Clinical relevance of macroglossia to disease progression in ventilation dependent patients with advanced ALS.

BACKGROUND: Macroglossia is one of the clinical signs that emerges in patients with amyotrophic lateral sclerosis (ALS) who are undergoing invasive ventilation. OBJECTIVE: We aimed to investigate the relationship between the progression of macroglossia and the clinical characteristics during the advanced stages of ALS. METHODS: Forty-one patients with ALS using invasive ventilation with tracheostomy were prospectively followed over a 3-year period. We evaluated the prevalence of macroglossia, motor disabilities including oral function, communication ability (communication stage I to V) as a marker of disease progression, and nutritional factors. We analyzed the potential factors affecting the progression of macroglossia using a multivariate logistic analysis. RESULTS: The number of patients with macroglossia was increased during the follow-up (from 24.4 to 53.7%), while the communication stage progressed from 2.6 in average (SD 1.7) to 3.5 (1.4). During the study, body weight increased, while energy intake decreased, suggesting progressive hypometabolism. Eight patients had newly developed macroglossia during the study and showed greater progression of communication impairment than those without macroglossia. Multivariate logistic regression analysis showed that communication impairment was a factor associated with macroglossia. CONCLUSION: Macroglossia in advanced ALS with invasive ventilation is associated with disease progression.

The effectiveness of a desensitization technique for mitigating oral and facial tactile hypersensitivity in institutionalized older persons: A randomized controlled trial.

BACKGROUND/PURPOSE: Oral health care provision in long-term care settings is often limited by specific behaviors exhibited by residents, which may be interpreted as a refusal of care. Such behaviors can be attributed to oral tactile hypersensitivity (TH), which is characterized by aberrations in the perception of oral stimuli. TH is also associated with a decline in ingestion and swallowing function. The purpose of this study was to examine the effectiveness of a technique for mitigating TH (TMH) among institutionalized older persons. MATERIALS AND METHODS: In this study, 18 institutionalized older persons (Mean age, 90.6 ±â€¯4.5 years; 92.9% females) with TH were randomized to a control group or an intervention group. Pre- and post-intervention assessments were conducted for seven participants in each group. Routine oral care was provided by the facility's staff in both groups. TMH in the intervention group was performed by a dental hygienist over a 3-month period. RESULTS: In the intervention group, the number of areas with TH was significantly reduced (P = 0.027). No significant change was observed in the control group. CONCLUSION: The results of this study suggest that TMH can effectively mitigate TH. Our findings provide clinicians with an additional treatment option for hypersensitivity in older patients. Additional long-term studies with larger sample sizes are required to confirm the effectiveness of this technique.

Oral health status of hospitalized amyotrophic lateral sclerosis patients: a single-centre observational study.

OBJECTIVE: To assess the intraoral conditions and oral function of patients with amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS: This single-centre, cross-sectional observational study included 50 ALS patients, who were treated with tracheostomy positive-pressure ventilation (TPPV) while hospitalized. The disease duration, TPPV duration, current number of teeth, number of occlusal units, number of decayed/missing/filled teeth, community periodontal index, bleeding on probing, dental calculus, maximum mouth opening, salivation rate, tongue anomalies (atrophy or hypertrophy) and tongue coating were determined for each patient. Differences in intraoral conditions according to disease duration or TPPV duration were statistically analysed. RESULTS: The maximum mouth opening was low in the included patients, with a mean distance of 13.7 ± 7.4 mm. Furthermore, the maximum mouth opening showed a significant negative correlation with both disease duration and TPPV duration. No statistically significant differences were found between any other intraoral parameters and disease duration or TPPV duration. CONCLUSIONS: Severe dental disease is uncommon among hospitalized ALS patients who receive oral care by nurses; however, mouth opening is very restricted in these patients. Early intervention for restricted mouth opening, directed by a dentist or dental hygienist, is essential in this population.

Oral function and nutritional status among the elderly with facial and oral tactile hypersensitivity who are under long-term care.

