Effects of Perioperative Oral Management in Patients with Cancer.

Perioperative oral management (POM) is used to prevent pneumonia in patients with cancer. However, the factors that expose hospitalized patients to increased risk of developing pneumonia remain unclear. For example, no study to date has compared the incidence of pneumonia in hospitalized patients by cancer primary lesion, or POM implementation, or not. We determined which patients were most likely to benefit from POM and examined the effects of POM on pneumonia prevention and mortality. In a total of 9441 patients with cancer who underwent surgery during hospitalization, there were 8208 patients in the No POM group, and 1233 in the POM group. We examined between-group differences in the incidence of pneumonia and associated outcomes during hospitalization. There was no significant between-group difference in the incidence of pneumonitis, however, patients with lung, or head and neck cancers, demonstrated a lower incidence of postoperative pneumonia. Among patients with lung and pancreatic cancers, mortality was significantly lower in the POM group. POM appears effective at reducing the risk of postoperative pneumonia in patients with certain cancers. Further, mortality was significantly lower in patients with lung and pancreatic cancers who received POM; hence, POM may be an effective adjuvant therapy for patients with cancer.

Standardization of Stimulus Location for Functional Electrical Stimulation of Swallowing.

Many nerves and muscles are involved in the swallowing process; hence neuromuscular disorders cause dysphagia resulting in aspiration pneumonia. A critical movement in the pharyngeal phase of swallowing is hyolaryngeal elevation to help protect the airway and open a relaxed upper esophageal sphincter. Functional electrical stimulation (FES) is expected to improve the function of muscles acting on the hyolaryngeal motion, which may contribute to airway protection in dysphagic patients. However, it is difficult to select the stimulus locations that effectively assist laryngeal elevation without the expertise in the anatomy of swallowing-related muscles. Therefore, this study investigated the method to standardize the selection of the stimulus locations based on the dimensions of the larynx. In addition, the effect of stimulus intensity on the amount of laryngeal elevation was evaluated.

What does oral care mean to society?

Oral care is defined in a narrow sense as cleaning of the teeth, oral cavity, and dentures, and in a broad sense as the maintenance of oral functions (feeding, swallowing, chewing, speech, aesthetics, etc.), dental treatment, feeding and swallowing training, and articulation training. In the past, it was recognized as simply cleaning the mouth, but the concept of oral care has gradually expanded, and many studies and surveys have been conducted in cooperation with various other professions. As a result, oral health care is involved not only in the prevention of pneumonia, but also in the onset and suppression for severity of diabetes, cardiovascular diseases, some malignant tumors, cerebrovascular diseases, rheumatoid arthritis, dementia, etc. It is also a powerful supportive therapy in cancer treatment. In the terminal stages of life, oral health care can help people to maintain their dignity by continuing to consume food orally until the end of their lives, and in times of disaster, oral health care has been found to be as important as attention to deep vein thrombosis. It has also been found to be effective in preventing severe diseases such as COVID-19. And, although it has not been discussed much, it has been found to have medical and economic benefits such as reducing the duration of hospitalization and treatment costs. This article reviews the results of research to date.

Cost-Effectiveness Analysis of Perioperative Oral Management after Cancer Surgery and an Examination of the Reduction in Medical Costs Thereafter: A Multicenter Study.

In April 2012, perioperative oral management (POM) was approved for inclusion in the national health insurance system of Japan to prevent the occurrence of pneumonia, a major complication in cancer patients. The subsequent decrease in the incidence of postoperative pneumonia indicated the prophylactic effect of POM. The constant increase in health expenditure necessitates a cost-effectiveness analysis. In addition, the effect of reducing healthcare costs owing to health technologies must be evaluated. In the present multi-institutional study, the cost-effectiveness analysis of POM was conducted by comparing the incidence of postoperative pneumonia and the healthcare costs between patients who received surgery for malignant tumors before (n = 11,886) and after (n = 13,668) the introduction of POM. Additionally, the effect of reducing healthcare costs was evaluated. Reductions in the number of patients who developed pneumonia, duration of hospitalization, and number of deaths were observed after the introduction of POM. The incremental cost-effectiveness ratio was 111,927 yen, hence the prevention of postoperative pneumonia needs 111,927 yen per patient in healthcare costs. Consequently, a maximum reduction of 250,368,129 yen in healthcare costs was observed between the incremental costs for pneumonia treatment and the cost of POM. These findings indicate that improvements in cost-effectiveness can be expected in the future through the development of procedure and system for POM.

