Fumiyo Tamura

Oral motor function and masticatory performance in the community-dwelling elderly

This study was performed to ascertain the relationships between oral motor functions, such as those of the tongue and lips, and age in the community-dwelling elderly, as well as to investigate the effects of these factors on masticatory performance. The subjects were 268 healthy elderly Japanese living in Kyoto. They were divided into four age groups and further classified into the following two groups by the presence or absence of posterior occlusal support: Eichner A or B1-B3 (group A), and Eichner B4 or C (group B). They were wearing removable or fixed dentures if they had missing teeth. Oral function evaluation items included (1) masticatory performance and (2) oral motor skills. Significant differences were noted among the age groups in tongue pressure within group A (P < 0.01) and group B (P < 0.05), and in the number of repetitions of the syllables /ta/ and /ka/ in group B (/ta/: P < 0.05, /ka/; P < 0.01). The number of natural teeth (β = 0.463, P < 0.001) in group A and tongue pressure (β = 0.436, P < 0.001) in group B were the only predictors of masticatory performance when the data were analyzed by multiple regression analysis. The tongue may compensate for the missing teeth in masticatory performance of those elderly who have lost their natural teeth. The results of this study highlight the importance of tongue function in masticatory performance.

A novel rapid oral bacteria detection apparatus for effective oral care to prevent pneumonia

OBJECTIVE To clarify the oral environment, we evaluated the usefulness and clinical applicability of a new apparatus developed for the simple and rapid quantification of oral bacteria. BACKGROUND Professional oral health care can reduce the number of oral bacteria and days of fever and inhibit the development of pneumonia. A novel detection apparatus was developed by applying the dielectrophoretic impedance measurement method. METHODS First, to determine the accuracy of this apparatus, employing standard samples of Escherichia coli. Next, to evaluate the oral environment, samples were taken from the tongue in elderly (mean age: 86.6 years) in nursing home. RESULTS In the first study, a good correlation was observed between the two methods (R = 0.999). In the second study, there were significant correlations between measurement values obtained using this apparatus and those obtained by the culture method (R = 0.852), as well as those obtained by the FM method (R = 0.885). CONCLUSION Our data showed that this rapid oral bacterial detection apparatus is effective in evaluating the oral hygiene to prevent pneumonia in the elderly.

Effect of oral care on cognitive function in patients with dementia.

. Chewing per-formance might stimulate brain functions and protectagainst the degradation of cognitive functions.However, it has not yet been concluded if oral healthdegenerates cognitive activities in longitudinal studies.In the present study, we carried out oral care and pro-spectively observed whether oral care improved cogni-tive function in dementia patientsA total of 446 patients with dementia staying in 10nursing homes were nominated for the study. The cri-terion for patient selection was that physical symptomsand cognitive impairment must have been stable for thepreceding 3 months. During this 3-month period, nopatient had acute disorders (e.g., severe infection, heartfailure, or stroke requiring special treatment and inten-sive care). Mini mental state examination (MMSE)

Relationship between oral bacteria count and pneumonia onset in elderly nursing home residents

Oral bacteria, which are a source of infection for aspiration pneumonia, were examined in frail older adults with the aim of establishing a standard bacteria count that indicates the risk of pneumonia onset in this group.

Effects of a palatal augmentation prosthesis on lingual function in postoperative patients with oral cancer: coronal section analysis by ultrasonography.

A palatal augmentation prosthesis (PAP) is used in postoperative patients with oral cancer as an intraoral appliance. The purpose of this study was to use ultrasound imaging to evaluate the effects of a PAP on lingual movement dynamics when postoperative patients with oral cancer swallowed food while wearing a PAP and to elucidate the effectiveness of the PAP. The subjects were seven patients with tongue cancer. They wore a PAP as an intraoral device to compensate for postoperative dysfunction after surgery for tongue cancer. The measurements were made by using ultrasonography. Ultrasound images of the lingual movement dynamics of the center of the tongue (central grooving of the tongue in a coronal plane, passing through the distal surfaces of both the left and right lower second premolars) during swallowing were obtained in M mode. The mean duration of lingual-palatal contact was 805.4 ± 306.0 ms in patients without a PAP and 621.8 ± 364.9 ms in those with a PAP. The duration decreased significantly in patients wearing a PAP (P = 0.03). The mean total duration of lingual movement was 1612.2 ± 478.3 ms in patients without a PAP and 1245.6 ± 272.5 ms in those with a PAP. The mean total duration decreased significantly in patients with a PAP (P = 0.03). The study results indicated that wearing an intraoral appliance may effectively help lingual movement on swallowing in postoperative patients with oral cancer.

