Evaluating clinical utility of subgingival and salivary endotoxin activity levels as periodontal biomarkers.

Objectives: The use of periodontal biomarkers for identification and monitoring of unique patient populations could foster better stratification of at-risk groups, increase access to treatment for those most in need, facilitate preventive measures and improve personalised care plans. The aim of this study was to examine the diagnostic and prognostic utility of oral lipopolysaccharides as bacterially-derived periodontal biomarkers. Methods: Periodontal parameters were recorded, and saliva and subgingival plaque samples were collected at the beginning of the study from periodontally healthy volunteers and periodontitis patients, and three months after completion of conventional periodontal treatment in the periodontitis group. Endotoxin activity in the samples was measured using the recombinant factor C assay. Associations between clinical periodontal parameters and subgingival and salivary endotoxin activities were analysed using a multivariate regression model, while the ROC curve was applied to estimate the sensitivity, specificity and c-statistics for salivary and subgingival endotoxin activities as diagnostic biomarkers for periodontitis. Results: Significant correlations were found between subgingival endotoxin activities, probing pocket depth and periodontal diagnosis, which were independent from patients' age, gender and smoking status. In addition, subgingival endotoxin levels had high specificity and sensitivity in detecting periodontal health and disease (0.91 and 0.85 respectively). Salivary endotoxin activity was positively associated with periodontal diagnosis, mean probing pocket depth, percentages of sites over 4 mm and full mouth bleeding score. However, it was inferior in discriminating patients with stable periodontium from those with periodontitis (sensitivity = 0.69, specificity = 0.61) compared to subgingival endotoxin activity. Conclusions: Subgingival endotoxin activity has good diagnostic and prognostic values as a site-specific periodontal biomarker and is not influenced by the patient's age, gender or smoking status. In contrast, salivary endotoxin activity, as a patient-level biomarker, is dependent on patient's age, has poorer diagnostic and prognostic capability, but shows good correlations with disease susceptibility and both its extent and severity.

Influential factors of saliva microbiota composition.

The oral microbiota is emerging as an influential factor of host physiology and disease state. Factors influencing oral microbiota composition have not been well characterised. In particular, there is a lack of population-based studies. We undertook a large hypothesis-free study of the saliva microbiota, considering potential influential factors of host health (frailty; diet; periodontal disease), demographics (age; sex; BMI) and sample processing (storage time), in a sample (n = 679) of the TwinsUK cohort of adult twins. Alpha and beta diversity of the saliva microbiota was associated most strongly with frailty (alpha diversity: ß = -0.16, Q = 0.003, Observed; ß = -0.16, Q = 0.002, Shannon; ß = -0.16, Q = 0.003, Simpson; Beta diversity: Q = 0.002, Bray Curtis dissimilarity) and age (alpha diversity: ß = 0.15, Q = 0.006, Shannon; ß = 0.12, Q = 0.003, Simpson; beta diversity: Q = 0.002, Bray Curtis dissimilarity; Q = 0.032, Weighted UniFrac) in multivariate models including age, frailty, sex, BMI, frailty and diet, and adjustment for multiple testing. Those with a more advanced age were more likely to be dissimilar in the saliva microbiota composition than younger participants (P = 5.125e-06, ANOVA). In subsample analyses, including consideration of periodontal disease (total n = 138, periodontal disease n = 66), the association with frailty remained for alpha diversity (Q = 0.002, Observed ASVs; Q = 0.04 Shannon Index), but not beta diversity, whilst age was not demonstrated to associate with alpha or beta diversity in this subsample, potentially due to insufficient statistical power. Length of time that samples were stored prior to sequencing was associated with beta diversity (Q = 0.002, Bray Curtis dissimilarity). Six bacterial taxa were associated with age after adjustment for frailty and diet. Of the factors studied, frailty and age emerged as the most influential with regards to saliva microbiota composition. Whilst age and frailty are correlates, the associations were independent of each other, giving precedence to both biological and chronological ageing as processes of potential importance when considering saliva microbiota composition.

Periodontal infectogenomics: a systematic review update of associations between host genetic variants and subgingival microbial detection.

