Association between intrinsic capacity and oral health in older patients in a frailty clinic

PURPOSE

This study aimed to investigate how intrinsic capacity (IC) deficit is associated with oral functional decline.

METHODS

This cross-sectional study enrolled older adults at a research hospital frailty clinic between July 2021 and May 2023. IC evaluation included the locomotion, cognition, vitality, psychology, and sensory domains. Criteria for deficits were established within each domain, and the number of IC deficit domains was calculated for each patient. Oral function assessment included oral hygiene, oral dryness, occlusal force, tongue-lip motor function, tongue pressure, masticatory function, and swallowing function. Patients who met three or more criteria were classified into the oral hypofunction (OHF) group. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between IC deficit and OHF.

RESULTS

Of 222 included patients (mean age 78.3 ± 6.3 years; 39.6% men), 105 (47.3%) met the criteria for OHF. This OHF group showed a significantly higher prevalence of locomotion, cognition, psychology, and sensory domain deficits than the normal oral function group. Multivariate analysis adjusted for age and sex revealed a significant association between IC deficits and OHF (odds ratio [OR], 1.33; 95% confidence interval [CI] 1.04-1.70). A significant association was also observed between the locomotion domain and OHF (OR, 2.06; 95% CI 1.13-3.76).

CONCLUSION

This study highlights the potential relationship between the number of IC domain deficits and oral functional decline, with the most significant domain being locomotion. Furthermore, it suggests a possible link between sensory and oral function.

Concordance in oral frailty five-item checklist and oral hypofunction: Examining their respective characteristics

OBJECTIVES

This study examined the diagnostic concordance and characteristics of the oral frailty five-item checklist (OF-5) and oral hypofunction (OHF).

MATERIALS AND METHODS

In this extensive cross-sectional study, older adults were enrolled at a research hospital frailty clinic between July 2021 and July 2023. The diagnosis of OF-5 and OHF was conducted using the proposed assessment methods. The concordance rate of these criteria was determined by evaluating each patient and calculating the number of patients meeting each diagnosis's criteria. Patients who tested negative for the OF-5 and OHF criteria and those who met only one criterion were included in the OF-5 and OHF characteristic analysis.

RESULTS

A total of 248 patients were included in the analysis (mean age 77.6 ± 6.8 years; 36.7 % men). Among the patients, 114 (46.0 %) and 116 (46.8 %) met the OF-5 and OHF criteria, respectively. Furthermore, 78 (31.5 %) participants met both the OF-5 and OHF criteria, whereas 96 (38.7 %) did not meet either criterion. Moreover, 36 (14.5 %) and 38 (15.3 %) patients tested exclusively positive for OF-5 and OHF, respectively. The OF-5-positive and OHF-negative group showed an older age, lower Mini Nutritional Assessment Short Form score, and higher fall risk than the OF-5-negative and OHF-negative group. However, no significant differences were observed between the OF-5-negative and OHF-positive and OF-5-negative and OHF-negative groups.

CONCLUSION

The concordance rate of OF-5 and OHF diagnoses was 70.2 %. OF-5 showed a potential association with nutritional status and fall risk. Further longitudinal analyses are warranted to explore our study results.

Oral Health and Nutritional Intake in Community-Dwelling 90-Year-Old Japanese People: A Cross-Sectional Study

INTRODUCTION

This study aimed to determine the relationship between dentition, mastication, salivation and nutritional intake in 90-year-old Japanese people.

METHODS

This cross-sectional study included 84 participants (39 men and 45 women) aged 90 years. We used questionnaires to collect demographic information, smoking status, nutritional intake and higher-level functional capacity. Nutritional intake was assessed using the validated Brief-Type Self-Administered Diet History Questionnaire, and higher-level functional capacity was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) questionnaire. Oral examinations, masticatory performance tests, stimulated salivary flow rate (SSF) tests, blood tests, blood pressure tests and body mass index (BMI) assessments were conducted. Univariable and multivariable linear regression analyses were performed.

