Longitudinal association of dentition status with dietary intake in Japanese adults aged 75 to 80 years

Exploring the association between number of teeth, food intake, and cognitive function: A 9-year longitudinal study

OBJECTIVES

This study aimed to investigate the association between the number of teeth, food intake, and cognitive function in Japanese community-dwelling older adults.

METHODS

This 9-year longitudinal study included a total of 293 analyzable participants who participated in baseline and follow-up surveys. Dental status (number of teeth and periodontal pocket depth), dietary assessment using the brief-type self-administered diet history questionnaire, cognitive function, and the following confounding factors were evaluated: educational level, financial satisfaction, living situation, smoking and drinking habits, history of chronic diseases, apolipoprotein E-ε4 carrier, body mass index, handgrip strength, instrumental activities of daily living, and depressive symptomatology. The Japanese version of the Montreal Cognitive Assessment was used to evaluate cognitive function. A multinomial logistic regression analysis for the intake level of each food categorized into three groups (low, moderate, high), and a generalized estimating equation (GEE) for cognitive function over nine years were performed.

RESULTS

After controlling for confounding factors, the number of teeth was shown to be associated with the intake of green-yellow vegetables and meat. Furthermore, the GEE indicated that the lowest quartile of intake of green-yellow vegetables significantly associated with lower cognitive function (unstandardized regression coefficient [B] = -0.96, 95 % confidence interval [CI]: -1.72 to -0.20), and the lowest quartile of intake of meat significantly associated with lower cognitive function (B = -1.42, 95 % CI: -2.27 to -0.58).

CONCLUSIONS

The intake of green and yellow vegetables and meat, which is influenced by the number of teeth, was associated with cognitive function in Japanese community-dwelling older adults.

CLINICAL SIGNIFICANCE

There are few studies that have examined the association between oral health, food intake, and cognitive function. This 9-year longitudinal study suggests that it is important to maintain natural teeth to enable the functional means to consume green-yellow vegetables and meat, and thereby help maintain cognitive function.

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.

A user-centered approach to the development of a diet education tool for older adults with tooth loss

BACKGROUND

Tooth loss is associated with suboptimal nutrient intake and greater risk of malnutrition.

OBJECTIVE

To develop and field-test a stakeholder-informed diet education tool that addresses the unique needs of older adults with tooth loss who do not wear dentures.

METHODS

An iterative user-centered approach was used. Initial content was developed based on findings from previous research. Stakeholder panels of older adults with 20 or fewer teeth, and dentists, were conducted at two time points to obtain feedback on the tool, which was revised following each panel. The tool was field-tested in a dental school clinic and evaluated using the Patient Education Materials Assessment Tool; it was further revised based on feedback.

RESULTS

A diet education tool entitled "Eating Healthier With Tooth Loss" was developed. Sections for fruits and vegetables, grains, and proteins food groups, and one addressing socioemotional aspects of eating with missing teeth were included. Panel members provided constructive, positive feedback; recommendations for editing text, images, design, and content were integrated. Field-testing in the dental clinic with 27 pairs of student dentists and their patients resulted in scores of 95.7% for understandability and 96.6% for actionability, with over 85% agreement with each item. The tool was revised based on field-testing feedback.

CONCLUSION

A diet education tool for older adults with tooth loss was developed using a user-centered approach, integrating the 'patient voice' and patient experiences with US dietary guidelines. Use of this tool is feasible in a dental clinic setting. Future research should explore usage in larger settings.

Relationships between oral function, dietary intake and nutritional status in older adults aged 75 years and above: a cross-sectional study

BACKGROUND

Malnutrition is related to impaired oral health and function that causes poor dietary intake, declining the general health of older adults. The role of dietary intake in the association between oral function and nutritional status of Chinese older adults (aged 75 and above) was examined in this cross-sectional study.

METHODS

Through the randomized cluster sampling method, 267 older adults living in rural areas of Qingdao, Shandong (aged 81.4 ± 4.3, 75-94 years) were chosen as the primary research participants. A Mini Nutritional Assessment - Short Form was used to determine nutritional status, and Food Frequency Questionnaire and 24-hour Food Intake Recall were used to assess dietary intake. The oral function was evaluated by analyzing the teeth, oral problems, bite force, tongue pressure, lip sealing pressure, chewing function questionnaire, whole saliva flow rate, 10-Item Eating Assessment Tool, and water swallow test.

RESULTS

Based on the MNA-SF score, it was divided into a well-nourished group and a malnutrition group, with the malnutrition group comprising 40.6% of participants. The participants in the malnutrition group showed a higher rate of xerostomia, lower bite force, tongue pressure, and lip sealing pressure, and higher Chewing Function Questionnaire and 10-Item Eating Assessment Tool scores. Furthermore, their plant fat, iron, cereals and potatoes, vegetables, fruits, and seafood intake were relatively low. The regression model indicated that exercise frequency, stroke, chewing and swallowing function, intake of vegetables and fruits were risk factors for nutritional status of older adults.

CONCLUSION

Malnutrition was relatively common among the Chinese older adults aged 75 and above, and it was significantly correlated with exercise frequency, stroke, chewing and swallowing function, and intake of vegetables and fruits. Therefore, nutrition management should be carried out under the understanding and guidance of the oral function and dietary intake of the older adults.

The predictive value of masticatory function for adverse health outcomes in older adults: a systematic review

Masticatory function is associated with a variety of health outcomes. The aim of this systematic review is to clarify the predictive value of masticatory function for adverse health outcomes, such as frailty, sarcopenia and malnutrition, in older adults. An online literature search covered articles published in English or Dutch in three databases (PubMed, Embase and CINAHL, last searched November 4th 2022). Inclusion criteria were: an observational study design, focus on adults aged ≥65 years and evaluation of the association between masticatory function and health outcomes. Reviews and articles published before the year 2000 were excluded. Methodological quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies of the U.S. National Institutes of Health. Study population demographics, methods for assessing masticatory function, and the association between masticatory function and adverse health outcomes were extracted. From the 34 included studies, 5 studies had a prospective design, 2 had a retrospective design, and the other 27 studies had cross-sectional design. The majority of the studies were conducted in Japan (74%, n = 26). Twenty studies (59%) used one indicator for masticatory function, the other 41% used two (n = 9) or more (n = 5) indicators. Masticatory function was most frequently assessed with the maximum occlusal force (MOF) (79%, n = 27). The identified health outcomes were clustered into 6 categories: physical parameters and sarcopenia, history of falling, nutritional status, frailty, cognitive function and mortality. Despite the complex and multidimensional character of both masticatory function and most identified adverse health outcomes, some significant associations were reported. Prospective studies showed that reduced masticatory function in older adults is associated with incidence of frailty and frailty progression, cognitive decline and all-cause mortality. Regarding the other identified adverse health outcomes, i.e., physical measures and sarcopenia, history of falling and nutritional status, only cross-sectional studies were available and results were less concordant. As all prospective studies showed that reduced masticatory function in older adults is associated with adverse health outcomes, prevention of decline of masticatory function by adequate oral care may contribute to healthy ageing.

Association between occlusal supports and nutritional status in older adults: A systematic review

Background/purpose

Impaired masticatory performance results in nutritional deficiencies in older adults. This systematic review aims to investigate the following clinical question (CQ): Do occlusal supports impact nutritional intake or nutritional status in older individuals?

Materials and methods

An extensive systematic literature search was performed to summarize the currently available knowledge to address the CQ. The cohort and intervention studies with participants of ≧60 years old or a mean age of 65 years performed before May 2021 were included. Studies were required to measure the parameters related to occluding tooth pairs/occlusal units and food/nutrient intake and/or nutritional status. Bias risk was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results

After an independent screening of 1130 initial records, 24 reports from 22 studies were included. Participants (n = 8684) in the included studies were mainly residents of nursing homes or community-dwelling individuals. Following the assessment of bias risk, it is revealed that all studies had methodological weaknesses. Over half of the studies concluded that there was an association between occlusal support and nutritional intake or status. However, it was also revealed that various confounding factors are involved in the association between occlusal support and nutrition.

