Association between dysphagia risk and sleep quality in community-dwelling older adults: A cross-sectional study.

Objectives: Exploring the effects of swallowing function on sleep quality could provide valuable insights into the potential impact of reduced swallowing function on sleep. However, pertinent studies are limited. Therefore, this study aimed to investigate the relationship between dysphagia risk and sleep health in community-dwelling older adults. Methods: Data for this cross-sectional study were obtained from the Shizuoka and Daiko studies conducted as part of the Japan Multi-Institutional Collaborative Cohort Study. Information on demographics, overall lifestyle, dysphagia risk, as well as sleep quality, duration, satisfaction, and regularity, was obtained using a self-administered questionnaire. Dysphagia risk and sleep quality were assessed using the Dysphagia Risk Assessment Questionnaire for the Community-dwelling Elderly and the Japanese version of the Pittsburgh Sleep Questionnaire Index, respectively. Multivariate logistic regression, adjusted for covariates, was employed to assess the association between dysphagia risk and sleep health. Results: Among the 3058 participants (1633 males, 1425 females) aged ≥60 years, 28.0 % exhibited dysphagia risk, and 19.1 % reported poor sleep quality. Those with dysphagia risk were more likely to experience poor sleep quality than those without dysphagia risk. In male participants, dysphagia was significantly associated with poor sleep quality, unsatisfactory sleep, and sleep irregularity, but was not significantly associated with unsatisfactory or irregular sleep in female participants. The Japanese version of the Pittsburgh Sleep Questionnaire Index components-subjective sleep quality, sleep latency, sleep disturbances, and daytime dysfunction-were associated with dysphagia risk in both sexes. Conclusions: Dysphagia risk is associated with sleep quality in older individuals in Japan. Thus, preserving swallowing function may contribute to enhancing sleep quality.

Effects of oral health-related quality of life on total mortality: a prospective cohort study.

BACKGROUND: The effects of oral health on mortality have been reported; however, the association between mortality and Oral Health-Related Quality of Life (OHQOL) is unknown. We investigated the effect of OHQOL on total mortality in a cohort consisting of dentists. METHODS: In this cohort study, we analyzed data from the Longitudinal Evaluation of Multi-phasic, Odonatological and Nutritional Associations in Dentists study. We conducted a baseline survey of general and oral health factors. We called for 31,178 participants and collected responses from 10,256 participants. We followed up with 10,114 participants (mean age ± standard deviation, 52.4 ± 12.1 years; females, 8.9%) for 7.7 years, until March 2014, to determine the average total mortality. OHQOL was assessed using the General Oral Health Assessment Index (GOHAI). The total score was divided into quartiles (Q1 ≤ 51.6, Q2 = 51.7-56.7, Q3 = 56.8-59.9, and Q4 = 60.0), with higher GOHAI scores indicating better OHQOL (score range, 12-60). The association between OHQOL and total mortality was analyzed using the Cox proportional hazards model. RESULTS: We documented 460 deaths. Males with low GOHAI scores possessed a remarkably high risk of total mortality. The multivariate adjusted-hazard ratios (aHRs), were 1.93 (95% confidence interval [CI], 1.07 - 3.48) for Q1, 1.69 (95% CI, 0.90 - 3.17) for Q2, and 0.65 (95% CI, 0.29 - 1.46) for Q3, relative to Q4 (trend p = 0.001). The aHRs in the multivariate model with all background variables were 1.69 (95% CI, 1.15-2.46) for Q1, 1.53 (95% CI, 1.04-2.27) for Q2, and 1.09 (95% CI, 0.71-1.70) for Q3, relative to Q4 (trend p = 0.001). In females, there was no significant association between the quartiles, in both the multivariate-adjusted model (trend p = 0.52) and multivariate-adjusted model with all background variables (trend p = 0.79). CONCLUSIONS: A lower OHQOL indicated an increased risk of total mortality in dentists. OHQOL may be used as an indicator for selecting treatment plans and personalized care interventions, thus contributing to increased healthy life expectancy. TRIAL REGISTRATION: Aichi Cancer Center, Nagoya University Graduate School of Medicine, and Hiroshima University (Approval numbers: 33, 632-3, 8-21, and E2019-1603).

Association of daily physical activity and leisure-time exercise with dysphagia risk in community-dwelling older adults: a cross-sectional study.