Loss of occlusal support affects the decline in activities of daily living in elderly people receiving home care

PURPOSE This study aimed to clarify whether the absence of occlusal support would lead to a decline in the activities of daily living (ADL) in elderly people receiving home care. METHODS The subjects of this study were 322 elderly individual aged 65 and older who were receiving home care during a one-year observation period. The subjects were divided into two groups according to the change in the total score of the Barthel Index (BI) during the prospective cohort study period (the dependent variable): the maintained/improved activities of daily living group, in which the score was unchanged or improved, and the worsened activities of daily living group, in which the score decreased. The relationship between occlusal status (the presence or absence of occlusal support) at the baseline measurement and each BI score change was evaluated in the slightly, moderately and totally dependent ADL subgroups. RESULTS The number of subjects in the maintained/improved and the worsened ADL groups was 152 and 170, respectively. The baseline characteristics of cognitive function and occlusal support were significantly different between the maintained/improved and the worsened ADL groups (p < 0.05). Among the ADL subgroups, significantly reduced scores in mobility and toilet use were observed only in the slightly dependent group (p < 0.05). CONCLUSIONS Our results suggest that the loss of occlusal support may be an important factor in the decline of ADL in elderly people receiving home care, especially slightly dependent people.

Tooth loss as risk factor for foreign-body asphyxiation in nursing-home patients

Foreign body asphyxiation causes severe medical conditions including pneumonia in the elderly requiring nursing care. The objective of this study was to elucidate the relationships between insufficient occlusal support due to tooth loss and the onset of asphyxiation accidents, and determine preventive measures for such accidents in nursing homes in Japan. The subjects were 437 elderly (110 men and 327 women) requiring nursing care. The frequency and risk factors for asphyxiation accidents and the food causing asphyxiation were examined in these subjects for 2.5 years, from June 2006 to December 2008. During the study period, 51 of the 437 subjects suffered asphyxiation. Self-feeding ability and loss of occlusal support were associated with a covariate-adjusted relative ratio for asphyxiation of 3.1 (95% confidence interval (CI)=1.50-6.44) and 1.7 (95% CI=1.12-2.74), respectively. To prevent asphyxiation in elderly people, it was found that maintaining or restoring occlusal support may be required. It was concluded that self-feeding ability and loss of occlusal support are significant risk factors for foreign-body asphyxiation among elderly people requiring nursing care.

Effects of the reappearance of primitive reflexes on eating function and prognosis.

Primitive reflexes can reappear with diseases of the brain, particularly those affecting the frontal lobes. Most studies on primitive reflexes have reported an association between such reflexes and brain damage, and the clinical symptoms of dementia. These reflexes can also be present during eating; however, their effects on eating function are difficult to evaluate. The purpose of the present study was to identify the frequency at which primitive reflexes reappear in elderly people, and to determine the effects that such reflexes have on eating function, nutritional status and prognosis.

Multicentered epidemiological study of factors associated with total bacterial count in the saliva of older people requiring nursing care

To clarify whether the number of present teeth, independent of other well‐known factors, was associated with the total bacterial count in the saliva of older people requiring care at nursing homes in a multicentered epidemiological survey.

Change in Food Intake Status of Terminally Ill Cancer Patients during Last Two Weeks of Life: A Continuous Observation.

BACKGROUND The oral food intake of terminally ill cancer patients is known to gradually decrease, but there are few reports about how oral intake changes around the terminal stage. It is important to clarify changes in oral food intake, as such changes affect the support and care of terminally ill cancer patients. OBJECTIVE We aimed to clarify changes in oral food intake in terminally ill cancer patients during the last 2 weeks before death. METHODS This retrospective cohort study was conducted at a designated cancer center hospital in Japan from January 2013 to June 2013. The subjects were recognized as clinically terminally ill cancer patients who were hospitalized for ≥14 days, and who had death as their reason for hospital discharge. One researcher investigated basic patient information and the food intake status of the subjects using their medical records. The basic information investigated was gender, age, type of cancer, and the presence of gastrointestinal obstruction 14 days prior to death. The Food Intake LEVEL Scale (FILS) was prospectively recorded. RESULTS After applying the exclusion criteria, 108 subjects were finally included in the analysis (59 males aged 70.3 ± 13.3 years; 49 females aged 70.3 ± 14.5 years). The FILS gradually declined, and half of the subjects were unable to take food orally 6 days before death. In 81 subjects, after excluding subjects with gastrointestinal obstruction, the FILS gradually declined, and half of the subjects were unable to take food orally 4 days prior to death. CONCLUSIONS Many terminally ill cancer patients can take food orally up to a few days prior to their death. Therefore, various specialists should support the oral intake of terminally ill cancer patients until immediately before their death.