Conclusion

This systematic review concludes that occlusal support might be associated with nutritional intake or nutritional status in the older population, although there are methodological limitations of each study. The evidence is still insufficient, and more well-designed studies are required.

Longitudinal association of oral functions and dementia in Japanese older adults

The relationship between oral functions and dementia was examined in 7384 older adults (age ≥ 75 years) who visited a dental clinic in Gifu, Japan. Participants without dementia in a baseline survey in April 2018 were followed until March 2021. As oral functions, chewing function, tongue and lip function, and swallowing function were assessed by self-administered questionnaire, by oral diadochokinesis test, and by repetitive saliva swallowing test, respectively. The presence of systemic diseases was based on data obtained from the National Database of Health Insurance of Japan. At follow-up, 415 (6%) participants were diagnosed with dementia. Multivariate logistic regression analyses showed the presence of dementia at follow-up was associated with female (odds ratio [OR] 1.386; 95% confidence interval [CI] 1.117-1.719), age (OR 1.078; CI 1.056-1.101), regular dental checkups (absence; OR 1.452; CI 1.180-1.788), brushing frequency ≥ twice/day (absence; OR 1.510; CI 1.194-1.911), decayed teeth (presence; OR 1.328; CI 1.071-1.648), swallowing function (poor; OR 1.484; CI 1.135-1.939) at baseline. It was found that poor swallowing function was associated with the future onset of dementia.

Exploring the attitudes of general dental practitioners to providing dietary advice alongside oral rehabilitation for older adults

OBJECTIVE

We aimed to capture General Dental Practitioners' (GDPs) views on delivering dietary advice to older adults in combination with treatment to replace missing teeth and identify solutions to help inform the development and implementation of future dietary interventions within primary dental care.

BACKGROUND

As natural teeth are lost, older adults may need to choose softer, more manageable foods which might be of lower nutrient density. Previous research has indicated that prosthodontic rehabilitation can improve masticatory function but not the intake of nutrients, highlighting a potential need for a combined approach of oral rehabilitation and dietary counselling.

MATERIALS AND METHODS

Semi-structured telephone interviews were conducted with a purposive sampling strategy of 12 GDPs. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme-analytic methods was used.

RESULTS

Twelve interviews were conducted with GDPs in the United Kingdom. The themes that emerged from the interviews included: the awareness of the importance of dietary advice among GDPs; the concerns GDPs had on patients' adherence to dietary advice; uncertainty over roles and responsibilities in the provision of dietary advice; and the limited time and remuneration for dietary advice in dental practice. A minor theme identified was the motivation of GDPs to implement dietary advice alongside oral rehabilitation. All reported that they were already providing dietary advice to their patients but that this was limited to caries prevention.

CONCLUSION

The GDPs interviewed expressed positive attitudes towards providing dietary advice alongside oral rehabilitation for older adults. However, a lack of confidence, awareness, time and remuneration are barriers to its provision in primary dental care. To facilitate the implementation of dietary advice alongside oral rehabilitation, clear guidance on and training in delivering dietary advice and multidisciplinary cooperation are required.

Effect of breakfast protein intake on muscle mass and strength in adults: a scoping review

BACKGROUND

The distribution of protein intake throughout the day is frequently skewed, with breakfast having the lowest protein intake across all age groups. There is no review that addresses the association between breakfast protein intake and muscle mass and strength.

OBJECTIVE

This scoping review aims to summarize the literature on the relationship between protein intake during breakfast and muscle mass and strength in adults.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Two independent reviewers screened and appraised the articles identified from 3 electronic databases (Medline, Web of Science, and Scopus) that focused on protein intake per meal and its impact on muscle-related outcomes.

RESULTS

A total of 14 763 articles were retrieved from 3 databases, and after the screening process, 15 articles were included for analysis. Approximately 58.8% of findings from 11 studies examining the association between high protein intake during breakfast and muscle mass indicated an increase in muscle mass among participants. Half of 6 studies (50.0%) exploring the relationship between high protein intake at breakfast and muscle strength demonstrated an increase in muscle strength. Consuming high amounts of protein at breakfast or more protein in the morning than in the evening was associated with an increase in the skeletal muscle index and lean body mass.

CONCLUSION

Protein consumption at breakfast revealed potential benefits in increasing muscle mass across 5 studies involving an elderly population and 2 studies encompassing middle-aged women and young men in our review. However, the relationship between protein intake at breakfast and muscle strength remains unclear. Further high-quality randomized controlled trials are required to examine whether adults can preserve skeletal muscle health outcomes by consuming higher amounts of protein at breakfast.

Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review

INTRODUCTION

Sarcopenia is loss of both muscle mass and function with age and is associated with inadequate protein intake. However, evidence to suggest an association with oral health is less clear.

OBJECTIVE

To scope peer-reviewed published evidence (2000-2022) pertaining to oral function in relation to sarcopenia and/or protein intake in older people.

METHODS

CINAHL, Embase, PubMed, and Scopus were searched. Included were peer-reviewed studies measuring oral function (e.g., tooth loss, salivary flow masticatory function, strength of muscles of mastication, and tongue pressure) and a measure of protein intake and/or a measure of sarcopenia (appendicular muscle mass and function). Full article screening was conducted by 1 reviewer with a random 10% screened in duplicate by a second reviewer. Relevant content pertaining to study type, country of origin, measures of exposure, and outcomes and key findings was mapped and the balance of data showing a positive versus null association of oral health with outcomes charted.

RESULTS

Of 376 studies identified, 126 were screened in full, yielding 32 included texts, of which 29 were original articles. Seven reported intake of protein and 22 reported measures of sarcopenia. Nine distinct oral health exposures were identified, with ≤4 studies relating to any one of these measures. Most data were cross-sectional in nature (27 studies) and from Japan (20 studies). The balance of data showed associations between tooth loss and measures of sarcopenia and protein intake. However, the balance of data pertaining to any association between chewing function, tongue pressure, or indices of oral hypofunction and sarcopenia was mixed.

CONCLUSION

A broad range of oral health measures have been studied in relation to sarcopenia. The balance of data suggests that tooth loss is associated with risk, but data pertaining to the oral musculature and indices of oral hypofunction are mixed.

KNOWLEDGE TRANSFER STATEMENT

The findings of this research will increase awareness among clinicians of the amount and nature of evidence pertaining to the relationship between oral health and risk of compromised muscle mass and function, including data showing that loss of teeth is associated with increased risk of sarcopenia in older people. The findings highlight to researchers the gaps in the evidence and where further research and clarification of the relationship between oral health and risk of sarcopenia is warranted.

Dental prosthesis use is associated with higher protein intake among older adults with tooth loss

BACKGROUND

Tooth loss is associated with reduced protein intake, which leads to sarcopenia and frailty in older adults.

OBJECTIVE

To evaluate the protective effect of dental prostheses on decreased protein intake in older adults with tooth loss.

METHODS

This cross-sectional study was based on a self-reported questionnaire targeting older adults. Data were obtained from the Iwanuma Survey of the Japan Gerontological Evaluation Study. We used % energy intake (%E) of total protein as the outcome and the use of dental prostheses and number of remaining teeth as explanatory variables. We estimated the controlled direct effects of tooth loss by fixing the use/non-use of dental prostheses based on a causal mediation analysis, including possible confounders.

RESULTS

Among 2095 participants, the mean age was 81.1 years (1SD = 5.1), and 43.9% were men. The average protein intake was 17.4%E (1SD = 3.4) of the total energy intake. Among participants with ≥20, 10-19 and 0-9 remaining teeth, the average protein intake was 17.7%E, 17.2%E/17.4%E and 17.0%E/15.4%E (with/without a dental prosthesis), respectively. Compared to participants with ≥20 remaining teeth, those with 10-19 remaining teeth without a dental prosthesis did not have a significantly different total protein intake (p > .05). Among those with 0-9 remaining teeth without a dental prosthesis, total protein intake was significantly low (-2.31%, p < .001); however, the use of dental prostheses mitigated the association by 79.4% (p < .001).

CONCLUSION

Our results suggest that prosthodontic treatment could contribute to maintaining protein intake in older adults with severe tooth loss.