Preventive Effects of Sustainable and Developmental Perioperative Oral Management Using the "Oral Triage" System on Postoperative Pneumonia after Cancer Surgery.

Perioperative oral management is widely recognized in the healthcare system of Japan. Conventionally, the surgeon refers patients with oral problems to a dental or oral surgery clinic in the hospital. However, frequent in-house referrals were found to increase the number of incoming patients resulting in unsustainable situations due to an insufficient workforce. In 2011, the Center for Perioperative Medicine was established at our hospital to function as a management gateway for patients scheduled to undergo surgery under general anesthesia. The "oral triage" system, wherein a dental hygienist conducts an oral screening to select patients who need preoperative oral hygiene and functional management, was established in 2012. A total of 37,557 patients who underwent surgery at our hospital from April 2010 to March 2019 (two years before and seven years after introducing the system) were evaluated in this study. The sustainability and effectiveness of introducing the system were examined in 7715 cancer surgery patients. An oral management intervention rate of 20% and a significant decrease in the incidence of postoperative pneumonia (aOR = 0.50, p = 0.03) indicated that this system could be useful as a sustainable and developmental oral management strategy to manage surgical patients with minimal human resources.

Pneumonia prevention effects of perioperative oral management in approximately 25,000 patients following cancer surgery.

AIM: We conducted a multicenter study to explore the risk factors of developing pneumonia and the effectiveness of perioperative oral management (POM) for the prevention of pneumonia in postsurgical patients. METHODS AND RESULTS: A survey covering eight regional hospitals was conducted over 4 years, from April 2010 to March 2014. Using the Diagnosis Procedure Combination database, a target group of 25,554 patients with cancer who underwent surgery was selected and assessed from a population of 346,563 patients without pneumonia on admission (sample population). The study compared the incidence of pneumonia and attempted to identify the significant predictive factors for its occurrence in these patients using multiple logistic regression analysis. Comparative assessment for the occurrence of pneumonia before and after POM implementation showed a significant incidence decrease after POM introduction in the target group, with no such change observed in the sample population. Multiple logistic regression analysis showed that the odds ratio for pneumonia occurrence after POM introduction was 0.44, indicating a reduced risk of pneumonia. CONCLUSION: POM in cancer patients was indeed effective in reducing the incidence of pneumonia in hospitals and thereby helped in preventing pneumonia during hospitalization.

Estimation of Muscle Activity Change under Different Bolus Conditions using Musculoskeletal Model of Swallowing.

Swallowing, deglutition, is realized by highly coordinated activities of many nerves and muscles, but it is hard to observe directly due to intracorporal movement, and there is a limitation to the number of muscles that can be percutaneously measured. In addition, since there are few studies on the mechanical analysis of the swallowing movement, the detailed muscle activity pattern during swallowing has not yet been clarified. To tackle this problem from the viewpoint of biomechanics, we have been developing the musculoskeletal model of swallowing which can estimate the activities of swallowing-related muscles based on the movements of hyoid bone and thyroid cartilage. In this paper, we analyzed the activities of swallowing-related muscles under two different bolus conditions: bolus of water and nectar thickened liquid to investigate the effect of physical property of bolus in the activities of swallowing-related muscles.

Numerical simulation of interaction between organs and food bolus during swallowing and aspiration.

The mechanism of swallowing is still not fully understood, because the process of swallowing is a rapid and complex interaction among several involved organs and the food bolus. In this work, with the aim of studying swallowing and aspiration processes noninvasively and systematically, a computer simulation method for analyzing the involved organs and water (considered as the food bolus) is proposed. The shape and motion of the organs involved in swallowing are modeled in the same way as in our previous study, by using the Hamiltonian moving particle simulation (MPS) method and forced displacements on the basis of motion in a healthy volunteer. The bolus flow is simulated using the explicit MPS method for fluid analysis. The interaction between the organs and the bolus is analyzed using a fluid-structure coupling scheme. To validate the proposed method, the behavior of the simulated bolus flow is compared qualitatively and quantitatively with corresponding medical images. In addition to the healthy motion model, disorder motion models are constructed for reproducing the aspiration phenomenon by computer simulation. The behaviors of the organs and the bolus considered as the food bolus in the healthy and disorder motion models are compared for evaluating the mechanism of aspiration.

A new oral care gel to prevent aspiration during oral care.