RESULTS

Multivariable linear regression analyses adjusted for sex, education, TMIG-IC and BMI ≤20 kg/m² showed that participants with masticatory performance <173 mg/dL had lower intake of folic acid and vitamin A than those with masticatory performance ≥173 mg/dL. SSF was positively associated with intake of vitamin A. The number of teeth was positively associated with the intake of β-carotene. With smaller effect sizes, masticatory performance, SSF and number of teeth were also associated with the intake of various micronutrients and carbohydrates.

CONCLUSION

Lower masticatory performance, lower SSF and fewer teeth were associated with a lower intake of several micronutrients, such as vitamin A, β-carotene and folic acids, in Japanese individuals of advanced age. Oral health practitioners should pay careful attention to the nutritional intake of older people with poor mastication, dry mouth and severe tooth loss.

Refabrication of an implant-retained obturator using the denture duplication technique in a bilateral maxillectomy patient with a free fibula osteocutaneous flap

PURPOSE

We aimed to introduce a simple method for refabrication of an implant-retained obturator using the denture duplication technique while retaining the custom abutments for a patient who underwent bilateral maxillectomy and reconstruction with a free fibula osteocutaneous flap. We have proposed this technique to facilitate the impression-making procedure for this extensive maxillary defect and to avoid lengthy and complicated laboratory procedures.

METHODS

A custom tray was developed by duplicating the fitting surface of an old obturator using silicone putty. The tray was used for a bite-pressure impression wherein both definitive impression and jaw relation were obtained simultaneously, reducing the time required for the placement of a new obturator.

CONCLUSIONS

We used the denture duplication technique to refabricate an implant-retained obturator while retaining the custom abutments. Decreased chairside time, fewer visits, the use of easily available materials, and uncomplicated laboratory procedures make this technique more economical and acceptable for patients. Using this approach, the patient was able to use the old prosthesis until the delivery of the new prosthesis. The replacement obturator that was developed using this method maintained an acceptable level of oral function.

Use of an occlusal ramp for rehabilitation after a mandibulectomy and its effects on mastication

STATEMENT OF PROBLEM

Patients with a mandibular defect can develop mandibular deviation, resulting in a loss of or reduction in occlusal contact and ultimately loss of function. The occlusal ramp is a prosthesis used to help restore the masticatory function of such patients and is used particularly in the maxillofacial rehabilitation of patients with masticatory dysfunction resulting from mandibular deviation. The occlusal ramp is usually attached to a mandibular denture or worn as an independent device placed on the palate corresponding to the mandible that produces the offset. However, evidence of the effects of its use is sparse.

PURPOSE

The purpose of this clinical study was to investigate the effects of occlusal ramp use in functional rehabilitation.

MATERIALS AND METHODS

This study included 10 patients who had received mandibulectomies (5 men and 5 women; mean age 76.7 years, range 67 to 90 years) with deviation of the mandible. An occlusal ramp was fabricated for each participant as part of their maxillofacial prosthetic treatment. Masticatory performance was evaluated before and after the treatment by measuring glucose extraction while masticating a piece of gummy jelly. The Wilcoxon signed-rank test was used for statistical analysis (α=.05).

RESULTS

The median masticatory performance score, represented as glucose concentration (mg/dL), was 82.45 before treatment and 115.45 after treatment, with an overall improvement of 33.00. Scores differed significantly before and after treatment (P=.005). Masticatory performance for each participant improved in the range of 17.7 to 103.3, highlighting the role that the occlusal ramp played in mastication, although with differing effects in each participant.

CONCLUSIONS

Masticatory performance in participants with mandibular deviation after a mandibulectomy was significantly improved with an occlusal ramp. This suggests the effectiveness of using occlusal ramps in maxillofacial prosthetic treatment for the recovery of masticatory function in patients with mandibular deviation.