Effect of mandibular bilateral distal extension denture design on masticatory performance

PURPOSE

Removable partial dentures have a wide range of applications as missing tooth prostheses, and the denture design can be quite diverse. However, the factors affecting masticatory function remain unclear. We investigated the effect of denture design, especially the use of indirect retainers and major connectors, on masticatory function in patients with mandibular bilateral distal extension dentures.

METHODS

Fifty-three patients with mandibular Kennedy Class I and Eichner classification B occlusal support were included in this study. Masticatory performance (MP) was assessed using gummy jelly. For the dentures, the type of major connector (bar or apron), presence or absence of indirect retainers, number of rests, and number of artificial teeth were evaluated. The number of functional teeth and occlusal support, Eichner classification, maxillary denture usage, mandibular residual ridge height, and duration of denture use were also evaluated. The factors influencing on the MP were evaluated using the Mann-Whitney U test, Spearman's correlation coefficient, and logistic regression analysis.

RESULTS

MP was significantly higher when the major connector was bar-type or when there was an indirect retainer than with an apron-type or no indirect retainer. MP was positively correlated with the number of functional teeth, occlusal support, and number of rests. Logistic regression analysis revealed that the number of functional teeth and the presence or absence of an indirect retainer were factors that significantly influenced the MP.

CONCLUSIONS

An indirect retainer setting is useful for achieving good masticatory performance in mandibular bilateral distal extension dentures.

Association between an Anti-Inflammatory Dietary Score and Periodontitis-Evidence from the Population-Based Hamburg City Health Study

While the effects of dietary patterns on cardiovascular risk and diabetes have been well studied, the evidence is scarce as to which diet has the greatest anti-inflammatory potential and how dietary patterns are associated with periodontitis. In the Hamburg City Health Study (HCHS), we developed an anti-inflammatory dietary score using a data-driven approach based on the relationship of relevant selected food groups with inflammatory biomarkers (hsCRP and IL-6). The aim of this cross-sectional study was to evaluate the association between the anti-inflammatory dietary score and the incidence of periodontitis in Hamburg, Germany. A total of n = 5642 participants fit the required inclusion criteria and were selected for analysis. Periodontal disease was assessed using probing depth, gingival recession, and bleeding on probing. Dietary intake was measured using a food frequency questionnaire (FFQ). A self-developed anti-inflammatory dietary score served as the key explanatory variable. Higher scores reflected lower inflammatory processes (measured through the biomarkers hsCRP and IL-6). Several covariates were included in the regression analysis. Regressions revealed that a higher anti-inflammatory dietary score was significantly associated with lower odds to be affected by periodontal disease in an unadjusted model (OR 0.86, 95% CI 0.82-0.89, p < 0.001) and in an adjusted model (age, sex, smoking, diabetes, hypertension, and physical activity) (OR 0.93, 95% CI 0.89-0.98, p = 0.003). Our study demonstrated a significant inverse association between an anti-inflammatory dietary score and periodontitis. Individuals with higher intake of proinflammatory nutrition should be specifically addressed to avoid periodontitis.

Evaluation of the Oral Health Conditions and Oral Health-Related Quality of Life in a Community-Dwellers Population Aged ≥ 45 Years in the Canton of Bern: A Preliminary Pilot Study

OBJECTIVE

To evaluate oral health conditions and oral health-related quality of life in community-dwellers aged ≥ 45 years in the Canton of Bern, Switzerland.

MATERIALS AND METHODS

One hundred subjects (63% males; mean age: 73 years), selected randomly using a cluster procedure within the Canton of Bern, underwent a clinical oral examination after completing questionnaires on socio-economic level, medical history, oral health behaviour, and Geriatric Oral Health Assessment Index (GOHAI). Descriptive analyses and multinomial regression models were applied to investigate the association between oral health diseases (dental caries and periodontitis) and specific participant characteristics.

RESULTS

The mean number of decayed, missing, and filled teeth (DMFT) was 0.30, 4.20, and 8.75, respectively; the mean DMFT score = 13.35. Dental caries prevalence (ICDAS > 0) was 15% and periodontitis prevalence was 46%. Logistic regression models revealed that living in an urban area was associated with lower odds (OR 0.03, _95%CI 0.00-0.36) of having periodontal disease. Male gender was associated with lower odds for dental caries (OR 0.31, _95%CI 0.09-1.01) and total lack of professional tooth cleaning was associated with higher odds for dental caries (OR 41.99, _95%CI 0.01-0.38). Ordinal logistic regression revealed that both the presence of dental caries (RR 12.80, _95%CI 1.47-111.20) and periodontal disease (RR 6.91, _95%CI 1.16-84.00) were statistically significantly associated with rheumatoid arthritis.

CONCLUSION

Within the study limitations, untreated dental caries and periodontal disease are prevalent in the Swiss population, despite the high level of self-performed oral hygiene and access to the dental care system.

Development of patient-centric eating advice for complete denture wearers

BACKGROUND

Edentulous people eat less healthily, and wearing dentures impairs eating function and enjoyment.

OBJECTIVE

To apply a sequential approach to integrate scientific evidence, and patient and professional experience to co-develop intervention to support better eating with dentures.

METHODS

Focus groups, two with purposive samples of patients and two with dental professionals, explored experiences and opinions about advice on eating with complete dentures. Findings were distilled with evidence from the literature to underpinned concepts for eating interventions. User engagement informed prioritisation of ideas and led to the development of a leaflet on eating with dentures.

RESULTS

Patients receive no advice on what they can realistically expect when eating with dentures, and professionals lacked confidence to provide eating advice. Patients did not think dentists a credible provider of eating advice, feeling peer support more appropriate and offering numerous strategies for eating with dentures. Concepts for eating intervention included a patient leaflet, Web-based eating interventions, patient support blogs, waiting room videos and improved nutrition training for dental professionals. User feedback informed prioritisation of ideas, leading to the development of a leaflet on eating with dentures. Justified by the data, the leaflet focused on patient-generated tips for overcoming the functional limitations of eating with dentures, and unobtrusive healthier eating advice. Face validity with users confirmed acceptability.

CONCLUSION

A systematic and rigorous integration of scientific evidence, expert experience and patient input has developed a patient-centric, evidence-based approach to a patent leaflet on eating with dentures that, based on initial face validity, is likely to be well received.

Association of the number of natural teeth with dietary diversity and nutritional status in older adults: A cross-sectional study in China

AIM

To investigate the association of the number of natural teeth with overall dietary diversity and nutritional status in a nationally representative study among older adults in China.

MATERIALS AND METHODS

A cross-sectional analysis was conducted among community-dwelling adults aged 65 years or older from the Chinese Longitudinal Healthy Longevity Study. According to the self-reported number of natural teeth, participants were categorized into ≥20, 10-19, 1-9 natural teeth, and edentulous. Dietary diversity score (DDS) was constructed based on intake frequencies of 10 food groups assessed by a simplified food frequency questionnaire. The geriatric nutritional risk index was used to measure the malnutrition status (i.e., normal, mild malnutrition, and moderate-to-severe malnutrition) among a subgroup of participants. Linear and multinomial logistic regression models were used to examine the corresponding associations.

RESULTS

Among 54,796 study participants, the mean (SD) age was 87.86 (11.45) years, 82.7% had poor dentition (<20 natural teeth), and 27.3% wore dentures. After multivariable adjustment, participants with poor dentition had lower DDSs (β_edentulous  = -0.39, 95% confidence interval [CI], -0.48, -0.30; β_{1-9 teeth}  = -0.46, 95% CI, -0.55, -0.37; β_{10-19 teeth}  = -0.36, 95% CI, -0.46, -0.26) than those with 20 natural teeth or more. For individual food items, edentulous, 1-9 and 10-19 natural teeth were associated with lower odds of regular intake of fresh fruits, fresh vegetables, meat, fish and aquatic products, eggs, legumes, preserved vegetables, tea, and garlic, but higher odds of regular intake of sugar and sweets. Among participants with poor dentition, individuals without dentures had lower intake frequencies of most food groups than those wearing dentures. In addition, poor dentition was related to lower odds of normal nutritional status (odds ratio = 0.49, 95% CI, 0.27, 0.89).