OBJECTIVE: The aim of this study was to systematically update the evidence for associations between host genetic variants and subgingival microbial detection and counts. MATERIALS AND METHODS: Following a previous systematic review (Nibali et al. J Clin Periodontol 43(11): 889-900, 15), an update of a systematic search of the literature was conducted in Ovid Medline, Embase, LILACS, and Cochrane Library for studies reporting data on host genetic variants and detection of microbes subgingivally published in the last 6 years. RESULTS: A total of 19 studies were included in the review, from an initial search of 2797 titles. Studies consisted mainly of candidate gene studies and of one genome-wide analysis. A total of 62 studies were considered for summary findings, including 43 identified in the previous systematic review of studies published up to 2015. Meta-analyses were done when appropriate including both papers in the original review and in the update. Meta-analyses revealed lack of associations between IL1 composite genotype and subgingival detection of Aggregatibacter acinomycetemcomitans, Poprhyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia. Promising evidence is emerging from other genetic variants and from sub-analyses of data from genome-association studies. Among other studies with candidate-gene, target SNPs were mainly within the IL10, IL6, IL4, IL8, IL17A, and VDR gene. CONCLUSIONS: IL1 composite genotype does not seem to be associated with subgingival microbial detection. Promising associations should be pursued by future studies, including studies employing -OMICS technologies. CLINICAL RELEVANCE: A better knowledge of which host genetic variant predispose to subgingival microbial colonization and to the development of progression of periodontal disease could potentially help to better understand periodontal disease pathogenesis and help with its management.

Association of periodontal disease with atherosclerosis in 70-year-old Japanese older adults.

Periodontal disease and arteriosclerotic disease are greatly affected by aging. In this study, the association of conventional risk factors and periodontal disease with atherosclerosis was longitudinally examined in Japanese older adults. Subjects in this study were 490 community-dwelling septuagenarians (69-71 years) randomly recruited from the Basic Resident Registry of urban or rural areas in Japan. At the baseline examination, all subjects underwent socioeconomic and medical interviews; medical examinations, including examinations for carotid atherosclerosis, hypertension, diabetes mellitus, and dyslipidemia; and conventional dental examinations, including a tooth count and measurement of probing pocket depth (PPD). After 3 years, 182 septuagenarians who had no atherosclerosis at the baseline examination were registered and received the same examination as at the baseline. In the re-examination conducted 3 years after the baseline survey, 131 (72.0%) of the 182 participants who had no atherosclerosis at the baseline examination were diagnosed with carotid atherosclerosis. Adjusting and analyzing the mutual relationships of the conventional risk factors for atherosclerosis by multiple logistic regression analysis for the 171 septuagenarians with a full set of data, the proportion of teeth with PPD ≥ 4 mm was independently related to the prevalence of atherosclerosis (odds ratio: 1.029, P < 0.022). This longitudinal study of Japanese older adults suggests that periodontal disease is associated with the onset/progression of atherosclerosis. Maintaining a healthy periodontal condition may be an important factor in preventing the development and progression of atherosclerosis.

Factors Influencing the Localization of Mandibular Third Molars in Twins.

PURPOSE: The aim of the present study was to evaluate the genetic and environmental factors influencing the localization of mandibular third molars by analyzing the panoramic radiographs of twins. We examined the mandibular third molars of Japanese monozygotic (MZ) and dizygotic (DZ) twins recruited by the Osaka University Center for Twin Research. MATERIALS AND METHODS: The present study included 49 pairs (98 participants) of MZ twins and 11 pairs (22 participants) of DZ twins. Using panoramic radiography, we evaluated the degree of eruption of mandibular third molars according to the height of the alveolus bone and the third molar space/crown width ratio. Using co-twin control analysis and a generalized linear mixed model, we evaluated the effects of various factors, including gender, age, body height, number of teeth, length of the lower dental arch, existence of a second molar, bruxism, and previous orthodontic therapy. RESULTS: Body height, third molar space/crown width ratio, and length of the mandibular dental arch were related to the degree of mandibular third molar eruption and were strongly influenced by genetic factors rather than common or unique environmental factors. CONCLUSIONS: The degree of third molar eruption was more similar among MZ twins than among DZ twins; therefore, genetic factors can be expected to have more significant influence than will environmental factors. These results can help identify the trend of third molar eruption from a young age, allowing us to advise the early extraction of mandibular third molars for patients with a short stature, narrow retromolar space, or short mandibular dental arch. In addition, if the genes that influence the degree of eruption were identified, we would be better equipped to predict an individual's risk of impaction, and indications for extraction might change.

Genome-wide scan identifies novel genetic loci regulating salivary metabolite levels.