Clinical report of six-month follow-up after cementing PEEK crown on molars

We conducted a six-month clinical follow-up on computer-aided design/computer-aided manufacturing-fabricated molar polyetheretherketone PEEK crowns to investigate their therapeutic effect. Only the PEEK crowns were examined as our study focused on short-term clinical evaluation of the new PEEK material. Twenty-three cases of PEEK crowns placed on the molars of 20 subjects (7 males and 13 females, mean age: 60.6 ± 14.2 years) were included in the study. The evaluation items were the condition of the crowns at the time of cementation and after six months, patient satisfaction, masticatory ability, and occlusal force. Mann-Whitney U tests with a significance level of 5% were used to examine the difference in glucose concentration by masticatory ability, occlusal pressure, and occlusal force, with and without PEEK crowns. The occlusion, margin fit, and contact of all 23 cases at the time of cementing were good. Six months after cementation, there was no crown desorption, fracture or crack, and prosthodontics was not needed in the 22 cases (one patient dropped out). No wear of the dental antagonist was observed. Patient satisfaction was generally high. There was no significant difference in masticatory ability between the groups with and without PEEK crowns. The subject's occlusal force was within the normal range. PEEK crowns used on molars can replace metal crowns and hold promise for an appropriate and effective treatment.

Assessment of masticatory efficiency based on glucose concentration in orthodontic patients - a methodological study

INTRODUCTION

Treatment for malocclusion can cause discomfort and pain in the teeth and periodontium, which may impair masticatory efficiency. The glucose concentration method is widely used to assess masticatory efficiency for its convenience in the clinical situation, although its validity has not been shown.

OBJECTIVE

The aims were to determine the validity of the glucose concentration method and investigate if this method can be applicable to orthodontic patients with braces.

DESIGN

Sixteen healthy individuals (7 men, 9 women, and 26±5 years old) and 16 patients with malocclusions needing orthodontic treatment (5 men, 11 women, and 26±4 years old) participated. Glucose concentration was measured after 5-, 10-, and 15-s mastication of gummy jelly and compared to Hue values obtained from the color-changing gum method (reference method). In addition, all participants were asked to fill out the Oral Health Impact Profile questionnaire (OHIP) to assess differences in perception related to the mouth before and after the placement of braces.

RESULTS

Glucose concentrations were strongly correlated to measures of the two-color chewing gum methods (R² =0.965). Both the glucose extraction and chewing gum hue value were the smallest for 5 s chewing cycles and increased as the number of chewing strokes increased for the 15 s chewing cycles. (Hue: R² = 0.510, P < 0.001; glucose: R² = 0.711, P < 0.001) Masticatory efficiency assessed by both methods was significantly lower in orthodontic patients compared to controls (P<0.05), even though it was not affected by bonding (P>0.09). In addition, OHIP scores in physical pain dimension and psychological disability were higher in orthodontic patients than in the control group (P<0.005).

CONCLUSION

Measurement of glucose concentration was confirmed as a reliable and convenient method for assessing masticatory efficiency. Furthermore, it appears that this method is applicable to patients with braces whose perception in the oral cavity could change.

Responsiveness of methods to evaluate objective masticatory function in removable partial denture treatments

PURPOSE

The aim of this study was to examine the responsiveness of chewing tests after removable partial denture (RPD) treatment in this prospective cohort study.

METHODS

Pre- and post-RPD treatment, objective masticatory function was evaluated in 248 patients via chewing tests involving peanuts, a gummy jelly, and a color-changeable gum. A statistical comparison was performed between the pre- and post-treatment scores, and the standardized response mean (SRM) was determined as the treatment effect size (ES).

RESULTS

After RPD treatment, the median particle size in the sieving method using peanuts significantly decreased, and the glucose concentration in the gummy jelly method significantly increased (P < 0.001). The ESs of the sieving and gummy jelly methods were larger (|SRM| = 0.3-0.4) than that of the gum method (|SRM| = 0.1). In the subgroup analysis, the sieving and gummy jelly methods resulted in a broader effective range (|SRM| ≥ 0.3) than the gum method. In patients without pre-treatment dentures, the ES was medium in the sieving method (|SRM| = 0.6) and weak in the gummy jelly and gum methods (|SRM| = 0.3-0.4). The pre-treatment level of masticatory function was significantly correlated with ES (ρ = 0.93, P < 0.001).