CONCLUSIONS

Older adults with poor dentition had significantly lower dietary diversity and worse nutritional status. Future studies are warranted to identify effective interventions to improve the dietary quality and nutrition status among partially and fully edentulous individuals, including those with Stage IV periodontitis.

Weight Loss Mediated the Relationship between Tooth Loss and Mortality Risk

Tooth loss is a risk factor for increased mortality; however, the underlying mechanism remains unclear. This study aimed to evaluate the mediating effect of weight change on the relationship between tooth loss and mortality risk. This was a 10-y follow-up prospective cohort study using the data from the Japan Gerontological Evaluation Study (JAGES). The participants were independent older adults aged ≥65 y at baseline and were followed up from 2010 to 2020. The incidence of death in 2013 and 2020, incidence of >5% weight loss/gain in 2010 and 2013, and the number of remaining teeth in 2010 were used as the outcome, mediator, and explanatory variables, respectively. We conducted causal mediation analysis by fitting the Cox proportional hazard model, including possible confounders. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) of the total effect (TE), natural indirect effect (NIE), and proportion mediated (PM) were estimated. Among the 34,510 participants, the mean age was 72.6 (SD = 5.4) y, and 47.6% were men. From 2013 to 2020, 14.0% of the participants (n = 4,825) died, 60.5% (n = 20,871) had 0 to 19 remaining teeth, and 17.2% (n = 5,927) and 8.4% (n = 2,907) experienced >5% weight loss and gain, respectively. The mortality rate was 0.016 per person-year among those with ≥20 remaining teeth and 0.027 per person-year among those with 0 to 19 remaining teeth. Weight loss of >5% significantly mediated the association between tooth loss and higher mortality risk (TE: HR, 1.28 [95% CI, 1.16 to 1.40]; NIE: HR, 1.03 [95% CI, 1.02 to 1.04]; PM, 13.1%); however, we observed a slight mediating effect for >5% weight gain (NIE: HR, 1.003 [95%CI, 1.0001 to 1.01]; PM, 1.3%). The present study suggests that a clinically meaningful level of weight loss mediated the association between tooth loss and increased risk of mortality among independent older adults.

Maria MT, Hori S, Morikawa M, Marito P, Kaneko N, Nohno K, Nose H, Masuki S, Ono T. Effects of Interval Walking Training on Oral Health Status in Middle-Aged and Older Adults: A Case-Control Study

The purpose of this study was to determine the effect of walking training "Interval Walking Training (IWT)" on oral health status. Participants were divided into two groups: an exercise intervention group and a non-intervention group (control). The intervention group consisted of 59 subjects (20 males, 39 females) aged 50 years or older who participated in the IWT program in Matsumoto from 2019 to April 2022. The control group consisted of 33 subjects (14 males and 19 females) aged 50 years or older who have visited Niigata University Medical and Dental Hospital and agreed to participate in the study. The intervention group underwent walking training (interval walking training) for at least 5-6 months. The walking training consisted of five sets of fast walking above 70% peak aerobic capacity for walking (VO₂peak) for 3 min, followed by 3 min of slow walking at ~40% VO₂ peak per day for more than four days/week. The oral health status was evaluated for the number of teeth, occlusal force, salivary occult blood, masticatory performance, and tongue pressure. A total of 57 participants were analyzed in the intervention group (18 males and 39 females, age: 66.7 ± 0.8 (mean ± S.E.) years) and 33 participants in the control group (14 males and 19 females, age: 74.5 ± 1.1 (mean ± S.E.) years). There were no significant differences in gender, salivary occult blood, tongue pressure, masticatory performance, or occlusal force between the two groups at the start of the intervention (p = 0.36, p = 0.48, p = 0.42, p = 0.58, and p = 0.08, respectively by unpaired t-test or χ² test). On the other hand, there were significant differences in age and BMI, with a trend toward lower age and higher BMI in the intervention group (p < 0.001 and p < 0.001, respectively, by unpaired t-test). In terms of rate of change, the intervention group showed a significant increase in occlusal force (F = 4.5, p = 0.04, ANCOVA) and a significant decrease in BMI (F = 7.3, p = 0.009, ANCOVA). No significant differences were observed in the other measured items. It was found that walking training in both middle-aged and older people does not only affect the physical aspect of weight loss but may help maintain and improve the occlusal force.

Protein Intake and Oral Health in Older Adults-A Narrative Review

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Functional dentition and associated factors

Studying the different indicators of functional dentition classification can contribute to the understanding of the associated factors, and thus help in the definition of strategies associated with oral health care. This approach has been little explored in the literature, especially when considering the older age group. Aim: The aim of this study is to evaluate the factors associated with three distinct functional dentition classification. Methods: Crosssectional exploratory study using secondary data from the Frailty in Older Brazilians (FIBRA) Project of 876 older adults living in Campinas, Brazil. The indicators of dental function assessed was number of natural teeth present, occluding pairs of teeth and the Eichner index, which were verified by trained dentists, following the World Health Organization criteria for epidemiological studies in oral health. The explanatory variable assessed was the selfperception of oral health-related quality of life measured by the Geriatric Oral Health Assessment Index (GOHAI) and its dimensions. It was also collected sociodemographic information such as age, gender, race/ethnicity, schooling, family income, smoking behavior and frailty status. The association was verified through Poisson regressions for number of teeth and pairs of teeth in occlusion and multinomial regression for the Eichner index, adjusted by sociodemographic and health variables. Results: Lower prevalence of participants with less than 21 teeth who negatively perceived GOHAI´s pain and discomfort dimension and higher prevalence of having less teeth among the ones that negatively perceived GOHAI´s physical and functional dimensions. No association was found between the perception of quality of life and occlusion pairs of teeth and the Eichner Index. Conclusion: Two out of three indicators assessed were associated with quality of life. Therefore, it is important to select sensitive indicators to be able to identify and better comprehend this relationship.

Eating Advice for People Who Wear Dentures: A Scoping Review

OBJECTIVE

A scoping review of available advice to address eating problems experienced by people who wear dentures was conducted in accordance with the PRISMA statement. The objective was to identify and map type, volume, and content of the available eating advice.

METHODS

Medline, CINAHL, and grey literature databases and Google were searched. Relevant content pertaining to study type, peer-review vs. grey literature, country of origin, advice content, and methods to evaluate effectiveness was mapped.

RESULTS

Of the 4591 records identified from peer-reviewed literature, 56 full papers underwent duplicate screening, resulting in 26 papers (from Germany (n = 1), Europe (n = 1), India (n = 2), Japan (n = 7), UK (n = 6), USA (n = 6), or other (n = 3)) being included in the review. These yielded 18 different items of relevant eating advice. Of the 258 screened websites, 63 were included, yielding 30 different items of eating advice. The most-cited advice was to eat soft food and avoid hard and sticky food, cut food into bite-sized pieces, and chew on both sides of the mouth and chew slowly and thoroughly. The identified advice was not supported by reference to peer-reviewed evidence. Advice included some conflicting messages and some advice was non-compliant with authoritative nutritional advice (e.g., avoid red meat, take a vitamin supplement).

CONCLUSION

There is support for providing eating advice at the time of denture provision. A broad range of advice based on clinical experience to support people who wear dentures to overcome the functional limitations exists. However, the efficacy of this advice in improving diet and eating experience has not been tested.

The Association of Dietary Intake, Oral Health, and Blood Pressure in Older Adults: A Cross-Sectional Observational Study

Hypertension is related to impaired mastication that causes malnutrition, declining the general health of older adults. This study assessed the role of dietary intake in the relationship between oral health and blood pressure. Eight hundred ninety-four adults aged ≥65 years who independently lived in rural regions of Japan participated in this study. Hypertension was classified according to the guidelines of the Japanese Society of Hypertension. The oral condition was evaluated by analyzing the remaining teeth, occlusal force, posterior occlusal support, masticatory performance, oral moisture, and oral bacterial level. Dietary intake was assessed using a brief self-administered dietary history questionnaire. Mann-Whitney U, chi-square, Kruskal-Wallis tests, and logistic regression analyses were used to elucidate the factors related to hypertension. Normotensive, hypertensive, and history of hypertension were observed in 30.9%, 23.8%, and 45.3% of the participants, respectively. The factors significantly associated with the hypertension were age, body mass index, posterior occlusal support condition, and sodium-to-potassium ratio related to salt intake and/or vegetable intake. Participants without posterior occlusion significantly had higher risk of hypertension (odds ratio = 1.72). This study suggested that there was an association between oral health and hypertension, while the loss of occlusal support may influence nutritional intake conditions.

