Association between denture use and food form in older adults requiring long-term care: A multicenter cross-sectional study.

PURPOSE: This study aimed to determine whether denture use contributes to maintaining and improving food forms in long-term care facility (LTCFs) residents. METHODS: In 888 residents of 37 LTCFs in Japan, the following were investigated: nutritional intake status, food forms, age, sex, Barthel index (BI), clinical dementia rating (CDR), number of teeth present, number of occlusal supports, swallowing function, and use of dentures. Among all residents, those who were well-nourished and had ≤9 occlusal supports were analyzed. Based on standardized criteria, the food forms consumed by the subjects were divided into two groups: dysphagia and normal diet, which were further classified into four levels. Analysis was performed using a generalized estimation equation with the four levels of food forms as dependent variables and age, sex, BI, CDR, presence of dysphagia, number of teeth present, and use of dentures as independent variables. RESULTS: The final analysis included 622 (70.0%) residents. Of these, 380 (61.1%) used dentures. The analyses revealed that food form was significantly associated with age (adjusted odds ratio [OR], 0.98), BI (OR, 1.04), number of teeth present (OR, 1.03), presence of dysphagia (OR, 0.44), and use of dentures (OR, 2.82). CONCLUSIONS: Denture use was associated with food forms among Japanese LTCF residents. This indicates that the use of dentures is related to the maintenance of food forms, even in the elderly who participate in few activities of daily living, have reduced cognitive function, and require long-term care.

Pneumonia incidence and oral health management by dental hygienists in long-term care facilities: A 1-year prospective multicentre cohort study.

OBJECTIVE: To investigate the association between oral health management (OHM) by dental hygienists and the occurrence of pneumonia, and determine the effectiveness of OHM in pneumonia prevention. BACKGROUND: In long-term care facilities in Japan, the need for professional OHM is increasing with an increase in the number of severely debilitated residents. MATERIALS AND METHODS: A 1-year prospective multicentre cohort study was conducted using data from 504 residents (63 men; mean age: 87.4 ± 7.8 years) in Japanese long-term care facilities. Basic information, medical history, willingness to engage in oral hygiene behaviour, need for OHM and oral conditions were investigated at baseline. In addition, information on the occurrence of pneumonia was collected using a follow-up survey after one year. A Poisson regression analysis with robust standard errors was conducted, with pneumonia as the dependent variable, and factors associated with OHM and pneumonia occurrence as explanatory variables. RESULTS: Overall, 349 (69.2%) residents required OHM by dental hygienists during that year of follow-up. Of those, 238 (68.2%) were provided with OHM, and 18 (7.5%) developed pneumonia. Among the 111 patients (31.8%) who were not provided with OHM, 21 (18.9%) developed pneumonia. The OHM group had lower pneumonia rates than the non-OHM group (prevalence rate ratio: 0.374; 95% CI: 0.210-0.665). CONCLUSION: Oral health management by dental hygienists was associated with a lower incidence of pneumonia among residents of long-term care facilities, underlining the importance of professional OHM for such individuals. It is recommended that OHM be practised routinely in long-term care facilities.

Acute Prevertebral Abscesses Caused by Bacterial-infected Traumatic Tooth Fractures.

We report a case of acute prevertebral abscess caused by traumatic tooth fractures in a 77-year-old Japanese man. After being transferred to our hospital the patient was initially diagnosed with a neck hematoma; however, blood culture showed Streptococcus parasanguinis, an oral bacterium, and an MRI examination suggested prevertebral abscesses. Tooth fractures, severe periodontitis, and peri-implantitis with Streptococcus parasanguinis were observed. Antibiotics were administered and fractured teeth were extracted. The patient's condition then gradually improved. We concluded that bacteremia caused by traumatic tooth fractures induced the acute prevertebral abscesses.

Multidisciplinary clinical approach by sharing oral examination information to treat a diabetes patient with dysgeusia.

Taste alteration is one of the complications of severe diabetes. It is important in diabetes treatment to assess taste alteration and perform dietary counseling, therapeutic exercise, and oral care. In this case, multidisciplinary clinical approach by medical staff was successful for a severely diabetic patient with dysgeusia.

New simple evaluation method of the monosyllable /sa/ using a psychoacoustic system in maxillectomy patients.