AIM: Although oral care is important in the prevention of aspiration pneumonia, the different institutions and practitioners employ various oral care methods, some of which are associated with the risk of aspiration. We have developed a new gel with the physical properties needed for waterless oral care. In the present study, we evaluated and investigated the properties and effectiveness of this gel. METHODS: The physical properties of the trial gel and commercial moisturizing gels were compared using a VAS scale. The effects of plaque elimination were evaluated in healthy volunteers. Brushing was carried out by a dental hygienist using the gel and water. The number of throat suctions performed during brushing was also counted, and the difference was evaluated. RESULTS: In the evaluation of physical characteristics, trial Gel B showed a significantly higher rating than the other gels. In plaque elimination, the rate of decrease in a modified PCR was significantly greater with the gel trial. Suctioning was also performed significantly fewer times with the trial gel. CONCLUSIONS: Good results were obtained with the newly developed trial Gel B with regard to the physical properties and the sensory evaluations. Its effectiveness was also confirmed in plaque elimination and in the evaluated risk of aspiration. The use of Gel B may have the potential to decrease the risk of aspiration during oral care and reduce the occurrence of aspiration pneumonia.

Development of a numerical simulator of human swallowing using a particle method (part 1. Preliminary evaluation of the possibility of numerical simulation using the MPS method).

The aim of the present study was to evaluate the possibility of numerical simulation of the swallowing process using a moving particle simulation (MPS) method, which defined the food bolus as a number of particles in a fluid, a solid, and an elastic body. In order to verify the accuracy of the simulation results, a simple water bolus falling model was solved using the three-dimensional (3D) MPS method. We also examined the simplified swallowing simulation using a two-dimensional (2D) MPS method to confirm the interactions between the liquid, solid, elastic bolus, and organ structure. In a comparison of the 3D MPS simulation and experiments, the falling time of the water bolus and the configuration of the interface between the liquid and air corresponded exactly to the experimental measurements and the visualization images. The results showed that the accuracy of the 3D MPS simulation was qualitatively high for the simple falling model. Based on the results of the simplified swallowing simulation using the 2D MPS method, each bolus, defined as a liquid, solid, and elastic body, exhibited different behavior when the organs were transformed forcedly. This confirmed that the MPS method could be used for coupled simulations of the fluid, the solid, the elastic body, and the organ structures. The results suggested that the MPS method could be used to develop a numerical simulator of the swallowing process.

Development of a numerical simulator of human swallowing using a particle method (Part 2. Evaluation of the accuracy of a swallowing simulation using the 3D MPS method).

The aim of this study was to develop and evaluate the accuracy of a three-dimensional (3D) numerical simulator of the swallowing action using the 3D moving particle simulation (MPS) method, which can simulate splashes and rapid changes in the free surfaces of food materials. The 3D numerical simulator of the swallowing action using the MPS method was developed based on accurate organ models, which contains forced transformation by elapsed time. The validity of the simulation results were evaluated qualitatively based on comparisons with videofluorography (VF) images. To evaluate the validity of the simulation results quantitatively, the normalized brightness around the vallecula was used as the evaluation parameter. The positions and configurations of the food bolus during each time step were compared in the simulated and VF images. The simulation results corresponded to the VF images during each time step in the visual evaluations, which suggested that the simulation was qualitatively correct. The normalized brightness of the simulated and VF images corresponded exactly at all time steps. This showed that the simulation results, which contained information on changes in the organs and the food bolus, were numerically correct. Based on these results, the accuracy of this simulator was high and it could be used to study the mechanism of disorders that cause dysphasia. This simulator also calculated the shear rate at a specific point and the timing with Newtonian and non-Newtonian fluids. We think that the information provided by this simulator could be useful for development of food products, medicines, and in rehabilitation facilities.

[Oral conditions and oral management approaches in mild dementia patients].

AIM: The oral management of dementia patients is critical to prevent aspiration pneumonia and maintain patients' quality of life. However, the oral health status of these patients has not been adequately elucidated thus far, and it is not well understood how oral care is managed for mild dementia patients. To provide effective oral management for mild dementia patients, we investigated their oral health status and how their oral care was managed. METHODS: We enrolled 10 outpatients aged 66 to 85 years old who regularly visited our neurology clinic. All of the patients had mild dementia. We conducted 2 questionnaire studies regarding oral hygiene and dentures and performed an oral examination to evaluate the changes in oral hygiene status over time. The questionnaire was designed to explore the understanding of oral hygiene methods. Oral care instructions were given to the patients and their caregivers. Three surveys of 2 questionnaires each were performed. The survey was conducted at the initial visit, and 3 months and 6 months later. RESULTS: Although oral care instructions were given to the patients and their caregivers, neither their plaque index nor gingival index showed major improvement over time. Based on the results of these questionnaires, patient awareness of oral hygiene did not change over time. CONCLUSION: It is difficult for patients with mild dementia to perform oral care by themselves. It is important to make oral hygiene habits second nature in middle-aged patients, to introduce oral management to be performed by the caregivers and to promote early dental intervention to improve and maintain oral hygiene status in mild dementia patients.