Associations between Dentition Status and Nutritional Status in Community-Dwelling Older Adults

BACKGROUND/OBJECTIVE

Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic.

METHODS

This was a cross-sectional study of data from older adults (65-89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self-Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables.

RESULTS

The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition.

CONCLUSION

This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status.

KNOWLEDGE TRANSFER STATEMENT

The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.

Breakfast Protein Quality and Muscle Strength in Japanese Older Adults: A Community-Based Longitudinal Study

OBJECTIVES

The amount of breakfast protein intake is important for maintaining muscle strength. However, the effect of breakfast protein quality (ie, bioavailability) remains unclear. We investigated the association between breakfast protein quality and the incidence of muscle weakness.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

Healthy older adults age 60-83 years without stroke, arthritis, Parkinson disease, or muscle weakness at baseline (maximum follow-up period and participations were 9.2 years and 5 times, respectively).

METHODS

Weakness was defined by the Asian Working Group for Sarcopenia 2019 criteria, using grip strength. Breakfast protein quality was evaluated using the protein digestibility-corrected amino acid score (PDCAAS), where higher scores represent higher quality, calculated from 3-day dietary records. Participants were classified according to sex-stratified tertiles of breakfast PDCAAS (ie, low to high groups). The association between PDCAAS and incident weakness was analyzed using the generalized estimating equation, after adjusting for sex, age, follow-up time, grip strength, body mass index, physical activity, cognition, education, smoking, economics, medical history, lunch and dinner PDCAASs, and energy and protein intake during 3 regular meals at baseline.

RESULTS

Overall, 14.4% of the initial sample was excluded owing to a diagnosis of weakness-related diseases, and 58.3% (n = 701) had at least 1 follow-up measurement for inclusion in the analysis. The mean ± SD follow-up period was 6.9 ± 2.1 years; the cumulative number of participants was 3019, and 282 developed weakness. Using the low PDCAAS group as the reference, the adjusted odds ratios (95% CIs) for incident weakness in the middle and high PDCAAS groups were 0.71 (0.43-1.18) and 0.50 (0.29-0.86), respectively.

CONCLUSIONS AND IMPLICATIONS

Higher breakfast protein quality was associated with a reduction in incident weakness in older adults, independent of protein intake. These findings may highlight the role of protein quality for muscle health in older adults.

Lower Masticatory Performance Is a Risk for the Development of the Metabolic Syndrome: The Suita Study

Objectives: Declined masticatory function has recently been receiving attention as a risk factor for poor general health. The present longitudinal analysis was conducted to clarify the relationship between decreased masticatory performance and the development of the metabolic syndrome (MetS) in a general urban cohort in Japan.

Methods: We surveyed 599 participants (254 men, 345 women; mean age at baseline, 65.8 ± 7.8 years) who underwent physical health checkups in the Suita study. We evaluated masticatory performance at baseline using test gummy jelly and divided participants into two groups: a “Lower group,” comprising participants in the lower 25% of the masticatory performance at baseline; and a “Normal group,” comprising all others. We estimated hazard ratios (HRs) for the Lower group by using Cox proportional hazard regression analysis to develop the MetS and the components of the MetS at follow-up, adjusting for age, smoking status, and periodontal status.

Results: On Cox proportional hazard regression analysis, the multivariable adjusted hazard ratio for the development of the MetS in the Lower group was 2.24 (95% confidence interval, 1.12–4.50) in men. The multivariable adjusted hazard ratio for the development of high blood pressure was 3.12 (1.42–6.87), for high triglycerides was 2.82 (1.18–6.76), and for high fasting plasma glucose was 2.65 (1.00–7.00) in men.

Conclusions: Lower masticatory performance suggested to be a risk factor for the development of the MetS as well as MetS components such as high blood pressure, high triglycerides, and high fasting plasma glucose in Japanese men.

Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA

We aimed to investigate the associations of poor oral health cross-sectionally with diet quality and intake in older people. We also examined whether change in diet quality is associated with oral health problems. Data from the British Regional Heart Study (BRHS) comprising British males aged 71-92 years and the Health, Aging and Body Composition (HABC) Study comprising American males and females aged 71-80 years were used. Dental data included tooth loss, periodontal disease, dry mouth and self-rated oral health. Dietary data included diet quality (based on Elderly Dietary Index (BRHS) and Healthy Eating Score (HABC Study)) and several nutrients. In the BRHS, change in diet quality over 10 years (1998-2000 to 2010-2012) was also assessed. In the BRHS, tooth loss, fair/poor self-rated oral health and accumulation of oral health problems were associated with poor diet quality, after adjustment. Similar associations were reported for high intake of processed meat. Poor oral health was associated with the top quartile of percentage of energy content from saturated fat (self-rated oral health, OR 1·34, 95 % CI 1·02, 1·77). In the HABC Study, no significant associations were observed for diet quality after adjustment. Periodontal disease was associated with the top quartile of percentage of energy content from saturated fat (OR 1·48, 95 % CI 1·09, 2·01). In the BRHS, persistent low diet quality was associated with higher risk of tooth loss and accumulation of oral health problems. Older individuals with oral health problems had poorer diets and consumed fewer nutrient-rich foods. Persistent poor diet quality was associated with oral health problems later in life.

Impact of Wearing Dentures on Dietary Intake, Nutritional Status, and Eating: A Systematic Review

INTRODUCTION

A key purpose of denture provision is to enable eating, yet the body of evidence pertaining to the impact of dentures on wide-ranging nutritional outcomes has not been systematically reviewed.

OBJECTIVES

To systematically review published evidence pertaining to the effect of wearing removable dental prosthesis on dietary intake, nutritional status, eating function, and eating related-quality of life (ERQoL).

METHODS

Eight questions relating to the impact of wearing dentures on nutritional outcomes were addressed. The target population was healthy adults aged ≥18 y. Data sources included Medline, Embase, CINAHL, and PubMed. Included were all human epidemiologic studies. The Newcastle-Ottawa score was used for appraisal of study quality. Harvest plots, vote counting, and accompanying narrative provided the basis for synthesis.

RESULTS

Of the 1,245 records identified, 134 were retrieved and eligibility assessed by 2 reviewers, and 41 studies were included in the synthesis (14 rated good quality, 20 fair, and 7 poor). The balance of data supported a positive impact of wearing full (5/7 studies) or partial (3/3 studies) dentures (vs. no dentures) on nutritional status, though no clear direction of effect was detected for the impact of dentures on dietary intake. The balance of data clearly showed that objective measures of eating function were compromised in full (14/15 studies) and partial (6/7 studies) denture wearers as compared with the dentate. Data showed that ERQoL was also compromised in denture wearers as compared with the dentate (3/3 studies). However, data showed a positive impact of wearing dentures on ERQoL (5/5 studies) as opposed to wearing no dentures.

CONCLUSION

The balance of evidence shows that despite no clear pattern on impact of wearing dentures on measured dietary intake, in those with tooth loss, wearing dentures can have a positive impact on nutritional status and enjoyment of eating.

KNOWLEDGE TRANSFER STATEMENT

The results of this systematic review can be used to advocate for health care services to address prosthodontic need to benefit nutritional outcomes. The findings will be of use in educating health care professionals on the impact of wearing dentures and not addressing prosthodontic need on nutritional outcomes.

Oral hypofunction and malnutrition among community-dwelling older adults: Evidence from the Otassha study

OBJECTIVE

This study investigated the association between oral hypofunction and malnutrition among community-dwelling older adults.

BACKGROUND

Oral hypofunction, a 7-component phenotype of the clinical features of oral health, has been described in Japan. Data about its association with nutritional status are limited.