PURPOSE: An objective assessment of speech would benefit the prosthetic rehabilitation of maxillectomy patients. This study aimed to establish a simple, objective evaluation of monosyllable /sa/ utterances in maxillectomy patients by using a psychoacoustic system typically used in industry. MATERIALS AND METHODS: This study comprised two experiments. Experiment 1 involved analysis of the psychoacoustic parameters (loudness, sharpness and roughness) in monosyllable /sa/ utterances by 18 healthy subjects (9 males, 9 females). The utterances were recorded in a sound-treated room. The coefficient of variation (CV) for each parameter was compared to identify the most suitable parameter for objective evaluation of speech. Experiment 2 involved analysis of /sa/ utterances by 18 maxillectomy patients (9 males, 9 females) with and without prosthesis, and comparisons of the psychoacoustic data between the healthy subjects and maxillectomy patients without prosthesis, between the maxillectomy patients with and without prosthesis, and between the healthy subjects and maxillectomy patients with prosthesis. RESULTS: The CV for sharpness was the lowest among the three psychoacoustic parameters in both the healthy males and females. There were significant differences in the sharpness of /sa/ between the healthy subjects and the maxillectomy patients without prosthesis (but not with prosthesis), and between the maxillectomy patients with and without prosthesis. CONCLUSION: We found that the psychoacoustic parameters typically adopted in industrial research could also be applied to evaluate the psychoacoustics of the monosyllable /sa/ utterance, and distinguished the monosyllable /sa/ in maxillectomy patients with an obturator from that without an obturator using the system.

Standardization of thresholding for binary conversion of vocal tract modeling in computed tomography.

Postoperative head and neck cancer patients suffer from speech disorders, which are the result of changes in their vocal tracts. Making a solid vocal tract model and measuring its transmission characteristics will provide one of the most useful tools to resolve the problem. In binary conversion of X-ray computed tomographic (CT) images for vocal tract reconstruction, nonobjective methods have been used by many researchers. We hypothesized that a standardized vocal tract model could be reconstructed by adopting the Hounsfield number of fat tissue as a criterion for thresholding of binary conversion, because its Hounsfield number is the nearest to air in the human body. The purpose of this study was to establish a new standardized method for binary conversion in reconstructing three-dimensional (3-D) vocal tract models. CT images for postoperative diagnosis were secondarily obtained from a CT scanner. Each patient's minimum settings of Hounsfield number for the buccal fat-pad regions were measured. Thresholds were set every 50 Hounsfield units (HU) from the bottom line of the buccal fat-pad region to -1024 HU, the images were converted into binary values, and were evaluated according to the three-grade system based on anatomically defined criteria. The optimal threshold between tissue and air was determined by nonlinear multiple regression analyses. Each patient's minimum settings of the buccal fat-pad regions were obtained. The optimal threshold was determined to be -165 HU from each patient's minimum settings of the Hounsfield number for the buccal fat-pad regions. To conclude, a method of 3-D standardized vocal tract modeling was established.

Investigation of the factors influencing the outcome of prostheses on speech rehabilitation of mandibulectomy patients.

PURPOSE: The aim of this study was to investigate the factors influencing the outcome of prostheses on speech rehabilitation of mandibulectomy patients. METHODS: Eleven patients (6 males and 5 females) who underwent mandibulectomy without glossectomy because of a tumor participated in the study. A Speech Intelligibility (SI) test was applied without and with a prosthesis to evaluate their speech ability. The type of resection, whether soft tissue grafting was undertaken or not, the continuity of mandibular bone, and the number of remaining teeth related to the stability of the prosthesis were determined from the medical records. The some of acoustic features, Formant 1 and Formant 2 range, were investigated to evaluate objectively the limitation of tongue movement. Five questionnaires were sent out to evaluate subjectively the difference in sense of discomfort while speaking with and without the prosthesis. These eleven items were entered into stepwise multiple regression models to determine the predictors of the differences in SI score without and with a prosthesis. RESULTS: Three variables, the ease of tongue movements, whether soft tissue grafting was undertaken or not, and whether the mandibular bone was continuous or not, contributed to the recovery of speech ability with prosthodontic treatment. CONCLUSION: The ease of tongue movement, no soft tissue grafting, and the continuity of mandibular bone contribute to the recovery of speech ability with prosthodontic treatment.