Improvements in oral functions of elderly after simple oral exercise

Orofacial and cervical myofunctional intervention programmes for older adults: A scoping review

INTRODUCTION

Senescent stomatognathic systems undergo anatomical changes that are not always compensated by physiology due to associated factors such as poorly fitted dentures, dental changes, and clinical conditions that trigger sarcopenia. When these conditions are not properly addressed, they can lead to nutritional deficiencies. Hence, this study aimed to map orofacial and cervical myofunctional intervention programmes for older adults, evaluate the current research in this area, and formulate suggestions for further investigation.

METHODS

Scoping review is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist. The EMBASE, LILACS, PubMed/Medline, Scopus, Web of Science, and grey literature databases were systematically searched. Studies addressing therapeutic programmes, myofunctional exercises, and their influence on the stomatognathic system of older adults were included. Studies with populations younger than 60 years, residing in long-term care facilities, homes, or hospital care, and with associated comorbidities were excluded, as well as secondary studies.

RESULTS

A total of 3098 studies were retrieved. After applying the eligibility criteria, nine studies were eligible for this review. The nine studies were published in English between 2008 and 2021 in the United States, Japan, and South Korea. The participants' mean ages ranged from 64 to 81 years, with a preponderance of females. Six of the studies divided the sample into intervention and control groups. Two studies referred to programmes to promote oral function through facial expression and tongue muscle exercises, salivary gland massage, and swallowing biomechanics. Seven studies report the positive influence of myofunctional exercises on the stomatognathic system.

CONCLUSION

The mapping concluded that therapeutic programmes, including educational actions, help prevent orofacial myofunctional disorders, and improve the functionality of the stomatognathic system.

The oral organ: A new vision of the mouth as a whole for a gerophysiological approach to healthy aging

This article brings a new perspective on oral physiology by presenting the oral organ as an integrated entity within the entire organism and its surrounding environment. Rather than considering the mouth solely as a collection of discrete functions, this novel approach emphasizes its role as a dynamic interphase, supporting interactions between the body and external factors. As a resilient ecosystem, the equilibrium of mouth ecological niches is the result of a large number of interconnected factors including the heterogeneity of different oral structures, diversity of resources, external and internal pressures and biological actors. The manuscript seeks to deepen the understanding of age-related changes within the oral cavity and throughout the organism, aligning with the evolving field of gerophysiology. The strategic position and fundamental function of the mouth make it an invaluable target for early prevention, diagnosis, treatment, and even reversal of aging effects throughout the entire organism. Recognizing the oral cavity capacity for sensory perception, element capture and information processing underscores its vital role in continuous health monitoring. Overall, this integrated understanding of the oral physiology aims at advancing comprehensive approaches to the oral healthcare and promoting broader awareness of its implications on the overall well-being.

Chewing ability and its associated factors among community-dwelling older adults in Chengdu, China: A cross-sectional study

AIM

To investigate the current status of chewing ability and analyze the risk factors among Chinese community-dwelling older adults.

METHODS

In this cross-sectional study, color-changeable gum and a color difference meter were used to assess chewing ability in the population. The statistical analysis employed multivariate logistic regression models to identify and quantify the factors influencing chewing ability.

RESULTS

A total of 373 community-dwelling adults aged 65 and older in Chengdu, in the west of China, were included in this study; 64 individuals (17.2%) exhibited signs of poor chewing ability. Female (odds ratio [OR]: 0.124, 95% CI: 0.057-0.268, p < .001), education level with college degree and above (OR: 0.114, 95% CI: 0.030-0.434, p = .001), number of teeth less than 20 (OR: 5.401, 95% CI: 2.509-11.626, p < .001), and decreased oral diadochokinesis (OR: 4.445, 95% CI: 1.775-11.132, p = .001) were significant factors in chewing ability in this study, after adjustment for potential variables.

CONCLUSIONS

The prevalence of decreased chewing ability among Chinese community-dwelling older adults was 17.2% and decreased chewing ability was associated with men, lower education level, less than 20 teeth and decreased oral diadochokinesis.

Effect of gum-chewing exercise on maintaining and improving oral function in older adults: A pilot randomized controlled trial

Background/purpose

Gum chewing has been found to improve oral function. Nevertheless, few randomized controlled trials have investigated the effects of gum-chewing exercises on oral function in older adults. This study aimed to examine the effect of gum-chewing exercises on oral function in older adults.