MATERIALS AND METHODS

This cross-sectional study enrolled 715 adults (mean age, 73.5 years; range, 65-91 years) from the Otassha Study. Oral hypofunction was defined as the presence of ≥3 of the following 7 components: poor oral hygiene; oral dryness; low occlusal force; low articulatory oral motor skill; low tongue pressure; low masticatory performance; and compromised swallowing function. The Mini Nutritional Assessment^® -Short Form (MNA^® -SF) was used to assess the nutritional status. Malnutrition was defined as having an MNA^® -SF score of seven or less. The association between oral hypofunction and nutritional status was evaluated using ordinal logistic regression analyses.

RESULTS

The prevalence rates of oral hypofunction and malnutrition were 42.7% and 4.1%, respectively. Multivariable Poisson regression analyses revealed that oral hypofunction was associated with malnutrition. The adjusted relative risk of malnutrition in the study participants with oral hypofunction was 3.00 with a 95% confidence interval of 1.29-6.98.

CONCLUSION

Community-dwelling older adults whose oral functions were compromised in multiple aspects had poor nutritional status.

Dental prosthetic treatment reduced the risk of weight loss among older adults with tooth loss

OBJECTIVES

Weight loss is a critical health issue in older adults. Oral function is essential for nutrient intake and can be restored using dental prosthetic treatments in patients with tooth loss. This study aimed to investigate the relationship between tooth loss and weight loss among the older adults and to evaluate the magnitude of its risk reduction by dental prosthetic treatment.

DESIGN

Three-year follow-up longitudinal study based on a self-reported questionnaire.

SETTING

Community-dwelling older adults in Japan.

PARTICIPANTS

Adults aged 65 and older (n = 53,690).

MEASUREMENTS

We used >10% weight loss during follow-up, the number of remaining teeth, and the use of dental prostheses as the outcome variable, exposure variable, and mediator, respectively. We fitted the logistic regression model including possible confounders and calculated the odds ratios (ORs) and 95% confidence intervals (95% CIs) of the controlled direct effect (CDE) at the level of use or nonuse of the dental prosthesis based on a causal mediation analysis framework. Additionally, we calculated the proportion eliminated by the dental prosthesis.

RESULTS

The mean age of participants was 72.6 years (1 SD = 5.5), and 47.4% were males. About 5.8% (n = 3132) of them experienced >10% weight loss during the follow-up. Weight loss was observed in 6.8% of the participants with 0-19 remaining teeth and in 4.3% of them with ≥20 remaining teeth. The CDE of 0-19 remaining teeth was greater when no one used dental prosthesis (OR = 1.41; 95% CI = 1.26-1.59) compared with that when all participants used dental prosthesis (OR = 1.26; 95% CI = 1.08-1.46). This indicated that dental prosthesis decreased the risk of weight loss by 37.3%.

CONCLUSION

Our study revealed that tooth loss increased the risk of clinically critical levels of weight loss among community-dwelling older adults. However, this risk was reduced by dental prosthetic treatment.

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 Chewing Ability and Nutritional Status in Japanese Older Adults: A Cross-Sectional Study

Objectives: This study aimed to determine the relationship between objective chewing ability and the nutritional status of Japanese community-dwelling elders. Design: A cross-sectional study. Participants: A total of 509 community-dwelling elders living in the Tokyo metropolitan area participated in a comprehensive survey conducted in October 2013. Measurements: The basic characteristics were sex, age, and body mass index. Undernutrition was examined through serum albumin levels. Chewing ability was examined through color-changeable xylitol gum by evaluating the color changes in chewing gum. Nutritional intake was examined using the semi-quantitative food frequency questionnaire. Results: In the poor chewing ability group, all nutrient intake levels were significantly low, except for carbohydrates, and intake levels for all food groups were significantly low, except for cereals, confectionery, sugars, seasonings, and spices. Additionally, after adjusting for covariates for sex, age, Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC) score, Mini-Mental State Examination (MMSE) score, body mass index (BMI), stroke, number of functional teeth, energy intake, and protein intake, chewing ability was found to be significantly associated with undernutrition. Conclusion: We concluded that chewing ability was closely associated with nutrient and different food groups’ intake, as well as undernutrition, among Japanese community-dwelling elders. Thus, to ensure comprehensive nutritional management, nutritionists and dentists should collaborate when treating the same patients.

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.

Associations between Chewing Difficulty, Subjective Cognitive Decline, and Related Functional Difficulties among Older People without Dementia: Focus on Body Mass Index

OBJECTIVE

This study aimed to determine whether chewing difficulty is associated with subjective cognitive decline (SCD) and related functional difficulties by body mass index.

DESIGN

A population-based cross-sectional study.

SETTING AND PARTICIPANTS

A nationwide sample of 54,004 individuals aged ≥65 years from the 2018 Korea Community Health Survey.

MEASUREMENTS

SCD and SCD-related functional difficulties were measured using the cognitive decline module of the Behavioral Risk Factor Surveillance System. Chewing difficulty was assessed based on a self-report questionnaire from an oral health-related behaviors interview survey. BMI was calculated from objective values by measuring height and weight through a physical meter.

RESULTS

Among the 54,004 individuals, the prevalence of SCD in underweight, overweight, and obesity group was 33.6% (n = 806), 30.3% (n = 9,691), and 28.7% (n=5,632) respectively. Chewing difficulty was associated with SCD and SCD-related functional difficulties. This association was more pronounced in underweight (BMI: <18.5 kg/m2) people [underweight: (odds ratio [OR] = 1.68, 95% confidence interval [CI] 1.48-1.92); normal weight: OR = 1.13, 95% CI 1.04-1.22; obese: OR = 1.15, 95% CI 1.05-1.27]. Similar trends were demonstrated for SCD-related functional difficulties (underweight: OR = 1.53, 95% CI 1.17-2.01; normal weight: OR = 1.36, 95% CI 1.15-1.63; obese: OR = 1.50, 95% CI 1.22-1.86).

CONCLUSIONS

Chewing difficulty was associated with SCD and SCD-related functional difficulties in older people. Our results suggest that underweight status may play roles in the associations between chewing difficulty and SCD and SCD-related functional difficulties.

Association of dental occlusal support with the Prognostic Nutritional Index in patients with esophageal cancer who underwent esophagectomy

BACKGROUND

The Prognostic Nutritional Index is useful for predicting surgical risk and overall survival based on preoperative immunological and nutritional status in patients undergoing digestive organ cancer surgery. The purpose of this study was to examine the association between the Prognostic Nutritional Index and dental status in patients with esophageal cancer who underwent esophagectomy.

METHODS

This retrospective case-control study included 73 patients who underwent resection of esophageal cancer (69 males, 4 females; age 36-83). General and dental status were evaluated. The Prognostic Nutritional Index was calculated based on the serum albumin concentration and the total lymphocyte count, and subjects were divided into two groups based on index scores: a higher group, characterized by scores ≥ 45 (n = 54); and a lower group, characterized by scores < 45 (n = 19). Univariate analysis and multiple logistic regression analyses were used to compare between groups.

RESULTS

Total protein, C-reactive protein, the number of sound and total decayed, missing and filled teeth, and the rate of patients with poor dental occlusal support showed significant differences between the lower and higher Prognostic Nutritional Index groups (p < 0.05). Stepwise logistic regression analysis by backward selection approach showed that low total protein, few sound teeth, and poor status of dental occlusal support were significantly associated with the lower Prognostic Nutritional Index (p = 0.007, 0.042, and 0.009, respectively).

CONCLUSION

Dental status, especially dental occlusal support and the number of sound teeth, showed a positive relationship with the Prognostic Nutritional Index in esophageal cancer patients who underwent esophagectomy.