CONCLUSIONS

These results suggest that the sieving and gummy jelly methods are more responsive than the gum method for RPD treatment and that the pre-treatment scores affect the responsiveness.

Masticatory Function Assessment of Adult Patients With Cleft Lip and Palate After Orthodontic Treatment

OBJECTIVE

To determine whether orthodontically treated patients with cleft lip and palate (CLP) possess a different masticatory function than those of untreated patients with normal occlusion.

DESIGN

Occlusal contact area, occlusal force, as well as masseter and anterior temporal muscular activity were measured during maximum voluntary clenching (MVC) tests. Mandibular left and right lateral movements during mastication were also assessed. To further elucidate the nature of masticatory function, especially to determine the rate of abnormal jaw movement patterns, a parametric error index (EI) was set. Finally, masticatory efficiency was evaluated with a glucose sensitive measuring device.

PARTICIPANTS

Fifteen patients with CLP who had previously completed the orthodontic treatments required to achieve an acceptable and more harmonious occlusion accepted to volunteer in this study along with 21 untreated patients who already possessed a normal occlusion.

RESULTS

Patients with CLP showed a significantly lower occlusal force, reduced occlusal contact area, and decreased masticatory efficiency as well as significantly higher EI value when compared with controls. However, there was no significant difference when analyzing muscle activity, although masticatory efficiency was significantly different between the 2 groups. Despite this result, the scores obtained by the patients with CLP in the masticatory efficiency tests were still in the normal range.

CONCLUSIONS

Orthodontic treatment for adult patients with CLP provides a satisfactory result for the patients' masticatory ability albeit significantly less ideal compared with untreated patients with normal occlusion.

Does Masticatory Ability Contribute to Nutritional Status in Older Individuals?

Mastication plays a primary role in the process of eating. Hence, compromised masticatory ability may affect the nutrition and quality of life, which are particularly important concerns among older individuals. It remains unclear how is the masticatory ability assessed regarding the nutritional status. We examined the effect of various oral factors on three masticatory ability tests conducted among older individuals. A total of 100 older individuals were enrolled in this study. Body mass index (BMI) as an indicator of nutritional status; and age, sex, and the number of occlusal and molar occlusal supports as clinical attributes were recorded. Three masticatory ability tests (masticatory efficiency, masticatory score, and satisfaction with mastication) were conducted, and tongue pressure, cheek pressure, and occlusal force were assessed as oral functions. A significant but weak correlation was found between masticatory efficiency and the masticatory score, but not between masticatory efficiency and satisfaction score. Objective masticatory efficiency was strongly associated with objective oral factors, whereas subjective assessments of masticatory ability (masticatory score and satisfaction score) were not. Furthermore, BMI was significantly associated with subjective assessments of masticatory ability but not with objective masticatory efficiency. Both subjective and objective assessments of masticatory ability, along with considerations of nutritional formulations, are required for the maintenance and improvement of nutritional status in older individuals.

The relationship between masticatory performance and intakes of foods and nutrients in Japanese male workers: A cross-sectional study

BACKGROUND

Although many studies have been conducted on the relationship between masticatory performance and nutrient ingestion in the elderly, few large-scale studies have been carried out using relatively young individuals.

OBJECTIVES

The objective of this study was to clarify the association between the masticatory performance evaluated by the gummy-jelly test, not by visual examination, and nutrient ingestion state based on the brief self-administered diet history questionnaire (BDHQ).

METHODS

This was a cross-sectional survey of 540 male workers. Somatometry, blood pressure measurement, blood test and medical interview were performed as a periodic health check-up. In the dental check-up, an oral examination, gummy-jelly test (glucosensor) and survey of ingested food and nutrients using BDHQ were performed. The participants were classified into two groups with low and normal values of masticatory performance. Participants with a score on the gummy-jelly test below 150 mg/dL or 150 mg/dL or higher were included in the low and normal groups, respectively.