Materials and methods

This was a single-blind, randomized controlled trial, conducted from November 2021 to January 2022. A total of 130 participants were divided randomly into the intervention and control groups. The intervention group was told to chew experimental gums for one month, while the control group was instructed to chew experimental tablets for one month. Maximum bite force, occlusal contact areas, oral dryness, tongue pressure, tongue and lip functions (number of times each of the following syllables is pronounced per second:/pa/,/ta/, and/ka/), masticatory function, subjective masticatory function, and gum-chewing time were measured at baseline and one month following intervention to assess outcomes.

Results

One month following the intervention, tongue pressure was significantly higher in the intervention group than in the control group (P = 0.027). In the within-group comparisons, maximum bite force (P < 0.001), unstimulated saliva flow (P < 0.001), tongue and lip functions (/pa/: P < 0.001;/ta/: P < 0.001;/ka/: P < 0.001), color scale value (P = 0.019), and ΔE value (P = 0.024) were significantly increased in the intervention group.

Conclusion

The results suggest that gum-chewing exercises can improve oral functions in older adults, although additional increases in masticatory load may be necessary to establish a more effective oral function training method using gum-chewing exercises in older adults.

Oral frailty is a risk factor for body weight loss after gastrectomy: a single-center, retrospective study

BACKGROUND

Body weight loss (BWL) is a serious complication of gastrectomy in patients with gastric cancer (GC). Nutritional intervention alone is inadequate for preventing BWL, and a new approach is needed. Oral frailty among older adults has recently attracted attention. This study aimed to investigate masticatory ability and BWL after gastrectomy.

METHODS

This was a single-center, retrospective study. Functional tooth units (FTU) were used to measure masticatory ability. Patients with FTU < 4 were defined as low FTU group and FTU ≥ 4 as high FTU group. The BWL was compared between the two groups.

RESULTS

Sixty patients who underwent distal gastrectomy for GC from March 2022 to January 2023 were enrolled in this study. The median FTU was 3 (range 0-12). The low-FTU group (FTU < 4) included 29 patients, while the high-FTU group (FTU ≥ 4) included 31 patients. The %BWL in the low FTU group was significantly higher than that in the high-FTU group at 1 and 3 months (p = 0.003 and p = 0.017, respectively). The risk factors associated with a %BWL > 5 at 1 and 3 months after gastrectomy were analyzed using logistic regression analysis. Only FTU < 4 was an independent risk factor after gastrectomy for GC in univariate and multivariate analyses (p = 0.028 and p = 0.006, respectively).

CONCLUSIONS

Low FTU in patients with preoperative GC was a risk factor for %BWL 1 and 3 months postoperatively. Appropriate oral interventions may be useful in improving the postoperative nutritional status after gastrectomy.

Nutritional Problems Related to Oropharyngeal and Esophageal Changes in Aging: A Narrative Review

Today, it is known that the elderly population is increasing rapidly with the quality of life. The United Nations estimate that one in six people will be 65 years or older by 2050. This situation causes interest in the old age period to increase day by day. In parallel with this, studies on the aging process have grown rapidly. Especially the health problems accompanying extended life expectancy and its treatment have become the focus of researchers in recent years. It is a known fact that some sensory and physiological changes in old age affect the quality of oral food intake and food taste. This may lead to inadequate nutritional intake and even rejection of food intake in the elderly. Therefore, severe malnutrition and sarcopenia occur in these individuals, and their life span is shortened. In this review, the effects of aging-related oropharyngeal and esophageal changes and problems on oral food intake will be evaluated. Our increasing knowledge on this subject will contribute to healthcare professionals in the prevention and treatment of health problems such as malnutrition that may occur during the aging process. In this review, a literature search was conducted with the keywords "older" or "elderly" or "geriatrics" and "nutrition" or "malnutrition" and "oropharyngeal functions" or "esophageal functions" in PubMed, ScienceDirect, and Google Scholar electronic databases. KEY TEACHING POINTSSome changes may occur in oropharyngeal and esophageal functions with aging.Sensory and physiological changes in the aging process affect oral food intake and nutritional status.Impairments in oral food intake in elderly individuals can lead to malnutrition and sarcopenia.Age-related changes affecting oral food intake increase the importance of nutritionists with the increase in the elderly population.

