Can masticatory performance be predicted by using food acceptance questionnaire in elderly patients with removable dentures?

Development of the Food Acceptance Questionnaire for Thai Partial and Complete Edentulism

This study aimed to develop the Food Acceptance Questionnaire (FAQ) to assess the masticatory ability of Thai older adults (≥60 years). Fifty participants were interviewed using open-ended questions about food they regularly consumed and avoided due to difficulty chewing. From a list of 140 items, 100 were recruited for a trial version of the FAQ. A total of 154 participants responded to the 5-point Likert scale on their chewing perception of each food item (1, impossible to chew; 5, most easily eaten). The average response of each food item was used as the chewing index (CI). The 100 food items were ranked and divided into five grades based on their CIs. Masticatory performance (MP) was objectively assessed by a visual scoring method using gummy jelly (UHA Mikakuto). Two foods from each grade that demonstrated the highest correlation with MP were selected to form the final 10-item FAQ. The FAQ score was calculated by summarizing the responses of 10 items. MP correlated strongly with the FAQ score (r = 0.57, p < 0.001), indicating its predictive validity. Furthermore, the FAQ indicates strong internal consistency (Cronbach's alpha coefficient = 0.90), indicating high reliability. In conclusion, this newly developed 10-item FAQ is valid and reliable for assessing the masticatory ability of Thai older adults.

Texture Analysis of Food Samples Used for the Evaluation of Masticatory Function

Introduction Food questionnaire surveys are often used to evaluate masticatory function. In daily clinical practice in Japan, a survey is performed using a list of food groups suitable for the Japanese diet. The foods on the list were categorized into five food groups based on their mastication index. The patient's masticatory function is determined by the food groups that can be eaten. The masticatory index, which indicates chewability, was defined based on the percentage of 110 denture wearers who responded that they could eat food normally. A survey with this list is useful because of its simplicity; however, there is a lack of objective data on the physical properties of food samples. Consequently, to make the results of the food questionnaire survey more objective indicators, we performed a texture analysis of the food samples on the list. Methods We performed a texture analysis of 93 samples from 77 food items on the list. Compression tests were performed using a texture analyzer, and hardness, cohesiveness, adhesiveness, viscosity, and gumminess were calculated by a texture profile analysis. Results Even with the same ingredients, the results differed depending on the presence or absence of food skin, the direction of pressing (vertical or horizontal), cooking methods, and temperature differences. However, the masticatory index was negatively correlated with hardness (-0.4157, p<0.001) and gumminess which is determined as the product of hardness×cohesiveness (-0.4980, p<0.001). Conclusion This study suggests that the masticatory index indicating chewability may be related to the hardness and cohesiveness of food samples. Even for foods with the same hardness, the degree of difficulty in forming a food mass is expected to vary depending on differences in cohesiveness. Moreover, the presence or absence of food skin, the direction of food fibers, cooking methods, and temperature differences change the physical properties of the food. Therefore, the composition and structure of the foods or eating habits of patients should be taken into consideration when conducting a food questionnaire survey.

The relationships between mastication and cognitive function: A systematic review and meta-analysis

Masticatory function such as chewing is expected to modify human cognitive function, and/or the possibility of improving cognitive function is also predicted. This systematic review investigated whether masticatory function affects cognitive function for older/young adults. Full articles written in English from January 2000 to April 2022 were collected using PubMed and Cochrane Library. Target outcomes were cognitive function test scores, cognitive processing speed (reaction time), and masticatory function. For each research question, two independent reviewers conducted the search and screening, data extraction, quality assessment, and risk of bias assessment. The reviewers resolved any disagreements by discussion. From 226 articles retrieved, 20 were included in this review. Older adults with lower scores on the cognitive function test had lower masticatory performance, lower chewing ability, chewing difficulty, and decreased number of teeth. An increased risk of cognitive impairment was found in older adults with masticatory dysfunction. For young adults, gum chewing significantly reduced the processing speed of cognitive tasks compared to no gum chewing. Although most of the evidence included had a low level of evidence and a high risk of bias because of the research designs, the results still suggest that mastication may be a factor in improving cognitive function.

Usefulness of the masticatory score by occlusal support

This study aimed to clarify the usefulness of masticatory score by occlusal support. A total of 605 adults were classified into four groups (A1, A2A3, B, and C) according to the Eichner classification, and the relationship between the amount of glucose eluted and masticatory score was investigated in each group. A significant correlation between the glucose eluted and masticatory score was observed in groups A2A3, B, and C, but not in A1, suggesting that the masticatory score is useful for evaluating the masticatory performance of complete denture wearers, but not adults with natural dentition.

The impact of residual ridge morphology on the masticatory performance of complete denture wearers

Statement of the problem

Morphology of the residual ridge (RR) is expected to influence the masticatory performance (MP) of complete denture (CD) patients, but considerable details of this relationship are unknown.

Purpose

We aimed to investigate the association between the objective MP and RR morphology of CD wearers and other contributory factors affecting their MP.

Materials and methods

Sixty-five patients with well-fitting upper and lower CDs with no complaints of pain were enrolled. The objective MP was measured using test gummy jelly and a fully automated measuring device. The RR form was divided into U-type, V-type, I-intermediate, and F-Flat, then combinations of upper and lower RR forms (combined RR) were classified. The height was measured using CD's denture basal surface replicas, while occlusal contact of CDs was assessed using a tooth contact analysis system. The relationship between surveyed factors and MP was evaluated using Spearman's rank correlation, Kruskal-Wallis test, generalized linear regression, and analysis of covariance.