Objective　In oral health care, a refusal action can cause difficulties, and tactile hypersensitivity (TH) may be a contributing factor. People with TH of the face and mouth clench their jaws. Despite numerous reports on TH among children with disabilities, reports on TH in the elderly who are under long-term care are scarce. The purpose of this study was to investigate TH among the elderly who are under long-term care.Methods　We selected 80 residents (8 men and 72 women; mean age: 91.1±6.2y) in a Tokyo nursing home and investigated the presence of TH in them. We also obtained patients' (1) basic information (sex, age, stage of long-term care needs (SCN), and the degree of independent living (IL)); (2) oral information (swallowing status, choking tendency, and intraoral residue); and (3) nutritional information (serum albumin (Alb) levels and body mass index (BMI)). We assessed the face (the forehead, cheek, and perioral area) and the intraoral environment (buccal mucosa, buccal cavity, and palate) as testing sites for TH, using the tester's palm and forefinger. We confirmed the presence of TH when the tested areas reacted partially or fully by shuddering. We classified the subjects into 2 groups based on the presence or absence of TH and analyzed our results using a chi-square test and Mann-Whitney U test. This investigation was approved by the Dentistry Ethics Screening Committee, Tokyo Medical and Dental University.Results　A total of 18 residents were diagnosed with TH (22.5%). Significant differences in SCN, IL, choking tendency, intraoral residue, swallowing status, serum Alb levels, and BMI (P<0.05) were reported between this group and the non-TH group.Conclusion　We demonstrated that residents with TH were in an advanced SCN and had a lower IL score and a decreased swallowing and nutritional status. Therefore, oral health care, promotion of nutritional status, and meal support are particularly important for the elderly with TH.

Analysis of resting salivation rate in patients with amyotrophic lateral sclerosis using tracheostomy invasive ventilation.

Patients with amyotrophic lateral sclerosis (ALS) often suffer from salivation problems such as drooling and dry mouth. We examined resting salivation rate cross-sectionally in 66 advanced ALS patients with tracheostomy invasive ventilation using a cotton roll method, and investigated clinical factors associated with salivation rate. Resting salivation rate in the patients was well preserved (median value 0.6 g/min), and was significantly more increased in patients with impairment of jaw movement (P = 0.007) or mouth opening (P = 0.003) than in patients with less impairment, and in patients with the mouth being constantly open ≥ 10 mm in rostrocaudal length than in patients with < 10 mm. These data indicate that salivation rate was increased with progression of dysfunction of voluntary jaw movement. Appropriate oral care is required in advanced ALS patients to maintain their oral hygiene and to avoid penetration of saliva into the airway.

Macroglossia in advanced amyotrophic lateral sclerosis.

INTRODUCTION: An enlarged tongue (macroglossia) has been reported in advanced-stage patients with amyotrophic lateral sclerosis (ALS). METHODS: In this study we examined the prevalence of macroglossia and analyzed clinical correlations in 65 ALS patients on tracheostomy-invasive ventilation (TIV). RESULTS: Macroglossia was found in 22 patients (33.8%). Compared with those without macroglossia, patients with macroglossia had a younger age of onset, longer duration of disease and TIV use, lower ALS Functional Rating Scale score, higher body mass index, lower energy intake, more severe communication impairment, and lower oral function. Logistic multivariate analysis showed that body mass index (BMI; P = 0.007) and communication impairment (P = 0.029) were significantly correlated with macroglossia. The duration of TIV use was at the cut-off level of significance (P = 0.05). CONCLUSIONS: Macroglossia may be the result of overfeeding and replacement by fat during long-term TIV use in patients with advanced ALS. Muscle Nerve, 2016 Muscle Nerve 54: 386-390, 2016.

Functional tooth units and nutritional status of older people in care homes in Indonesia.

OBJECTIVES: To investigate the relationship between functional tooth units (FTUs) and nutritional status. METHODS: One hundred females (mean age: 72.4 ± 8.2 years) at four private care homes in Jakarta, Indonesia were interviewed and clinically examined. The oral examination included the assessment of teeth, prosthetic status, and number of FTUs. The total number of FTUs was further divided by tooth composition: natural tooth against natural tooth (NN-FTUs), natural tooth against denture (ND-FTUs), and denture against denture (DD-FTUs). Nutritional status was evaluated using the body mass index (BMI) and the Mini Nutritional Assessment (MNA). RESULTS: The mean numbers of teeth present, NN-FTUs, ND-FTUs, DD-FTUs, and total FTUs were 13.1 ± 10.4, 1.7 ± 3.0, 1.2 ± 3.3, 0.4 ± 1.2 and 3.3 ± 4.4, respectively. The mean BMI and MNA scores were 24.8 ± 5.0 and 22.6 ± 2.8, respectively. Subjects with a normal BMI had a significantly higher total number of FTUs (3.6 ± 4.6) compared with underweight subjects (0.1 ± 0.3). Subjects with a normal MNA had a significantly higher number of NN-FTU (2.6 ± 3.7) compared to those who were at risk or in a state of under-nutrition (1.2 ± 2.4). CONCLUSION: This study revealed significant relationships between the number of FTUs and nutritional status. Keeping the posterior occlusion should be emphasized in order to maintain good nutritional status in older subjects.

The relationship between turbidity of mouth-rinsed water and oral health status.