Improvements in Maximum Bite Force with Gum-Chewing Training in Older Adults: A Randomized Controlled Trial

No specific methods have been officially proposed for the prevention and improvement of oral hypofunction. Therefore, in this randomized controlled trial, we aimed to develop a gum-chewing training program and determine its effects in older adults. A total of 218 older adults, aged 65-85 years, were randomly allocated to the intervention or control groups. The intervention group chewed the experimental gum daily, whereas the control group consumed the experimental granular food daily. The outcome assessments measured the maximum bite force, occlusal contact areas, oral dryness, tongue pressure, tongue and lip functions, masticatory function, and gum-chewing time. The measured values for each outcome were compared between groups using the Mann-Whitney U test and within groups pre- and post-intervention using the Wilcoxon signed-rank test. A total of 211 participants completed the study. After 2 months, the intervention group had a significantly higher maximum bite force than the control group (p = 0.01), indicating that gum-chewing training improved maximum bite force in older adults. This was determined using one type of bite force measuring device. Therefore, it is suggested that gum-chewing training has a high potential to improve oral hypofunction.

Lip and tongue pressure and the functionality of oro-facial structures in healthy individuals

BACKGROUND

With the ageing process changes in the musculature of oro-facial structures take place, consequently there is a reduction in the strength and mobility of the lips, tongue and cheeks.

OBJECTIVE

The aim of this study was to correlate oro-facial structures and chewing and swallowing functions among a group of senior citizens and young adults and check the influence of lip and tongue pressure of these functions.

METHODS

This is an observational, cross-sectional and analytical study. Thirty seniors with an average age of 67.13 years and 30 young adults with an average age of 22.03 years participated in the study. The Oro-facial Myofunctional Assessment Protocol with Scores for the Elderly and the Oro-facial Myofunctional Assessment Protocol with Expanded Scores were also used. The evaluation of the force of pressure of the lips and tip and dorsum of the tongue was carried out using the Biofeedback device Pró-Fono: Lip and Tongue Pressure.

RESULTS

Young adults had a higher evaluation score for the aspect/posture of the face, cheeks, lips, mentalis muscle, tongue, mobility of lips, tongue, jaw and cheeks, chewing and swallowing functions, total time and chewing strokes, and tip pressure and dorsum of tongue. According to the Structural Equation Modelling, a direct relationship was found between the tongue dorsum pressure force and the swallowing function.

CONCLUSION

With healthy ageing changes occurring in the appearance, posture and mobility of the lips, tongue, jaw and cheeks, with the seniors and reduced performance of chewing and swallowing functions.

Assessment of subjective and objective masticatory function among elderly individuals with mild cognitive impairment

BACKGROUND

Masticatory function is known to be related to cognitive ability; therefore, factors for improving masticatory function should be identified.

AIMS

This study aimed to identify factors influencing masticatory function associated with mild cognitive impairment (MCI) in elderly individuals.

METHODS

A total of 123 elderly participants [mean age: 76.5 ± 6.5 years; 82 females (66.7%), 41 males (33.3%)] were included. Cognitive function was evaluated by the Korean version of the Mini-Mental State Examination (KMMSE). Questionnaires for subjective evaluation were administered, and dynamic objective masticatory function evaluations, including chewing tests and bite force measurements, were performed. Intergroup differences were evaluated by the Wilcoxon rank-sum and chi-square test, and correlations between cognitive ability and masticatory function were evaluated by multilinear logistic regression.

RESULTS

The number of teeth, number of posterior teeth, bite force, masticatory ability index (MAI) and posterior support status showed significant differences between the normal (KMMSE > 23) and MCI (KMMSE ≤ 23) groups. However, only the MAI, representing dynamic masticatory performance, was significantly associated with MCI regardless of age, sex and removable prostheses. The number of teeth and posterior teeth, bite force, subjective masticatory ability and posterior occlusal support showed no significant association with MCI.

DISCUSSION

These results suggested the importance of chewing function for preventing the progression of cognitive impairment.

CONCLUSIONS

Considering that only the MAI was significantly associated with MCI, it is more important to improve chewing efficiency by harmonizing therapeutic prosthetics with the surrounding masticatory system than simply increasing the number of teeth to prevent or delay cognitive impairment in elderly individuals.