Results

Participants with F-F and V-F combined RR forms had the lowest MP, while those with U-U and U-I forms had the highest MP, regardless of RR height. Participants with low RR height had the lowest MP, and those with high RR height had the highest MP, regardless of RR form. The analysis of covariance revealed that mandibular RR height, combined RR forms, and total occlusal contact area significantly affected the MP.

Conclusions

Our findings confirmed that the mandibular RR height, RR form combinations, and occlusal contact influence the MP of CD wearers.ClinicalImplications:The MP of CD wearers varied, depending on the height and form of the RR, as well as the occlusal contact area of the CDs. The results of this manuscript show that the morphology of the denture bearing area and the occlusion of the CDs are essential factors in predicting the treatment outcome of CD wearers. This allows the clinician to fabricate a complete denture with the denture basal surfaces adjusted and occlusion provided according to the patient. CD patients can be educated on how to chew to improve MP based on their own RR morphology.

Association between masticatory performance and oral conditions in adults: A systematic review and meta-analysis

OBJECTIVES

To give an overview of the evidence on the associations between oral condition factors and masticatory performance of adults, and to evaluate the direction and level of the associations.

DATA/SOURCES

Medline (PubMed), Embase (Ovid) and CINAHL Plus (EBSCOhost) were searched up to May 2022 for cross-sectional studies on oral conditions and masticatory performance in adults. Methodological quality of the included studies was independently evaluated based on the Joanna Briggs Institute critical appraisal checklist for analytical cross-sectional studies. Data on the associations between oral condition factors and masticatory performance were extracted. Meta-analysis was conducted on correlation coefficients.

STUDY SELECTION

Of the 8,035 records identified, 97 articles (88 studies) were included in the qualitative synthesis, and 18 studies were included in the meta-analyses. Among the oral condition factors that had associations with masticatory performance, the number of natural/remaining teeth or functional tooth pairs was reported by the largest number of studies, followed by perioral muscle status, dental prosthetic status, oral moisture status and periodontal status. Results of the meta-analyses showed that the positive association with the number of natural/remaining teeth was the strongest (pooled correlation coefficient: 0.51, 95%CI: 0.48 to 0.54), followed by the number of functional tooth pairs, maximum tongue force/pressure, while the association with the oral moisture status was the weakest.

CONCLUSIONS

Number of natural/remaining teeth and functional tooth pairs, perioral muscle status, oral moisture status, dental prosthetic status and periodontal status are the main oral condition factors influencing masticatory performance. Based on the limited evidence available, among these factors, the number of natural/remaining teeth has the strongest positive association, with a very low quality of evidence.

CLINICAL SIGNIFICANCE

This study provides valuable information on the oral condition factors associated with masticatory performance, which would be important for policymakers and clinical practitioners when deciding on the strategies for improving the masticatory performance of adults. This review highlights the need for standardization of measures and classifications of masticatory performance and oral conditions.

REGISTRATION

PROSPERO (registration number: CRD42021256824).

Effective oral function improvement by restoration-driven implant treatment after mandibular resection with a scapular flap: a case report

BACKGROUND

The extensive loss of teeth and surrounding tissues due to mandibulectomy for an oral tumor not only impacts negatively on appearance, but also often causes various functional disorders, decreasing quality of life (QOL). In the present case, reconstruction with a scapular flap was carried out along with segmental mandibulectomy, aiming for functional restoration through restoration-driven implant treatment. A good outcome was obtained, with improvement of masticatory function and QOL following the prosthetic treatment.

CASE PRESENTATION

The patient was a 37-year-old woman diagnosed with ossifying fibroma in the left side of the mandible. Segmental mandibulectomy and reconstruction with a scapular flap were carried out. Implant diagnostic simulation was performed, and based on the result, secondary reconstruction using a particulate cancellous bone and marrow graft was carried out by an oral surgeon. After wound healing was complete, implant placement was performed twice, and the final prosthodontic treatment was completed. Masticatory performance and maximum bite force, which are indices of masticatory function, were improved from before to after prosthetic treatment. In addition, oral health-related QOL was improved from before to after prosthetic treatment.

CONCLUSION

In the present case, restoration-driven implant treatment was performed in a patient following segmental mandibulectomy for a mandibular tumor, with a good outcome. Planning the treatment measures with a focus on the final prosthetic vision can lead to improvement of oral function in patients with extensive mandibular defects.

Comparison of oral hypofunction tests and determination of reference values for a subjective masticatory function test

Background

In Japan, oral hypofunction has been recognized as a disease since 2018. An alternative to occlusal force testing for assessing oral hypofunction is the evaluation of the number of natural teeth. Subjective masticatory function testing, which evaluates the ease or difficulty in chewing foods, is an effective alternative to occlusal force testing. However, no reference values have been established for this test. We determined the reference values of the subjective masticatory function test and evaluated its potential as a substitute for the number of natural teeth for assessing oral hypofunction.

Methods

The sample consisted of 184 older adults who visited the Department of Geriatric Dentistry, Showa University Dental Hospital, from July 2018 to January 2020. The subjective masticatory function test (table for evaluation of chewing function in complete denture wearers [Chewing Score 20]) was performed using 20 foods. The occlusal force test and a receiver operating characteristic curve were used to determine the reference values for Chewing Score 20. The sensitivity, specificity, and positive and negative predictive values were calculated and compared with the occlusal force test and the number of natural teeth.

Results

A significant correlation (r) was found between the occlusal force test and the Chewing Score 20 (r = 0.526, p < 0.001). The reference value for Chewing Score 20 was < 85. Although the Chewing Score 20 was less sensitive than the number of natural teeth, it demonstrated a higher specificity and a positive predictive value.

Conclusion

Herein, a score of < 85 on the subjective masticatory function test was determined to be the optimal quantitative reference. The subjective masticatory function test may be used as an alternative for assessing oral hypofunction.

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.