Saliva, as a biofluid, is inexpensive and non-invasive to obtain, and provides a vital tool to investigate oral health and its interaction with systemic health conditions. There is growing interest in salivary biomarkers for systemic diseases, notably cardiovascular disease. Whereas hundreds of genetic loci have been shown to be involved in the regulation of blood metabolites, leading to significant insights into the pathogenesis of complex human diseases, little is known about the impact of host genetics on salivary metabolites. Here we report the first genome-wide association study exploring 476 salivary metabolites in 1419 subjects from the TwinsUK cohort (discovery phase), followed by replication in the Study of Health in Pomerania (SHIP-2) cohort. A total of 14 distinct locus-metabolite associations were identified in the discovery phase, most of which were replicated in SHIP-2. While only a limited number of the loci that are known to regulate blood metabolites were also associated with salivary metabolites in our study, we identified several novel saliva-specific locus-metabolite associations, including associations for the AGMAT (with the metabolites 4-guanidinobutanoate and beta-guanidinopropanoate), ATP13A5 (with the metabolite creatinine) and DPYS (with the metabolites 3-ureidopropionate and 3-ureidoisobutyrate) loci. Our study suggests that there may be regulatory pathways of particular relevance to the salivary metabolome. In addition, some of our findings may have clinical significance, such as the utility of the pyrimidine (uracil) degradation metabolites in predicting 5-fluorouracil toxicity and the role of the agmatine pathway metabolites as biomarkers of oral health.

Epigenetic findings in periodontitis in UK twins: a cross-sectional study.

BACKGROUND: Genetic and environmental risk factors contribute to periodontal disease, but the underlying susceptibility pathways are not fully understood. Epigenetic mechanisms are malleable regulators of gene function that can change in response to genetic and environmental stimuli, thereby providing a potential mechanism for mediating risk effects in periodontitis. The aim of this study is to identify epigenetic changes across tissues that are associated with periodontal disease. METHODS: Self-reported gingival bleeding and history of gum disease, or tooth mobility, were used as indicators of periodontal disease. DNA methylation profiles were generated using the Infinium HumanMethylation450 BeadChip in whole blood, buccal, and adipose tissue samples from predominantly older female twins (mean age 58) from the TwinsUK cohort. Epigenome-wide association scans (EWAS) of gingival bleeding and tooth mobility were conducted in whole blood in 528 and 492 twins, respectively. Subsequently, targeted candidate gene analysis at 28 genomic regions was carried out testing for phenotype-methylation associations in 41 (tooth mobility) and 43 (gingival bleeding) buccal, and 501 (tooth mobility) and 556 (gingival bleeding) adipose DNA samples. RESULTS: Epigenome-wide analyses in blood identified one CpG-site (cg21245277 in ZNF804A) associated with gingival bleeding (FDR = 0.03, nominal p value = 7.17e-8) and 58 sites associated with tooth mobility (FDR < 0.05) with the top signals in IQCE and XKR6. Epigenetic variation at 28 candidate regions (247 CpG-sites) for chronic periodontitis showed an enrichment for association with periodontal traits, and signals in eight genes (VDR, IL6ST, TMCO6, IL1RN, CD44, IL1B, WHAMM, and CXCL1) were significant in both traits. The methylation-phenotype association signals validated in buccal samples, and a subset (25%) also validated in adipose tissue. CONCLUSIONS: Epigenome-wide analyses in adult female twins identified specific DNA methylation changes linked to self-reported periodontal disease. Future work will explore the environmental basis and functional impact of these results to infer potential for strategic personalized treatments and prevention of chronic periodontitis.

Genetic and environmental contributions to the association between mood disorder and periodontal disease: A cross-sectional study among female twins in the UK.

AIM: This study aimed to investigate the factors associated with periodontal traits considering genetic and environmental background in predominantly older female twins. METHODS: This was a cross-sectional study using self-reported questionnaires for periodontal traits in TwinsUK. Age-adjusted and age-stratified multivariate analyses were conducted for all twins. Subsequently, co-twin control analysis within genetically identical twins who were discordant for periodontal traits was performed by controlling for genetic confounders. RESULTS: Data of twins aged 20-91 were available in 4,143 individuals for self-reported periodontitis and 4,244 for gum bleeding. Age-adjusted model showed increasing risk in the following: smoking, anxiety/stress and depression for both periodontal traits. Within discordant monozygotic (MZ) twins (514 individuals for periodontitis and 754 for gum bleeding), the association of anxiety/stress remained significant for both periodontitis (OR 1.60, CI: 1.02-2.52) and gum bleeding (OR 1.60, CI: 1.06-2.40). A significant relationship for depression remained for periodontitis (OR 1.68, CI: 1.04-2.70), but it was no longer significant for gum bleeding. Age stratification showed that the association of mood disorders with periodontal traits was generally stronger in older group. CONCLUSIONS: Multivariate analysis among discordant MZ female twins found mood disorders were independently associated with periodontal traits, suggesting that genetic/early-life environmental factors may not explain this association.