Evaluating the effectiveness of stepwise swallowing training on dysphagia in patients with Alzheimer's disease: study protocol for a randomized controlled trial

BACKGROUND

The high prevalence of dysphagia among Alzheimer's disease (AD) patients has become a public health and economic concern. Therefore, effective and accessible dysphagia treatments are needed. As a fundamental rehabilitation of dysphagia, swallowing muscle exercises have received increased attention. Stepwise swallowing training (SST), integrated with all swallowing organs movement, is expected to improve swallowing dysfunction among AD patients. By using a randomized controlled trial design, we propose a multi-center research to evaluate the effectiveness of SST program among AD patients.

METHODS

A multi-center exploratory randomized controlled trial, with a 4-week follow-up period, will be conducted in three major public psychiatric hospitals in Guangdong, China. Participants in the control group will be assigned to routine dysphagia care, while participants in the intervention group will undergo the same nursing care and additionally receive the SST program. The SST program includes five sections of swallowing organs training: lip movement, facial movement, tongue movement, mandibular movement, and neck movement. Primary outcomes evaluate the swallowing function, namely, Water Swallowing Test (WTS) and Standard Swallowing Assessment (SSA). Secondary outcomes aim at measuring the improvement of negative impacts of dysphagia, namely eating behavior, ability of daily activity, and nutritional status. Data will be collected at baseline (T₁), at 2 weeks (T₂, intervention), and 4 weeks after intervention (T₃, follow-up).

DISCUSSION

This study will offer trial-based evidence of the effectiveness of SST in relieving dysphagia among AD patients. SST program is expected to improve both the swallowing function and reduce the negative impacts of dysphagia, with an exploration of acceptability in the SST program.

TRIAL REGISTRATION

Chinese Clinical Trial Registry, ChiCTR2200056481 . Prospectively registered on 6 February 2022.

Similarities, differences and overlaps between frailty and Parkinson's disease

Parkinson's disease is a neurodegenerative disorder clinically characterized by bradykinesia, rest tremor, rigidity, and postural and gait disturbances, which are frequently observed in older people. It also shows non-motor symptoms, such as depression, anxiety, cognitive impairment and dementia. The number of patients is gradually increasing worldwide. Aging is a risk factor for the onset of Parkinson's disease, and various physiological effects of aging influence its progression. Frailty is a geriatric syndrome in which the reversible and vulnerable status between robustness and disability is affected by various physiological stressors with aging. Frailty consists of physical, psychological and social aspects. Furthermore, sarcopenia, a syndrome characterized by the loss of muscle mass, strength and function, is also significantly associated with frailty. To maintain the quality of life of older people, frailty, including sarcopenia, should be quickly and appropriately managed. Polypharmacy is an important factor causing the progression of frailty in geriatric syndrome. Although Parkinson's disease and frailty have similar symptoms, and are considered to affect each other, the clinical features and mechanisms of both largely remain unclear. Nevertheless, little literature on the relationship between frailty and Parkinson's disease is currently available. This narrative review aims to clarify the relationships between Parkinson's disease and frailty, not only on the physical, but also on the mental, cognitive, and social aspects and issues regarding polypharmacy in Parkinson's disease explored by previous studies. Geriatr Gerontol Int 2022; 22: 259-270.

Motor Performance and Skill Acquisition in Oral Motor Training With Exergames: A Pilot Study

Objective

To investigate the effects of oral-motor training with exergames on motor performance and motor skill acquisition in two different age groups.

Methods

Thirty-two healthy participants were recruited in the current pilot study and divided equally into two groups (Gen Z and Baby Boomers) according to their age. A pair of electromyographic (EMG) electrodes were placed on the participants’ masseter muscles. The EMG device communicated via Bluetooth with a mobile video game in response to the electromyographic activity of the masseter muscles during clenching. During the experimental session, participants were asked to play a video game in five blocks of 5 min each, with a 3-min break between each time block. The goal of the game was to collect as many coins (game points) as possible and to dodge/avoid upcoming obstacles (game life). Motor performance was assessed by performance scores and the number of game lives. Skill acquisition was measured by task efficiency (ratio of performance scores and number of game lives) across time blocks.

Results

The results of the study showed significantly lower performance scores (p < 0.001), a higher number of game lives (p < 0.001), and lower task efficiency in the Baby Boomer group compared to the Gen Z group. Specifically, the results showed that there was a significant difference in task efficiency between the first and second, third and fourth, fourth- and fifth-time blocks in the Gen Z group (p < 0.002). However, there was only a significant difference between first- and second-time blocks in the Baby Boomer group (p = 1.012), suggesting that skill acquisition in the Baby Boomer group did not change significantly over the course of the time blocks.