This study aimed to clarify the association of daily physical activity and leisure-time exercise with the risk of dysphagia in community-dwelling Japanese older adults using a questionnaire-based survey. We analyzed 3070 participants (1657 men, 1413 women; age 66 ± 4 years [mean ± SD]) of the Shizuoka and Daiko studies within the Japanese Multi-Institutional Collaborative Cohort study. We used the Dysphagia Risk Assessment for the Community-dwelling Elderly questionnaire to assess dysphagia risk and the International Physical Activity Questionnaire to assess daily physical activity and leisure-time exercise. Logistic regression analyses were used to evaluate the independent association of the amount of physical activity and leisure-time exercise with dysphagia risk. The proportion of participants with dysphagia risk was 27.5% (n = 844) and the risk was significantly higher in women (29.8%, n = 421) than in men (25.5%, n = 423; P = 0.008). Daily physical activity was not associated with dysphagia risk. A greater amount of leisure-time exercise was associated with lower dysphagia risk (P for trend = 0.003) and individuals in the highest leisure-time exercise quartile had a significantly lower odds ratio (0.68, 95% CI 0.52-0.89) than those in the lowest quartile, even after adjusting for the covariates.

Co-occurring KEAP1 and TP53 mutations in lung squamous cell carcinoma induced primary resistance to thoracic radiotherapy: A case report.

In lung squamous cell carcinoma, KEAP1 mutations frequently coexist with TP53 mutations. A preclinical model showed that mutations leading to the activation of the KEAP1-NRF2 pathway contribute to clinical radioresistance. However, there have been few clinical reports on the association between the presence of KEAP1 and TP53 mutations in patients with lung squamous cell carcinoma. Here, we report the case of a 62-year-old patient with advanced lung squamous cell carcinoma with KEAP1 and TP53 mutations who experienced primary resistance to thoracic radiotherapy. She was administered pembrolizumab in combination with cytotoxic agents as the first-line treatment and the best response was a partial response. However, the mediastinal lymph node metastases regrew 11 months after the chemotherapy. Thus, she received thoracic radiation therapy for localized lesions. However, the lesions within the radiation field had apparently progressed. Although she received subsequent chemotherapy, the lesion rapidly progressed. Treatment strategies including radiotherapy based on genetic stratification, such as KEAP1 and TP53 mutation status, should be implemented for lung squamous cell carcinoma.

Prevalence of oral Epstein-Barr virus and Porphyromonas gingivalis and their association with periodontal inflamed surface area: A cross-sectional study.

We previously reported that oral herpesviruses, such as Epstein-Barr virus (EBV), are associated with periodontitis. However, the relationship between oral EBV or dual oral EBV and Porphyromonas gingivalis infections and periodontal inflammation severity remains unclear. We conducted this study to determine the relationship between oral EBV and P gingivalis prevalence and the periodontal inflamed surface area (PISA) in middle-aged and older adults. We analyzed 205 patients (median age, 70 years) who visited Hiroshima University Hospital. Tongue swab samples were used to investigate the presence of EBV and P gingivalis DNA using real-time PCR. Probing pocket depth and bleeding on probing were measured at 6 sites per tooth. PISA scores were calculated based on the results of probing pocket depth and bleeding on probing. Propensity scores were calculated via logistic regression analysis of 8 clinical factors: age, sex, smoking status, remaining teeth, denture use, hypertension, diabetes, and hyperlipidemia. EBV DNA was present in 41 of the 205 participants (20.0%). Thirty-seven EBV-positive or -negative participants in 74 matched pairs after propensity-score matching were examined via univariate analysis. EBV-positive participants exhibited higher plaque control record scores and PISAs than did EBV-negative participants. EBV DNA was significantly associated with plaque control record scores and PISA (both P = .04). Of the 205 participants, 111 were positive for P gingivalis (54.1%). Nineteen participants (9.3%) were infected with both oral EBV and P gingivalis. Logistic regression analysis revealed that dual infection with EBV and P gingivalis was significantly associated with diabetes (odds ratio = 3.37, 95% confidence interval: 1.13-10.1; P = .03). Oral EBV prevalence is associated with oral hygiene and the spread of inflamed periodontal tissue. Diabetes may be a risk factor for dual infection with oral EBV and P gingivalis.

Age-related changes in oral tactile and thermal sensation throughout adulthood.

