Impact of occlusal force on decline in body mass index among older Japanese adults: Finding from the SONIC study.

OBJECTIVES: To determine any independent influence of occlusal force and of number of natural teeth on decline in body mass index (BMI) among older Japanese adults. DESIGN: Longitudinal study over a 3- to 6-year period. SETTING: Urban and rural area in Japan. PARTICIPANTS: Independently living Japanese adults aged 69-71 years and 79-81 years at baseline. This analysis excluded participants who were defined as underweight at baseline. MEASUREMENTS: Information was collected on age, gender, occlusal force, the number of teeth, BMI, socioeconomic factors, medical history, the number of daily prescription medications, cognitive function, depressive symptoms, hand grip strength, and physical function. Maximal occlusal force was measured with a pressure-sensitive sheet. Nutritional status was assessed using BMI, and participants with BMI <21.5 were defined as underweight. Then, they were divided into two groups: a "BMI declined" group who were defined as underweight at either 3- or 6-year follow-up survey, and a "BMI maintained" group who were not defined as underweight at both follow-up surveys. Logistic generalized estimating equation (GEE) models were used to assess the effect of occlusal force and the number of teeth at baseline on decline in BMI over 3 or 6 years, after adjusting for possible covariates associated with nutritional status. RESULTS: The final analysis included 704 participants. Eighty-six (12.2%) participants were classified into the BMI declined group. Logistic GEE models showed that the number of teeth was not significantly associated with decline in BMI. However, occlusal force was significantly associated with decline in BMI (odds ratio = 0.90, 95% confidence interval = 0.83-0.97) after adjusting for covariates. CONCLUSION: Participants with lower occlusal force were more likely to be in the BMI less than 21.5 kg/m2 . The findings suggest that to prevent decline in oral function is important to maintain nutritional status.

Reconstruction of right ventricular outflow tract stenosis and right ventricular failure after Ross procedure - comprehensive assessment of adult congenital heart disease with four-dimensional imaging: a case report.

BACKGROUND: Re-intervention after Ross procedure into the right ventricular outflow tract might be needed in patients in the long term. However, right ventricular outflow tract re-intervention indications are still unclear. Comprehensive assessment of total hemodynamics is needed. A 42-year-old Japanese woman was referred to our hospital for moderately severe pulmonary regurgitation and severe tricuspid regurgitation after a Ross-Konno procedure. Thirteen years after surgery, she developed atrial fibrillation and atrial flutter and complained of dyspnea. Electrophysiological studies showed re-entry circuit around the low voltage area of the lateral wall on the right atrium. Four-dimensional flow magnetic resonance imaging revealed moderate pulmonary regurgitation, severe tricuspid regurgitation, and a dilated right ventricle. Flow energy loss in right ventricle calculated from four-dimensional flow magnetic resonance imaging was five times higher than in normal controls, suggesting an overload of the right-sided heart system. Her left ventricular ejection fraction was almost preserved. Moreover, the total left interventricular pressure difference, which shows diastolic function, revealed that her sucking force in left ventricle was preserved. After the comprehensive assessments, we performed right ventricular outflow tract reconstruction, tricuspid valve annuloplasty, and right-side Maze procedure. A permanent pacemaker with a single atrial lead was implanted 14 days postoperatively. She was discharged 27 days postoperatively. Echocardiography performed 3 months later showed that the size of the dilated right ventricle had significantly reduced. DISCUSSION: A four-dimensional imaging tool can be useful in the decision of re-operation in patients with complex adult congenital heart disease. The optimal timing of surgery should be considered comprehensively.

Relationship between oral stereognostic ability and dietary intake in older Japanese adults with complete dentures.

PURPOSE: Oral stereognostic ability (OSA) is a useful indicator of oral perception to recognize food characteristics during mastication. Previous studies have shown associations between dietary intake and oral health status, such as taste perception. However, the effect of oral sensory ability on dietary intake is unclear. The purpose of this study was to investigate the association between oral sensory ability and dietary intake in older Japanese complete denture wearers. METHODS: This cross-sectional study included 164 participants aged 69-71 or 79-81years old, wearing both maxillary and mandibular complete dentures. OSA test was used to evaluate oral tactile perception. Diet during the preceding month was assessed using a self-administered diet history questionnaire. Multivariable linear regression analysis was conducted to assess the association between OSA score and food and nutrient intake after adjusting for age, sex, socioeconomic factors, and occlusal force. RESULTS: The bivariate analysis showed that OSA score was significantly and positively correlated with intake of green and yellow vegetables and negatively correlated with intake of cereals among examined foods. OSA score was also positively correlated with intake of vitamins A, B2, and C and α-tocopherol (as a substitute for vitamin E) among examined nutrients. After adjusting for age, sex, socioeconomic factors, and occlusal force, OSA score remained significantly associated with intake of green and yellow vegetables and α-tocopherol. CONCLUSIONS: OSA was significantly associated with intake of green and yellow vegetables in older complete denture wearers.