Conclusion

The study showed higher motor performance and superior motor skill acquisition with novel exergame training in the Gen Z group compared to the Baby Boomer group. The results of the study indicate that there is an improvement in oral motor skills with short-term training, yet the differences in oral motor skills between the two groups are still evident. The Baby Boomer group, unlike the Gen Z group, did not show robust improvement in task efficiency over the course of the series.

Effects of oral exercise on tongue pressure in Taiwanese older adults in community day care centers

Background/purpose

Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period.

Materials and methods

Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants’ tongue pressures.

Results

A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021).

Conclusion

Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults.

Covid-19: Signs and symptoms related to the feeding behavior

COVID-19 reached pandemic level in March 2020 and the number of confirmed cases continued to increase worldwide. The clinical course of the disease has not yet been fully characterized, and some specific symptoms related to smell, taste, and feeding behavior require further examination. The present study aimed to assess the presence of symptoms related to the feeding behavior occurred during and/or after COVID-19 in adults residing in Portugal and to link them to disease severity using a multivariate approach. Data were collected from May to September 2020, through a questionnaire answered online containing questions about general and specific symptoms before, during and after COVID-19. 362 participants were included: 201 were symptomatic, being 15 hospitalized and 186 non-hospitalized. Cluster analysis grouped the symptomatic non-hospitalized participants as mild and severe cases. For these patients, the most frequent symptoms related to the feeding process were smell disorders in 40% and 62%, taste disorders in 37% and 60%, and dry mouth, in 23% and 48% of the mild and severe cases, respectively. Dry mouth was significantly associated with difficulty to swallow, pain during swallow, choking when eating or drinking, and preference for mushy/pasty foods (p < 0.01; Chi-squared test). Among the severe cases, the incidence of coughing during the meal (31%), difficulty (19%) and pain during swallow (17%), preference for mushy/pasty foods (10%) and choking when eating or drinking (6%) were clinically relevant and may indicate the presence of swallowing disorders. This group also showed a higher frequency of general symptoms, such as fever, headache, abdominal pain, tiredness, diarrhea, nausea, and shortness of breath (p < 0.05; Chi-squared test). Smell disorders, taste disorders and dry mouth were the most frequent symptoms related to the feeding behavior for both mild and severe cases. Dry mouth was significantly associated with swallowing difficulties and future research should investigate it as a frequent symptom and as a predictive of the presence of eating and swallowing disorders in COVID-19 cases.

A Systematic Review and Meta-analysis of the Effect of Oral Exercises on Masticatory Function

The aim of the current systematic review was to summarize and to evaluate the available information on the effectiveness of oral exercise in improving the masticatory function of people ≥18 y. Electronic databases (Medline, Embase, CENTRAL) and gray literatures were searched (up to December 2020) for relevant randomized and nonrandomized controlled clinical trials. Two reviewers independently conducted the study selection, data extraction, and quality assessments. Meta-analysis was conducted for the comparison of bite force and masticatory performance using mean difference (MD) and standardized mean difference (SMD), respectively. GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment was adopted for collective grading of the overall body of evidence. Of the 1,576 records identified, 18 studies (21 articles) were included in the analysis. Results of meta-analysis indicated that oral exercise could significantly improve the mean bite force of the participants (parallel comparison: MD, 41.2; 95% CI, 11.6-70.7, P = 0.006; longitudinal comparison: MD, 126.5; 95% CI, 105.2-144.9, P < 0.001). However, the improvement in masticatory performance was not significant (parallel comparison: SMD, 0.11; 95% CI, -0.20 to 0.42, P = 0.48; longitudinal comparison: SMD, 0.4; 95% CI, -0.11 to 0.91, P = 0.13). Results of meta-regression showed that greater improvements in bite force can be achieved among younger adults and with more intensive exercise. Chewing exercise is the most effective oral exercise, followed by clenching exercise, while simple oral exercise may not have a significant effect. Based on the results of the meta-analysis and GRADE assessment, a weak recommendation for people with declined masticatory function to practice oral exercise is made.

Association between masticatory movement and oral and physical function in healthy older women

PURPOSE

This study examined the association between masticatory movement and oral and physical function in healthy older women using clinical assessments considering central motor control.