A Two-Year Longitudinal Study of the Association between Oral Frailty and Deteriorating Nutritional Status among Community-Dwelling Older Adults

Background: Limited longitudinal studies exist to evaluate whether poor oral health and functions affect the incidence of deteriorating nutritional status. We investigated if there were longitudinal associations between oral frailty, defined as accumulated deficits in oral health, and deteriorating nutritional status among community-dwelling older adults. Methods: The study population consisted of 191 men and 275 women (mean age, 76.4 years) from the Takashimadaira Study. Multifaced oral health assessment was performed at baseline, and oral frailty was defined as having ≥3 of the following six components: fewer teeth, low masticatory performance, low articulatory oral motor skill, low tongue pressure, and difficulties in chewing and swallowing. Nutritional status assessment was performed at baseline and two-year follow-up using the Mini Nutritional Assessment^®-Short Form (MNA^®-SF). Deteriorating nutritional status was defined as a decline in the nutritional status categories based on the MNA^®-SF score during the study period. The association between oral frailty and deteriorating nutritional status was assessed using logistic regression analyses. Results: Oral frailty was observed in 67 (14.4%) participants at baseline. During the study, 58 (12.4%) participants exhibited deteriorating nutritional status. After adjusting for potential confounders, oral frailty was significantly associated with deteriorating nutritional status (adjusted odds ratio, 2.24; 95% confidence interval, 1.08–4.63). Conclusion: Community-dwelling older adults with oral frailty had an increased risk of deteriorating nutritional status.

Aging and Senescence of Dental Pulp and Hard Tissues of the Tooth

The ability to consume a meal using one's own teeth influences an individual's quality of life. In today's global aging society, studying the biological changes in aging teeth is important to address this issue. A tooth includes three hard tissues (enamel, dentin, and cementum) and a soft tissue (dental pulp). With advancing age, these tissues become senescent; each tissue exhibits a unique senescent pattern. This review discusses the structural alterations of hard tissues, as well as the molecular and physiological changes in dental pulp cells and dental pulp stem cells during human aging. The significance of senescence in these cells remains unclear. Thus, there is a need to define the regulatory mechanisms of aging and senescence in these cells to aid in preservation of dental health.

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.

Functional dentition and changes in dietary patterns among older adults in Thailand

OBJECTIVE

To investigate the relationship between functional dentition (FD) and changes in dietary patterns (DP) in older adults.

DESIGN

This was a 12-month prospective study, with dental examinations at baseline and questionnaires at baseline and follow-up. Dentition was classified as FD (containing ≥10 occlusal contacts), non-FD with dentures and non-FD without dentures. A 154-item FFQ assessed dietary intake in the previous month. Food items (servings/d) were combined into twenty-two food groups based on their similar nutrient profile, culinary use and previous studies in Thailand. DP were identified through factor analysis of baseline intake and applied scores were used to estimate changes in DP scores. The association between baseline FD (exposure) and change in each DP score (outcome) was tested in linear regression models adjusting for baseline socio-demographic factors, behaviours, chronic conditions, medications, total energy intake and DP score.

SETTING

Phetchaburi, Thailand.

PARTICIPANTS

Totally, 788 community dwellers aged ≥ 60 years.

RESULTS

In total, 651 participants were retained after 12 months (82·6 % retention rate), of whom 14·1 % had FD. Having an FD was positively associated with larger increases in vegetable intake. Three DP were identified. Participants with FD had larger increases in healthy (0·13; 95 % CI: -0·13, 0·39) and carbohydrate-rich diets intake (0·12; 95 % CI: -0·17, 0·40) as well as larger reductions in meat-rich diet intake (-0·12; 95 % CI: -0·45, 0·21) than those with neither FD nor dentures. However, these differences were not significant.

CONCLUSION

There was little support for an association between baseline FD and changes in DP.

Effect of oral health intervention on cognitive decline in community-dwelling older adults: A randomized controlled trial

PURPOSE

The incidence of dementia is rapidly increasing worldwide, especially in developed countries. Little is known regarding the effectiveness of dental intervention to prevent dementia or a decline in cognitive functions among community-dwelling older adults, but a few studies have reported a correlation between the lack of regular dental checkups and dementia. For that reason, this study aimed to investigate the effects of oral health intervention on cognitive functions in community-dwelling subjects with a mild cognitive decline via a randomized controlled trial.

PATIENTS AND METHODS

Fifty-five community-dwelling older adults with a Mini-Mental State Examination score of ≥21 to ≤26 who had not visited a dental clinic in the previous year were randomized to an intervention group (n = 28) or a control group (n = 29). The intervention group received monthly oral health intervention by dental hygienists for 8 months while the control group did not. Data on demographics, cognitive function and oral parameters were collected before and after the intervention.

RESULTS

Twenty-five subjects in the intervention group (mean age 77.0 years) and 25 in the control group (mean age 72.8 years) completed the study. Significant improvements were observed in the Trail Making Test (TMT)-A, TMT-B, bleeding on probing rate, oral diadochokinesis, tongue pressure and chewing ability in the intervention group (P < 0.05). There were also significant interactions between the TMT-A and TMT-B scores, oral diadochokinesis, tongue pressure and chewing ability (P < 0.05).

CONCLUSION

Oral health intervention by dental hygienists may be effective for improving the oral health and executive function of cognitive function assessed via TMT.

Oral Manifestations of Systemic Diseases

Signs and symptoms representative of a systemic condition can manifest in the oral cavity and orofacial region. Such conditions may be previously diagnosed, or the orofacial manifestation may be the presenting sign of an acute or chronic systemic condition not previously diagnosed. Pathologic processes in the mouth, jaws, and contiguous structures could have a direct and indirect impact on the patient's overall systemic condition. Moreover, systemic conditions may result in compromised function of the orofacial region or impact patients' oral health profile. This article reviews selected systemic conditions that present or impact on the oral cavity and orofacial region.

Dentition and nutritional status of aged New Zealanders living in aged residential care

BACKGROUND

Previous studies of the nutritional status of older individuals have used measures such as plasma vitamin and mineral levels, which can be difficult to interpret. The relationship between nutrition and dentition has been limited to studying exposures such as the number of posterior occluding pairs of teeth, edentulousness, and the number of natural teeth.

OBJECTIVES

To investigate the association between dentition status and nutritional status in a national survey of older New Zealanders living in aged residential care facilities.

MATERIAL AND METHODS

Secondary analysis of clinical oral status and nutrition data collected in 2012 in New Zealand's Older People's Oral Health Survey. The validated Mini Nutritional Assessment short format was used to categorize participants as "normal nutritional status," "at risk of malnutrition" or "malnourished."

RESULTS

Just under half of older New Zealanders living in aged residential care facilities were classified as either at risk of malnutrition or malnourished (with about one in sixteen in the latter category). The prevalence of malnutrition was higher among those in hospital-level and psychogeriatric-level care, as well as in those of high socioeconomic status. Individuals who were at risk of malnutrition had the most untreated dental caries and untreated coronal caries. Relative to their counterparts in nursing-home-level care, dentate individuals in hospital-level care were 2.4 times-and those in psychogeriatric-level care were 2.8 times-as likely to be malnourished or at risk of it.

CONCLUSIONS

Just under half of the New Zealanders living in aged residential care were at risk of malnutrition or were malnourished. Greater experience of untreated dental caries was associated with a higher rate of being malnourished or at risk of it. Poorer cognitive function and greater dependency were important risk indicators for malnutrition.

Functional Dentition and 12-Month Changes in Body Measurements among Thai Older Adults

This study evaluated the association of functional dentition with 12-month changes in body measurements and nutrient intake among older adults. Data from 651 community dwellers, aged 60 years and over, in Phetchaburi, Thailand, were analysed (retention rate: 83%). Data were collected via interviews (including a semi-structured food frequency questionnaire), anthropometric measurements and dental examinations. Associations were tested in linear regression models adjusted for baseline sociodemographic factors, behaviours, chronic conditions and medications. On average, participants experienced a significant increase in body mass index (BMI) and significant decreases in waist circumference (WC) and triceps skinfold thickness (TSF). A negative, albeit not significant, association between functional dentition and change in BMI was observed after adjusting for confounders. Whilst participants who had non-functional dentition without dentures experienced increases in BMI (predicted mean change: 0.25; 95% Confidence Interval: 0.09, 0.41), those who had non-functional dentition with dentures (0.21; 95%CI: −0.08, 0.50) and functional dentition (−0.07; 95%CI: −0.42, 0.28) remained stable. No similar trends were noted for WC or TSF. Functional dentition was not associated with changes in nutrient intake either. The findings provide little evidence on the association of functional dentition with short-term changes in nutrient intake or nutritional status.