Oral care help to maintain nutritional status in frail older people.

The purpose of this study was to evaluate the effect of continuous oral care on the nutritional status of older people who require care using a 1-year randomized, controlled study. Fifty-three residents of a nursing home in Japan participated in this study. Subjects were randomly divided into two groups, an oral care intervention group and control group. The subjects in the oral care intervention group received professional oral care from a dentist three times a week over the course of 1 year. Body weight, body mass index (BMI), serum albumin, and high-density lipoprotein cholesterol (HDL-C) were measured as objective indicators of nutritional status at baseline and after 1 year, and compared between the groups. In the oral care group, no significant decline was seen in all indicators from the start to the end of the intervention, but in the control group there was a statistically significant decline in all indicators at the end of the year. These results suggest that the intervention of oral care alone can serve to maintain the nutritional status of older people who require care. Implementation of continuous oral care is an important task from the viewpoint of maintaining nutritional status in older people.

Colonization of dental plaque by respiratory pathogens in dependent elderly.

Pneumonia can be a life-threatening infection, especially in the elderly, and it is a significant cause of morbidity and mortality. The purpose of this study was to assess the existence of oral infectious pathogens potentially causing the respiratory disease in the dependent elderly. The dental plaques of 138 dependent elderly were examined to identify microorganisms by the culture method. Twenty-one species of microorganisms were detected in the dental plaques in this study. In 89 cases out of 138 (64.5%), potential respiratory pathogens colonized in the dental plaques of the dependent elderly. The results of the present study revealed that bacteria that commonly cause respiratory infection colonized in dental plaques of the aged, dependent subjects. Therefore, dental plaques must be considered a specific reservoir of colonization and subsequent aspiration pneumonia in dependent elderly.

Developing an instrument to support oral care in the elderly.

BACKGROUND: The dramatic increase in the number of dependent elderly in developed countries has created a great need for their improved oral care. However, optimal oral care by caregivers is not possible because of time constraints, difficulty involved in brushing other individuals' teeth, lack of co-operation, and the lack of perceived need. Therefore, the development of an effective instrument simplifying and supporting oral care to relieve the strain on caregivers is a matter of some urgency. PURPOSE: In order to clean the mouths of elderly dependent patients, we have developed a new oral care support instrument (an electric toothbrush in combination with an antibacterial-agent supply and suction system). The purpose of the present study was to develop and evaluate a new oral care support instrument. METHODS: a) Plaque removal study: The plaque- removing ability of this new instrument in 70 outpatients was compared with the Plak Control D9011 (Braun Gillette Japan Inc.) as a control by means of the Turesky modification of the Quigley and Hein plaque index. b) Clinical study: The subjects were 10 dependent elderly who received oral care using the new oral care support instrument for two weeks. The plaque and gingival indices were used for clinical evaluations. RESULTS: a) Plaque removal study: Brushing with the new oral care support instrument removed significantly more plaque than with the Plak Control D9011. b) Clinical study: The new oral care support instrument allows a more effective removal of dental plaque and shows a significant improvement in the gingival indices in dependent elderly. CONCLUSION: It is concluded that the new oral care support instrument is effective and can be recommended for oral care in the dependent elderly.

Development of a systematic oral care program for frail elderly persons.

The purpose of this study was to develop, implement and evaluate a systematic oral care program for community-dwelling-dependent or institutionalized elderly adults. The study group consisted of 20 dependent elderly adults of which 15 were living in the community and five were in a nursing home. After eight weeks of systematic oral care, the plaque and gingival indices were scored and compared with baseline measurements. Also at the end of the study, caregivers completed a questionnaire that assessed their perspective on the advantages, disadvantages, burden and fatigue in providing the systematic oral care program. The results of this study demonstrate that a systematic oral care program reduced plaque and gingival indices for the subjects as well as reducing the caregivers' burden and fatigue in providing daily oral care.