METHODS

A total of 107 independent older women (mean age, 74.37 ± 4.46 years; age range, 66-84 years) living in the community participated in this cross-sectional study. The subjects selected were those aged 65 years or older with at least 28 teeth and without oral dysfunction, temporomandibular joint (TMJ) disease, cerebrovascular disease, or neuromuscular disease. The following items of oral and physical function were measured: masticatory path pattern, masticatory perfor-mance, oral diadochokinesis (ODK), tongue pressure, single-leg stance with eyes open (SLS), stepping test, and grip strength. Logistic regression analysis adjusting for age was performed to investigate the association between masticatory movement and other items.

RESULTS

In total, 30.8% of subjects were classified into the abnormal group regarding masticatory path pattern, having a significantly lower value than that of the normal group in masticatory performance (unadjusted p = 0.021). After adjusting for age, the masticatory path pattern was significantly associated with masticatory performance ( p = 0.032); ODK /pa/ ( p < 0.001), /ta/ ( p = 0.022), and /ka/ ( p = 0.016); and stepping test ( p = 0.018). Tongue pressure, SLS, and grip strength were not significantly associated with masticatory path pattern.

CONCLUSION

Masticatory movement in older women was associated with masticatory performance, tongue and lip motor skills, and physical agility, which might be influenced by central motor control.

Simple oral exercise with chewing gum for improving oral function in older adults

BACKGROUND

As general and oral health are closely interrelated, promoting oral health may extend a healthy life expectancy.

AIMS

To evaluate the long-term effects of simple oral exercise (SOE) and chewing gum exercise on mastication, salivation, and swallowing function in adults aged ≥ 65 years.

METHODS

Ninety-six participants were assigned to control, SOE, and GOE (chewing gum exercise with SOE) groups. The SOE comprised exercises to improve mastication, salivation, and swallowing function. Control group participants performed no exercises. The intervention period was 8 weeks, followed by a 3-week maintenance period. The Mixing Ability Index (MAI), occlusal force, unstimulated saliva, and repetitive saliva swallowing test were evaluated at baseline and 2, 5, 8, and 11 weeks later. Self-reported discomfort was re-evaluated after 8 weeks.

RESULTS

After 8 weeks, mean MAI differences from baseline significantly increased in both groups; the increase in the GOE group was largest and four times higher than in the control group. Mean differences of occlusal force from baseline increased by 56 N (SOE group) and 60 N (GOE group). The increase of salivation was greater in the SOE (3.6-fold) and GOE (2.2-fold) groups than in the control group. Furthermore, 27% and 18% of SOE and GOE group participants, respectively, were re-categorized as having good swallowing function. Participants reported less discomfort as oral functions improved.

DISCUSSION

These findings may facilitate the development of clinical practice guidelines for optimal oral care in older adults.

CONCLUSION

While both SOE and GOE may improve oral function in older adults, GOE is recommended for those with impaired mastication.

TRIAL REGISTRATION

KCT0003305, retrospectively registered 31/10/2018.

Diagnostic accuracy of patient-reported dry mouth as a predictor for oral dryness in terminally ill cancer patients

PURPOSE

The aim of the study was to determine the diagnostic accuracy of patient-reported dry mouth using an oral moisture-checking device in terminally ill cancer patients.

METHODS

The study was conducted following the STARD guidelines, and the participants were recruited prospectively from the Palliative Care Unit, Kyoto Medical Center, Japan, between 1 January 2017 and 30 November 2018. Patients reporting dry mouth were asked to rate oral dryness on a 5-point rating scale. The outcome was oral dryness at the lingual mucosa, measured using an oral moisture-checking device. Receiver operating characteristic (ROC) curves were plotted, and the sensitivity, specificity, positive and negative predictive values (PPV and NPV), positive and negative likelihood ratios (LR), and overall diagnostic accuracy were calculated.

RESULTS

Of 103 participants, the prevalence of oral dryness was 65.0%. ROC analysis indicated that patient-reported dry mouth was a poor predictor of oral dryness, with an area under the curve of 0.616 (95% confidence interval: 0.508-0.723), a sensitivity of 46.3%, a specificity of 75.8%, a PPV of 55.9%, an NPV of 68.1, a positive LR of 1.9, a negative LR of 0.7, and an overall diagnostic accuracy of 64.1%, with a cut-off value of 3 points.

CONCLUSION

In conclusion, patient-reported dry mouth is not a useful parameter for the assessment of oral dryness in terminally ill cancer patients.

