Mitsuyoshi Yoshida

Oral Care Reduces Pneumonia in Older Patients in Nursing Homes

Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people.

Decreased Tongue Pressure Reflects Symptom of Dysphagia

The tongue plays a key role in oropharyngeal swallowing. It has been reported that maximum isometric tongue pressure decreases with age. The risk for dysphagia resulting from low tongue strength remains unclear. This study was designed to reveal the relationship between tongue pressure and clinical signs of dysphagic tongue movement and cough and to demonstrate the clinical value of tongue pressure measurement in the evaluation of swallowing function. One hundred forty-five institutionalized elderly in five nursing homes participated. Evaluation of physical activity with self-standing up capability and mental condition with Mini Mental Status Examination (MMSE) were recorded. Maximum tongue pressure was determined using a newly developed tongue pressure measurement device. Voluntary tongue movement and signs of dysphagic cough at mealtime were inspected and evaluated by one clinically experienced dentist and speech therapist. The relationship between level of tongue pressure and incidence of cough was evaluated using logistic regression analysis with physical and mental conditions as covariates. Tongue pressure as measured by the newly developed device was significantly related to the voluntary tongue movement and incidence of cough (p < 0.05). The results of this study suggest that tongue pressure measurement reflects clinical signs of dysphagic tongue movement and cough and that measurement of tongue pressure is useful for the bedside evaluation of swallowing.

Relationship between nutrition status and dental occlusion in community‐dwelling frail elderly people

Aim:  This study aimed to determine the risk of malnutrition in some communities where the frail elderly receive public long‐term care insurance. We also clarified the dental problems in those at risk of malnutrition.

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.

Influence of aging and denture use on liquid swallowing in healthy dentulous and edentulous older people.

OBJECTIVES: To clarify the influence of aging and denture use on swallowing in healthy edentulous people aged 75 and older.

Correlation between dental and nutritional status in community-dwelling elderly Japanese

Aim:  The purpose of this study was to clarify the correlation between dental and nutritional status among community‐dwelling elderly Japanese people.

Functional dental occlusion may prevent falls in elderly individuals with dementia

To the Editor: More than one-third of persons aged 65 and older fall each year, and in half, falls are recurrent. The prevention of falls in this growing population is a primary concern for maintaining an adequate quality of life. Elderly persons with cognitive impairment and dementia have two times the risk for falls as cognitively normal elderly persons. It has been demonstrated that multifactorial assessment and intervention focused on these risk factors, including impaired gait and balance (postural instability), environmental hazards, drugs, and cardiovascular diagnoses, has been successful in preventing falls in cognitively normal elderly persons but not in the elderly with cognitive impairment and dementia. It can be hypothesized that primitive reflexes such as postural stability are more important for demented elderly. When in an upright position, permanent oscillations are generated to maintain balance. Sensorial afferents are provided from proprioceptive, tactile, vestibular, and visual receptors. Proprioception of the mandibular system arises from the masticatory muscular system and dentoalveolar ligaments. Poor or absent dental occlusion may decrease proprioception in this area, interfering with the stability of head posture. In this study, the incidence of falls in individuals with adequate dental occlusion is compared with that of those with inadequate dental occlusion. In addition, in a smaller pilot study, the effect of improved dental occlusion on occurrence of falls was investigated in subjects who had previously fallen recurrently. Subjects for this study were 146 ambulatory elderly persons who had been admitted to a special geriatric hospital for individuals with behavior disorders who were also suffering from severe dementia. Inclusion criteria limited subjects to those who could walk, with or without a cane, for all of their ambulation. Multifactorial assessments of each patient’s function, including the Mini-Mental State Examination (MMSE), and pharmacotherapeutic status were performed, and occupational therapists conducted daily group rehabilitations to maintain physical ability. One dentist (MY) classified each subject’s occlusion into one of three categories: Group AFnatural dentition with adequate function, Group BFpartially or fully edentulous but maintaining functional occlusion with dentures in either or both jaws, and Group CFfunctionally inadequate occlusion with no dentures. Subjects were also divided into two groups: the high falls group ( 2 falls during the previous year), and the low falls group ( 1 falls). In a smaller pilot study, denture treatment was provided for a small subgroup of high falls patients who gave informed consent. After denture delivery, the incidence of falls was recorded over 1 year. During the 1-year investigative period, 41 of 146 patients had recurrent falls. No differences between the high and low falls groups in proportion of women (75.6% vs 69.5%), mean age (83.1 6.4 vs 81.9 6.9), use of psychoneurotic medications (56.1% vs 61.9%), or mean MMSE score (9.6 6.7 vs 11.8 6.3) were found. Dental status was significantly different between the high and low groups (Po.001) (Table 1). In the high falls group, 10 patients (2 men and 8 women, mean age standard deviation 81.0 8.0, mean MMSE score 12.1 4.0) who gave informed consent received denture treatment. Conventional denture treatments were provided, and all patients used dentures after treatment. During the investigative period after denture delivery, three patients were excluded because they were comatose or dead. All of the seven remaining patients experienced decreased frequency of falls, with five patients experiencing one or no falls during 1 year of follow-up. Within the limits of this study, it was found that patients with functionally inadequate dental status had significantly more-frequent falls than those with functionally adequate occlusion composed of natural teeth, dentures, or both. Because tooth loss may result in a decrease in proprioception in the masticatory muscles or dentoalveolar ligaments, an associated perturbation of visual stabilization and postural imbalances may be induced. One study indicated that dental occlusal condition is associated with reduced lower extremity dynamic strength, agility, and balance function in elderly people. These findings suggest that functional occlusion of natural or artificial teeth may play an important role in generating an adequate posture reflex through mandibular stability, preventing falls. The current small intervention pilot study, which reconstructed occlusion with dentures, supports these finding. In conclusion, poor or inadequate dental occlusion may be a predisposing factor for falls in older people, and improving occlusion deserves attention as an approach to prevention of falls in elderly patients. A dental examination is recommended for inclusion in the standard health examination for elderly persons, especially those with symptoms of dementia.