Although the life expectancy of women is over 80 years in many countries, oral sensation has scarcely been compared between adults ≥ 80 years and younger age groups. The purpose of this study was to clarify age-related changes in oral sensation throughout adulthood. After exclusion of individuals with factors that might have confounded somatosensory performance, 123 female participants were divided into four age groups: 20-39 years, 40-59 years, 60-79 years, and 80-96 years. Perceptions of tactile and thermal sensations were examined at points on the anterior and posterior palate, anterior and posterior tongue, lower labial-attached gingiva, lower lip, and buccal mucosa; two-point discrimination was examined only on the tongue. The tactile and two-point discrimination thresholds for the anterior and posterior tongue were significantly higher in the 80-96-year-old group than in any other age group (p < 0.05). The tactile threshold for the buccal mucosa was significantly higher in the 80-96-year-old group than in the 60-79-year-old group (p < 0.05). The percentage of participants able to perceive a warm stimulus (50 °C) in the buccal mucosa was significantly lower in the 80-96-year-old group than in the 20-39-year-old group (p < 0.05). Only the topography of the warm sensation perception changed with age. This cross-sectional study suggests that oral tactile and thermal sensation for warm stimuli deteriorates with age in a site-specific manner, especially after the age of 80 years, but the same does not occur with cool stimuli.

High Rate of Oral Candida Detection in Dependent Japanese Older People.

The aim of this study was to clarify the association between oral Candida detection and the dependency status of older people. This study included 31 older people aged ≥70 years who had a certified need for long-term care or support and received care in a local day care center; it also included 27 independent older patients aged ≥70 years who visited Hiroshima University Hospital. Oral Candida was detected by a polymerase chain reaction using swab samples from the tongue surface. Oral moisture was significantly reduced in dependent older people, compared with independent older people (p = 0.003). There was a weak negative relationship between numbers of bacteria and levels of oral moisture (Spearman's rank correlation coefficient; R = -0.29, p = 0.01). Dependent older people exhibited a significantly higher rate of Candida albicans detection (35.5%) compared with independent older people (11.1%). Dependent older people also exhibited a higher rate of concurrent detection of both C. albicans and Candida glabrata (32.3%) compared with independent older people (11.1%), but this difference was not statistically significant. Thus, dependent older people may be more susceptible to oral C. albicans infection, compared with independent older people. Good oral hygiene is necessary to prevent oral Candida infection in dependent older people.

Palatal augmentation prosthesis (PAP) can improve swallowing function for the patients in rehabilitation hospital.

PURPOSE: The aim of this study was to clarify the effects of fitting palatal augmentation prosthesis (PAP) on the swallowing function for the patients in rehabilitation hospital. METHODS: The subjects included 18 elderly hospitalized patients whose body mass index was <18.5kg/m2. All subjects wore maxillary complete denture. During a videofluoroscopic examination in which the patients were asked to swallow, post-swallowing pyriform sinus residue was detected. The subjects' maxillary dentures were then modified into PAPs by recording tongue movement in the palatal region. The resulting swallowing dynamics were evaluated qualitatively and quantitatively before and after fitting the PAP. RESULTS: We found that fitting the PAP resulted in the resolution of aspiration in two patients and disappearance of pharyngeal residue in three. The pharyngeal delay and transit times were significantly shortened. CONCLUSIONS: These results demonstrated that PAPs could be beneficial treatment devices that may reduce post-swallowing pharyngeal residue formation due to decreased muscle strength.

Detection of oral bacteria on the tongue dorsum using PCR amplification of 16S ribosomal RNA and its association with systemic disease in middle-aged and elderly patients.

The association between oral health and systemic disease is recognized in the literature. The present study aimed to clarify the association between oral bacteria on the tongue dorsum and factors associated with oral health and systemic disease in middle-aged and elderly patients. The association between bacterial numbers, oral health status and systemic disease was preliminarily investigated in 70 patients (mean age, 69.5 years; range, 45-92 years) who visited the Department of Oral Health, Hiroshima University Hospital (Hiroshima, Japan). The bacterial 16S ribosomal RNA gene was employed to quantitate bacterial numbers using real-time polymerase chain reaction (PCR). PCR was also performed to detect the DNA of periodontal disease-related bacteria. Oral bacterial numbers were marginally negatively correlated with moisture levels on the tongue surface [Spearman's rank correlation coefficient (R)=-0.131, P=0.28). Subjects with bleeding on probing (BOP) or a ≥4 mm probing depth (PD) exhibited higher Porphyromonas gingivalis (P. gingivalis)-positive rates (50.0 and 51.1%, respectively) than those without BOP or a <4 mm PD (39.5 and 30.4%, respectively). Subjects with medical histories of hypertension, diabetes, stroke and heart disease exhibited a trend toward higher P. gingivalis-positive rates than those without such disorders. These findings indicated that the tongue moisture level may be associated with bacterial numbers on the tongue surface, while P. gingivalis on the tongue surface may be associated with systemic and periodontal diseases. Further investigation in a larger number of participants is necessary to clarify the correlation between bacterial numbers and systemic disease.