Occlusal force is correlated with cognitive function directly as well as indirectly via food intake in community-dwelling older Japanese: From the SONIC study.

BACKGROUND: Growing evidence suggests that oral health may be an important factor associated with cognitive function in aged populations. However, many previous studies on this topic used insensitive oral indicators or did not include certain essential covariates. Thus, we examined the association between occlusal force and cognitive function in a large sample of older adults, controlling for dietary intake, vascular risk factors, inflammatory biomarkers, depression, and genetic factors. METHODS: In this cross-sectional study of older community-dwelling Japanese adults, we examined data collected from 994 persons aged 70 years and 968 persons aged 80 years. Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Oral status and function were evaluated according to the number of remaining teeth, periodontal pocket depth, and maximal occlusal force. Associations between MoCA-J scores and occlusal force were investigated via bivariate and multivariate analyses. RESULTS: Education level, financial status, depression score, and intake of green and yellow vegetables, as well as number of teeth and occlusal force, were significantly correlated with MoCA-J scores in both age groups. Among individuals aged 80 years, CRP and periodontal status were weakly but significantly associated with MoCA-J score. After controlling for all significant variables via bivariate analyses, the correlation between maximal occlusal force and cognitive function persisted. A path analysis confirmed the hypothesis that cognitive function is associated with occlusal force directly as well as indirectly via food intake. CONCLUSIONS: After controlling for possible factors, maximal occlusal force was positively associated with cognitive function directly as well as indirectly through dietary intake.

Association between salivary flow rate and depressive symptoms with adjustment for genetic and family environmental factors in Japanese twin study.

OBJECTIVES: The association between salivary flow rate (SFR) and depressive symptoms have been inconclusive. The present study aimed to investigate the association between SFR and depressive symptoms with and without adjustment for genetic and family environmental factors. MATERIALS AND METHODS: We conducted a cross-sectional study using twins and measured SFR and depressive symptoms as the outcome and explanatory variables, respectively. We also performed three-step regression analyses by first analysing the association between SFR and depressive symptoms without adjustment for genetic and family environmental factors (individual-level analyses). We then performed between-within analyses using monozygotic (MZ) and same-sex dizygotic (DZ) twin pairs, and finally using only MZ twin pairs. These between-within analyses estimated the coefficients adjusted for genetic and family environmental factors. Furthermore, differences in the associations between individual-level and between-within suggest confounding by genetic and family environmental factors. RESULTS: We conducted 448 twins aged ≥20 years. In individual-level analyses in males and between-within analyses using MZ and same-sex DZ male twin pairs, SFR associated with depressive symptoms. In between-within analyses using only MZ male twin pairs, SFR did not associate with depressive symptoms. In females, SFR did not associate with depressive symptoms in both individual-level and between-within analyses. CONCLUSIONS: The present study revealed that the association between SFR and depressive symptoms was affected by common genetic factors in males. CLINICAL RELEVANCE: Understanding this association between SFR and depressive symptoms with adjustment for genetic and family environmental factors could lead to an important consideration for the prevention and treatment of hyposalivation.

Examination of the Relationship between Oral Health and Arterial Sclerosis without Genetic Confounding through the Study of Older Japanese Twins.

OBJECTIVE: Although researchers have recently demonstrated a relationship between oral health and arterial sclerosis, the genetic contribution to this relationship has been ignored even though genetic factors are expected to have some effect on various diseases. The aim of this study was to evaluate oral health as a significant risk factor related to arterial sclerosis after eliminating genetic confounding through study of older Japanese twins. SUBJECTS AND METHODS: Medical and dental surveys were conducted individually for 106 Japanese twin pairs over the age of 50 years. Maximal carotid intima-media thickness (IMT-Cmax) was measured as a surrogate marker of arterial sclerosis. IMT-Cmax > 1.0 mm was diagnosed as arterial sclerosis. All of the twins were examined for the number of remaining teeth, masticatory performance, and periodontal status. We evaluated each measurement related with IMT-Cmax and arterial sclerosis using generalized estimating equations analysis adjusted for potential risk factors. For non-smoking monozygotic twins, a regression analysis using a "between within" model was conducted to evaluate the relationship between IMT-Cmax and the number of teeth as the environmental factor controlling genetic and familial confounding. RESULTS: We examined 91 monozygotic and 15 dizygotic twin pairs (males: 42, females: 64) with a mean (± standard deviation) age of 67.4 ± 10.0 years. Out of all of the oral health-related measurements collected, only the number of teeth was significantly related to arterial sclerosis (odds ratio: 0.72, 95% confidence interval: 0.52-0.99 per five teeth). Regression analysis showed a significant association between the IMT-Cmax and the number of teeth as an environmental factor (p = 0.037). CONCLUSIONS: Analysis of monozygotic twins older than 50 years of age showed that having fewer teeth could be a significant environmental factor related to arterial sclerosis, even after controlling for genetic and familial confounding.