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.

Microbiological assessment of effects of clinical mouth rinses on common oral microbes.

Dry mouth occurs frequently in aged individuals, as well as in patients who are hospitalized, receiving multiple drugs, undergoing radiation treatment to the head and neck, or wearing a removable denture prosthesis, use of mouth rinse being often an option for relief. In the present study, we performed microbiological assessments of subjects given three different commercially available mouth rinses commonly employed in clinical practice (Peptisal, Biotène, ConCool) to determine their effects. For bacterial clearance in vitro, Peptisal showed the highest level of suppression of oral indigenous bacteria found in both planktonic formations and biofilm. Furthermore, the inhibitory effects of these agents on biofilm formation on acrylic resin plates were examined using scanning electron microscopy. Again, Peptisal proved superior, because acquisition of resistance to antimicrobial peptides by a sensitive microbial strain was rarely observed. We conclude that Peptisal is an effective mouth rinse for clearance of planktonic and biofilm microorganisms present in the oral cavity.

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.

Multifactorial risk assessment for survival of abutments of removable partial dentures based on practice-based longitudinal study.

OBJECTIVES: Predicting the tooth survival is such a great challenge for evidence-based dentistry. To prevent further tooth loss of partially edentulous patients, estimation of individualized risk and benefit for each residual tooth is important to the clinical decision-making. While there are several reports indicating a risk of losing the abutment teeth of RPDs, there are no existing reports exploring the cause of abutment loss by multifactorial analysis. The aim of this practice-based longitudinal study was to determine the prognostic factors affecting the survival period of RPD abutments using a multifactorial risk assessment. METHODS: One hundred and forty-seven patients had been previously provided with a total of 236 new RPDs at the Osaka University Dental Hospital; the 856 abutments for these RPDs were analyzed. Survival of abutment teeth was estimated using the Kaplan-Meier method. Multivariate analysis was conducted by Cox's proportional hazard modelling. RESULTS: The 5-year survival rates were 86.6% for direct abutments and 93.1% for indirect abutments, compared with 95.8% survival in non-abutment teeth. The multivariate analysis showed that abutment survival was significantly associated with crown-root ratio (hazard ratio (HR): 3.13), root canal treatment (HR: 2.93), pocket depth (HR: 2.51), type of abutments (HR: 2.19) and occlusal support (HR: 1.90). CONCLUSION: From this practice-based longitudinal study, we concluded that RPD abutment teeth are more likely to be lost than other residual teeth. From the multifactorial risk factor assessment, several prognostic factors, such as occlusal support, crown-root ratio, root canal treatment, and pocket depth were suggested. CLINICAL SIGNIFICANCE: These results could be used to estimate the individualized risk for the residual teeth, to predict the prognosis of RPD abutments and to facilitate an evidence-based clinical decision making.

Assessment of bone density in the posterior maxilla based on Hounsfield units to enhance the initial stability of implants.

PURPOSE: The poor bone quality that exists in the posterior maxilla is associated with lower initial stability and higher failure rates in implants. This study examined the bone densities of edentulous posterior maxillae by computed tomography (CT). MATERIALS AND METHODS: Based on CT images, the voxel values representing implant replacement in the posterior maxillary regions of 30 patients were calculated in the range from 150 to 2,000 Hounsfield units (HU). The bone densities of these regions were categorized according to Misch's classification and compared among individuals and between sexes. RESULTS: The average of the median individual CT values was 495 HU (95% confidence interval: 442-547 HU) and was significantly higher in males than in females. Most of the bone in the posterior maxillae was classified as D3 (350-850 HU) or D4 (150-350 HU) according to Misch's classification, comprising 50% and 32% of the entire regions, respectively. CONCLUSIONS: More than 80% of the edentulous posterior maxillae consisted of porous cortical crest or no cortical bone according to CT, although the bone densities varied markedly among individuals. More detailed assessments of bone density may be useful to enhance initial stability of implants in the posterior maxilla.