The relationship between bone density and the oral function in older adults: a cross-sectional observational study.

BACKGROUND: Falls among older adults with a low bone density can lead to a bedridden state. Declining bone density increases the risk of falls resulting fractures in older adults. A person's physical performance is known to be closely related to bone density, and a relationship between the physical performance and the oral function is also known to exist. However, there currently is a lack of evidence regarding the relationship between bone density and the oral function. We assessed the relationship between the bone density and the both the oral function and physical performance among older adults. PATIENTS AND METHODS: 754 older adults aged 65 years or older who independently lived in rural regions and who were not taking any medications for osteoporosis participated. We checked all participants for osteoporosis using an ultrasonic bone density measuring device. Regarding the oral function, we evaluated the following factors: remaining teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure. We also evaluated body mass index (BMI) and skeletal muscle mass Index as clinical characteristics. The normal walking speed, knee extension force and one-leg standing test were evaluated as physical performance. For the statistical analyses, we used the Mann-Whitney U test, chi-square test, the Kruskal-Wallis, and a multiple regression analysis. RESULTS: Eighty-one percent of the females and 58% of the males had osteoporosis or a decreased bone mass. The occlusal force, masticatory performance and the tongue pressure showed significant association with the bone density. The participants physical performance showed a significant association with their bone states except for walking speed. According to a multiple regression analysis, clinical characteristics (sex, age, BMI), one-leg standing and occlusal force showed independent associations with the bone density. It was suggested that the bone density tends to increase if the occlusal force is high and/or the one-leg standing test results are good. CONCLUSIONS: The bone density in the older adults showed a significant relationship not only with clinical characteristics or physical performance, but also with occlusal force. It may also be effective to confirm a good oral function in order to maintain healthy living for older adults.

Validity of a dysphagia screening test following resection for head and neck cancer.

BACKGROUND: The aim of this study was to evaluate the validity of a dysphagia screening test (DST) in patients who have undergone resection for head and neck cancer (HNC). In addition, we examined whether or not combined effects of DSTs improve the detection accuracy of penetration/aspiration. METHODS: Thirty-six HNC patients were participated. The DST consisted of the repetitive saliva swallowing test (RSST), the water swallowing test (WST), the modified water swallowing test (MWST), the food test (FT), and tongue pressure. A videofluoroscopic swallowing study was conducted, and the penetration-aspiration scale was used for scoring. For statistical analyses, we used the receiver operating characteristic (ROC) analysis. Furthermore, the accuracy of the determination of penetration/aspiration was evaluated by combining two or three DSTs. RESULTS: The penetration/aspiration could be predicted with moderate accuracy based on MWST and FT. The area under the ROC curve (AUC) values of the MWST and FT were 0.76 (p = 0.03) and 0.80 (p = 0.050), and the sensitivity/specificity was 0.9/0.61 (MWST) and 0.8/0.8 (FT), respectively. As a result of combining 2 or 3 DSTs, the combination of "MWST and FT" was the most accurate, with an AUC of 0.87 (p = 0.02). The combination of three tests had lower accuracy than the combination of two tests. CONCLUSION: Based on our results, it is recommended that MWST or FT be used when only one type of DST is performed. In addition, the combination of two DSTs may detect aspiration patients more accurately than one alone.

Does Oral Hypofunction Promote Social Withdrawal in the Older Adults? A Longitudinal Survey of Elderly Subjects in Rural Japan.

It is often assumed that oral hypofunction is associated with social withdrawal in older adults because decreased motor function is related to decreased oral function. However, few studies have examined the relationship between social withdrawal in older adults and oral function. This longitudinal study aimed to clarify the relationship between changes in the level of social withdrawal and oral function in independent older adults. Participants were 427 older adults aged 65 years or older who took part in a self-administered questionnaire from 2016 to 2017 (baseline), and again two years later (follow-up). At baseline, 17 items related to oral function and confounding factors related to withdrawal, physical condition, physical function, and cognitive function were evaluated. A Cox proportional hazard model was used to examine the oral functions that negatively impact social withdrawal. The following factors were significantly associated with the worsening of social withdrawal: the number of remaining teeth, gingival condition, occlusal force, masticatory efficiency, and items related to swallowing and dry mouth. Older adults with cognitive issues who walk slowly and have a weak knee extension muscle were also significantly more likely to have oral frailty. Those who were found to have oral frailty at baseline were 1.8 times more likely to develop withdrawal compared to those with robust oral function. The results indicated that the worsening of withdrawal was associated with oral hypofunction at baseline. Since oral hypofunction was associated with the worsening of social withdrawal in older adults, it is important to maintain older adults' oral function.

Basic survey for the prevention of intraoral residual medication in older adults: A pilot study.

OBJECTIVE: This study aimed to assess the relationship between oral hygiene/stomatognathic function and residual intraoral medication in older adults and to identify the oral factors associated with residual oral medication. METHODS: The study included 309 older adults (77 men, 232 women, mean age: 74.1 ± 7.4 years) who were prescribed medications at regular intervals. The following survey items were assessed: overall physical condition, intraoral condition and oral function. Participants prescribed oral medication were classified into groups with and without residual medication in the oral cavity. Statistical analysis was performed using univariate analysis for each of the factors contributing to the presence of residual medication. RESULTS: Only 1.9% of all patients had residual medication, which suggests that older adults in this survey had a low risk of residual intraoral medication. However, greater attention should be given to residual intraoral medication in older adults receiving long-term care. Powdered-form oral medications were more likely to remain in the oral cavity. Older adults with residual medication had a tendency to have less occlusal support, poor tongue hygiene and poor tongue movement. Oral function, particularly functions that are closely related to swallowing, was significantly lower in the residual intraoral medication group when compared to those of the group without residual intraoral medication. CONCLUSIONS: Reduced oral function and powered medication were associated with greater residual intraoral medication in this sample of older Japanese adults.

Is a History of Falling Related to Oral Function? A Cross-Sectional Survey of Elderly Subjects in Rural Japan.

BACKGROUND: Deteriorated physical function makes older adults prone to fall, and it is therefore known to prompt elders to require long-term care. In this regard, oral function can be related to the loss of motor function. This cross-sectional study assessed the oral factors that increase the risk of falling among older adults. METHODS: We surveyed 672 self-reliant elderly individuals aged ≥65 years who were dwelling in a rural area. We assessed each subject's risk of falling and any related anxiety. Oral-related conditions (number of teeth, occlusal support, masticatory performance, occlusal force, and tongue pressure) and physical motor functions (gait speed, knee extension force, and one-legged standing) were also assessed. Statistical analyses were performed using Mann-Whitney's U-test, the χ2 test, and a logistic regression model. RESULTS: In all subjects, 23% had a history of falling, while 40% had anxiety over falling. Both factors were significantly higher among female subjects, who also had slower gait speeds, and greater lateral differences in occlusion. The subjects with histories of falling were older, had impaired physical motor function, and exhibited a decrease in occlusal force and left/right occlusal imbalances. We recognized similar trends for anxiety about falling. CONCLUSIONS: These results revealed that the risk of falling might be lessened by maintaining healthy teeth occlusion and promoting healthy oral function.