Does case severity make a difference to clinical improvement following complete denture treatment?

PURPOSE: The aim of this study was to investigate the effect of case severity on clinical outcomes when fabricating new complete dentures. MATERIALS AND METHODS: Participants were separated into severe and moderate groups using the index of case difficulty for edentulous patients developed by the Japan Prosthodontic Society. Before and after treatment, self-assessed masticatory ability and oral health-related quality of life (OHRQoL) were examined, and the authors compared them according to case severity using the Mann-Whitney U test. To compare findings before and after treatment, the authors used the Wilcoxon signed rank test. RESULTS: In the severe group, both scores were significantly improved after treatment (P < .01). However, in the moderate group, there was no significant difference in self-assessed masticatory ability as measured by the food acceptance score before and after treatment (P = .11). Before treatment, OHRQoL as measured by the Oral Health Impact Profile score was significantly higher in the severe group than in the moderate group (P < .01). However, after treatment, there was no significant difference between the two groups (P = .92). CONCLUSIONS: The authors concluded that case severity makes a difference in the edentulous patient's OHRQoL and self-assessed masticatory ability during complete denture treatment. Evaluating case severity with the index before treatment is a useful tool for patients and clinicians to predict clinical outcomes.

Association of personality traits with oral health-related quality of life independently of objective oral health status: a study of community-dwelling elderly Japanese.

OBJECTIVES: Oral health-related quality of life (OHRQoL) is being increasingly used in epidemiologic studies of dentistry. However, patient-reported OHRQoL does not always coincide with clinical measures. Previous studies have shown a relationship between OHRQoL and personality, but did not concomitantly investigate oral function. We aimed to examine the association among personality traits, oral function, and OHRQoL using a large sample of community-dwelling Japanese elderly. METHODS: The participants (n = 938; age, 69-71 years) were drawn from a complete enumeration of an urban area and a rural area of both the Tokyo metropolitan area and Hyogo Prefecture. The self-perceived impact of OHRQoL was measured using the Geriatric Oral Health Assessment Index (GOHAI). The oral status and socioeconomic characteristics were recorded in each participant, and personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness) were assessed with the NEO-five-factor inventory. Multiple linear regression analysis was performed to examine the relationships between OHRQoL and other factors, with p < 0.05 considered to be statistically significant. RESULTS: Neuroticism was negatively associated with the GOHAI score in bivariate analyses (Spearman rank-order correlation coefficient (rs )= -0.20), whereas extraversion was positively associated (rs = 0.17). In the regression analyses, neuroticism (standardized partial regression coefficient (ß) = -0.179) and extraversion (ß=0.094) were significantly associated with the GOHAI scores independently of the number of teeth, maximal occlusal force, and financial status. CONCLUSIONS: Personality traits are associated with OHRQoL independently of objective measures of oral health status in community-dwelling elderly Japanese. CLINICAL SIGNIFICANCE: This study showed personality traits are associated with OHRQoL independently of dental status and oral function in old Japanese people. As elderly patients undergo increasingly complex dental treatments, there is a need to evaluate patient personality traits prior to dental treatment and predict patient expectations and responses to planned treatment. This is advantageous in determining the most appropriate therapy.

Overeruption of teeth opposing removable partial dentures: a preliminary study.

One of the purposes of prosthodontic treatment is to prevent overeruption of opposing teeth, but there is currently minimal literature describing the efficacy of removable partial dentures (RPDs) in performing this function. This study investigated overeruption following RPD treatment. The study participants were 33 patients treated with RPDs, and overeruption was evaluated by comparing the surface computeraided design data of dental casts made at two different time points-before and after RPD treatment. Overeruption was observed in 38.1% of teeth opposed by the RPD, which was much less than the proportion of teeth that overerupted when not opposed by the RPD.