Maximal voluntary tongue pressure is decreased in Japanese frail elderly persons

BACKGROUND AND OBJECTIVE To quantitatively estimate tongue function, we developed a handy device for intraoral pressure measurement. The objective of this study was to assess maximum voluntary tongue pressure (MVTP) in Japanese frail elderly persons receiving nursing care services. MATERIALS AND METHODS The study included 42 men and 87 women, aged 58-100 years. To record MVTP, the participants were asked to compress the balloon (diameter: 18 mm) of the disposable intraoral pressure probe onto their palates for 7 s using the maximum voluntary effort of the tongue. Pressures were recorded three times at 1 min intervals. RESULTS Maximum voluntary tongue pressure was successfully measured in 111 persons. Mean (standard deviation) MVTP was 18 (12) kPa, with a range of 0-63 kPa. The remaining 18 persons could not accurately follow our instructions and MVTP could not be measured. CONCLUSION In comparison with the reported standard value using the same device, the frail elderly persons included in our study were found to exert less MVTP than healthy dentate individuals. These results suggest the need for proper quantitative evaluation of oral function, including tongue capacity, at nursing care facilities.

Manometric evaluation of oral function with a hand-held balloon probe.

Tongue pressure measured with a disposable hand-held balloon probe has been used for assessing tongue function; however, no diagnostic standard for assessing other oral functions exists currently. In this study, to develop a method for multifactorial manometric evaluation of oral functions, 20 men and 20 women (21-32 years of age) were instructed to apply 7-s maximal voluntary muscular effort on a hand-held balloon probe placed against the anterior and lateral parts of the palate, buccal surface of the molars on the habitual chewing side and labial surface of the anterior teeth for measuring anterior and posterior tongue, cheek and lip pressures (LPs), respectively. Intra-session reproducibility was determined by three repeated measurements, and associations between the obtained and the conventional data on oral diadochokinesis were tested. The men exhibited higher values of all the pressure types. Further, both genders showed a positive correlation between anterior and posterior tongue pressures (PTPs) (P < 0·05), but only the women exhibited positive correlations between anterior tongue and cheek pressures, cheek and PTPs, anterior tongue and LPs, and cheek and LPs (P < 0·05). No statistically significant correlation was found between the pressures and the number of syllabic articulations, except between LP and the number of /pa/ articulations in the women (r = 0·524, P < 0·05). In conclusion, the balloon probe method enables objective manometric evaluation of oral functions and could be an effective tool for clinical epidemiological studies and evidence-based decision-making in nursing care.

Body weight and serum albumin change after prosthodontic treatment among institutionalized elderly in a long-term care geriatric hospital.

OBJECTIVES An important purpose of denture treatment is the improvement of nutritional intake. This is especially important for the dependent elderly who have a high risk of protein-energy malnutrition. To evaluate the impact of denture treatment on such a population, we compared body weight as an indicator of nutritional status before and 6 months after prosthodontic treatment. METHODS This study was conducted in a long-term care geriatric hospital in Hiroshima, Japan from October 2004 to September 2006. One hundred and four patients received complete or partial denture treatment in both jaws. Nineteen patients were lost to the study because of the development of severe physical conditions or death. Among the remaining 85 patients, 66 used their new prostheses and 19 did not. Body weight and serum albumin levels were examined at prosthesis insertion and 6 months after treatment. RESULTS Six months after prosthodontic treatment body weight changes were significantly different between users and non-users regardless of denture type and, in addition, serum albumin level were significantly increased among individuals using partial denture in either or both jaws (P < 0.05). CONCLUSION It can be concluded that prosthodontic treatment may improve the nutritional status of institutionalized elderly.