Factors related to masticatory performance in healthy elderly individuals.

PURPOSE: Maintenance of natural dentition and/or prosthodontic rehabilitation is necessary for good masticatory function. Although other factors such as physical and oral functions are also important for masticatory performance, only a few studies have evaluated their roles. The aim of the current study was to assess factors associated with masticatory performance among elderly individuals, while maintaining and/or reconstructing all occlusal support areas. METHODS: The present study was designed and implemented as a cross-sectional study, involving a total of 262 participants (mean age: 74.2±5.9years) who participated in the Kyoto Elders Physical Fitness Measurement Research Project. Individuals with partial or complete edentulousness who did not use dentures were excluded from the study. The predictor variables included physical status (i.e., age, gender, body-mass index, and grip strength), oral conditions (i.e., number of present teeth, temporomandibular joint noise, and denture wearer), and oral functions (i.e., maximum voluntary occlusal force; occlusal contact area; cheek pressure; oral diadochokinesis test /pa/, /ta/, /ka/; and maximum voluntary tongue pressure). The variable outcome was masticatory performance. These variables among the participants using univariate and multivariate analyses were compared. RESULTS: Grip strength, number of present teeth, maximum voluntary occlusal force, occlusal contact area, oral diadochokinesis /ka/ /ta/, and maximum voluntary tongue pressure were significant factors for masticatory performance. Stepwise regression analysis showed that grip strength, maximum voluntary occlusal force, and diadochokinesis /ta/ significantly affected masticatory performance. CONCLUSIONS: Masticatory performance was closely associated with grip strength, maximum voluntary occlusal force, and diadochokinesis /ta/ among healthy elderly participants.

Prevalence of drug-resistant opportunistic microorganisms in oral cavity after treatment for oral cancer.

Drug-resistant opportunistic infections may cause health problems in immunocompromised hosts. Representative microorganisms in opportunistic infections of the oral cavity are Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans. We investigated the prevalence of drug-resistant opportunistic microorganisms in elderly adults receiving follow-up examinations after primary treatment of oral cancer. Oral microorganisms were collected from patients satisfactorily treated for oral cancer (defined as good outcomes to date) and a group of healthy adults (controls). After identification of microorganisms, the prevalence of drug-resistant microorganisms was studied. Pulsed-field gel electrophoresis (PFGE) and staphylococcal cassette chromosome mec (SCCmec) typing were also performed for methicillin-resistant S aureus (MRSA). Statistical analysis revealed no significant differences in the prevalences of the three microorganisms between the groups. Surprisingly, 69.2% of S aureus isolates showed oxacillin resistance, suggesting that MRSA colonization is increasing among older Japanese. These MRSA isolates possessed SCCmec types II and IV but no representative toxin genes. Our results indicate that a basic infection control strategy, including standard precautions against MRSA, is important for elderly adults, particularly after treatment for oral cancer.

The green tea polyphenol (-)-epigallocatechin gallate precipitates salivary proteins including alpha-amylase: biochemical implications for oral health.

Green tea is a popular drink throughout the world, and it contains various components, including the green tea polyphenol (-)-epigallocatechin gallate (EGCG). Tea interacts with saliva upon entering the mouth, so the interaction between saliva and EGCG interested us, especially with respect to EGCG-protein binding. SDS-PAGE revealed that several salivary proteins were precipitated after adding EGCG to saliva. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) peptide mass fingerprinting indicated that the major proteins precipitated by EGCG were alpha-amylase, S100, and cystatins. Surface plasmon resonance revealed that EGCG bound to alpha-amylase at dissociation constant (K(d)) = 2.74 × 10(-6) M, suggesting that EGCG interacts with salivary proteins with a relatively strong affinity. In addition, EGCG inhibited the activity of alpha-amylase by non-competitive inhibition, indicating that EGCG is effective at inhibiting the formation of fermentable carbohydrates involved in caries formation. Interestingly, alpha-amylase reduced the antimicrobial activity of EGCG against the periodontal bacterium Aggregatibacter actinomycetemcomitans. Therefore, we considered that EGCG-salivary protein interactions might have both protective and detrimental effects with respect to oral health.