unit increase in chewing function scores was related to a decrease of 0.87 OHIP-J14 units (95% CI: -1.0 to -0.72, p < 0.001). The correlation between perceived chewing ability and OHRQoL was not substantially influenced by age and number of teeth, but by gender, years of schooling, treatment demand and denture status.

Conclusion

Patients' perception of their chewing ability was substantially related to their OHRQoL.

[Impact of the existing tooth number on daily performance: pilot study]

To establish the relation between the aspects associated to the number of the teeth and the impact on daily performance it was realized a pilot study with 75 voluntary patients that had been divided in three groups: short arch, complete and toothless. To evaluate the impact the IODD was used (Index of the Oral Impacts on Daily Performance). The results had evidenced that 16% of the participants had at least one daily activity affected. Although it have not been registered significant difference between the groups in relation to each one of the activities, the percentage that the complete arch group was less affected with the activity: to chew, to speak/to pronounce words and to smile clearly, on the other hand the activities that had less affected the toothless group were: to clean the mouth/teeth and to sleep. In relation to the mean of the IODD, that was lower in the group with complete arc and it was similar between the others two groups. The means of the variables: frequency and severity of the impacts were less in the group with the complete arch and had values approached in the others two groups. Based on the results, could be concluded that no significant differences were registered between the groups in relation to each one of the affected daily activities.

Poor chewing ability is associated with lower mucosal moisture in elderly individuals

Oral dryness is common among aging individuals and its objective evaluation is an important issue for improving their oral health. In the present study, we measured the objective mucosal moisture in elderly individuals with a moisture checker and evaluated its relation with laboratory findings and subjective oral status. The subjects were 502 adults (244 men and 258 women), with a mean age of 72.3 +/- 6.7 years, who participated in a regular medical screening program in Nagasaki Prefecture, Japan. We evaluated the moisture of the oral mucosa by measuring the weight percentage of water content in the oral epithelium, subjective oral dryness, self-assessed chewing ability ["good" ("able to chew all foods") or "poor" ("able to chew soft foods only" and "unable to chew any foods")], and laboratory findings. The values obtained with a moisture checker, which represent objective oral mucosal moisture, were significantly lower in women with poor chewing ability than those with good chewing ability (28.2 +/- 2.4% vs. 29.2 +/- 2.0%, p = 0.004) and in all subjects (28.4 +/- 2.4% vs. 29.1 +/- 2.0%, p = 0.004), but not in men (28.6 +/- 2.5% vs. 29.0 +/- 2.0%, p = 0.27). When multiple logistic regression analysis was performed on confounding factors, older age (OR: 1.24, p = 0.015), women (OR: 1.70, p = 0.016), and anemia (OR: 1.96, p = 0.030) were significantly associated with self-assessed chewing ability. Our current study indicates that poor chewing ability is associated with lower mucosal moisture in elderly individuals.

Validating an alternate version of the chewing function questionnaire in partially dentate patients

Background

The aim of this study was to investigate the dimensionality, reliability, and validity of an alternate version of the chewing function questionnaire in partially dentate patients in Japan.

Methods

Subjects were partially dentate patients who attended the prosthodontic clinic at Tokyo Medical and Dental University (N = 491, 71% women, mean age (± SD): 63.0 ± 11.5 years). The questionnaire asked each subject to rate his or her ability to chew 20 common Japanese foods. For each individual, responses were combined to yield a chewing function summary score, with higher scores indicating better self-reported chewing ability. We used exploratory factor analysis to investigate the scores' dimensionality. For validity assessment, we computed the correlations between the chewing function score and oral health-related quality of life (OHRQoL, as measured by the Japanese 14-item Oral Health Impact Profile (OHIP-14)) Internal consistency of scores and test-retest reliability were investigated by asking a subset of subjects (N = 62) to complete the questionnaire twice, 2 weeks apart.

Results

Exploratory factor analysis provided some evidence that self-reported chewing ability can be characterized by a summary score as the original authors suggest. Support for the validity of chewing function scores using the alternate version of the questionnaire was derived from correlations with OHIP-14 scores (r = -0.46, 95% confidence interval (CI): -0.53 to -0.39); thus, better chewing ability was associated with less impaired OHRQoL. Internal consistency was 'satisfactory,' with a Cronbach's alpha of 0.90 (lower limit of 95% CI: 0.89). The test-retest reliability was 'good,' with an intraclass correlation coefficient of 0.69 (95% CI: 0.56 to 0.82).

Conclusion

The alternate version of the chewing function questionnaire can be used as a stand-alone instrument because of the demonstrated reliability and validity of scores obtained using the questionnaire in partially dentate patients.