Dentition, nutritional status and adequacy of dietary intake in treatment naïve head and neck cancer patients

OBJECTIVES

To examine the relationship of reduced numbers of occluding teeth and dietary intake (DI), nutrition impact symptoms (NIS), and weight loss (WL) in head and neck cancer (HNC) patients.

METHODS

As a part of the standard of care, treatment-naïve HNC patients (n = 104) completed dental evaluation (number of teeth, total anterior/posterior occlusal teeth, Eichner Index (EI) classification), WL, DI questionnaire and HNC Symptom Checklist©. Descriptive statistics (Kruskal-Wallis, Fisher-exact, χ² tests) and (uni-) multi-variable logistic regression.

RESULTS

Overall, 42, 45 and 13% of patients were in EI-class A, B and C with a median of 8, 3, and 0 total posterior occlusal teeth. EI-class B/C patients were older, more likely to have impaired DI (OR = 3.88; 95%CI:1.63-9.26; P = 0.002) and reported interference with DI by 11 NIS (p < 0.05). DI was, however, reported as unimpaired in 77, 49 and 39% of patients in EI-class A, B and C, respectively. The subset of EI-class B/C patients with impaired DI, had more NIS interference with DI (P < 0.05; difficulty chewing, pain, early satiety, lack of energy); EI-class C patients additionally had dry mouth, thick saliva and dysphagia (P < 0.05). In logistic regression, EI-classes B/C patients with reduced (vs unimpaired) DI were more likely to have ≥5% WL (OR = 10.1; 95%CI:2.0-50.0), higher NIS interference (range OR 4.3-10.7).

CONCLUSIONS

More than half of these HNC patients had reduced numbers of occlusal teeth or were edentulous. EI-class B/C patients did not necessarily have impaired DI, however the combination of EI-class B/C and a constellation of NIS, associated with reduced DI.

CLINICAL SIGNIFICANCE

Treatment naïve head and neck cancer (HNC) patients with reduced occlusal and masticatory performance (Eichner Index B/C) and reduced dietary intake are at high risk for weight loss. Identifying HNC patients at risk may improve their oral health, dietary intake and reduce their risk of weight loss.

Combined effect of poor appetite and low masticatory function on sarcopenia in community-dwelling Japanese adults aged ≥ 75 years: A 3-year cohort study

OBJECTIVE

This study aimed to investigate the longitudinal association of the combination of poor appetite (PA) and low masticatory function (LMF) with sarcopenia in community-dwelling older adults.

METHODS

In total, 173 community-dwelling Japanese adults aged ≥ 75 years participated in the 3-year cohort study. Appetite assessment using the Simplified Nutritional Appetite Questionnaire (SNAQ) and masticatory function assessment using spectrophotometric measurement of differences in gum colour before and after masticating colour-changeable chewing gum (ΔE*ab) were performed at baseline. SNAQ score of ≤ 14 was defined as PA. The lowest tertile of ΔE*ab was defined as LMF. Follow-up examinations were administered annually over a 3-year period to determine sarcopenia incidence, which was defined by the criteria proposed by the Asian Working Group for Sarcopenia. Adjusted hazard ratios (HRs) of sarcopenia incidence according to the presence of PA and LMF were calculated using Cox proportional hazards regression models.

RESULTS

At baseline, 81 participants (46.8%) had neither PA nor LMF, 34 (19.7%) had PA alone, 35 (20.2%) had LMF alone, and 23 (13.3%) had both PA and LMF. On follow-up, 31 participants (17.9%) developed sarcopenia. After adjusting for covariates, the adjusted HR for sarcopenia in participants with both PA and LMF was 4.4 (95% confidence interval = 1.6-12.2) compared with those without PA or LMF. PA or LMF alone was not significantly associated with sarcopenia development.

CONCLUSIONS

Coexisting PA and LMF increase the risk of sarcopenia development among community-dwelling Japanese adults aged ≥ 75 years.

Relationship between Oral Assessment Guide score and hypoalbuminemia in newly hospitalized patients

This cross-sectional study investigated the relationship between Oral Assessment Guide (OAG) scores and malnutrition in newly hospitalized patients. A total of 880 hospitalized adults were enrolled. Hypoalbuminemia was defined as serum albumin less than 3.5 g/dL. Patients with hypoalbuminemia were older (P < 0.001), had a higher prevalence of respiratory diseases (P < 0.01), a higher prevalence of digestive diseases (P < 0.01), a lower prevalence of oral feeding (P < 0.001), a lower body mass index (P < 0.001), and higher OAG scores (P < 0.001) than those without hypoalbuminemia. Multivariate logistic regression analyses showed that the prevalence of hypoalbuminemia was significantly related to age (odds ratio [OR] = 1.05, P < 0.001), absence of oral feeding (OR = 2.72, P < 0.001), presence of respiratory diseases (OR = 2.53, P < 0.01), presence of digestive diseases (OR = 1.64, P < 0.01), and OAG scores (OR = 1.14, P < 0.01). Regarding OAG scores, the OR of hypoalbuminemia was greater in patients with disorders (scores 2 or 3) of swallowing (vs. score 1, OR = 1.83, P < 0.05) and saliva (vs. score 1, OR = 1.51, P < 0.05). There appears to be a positive association between OAG scores and hypoalbuminemia in hospitalized patients.

Impact of Tongue Pressure and Peak Expiratory Flow Rate on Nutritional Status of Older Residents of Nursing Homes in Japan: A Cross-Sectional Study

OBJECTIVES

Swallowing function is critical for continuing oral feeding to prevent frailty in older adults. In this study, we investigated the impact of tongue pressure and pulmonary function on the nutritional status of older adults.

DESIGN, SETTING, PARTICIPANTS

This cross-sectional study was conducted in Kitakyushu, Japan from August 2017 to November 2018. Fifty-two residents aged >65 years of age from three nursing care insurance facilities in Kitakyushu City, Japan were recruited.

MEASUREMENTS

Oral health status, swallowing function, nutritional status using a mini nutritional assessment short form (MNA-SF), cognitive function, activities of daily living, peak expiratory flow rate (PEFR) for pulmonary function, and tongue pressure were assessed. The associations between nutritional status and the above factors were analysed using a logistic regression model.

RESULTS

Participants were divided into two groups: well-nourished group (MNA-SF ≤12) and undernutrition group (MNA-SF <12). Multivariate logistic regression analysis revealed that the correlations of PEFR [odds ratio (OR) = 0.23, 95% confidence interval (CI) = 0.23-0.89 p=0.033) and tongue pressure (OR = 0.88, 95% CI = 0.88-0.99, p=0.029) remained significant even after adjustment with possible confounders.

CONCLUSION

Maximum tongue pressure and PEFR in older adults were significantly associated with their nutritional status. These findings suggest that maintaining oral and pulmonary function may be a preventive factor against a decrease in the nutritional status of older frail adults.

Association between metabolic syndrome and tooth loss: A systematic review and meta-analysis

BACKGROUND

The authors conducted a systematic review and meta-analysis to verify the existence and level of scientific evidence concerning the association between metabolic syndrome (MetS), as the main exposure, and tooth loss (TL), as the outcome.

TYPES OF STUDIES REVIEWED

Through electronic databases and partially through gray literature, the authors identified observational studies in adults. The authors used no date or language restrictions. The authors evaluated the studies' methodological quality by using the Newcastle-Ottawa Scale. The authors conducted a random-effects model meta-analysis. The authors assessed the quality of evidence by using the Grading of Recommendations Assessment, Development and Evaluation criteria.

RESULTS

Twelve studies met the eligibility criteria, and 9 were retained for the meta-analysis. Most were cross-sectional studies with good methodological quality. Participants with MetS had fewer teeth (standardized mean difference, -2.77; 95% confidence interval, -4.56 to -0.98) and an increased likelihood of lacking functional dentition (odds ratio, 2.37; 95% confidence interval, 1.89 to 2.96) than did those without MetS. The overall quality of evidence was very low.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Better-conducted longitudinal studies are necessary to establish a causal relationship between MetS and TL to inform the best strategies to prevent TL in populations with MetS.