OBJECTIVES: The purpose of this study was to examine the relationship between turbidity of mouth rinsed water and oral health status such as dental and periodontal conditions, oral hygiene status, flow rate of saliva and oral bacteria. MATERIALS AND METHODS: Subjects were 165 patients who visited the Dental Hospital, Tokyo Medical and Dental University. Oral health status, including dental and periodontal conditions, oral hygiene status and flow rate of saliva, was clinically examined. The turbidity was measured with a turbidimeter. Quantification of Fusobacterium spp, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and total bacteria levels was performed using real-time PCR. The Pearson correlation and multiple regression analysis were used to explore the associations between the turbidity and oral health parameters. RESULTS: The turbidity showed significant correlations with the number of decayed teeth and deep pockets, the plaque index, extent of tongue coating and Fusobacterium spp, P. gingivalis, T. forsythia, T. denticola and total bacteria levels. In a multiple regression model, the turbidity was negatively associated with the flow rate of saliva and positively associated with the total number of bacteria (p < 0.001). CONCLUSION: Current findings suggested that turbidity of mouth rinsed water could be used as an indicator to evaluate oral health condition and the amount of bacteria in the oral cavity. In addition, the turbiditimeter appeared as a simple and objective device for screening abnormality of oral health condition at chair side as well as community-based research.

The effects of professional oral health care on patients in the subacute stage of emergent neurosurgical disorders.

This study evaluated the effectiveness of professional oral health care (POHC) on patients who were in the subacute stage of neurosurgical disorders. Forty subjects (26 male, 14 female) with acute cerebrovascular disorders or neurotrauma were randomly divided into two groups. The intervention group (n = 21) received POHC treatment by dental hygienists, and the control group (n = 19) did not. To evaluate the change in oral health status of the subjects, an oral examination was carried out at baseline and four weeks later. For the subjects in the intervention group, periodontal condition, oral hygiene status, and oral function improved statistically significantly. The detection rate for methicillin-resistant Staphylococcus aureus (MRSA) was statistically significantly lower in the intervention group than in the control group. These results suggest that POHC performed by dental hygienists in collaboration with nurses plays an important role in the promotion not only of oral health but also of general health.

Factors associated with self-assessed oral health in the Japanese independent elderly.

OBJECTIVES: The purpose of this research was to analyse the relationship between oral health status, oral motor function, daily life situations and self-assessed oral health. MATERIALS AND METHODS: A cross-sectional survey was conducted on 190 independent elderly volunteers aged 62-99 years from senior citizen centres in Tokyo, Japan. A questionnaire survey and oral examination were conducted on each participant. For the descriptive analyses, Independent t-test and the chi-squared test were used. Following that, using four latent variables, (oral health, oral function, daily life situations and chronic health condition), a structural equation modelling analysis (SEMA) was undertaken. RESULTS: In the descriptive analyses, there were no significant differences between self-assessed oral health and oral health status. However, there were significant differences between self-assessed oral health and oral function and daily life situations. Findings from SEMA revealed that daily life situations and oral function have independent effects on self-assessed oral health and that the relationship between self-assessed oral health and oral health status was weak. CONCLUSIONS: Many factors affect self-assessed oral health status. Dental clinicians and researchers should attempt to understand these factors and incorporate them into effective personal and population-based oral health education and oral health promotion programmes.

Evaluation of an oral function promotion programme for the independent elderly in Japan.

OBJECTIVES: The purpose of this study was to provide an oral function promotion programme for the independent elderly and evaluate the changes in oral health status and oral function. BACKGROUND: Few studies have scientifically analysed and evaluated the effectiveness of oral function promotion programmes provided for the independent elderly. MATERIALS AND METHODS: The subjects were independent elderly females (mean age: 74.6 +/- 6.3) recruited from senior citizens' centres in Tokyo. The intervention group (n = 79) received a 3-month oral function promotion programme, which included facial muscle and tongue exercises and salivary gland massages. The control group (n = 62) did not receive this programme. RESULTS: In the intervention group, the tongue coating scores decreased and the organoleptic score of oral malodour fell. The amount of food debris in the oral cavity decreased and the tongue dryness improved. Furthermore, the salivary flow rate increased. The length of time for maintaining the tongue in the forward position increased from 11.2 s to 18.7 s, and the number of times for moving the tip of the tongue in a clockwise circular motion, counter-clockwise circular motion and side-to-side motion within 30 s, increased from 14.5 to 20.6, 14.5 to 20.2, and 17.2 to 23.3 respectively. The number of times for movement of the lips significantly improved from 23.0 to 28.8 and the pronunciation of words was observed to be clearer. CONCLUSION: An oral function promotion programme was effective in improving the oral health status and oral function of an independent elderly population.