Saúde bucal e o desempenho diário de adultos em Chapecó, Santa Catarina, Brasil

O uso de indicadores subjetivos na odontologia vem se ampliando. Este estudo transversal de base populacional realizado em Chapecó, Santa Catarina, Brasil, analisou a relação entre condição bucal e qualidade de vida em adultos de 35 a 44 anos de idade (n = 622) e verificou a influência de: hábitos, visita ao dentista, auto-avaliação da saúde e características sócio-demográficas nesse processo. Usou-se uma amostra selecionada em múltiplos estágios e coleta com profissionais previamente treinados. A proporção de respostas foi de 81%. Na análise dos fatores determinantes para baixa (Oral Impact on Daily Performance - OIDP < 3) e alta (OIDP > 10) interferência da saúde bucal no cotidiano, utilizou-se modelo de regressão logística múltipla, não condicional, hierarquizada. A saúde bucal interferiu no cotidiano de 20,7% dos participantes e foi mais grave em 11,4%. Morar em domicílios de maior aglomeração e áreas de pior condição de vida, ser mulher e sentir dor orofacial no último semestre compuseram fatores associados a maior interferência. É recomendável que a percepção dos indivíduos seja considerada simultaneamente à condição clínica na definição de ações dos serviços e de grupos prioritários ao atendimento em saúde bucal.

Development and evaluation of an index of eating difficulty for older southern Chinese people

The objectives of this study were to develop and evaluate the validity and reliability of a new index to assess difficulty in eating certain foods among older southern Chinese people. The Index of Eating Difficulty (IED) was developed using a Guttman scaling analysis. After two pilot studies in which subjects were asked to grade 39 typical, frequently eaten Chinese foods, 10 of the 39 foods were selected and divided into five groups based on their texture and frequency of being eaten by older people. In the main study, 1229 Chinese generally healthy subjects aged 55 years and above, attending routine health checks in the Check-up Centre of the First Affiliated Hospital of Guangxi Medical University, Nanning of Guangxi province, China were interviewed to psychometrically test the index. Content, face and criterion validity, coefficients of reproducibility and scalability and test-retest reliability were tested. For criterion validity, the index was significantly associated with three other established eating difficulty measures, namely, general eating difficulty, dissatisfaction with chewing ability and oral impact on daily performances eating scores (P < 0.001 for all tests). The coefficients of reproducibility and scalability were 0.99 and 0.89, respectively. Weighted kappa for test-retest reliability was 0.89. The present results indicate that the IED is a valid and reliable measure to be used among older southern Chinese people.

Oral health conditions of community-dwelling cognitively intact elderly persons with disabilities

OBJECTIVES

To present descriptive information on oral health and health care of community-dwelling elderly persons with disabilities who are living at home.

BACKGROUND

Most previous studies have focused on specific subpopulations, namely, persons who are essentially healthy and independent, are homebound, or are nursing home residents. Little information appears to be available on community-residing elderly persons with disabilities.

MATERIALS AND METHODS

A total of 641 participants aged 65 years and over in a Medicare Demonstration who were cognitively intact, completed an oral health questionnaire within 1 year of Demonstration entry. Demonstration participants were required to be living in the community, need or receive help with 2+ activities of daily living (ADLs) or 3+ instrumental ADLs (IADLs), and have recently experienced significant health services utilisation.

RESULTS

Subject mean age was 79.1 years, 73.8% were female, and 4% were minority. They were dependent in a mean of 1.8 ADLs and 2.9 IADLs. 43.1% reported that they had no natural teeth, 77.4% had dentures, 58.8% frequently felt their mouth was dry, 5.2% had jaw pain now and 6.1% had at some time experienced burning sensations in their mouth or tongue. 40.4% reported that they were currently in need of dental treatment, although 56.2% indicated they now had a dentist, and 42.1% identified having a dental visit within the past 12 months. 19.7% indicated some dental insurance coverage.

CONCLUSION

This is one of the first studies to focus on community-dwelling elderly people with disabilities. Substantial oral health morbidity was reported.

Relationship between general health status and the change in chewing ability: a longitudinal study of the frail elderly in Japan over a 3-year period

OBJECTIVES

The aim of the present study was to identify the onset predictors of a change in chewing ability over a 3-year period in the frail elderly.

METHODS

The subjects were frail elderly people living in southern Japan. Data were collected at baseline (n = 92) and 3 years later (n = 60). The dependent variable was a change in self-rated chewing ability. The independent variables were age, gender, number of present teeth, dentition, maximum bite force (evaluated using a pressure-sensitive foil), basic activities of daily living, self-rated general health status, higher level of competence (evaluated using Tokyo Metropolitan Institute of Gerontology index), cognitive status (evaluated by revised Hasegawa Dementia Rating scale), and quality of life (evaluated using Philadelphia Geriatric Center morale scale) at baseline. To identify the most reliable predictors, bivariate analysis and multiple logistic regression analysis were performed, with the change of chewing ability as the dependent variable.

RESULTS

Bivariate analysis showed the change in chewing ability was significantly associated with general health status (p < 0.01), number of present teeth (p < 0.05) and maximum bite force (p < 0.01). Backward logistic regression analysis revealed that the most reliable predictor of a change in chewing ability at 3 years was general health status (odds ratio = 6.35, 95% CI = 1.69-23.88).

CONCLUSION

The present findings suggest that general health status at baseline produces a change in chewing ability.