RESULTS

Two hundred and forty-eight participants (45.8%) had low masticatory performance, and 292 (53.2%) had normal masticatory performance. The intakes of some minerals and vitamins, such as calcium, vitamin D, vitamin B₂ , small fish with bones and non-oily fish, were significantly lower in the low masticatory group than in the normal group. In contrast, the intake of sugar for coffee and tea and that of chicken were significantly higher in the low masticatory group than in the normal group.

CONCLUSION

This study suggested that low masticatory performance can affect nutrient intake, which may cause non-communicable diseases.

Association between tongue and lip motor functions and mixing ability in complete denture wearers

BACKGROUND

Masticatory performance of elderly complete denture wearers is low, which may lead to restriction on intakes of several foods such as fresh fruit or raw vegetables.

AIM

The aim of this study was to investigate the relationship between tongue motor function, lip motor function, and mixing ability in complete denture wearers.

MATERIALS AND METHODS

Participants comprised 54 complete denture wearers with a mean age of 77.1 years. Maximum tongue pressure and oral diadochokinesis were measured to evaluate tongue and lip motor functions. A color-changeable, chewing gum was used to evaluate mixing ability. The relationship between tongue and lip motor functions and mixing ability was assessed using stepwise multiple regression analysis.

RESULTS

The stepwise multiple regression analysis identified maximum tongue pressure, the number of repetitions of the syllable "ka", and gender as significant predictors for mixing ability among complete denture wearers.

DISCUSSION

The elderly edentulous individuals mainly used tongue motor function in oral motor functions for mixing color-changeable chewing gums, which might be ascribable to wearing complete dentures.

CONCLUSIONS

Under the limited conditions of this study, factors relating to tongue motor function, tongue pressure and the number of repetitions of the syllable "/ka"/ significantly contributed to the mixing ability of complete denture wearers. It was suggested that tongue motor function had positive effect on the mixing ability of complete denture wearers.

Systematic review of measurement properties of methods for objectively assessing masticatory performance

The objectives of this study is to identify methods for objectively assessing masticatory performance (MP) and to evaluate their measurement properties. A secondary objective was to identify any reported adverse events associated with the methods to assess MP. Bibliographic databases were searched, including MEDLINE, Embase, Web of Science Core Collection, Cochrane, and Cinahl databases. Eligible papers that satisfied predefined inclusion and exclusion criteria were appraised independently by two investigators. Four other investigators independently appraised any measurement properties of the assessment method according to the consensus-based standards for the selection of health measurement instruments checklist. The qualities of the measurement properties were evaluated using predefined criteria. The level of evidence was rated by using data synthesis for each MP assessment method, where the rating was a product of methodological quality and measurement properties quality. All studies were quality assessed separately, initially, and subsequently for each method. Studies that described the use of identical assessment method received an individual score, and the pooled sum score resulted in an overall evidence synthesis. The level of evidence was synthesized across studies with an overall conclusion, that is, unknown, conflicting, limited, moderate, or strong evidence. Forty-six out of 9,908 articles were appraised, and the assessment methods were categorized as comminution (n = 21), mixing ability (n = 23), or other methods (n = 2). Different measurement properties were identified, in decreasing order construct validity (n = 30), reliability (n = 22), measurement error (n = 9), criterion validity (n = 6), and responsiveness (n = 4). No adverse events associated with any assessment methods were reported. In a clinical setting or as a diagnostic method, there are no gold standard methods for assessing MP with a strong level of evidence for all measurement properties. All available assessment methods with variable level of evidence require lab-intensive equipment, such as sieves or digital image software. Clinical trials with sufficient sample size, to infer trueness and precision, are needed for evaluating diagnostic values of available methods for assessing masticatory performance.