Association among kidney function, frailty, and oral function in patients with chronic kidney disease: a cross-sectional study

Background

Chronic kidney disease (CKD) involves many factors that can cause frailty and oral hypofunction. We aimed to investigate the prevalence of frailty and oral hypofunction and to examine the associations among kidney function, frailty, and oral function in adults with CKD in Japan.

Methods

This cross-sectional study was conducted at two institutions. The participants included 109 patients with CKD stages 3–5 who visited outpatient clinics or were admitted for inpatient treatment. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study frailty criteria. Oral function was evaluated by assessing oral motor skills [oral diadochokinesis (ODK) rate], masticatory ability, and the repetitive saliva swallowing test. The estimated glomerular filtration rate (eGFR) was used to indicate kidney function. We examined the associations among kidney function, frailty, and oral function using binomial logistic regression analysis.

Results

In total, 31 participants (28.4%) were classified as being frail. Univariate analysis showed that age, body mass index, eGFR, and haemoglobin level were significantly associated with frailty. ODK and swallowing function were significantly associated with frailty. Multivariate analysis revealed that frailty was significantly associated with eGFR [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92–1.00, p = 0.048] and ODK rate (OR 0.68, CI 0.47–0.98, p = 0.038). However, no significant association was found between CKD severity and masticatory or swallowing function.

Conclusion

We found a high prevalence of frailty in patients with CKD and a significant association between frailty and oral motor skills, affecting the swallowing function of patients with nondialysis CKD. The high prevalence of frailty among patients with CKD suggests that routine assessment of frailty is necessary to prevent the development of severe complications. In addition, oral and kidney function should be carefully evaluated, and oral health education and interventions should be performed for patients with CKD.

Oral Management in Rehabilitation Medicine: Oral Frailty, Oral Sarcopenia, and Hospital-Associated Oral Problems

Oral health is a crucial but often neglected aspect of rehabilitation medicine. Approximately 71% of hospitalized rehabilitation patients and 91% of hospitalized acute care patients have impaired oral health. Poor oral condition in hospitalized patients can be attributed to factors such as age, physical dependency, cognitive decline, malnutrition, low skeletal muscle mass and strength, and multimorbidity. Another major factor is a lack of knowledge and interest in oral problems among health care workers. Recently, new concepts have been proposed, such as oral frailty, oral sarcopenia, and hospital-associated oral problems. Oral frailty, the accumulation of a slightly poor status of oral conditions and function, strongly predicts physical frailty, dysphagia, malnutrition, need for long-term care, and mortality in community-dwelling older adults. Oral sarcopenia refers to sarcopenia associated with oral conditions and function, although its definition has not yet been fully discussed. Hospital-associated oral problems are caused by disease, disease treatment, surgery, endotracheal intubation, poor self-care abilities, lack of care by medical staff, drugs, and iatrogenic factors during hospitalization. Furthermore, oral problems have negative impacts on rehabilitation outcomes, which include functional recovery, length of hospital stay, discharge home, and in-hospital mortality. Oral health management provided by dental hygienists improves not only oral status and function, swallowing function, and nutritional status but also activities of daily living, discharge home, and in-hospital mortality in post-acute rehabilitation. Oral rehabilitation, promotion, education, and medical-dental collaboration can be effective interventions for oral problems and therefore are necessary to improve rehabilitation outcomes.

Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Aging is accompanied by profound changes in many physiological functions, leading to a decreased ability to cope with stressors. Many changes are subtle, but can negatively affect nutrient intake, leading to overt malnutrition. Poor oral health may affect food selection and nutrient intake, leading to malnutrition and, consequently, to frailty and sarcopenia. On the other hand, it has been highlighted that sarcopenia is a whole-body process also affecting muscles dedicated to chewing and swallowing. Hence, muscle decline of these muscle groups may also have a negative impact on nutrient intake, increasing the risk for malnutrition. The interplay between oral diseases and malnutrition with frailty and sarcopenia may be explained through biological and environmental factors that are linked to the common burden of inflammation and oxidative stress. The presence of oral problems, alone or in combination with sarcopenia, may thus represent the biological substratum of the disabling cascade experienced by many frail individuals. A multimodal and multidisciplinary approach, including personalized dietary counselling and oral health care, may thus be helpful to better manage the complexity of older people. Furthermore, preventive strategies applied throughout the lifetime could help to preserve both oral and muscle function later in life. Here, we provide an overview on the relevance of poor oral health as a determinant of malnutrition and sarcopenia.