Significance of occlusal force for dietary fibre and vitamin intakes in independently living 70-year-old Japanese: from SONIC Study.

OBJECTIVES: The number of teeth has frequently been used as an indicator of oral health in investigations of food intake; however, this measure does not represent the efficacy of the masticatory performance. Masticatory performance may be more important for food selection and avoidance than number of remaining teeth. The aim of this study was to investigate the association of occlusal force with habitual dietary intakes in independently living older Japanese. METHODS: The study population was 757 community-dwelling people aged 69-71 years old. Bilateral maximal occlusal force in the intercuspal position was measured with pressure-sensitive sheets. Removable denture wearers kept their dentures in place during the measurements. Dietary habits during the preceding month were assessed using a brief-type self-administered diet history questionnaire that measures consumption frequencies of selected food commonly consumed and calculates energy-adjusted dietary intakes. Linear trends of food and nutrient intakes with decreasing occlusal force were tested after adjusting for gender and socioeconomic factors. RESULTS: After adjusting for socioeconomic status and the number of remaining teeth, decline of occlusal force was significantly associated with lower intakes of vegetables, vitamins A, C, B6, folate, and dietary fibre (P for trend<0.05). In contrast, number of teeth was significantly associated only with calcium and zinc, controlling for occlusal force. CONCLUSIONS: It is concluded that occlusal force was significantly associated with intakes of vitamins and dietary fibre rather than number of remaining teeth in independently living older Japanese.

Replacement of a mandibular implant-fixed prosthesis with an implant-supported overdenture to improve maintenance and care.

PATIENTS: A 69-year-old woman presented to the Osaka University Dental Hospital. She had two chief complaints, (a) food accumulation under the lower teeth and (b) poor maxillary denture retention while eating. On clinical examination the patient presented with a maxillary complete denture and fixed mandibular implant prosthesis. For preventing food accumulation under the fixed implant prosthesis and to keep the maxillary denture stable by providing posterior occlusal contact for bilaterally balanced occlusion, the use of a mandibular implant-supported overdenture with self-adjusting magnetic attachments provided a prosthetic solution for this patient. After provided the new dentures, the patient was pleased and was comfortable with the aesthetic, stability and retention of the dentures. There were no discernable clinical or radiographic changes after 1 year of use. DISCUSSION: To prevent food accumulation beneath the fixed implant prosthesis and maintain the stability of the maxillary denture by providing posterior occlusal contact for bilaterally balanced occlusion, a mandibular implant-retained overdenture with magnetic attachments was used to provide a prosthetic solution for this patient. CONCLUSION: In this clinical case, an implant-fixed prosthesis in the edentulous mandibular region was replaced into an implant-supported overdenture with considerations for (a) preventing the food accumulation beneath the lower prosthesis, (b) achieving the proper occlusion in the posterior part for maxillary denture stability and (c) ease of maintenance and care for the prostheses.

Effect of dental status and masticatory ability on decreased frequency of fruit and vegetable intake in elderly Japanese subjects.

PURPOSE: The aim of this study was to investigate the association of masticatory ability and dental status with intake of fruits and vegetables after adjusting for other factors in independently living elderly Japanese subjects. MATERIALS AND METHODS: The study population consisted of 1,535 community-dwelling, independent elderly subjects over the age of 60 years. Self-assessed general health, financial status, dental status, self-assessed masticatory ability by food acceptance, and frequency of food intake were evaluated from responses to a questionnaire. Multiple logistic regression analysis for shortage of food intake was carried out. RESULTS: Of the participants, 29% had natural dentitions in both the maxilla and mandible and 15% were edentulous in at least one arch and wearing a complete denture. Percentages of participants with nutrient shortages of meat, fish and seafood, green and yellow vegetables, other vegetables, and fruits were 44%, 17%, 30%, 33%, and 12%, respectively. Multiple logistic regression analysis showed that men and subjects with a poor financial status had significant associations with shortages of dietary intake. In addition, shortages of meat, green and yellow vegetables, other vegetables, and fruit were significantly related to poor masticatory ability but not to dental status. Masticatory ability was significantly associated with shortages of green and yellow vegetables. CONCLUSION: Multivariate analyses showed that after adjusting for age, sex, and financial status, self-assessed masticatory ability rather than dental status by itself was significantly associated with shortages in vegetable and fruit intake in independently living elderly Japanese subjects.