Changes in mandibular movement during chewing of different hardness foods

In order to clarify the change in mandibular movement during chewing of foods with different hardness, 20 healthy subjects were asked to chew 3 types of gummy jellies (containing 6, 8, and 10% gelatin), and the masseter muscular activity and the mandibular movement were recorded. The indicators representing the muscular activity (integral value of masseter muscular activity), the mandibular movement (opening distance, masticatory width, cycle time, opening maximum velocity and closing maximum velocity), and the stability of masticatory movement were calculated, respectively, and compared among the three foods. The integral value of masseter muscular activity was smallest for the 6% gelatin and significantly increased in order as the content of gelatin increased to 8, 10%. The value of each indicator for the mandibular movement increased gradually as the food got harder. The value for all indicators was significantly larger for the 10 than the 6%. However, between the two foods, no significant change was observed for the several indicators. The mean ratio of the 10% gelatin to the 8% gelatin for the cycle time was extremely small, being 1.01, but was between the range of 0.89–1.07 showing aspects of changes within each individual. The other indicators showing small ratio were similar in this aspect. The parameters representing stability of movement showed the lowest values for the 8% gelatin. It was suggested that the hardness of food affected mandibular movement during mastication, but the movement changed variously according to the hardness and exerted muscular activities.

An innovative masticatory efficiency test using odour intensity in the mouth as a target marker: a feasibility study

A large number of studies have reported the findings for masticatory efficiency tests; however, some objective masticatory efficiency tests have a drawback, in that subjects are required to spit out the test material. This study examined the possibility of a masticatory efficiency test that evaluates the intensity of odours released when chewing an odour compound-containing material. A total of 20 volunteers were used in this study. The odour intensity in the breath after chewing a gum was measured by portable odour sensor device. The odour intensity after chewing the gum was measured over four chewing durations and at four intervals between spitting out and measurement of the odour intensity. The volume of stimulated saliva was measured by calculating the difference in the weight of the gauze before and after chewing to examine the effect of saliva flow. With an increase in chewing duration, odour intensity reduced. The odour intensity was the highest immediately after chewing. There was a positive correlation between odour intensity and gummy jelly-related masticatory efficiency test value (G-METV), which was significant for 10-s chewing. The regression equation was calculated from three objective variables of odour intensity and G-METV as dependent variable. Pearson's correlation coefficient between G-METV and the odour intensity-related masticatory efficiency value (O-METV) was 0·68. The coefficient of variation of O-METV was significantly lower than that of G-METV. These results suggest that the masticatory performance can be estimated by measuring the odour intensity immediately after chewing food containing odour compounds for 10 s.

Association between tongue and lip functions and masticatory performance in young dentate adults

Motor functions of masticatory organs such as the tongue, lips, cheeks and mandible are known to deteriorate with age, thereby influencing masticatory performance. However, there are few reports on the relationships between tongue and lip functions and masticatory performance. To investigate the relationship between tongue and lip functions and comprehensive masticatory performance, by evaluating crushing, mixing and shearing abilities in young dentate adults. Participants comprised 51 dentate adults with a mean age of 25 years. Maximum tongue pressure and oral diadochokinesis were measured to evaluate tongue and lip functions. A multiple sieving method using peanuts was performed to evaluate crushing ability. A colour-changeable chewing gum was performed to evaluate mixing ability. A test gummy jelly was performed to evaluate shearing ability. The relationship between tongue and lip functions and each masticatory performance was assessed using Pearson's correlation coefficients. In addition, stepwise multiple regression analysis was performed to identify predictors of crushing ability. Crushing ability was significantly correlated with maximum tongue pressure and the number of repetitions of the syllables /pa/, /ta/ and /ka/. Maximum tongue pressure and number of repetitions of the syllable /pa/ were identified as significant predictors for crushing ability. Mixing ability was significantly correlated with the number of repetitions of the syllable /pa/. Shearing ability was not significantly correlated with tongue and lip functions. Masticatory performance during the chewing of brittle foods such as peanuts and solid foods such as chewing gum appears to be correlated with tongue and lip functions.