Association of mastication and factors affecting masticatory function with obesity in adults: a systematic review.

BACKGROUND: A substantial number of adults suffer from obesity, that is caused by the risk factor, masticatory dysfunction. The association between mastication and obesity, however, is inconclusive. This systematic review aims to provide literature regarding the association between mastication and factors affecting masticatory function, and obesity in adults. METHODS: Four electronic databases (PubMed, EMBASE, Cochrane Library, and Web of Science) were used to search for publications that met the following criteria: published between 2007 and 2016, written in English, and assessed the associations between mastication and obesity among the population aged ≥18 years. The included publications were analyzed based on the study design, main conclusions, and strength of evidence identified by the two authors who screened all the abstracts and full-text articles and, abstracted data, and performed quality assessments by using a critical appraisal tool, the Critical Appraisal Skills Programme Cohort Studies Checklists. RESULTS: A total of 18 articles (16 cross-sectional, 1 cohort studies, and 1 randomized controlled trial [RCT]) met our inclusion criteria and were evaluated. Poorer mastication was associated with obesity in 12 out of 16 cross-sectional studies. One cohort study showed that the obesity group displayed higher tooth loss than the normal weight group. One RCT demonstrated that gum-chewing intervention for 8 weeks significantly decreased waist circumference. CONCLUSIONS: Most studies revealed a positive association between mastication and obesity among adults. Nonetheless, most of them are cross-sectional studies, which are insufficient to demonstrate a causal relation. Further advancement requires RCT, especially an intervention of improvement of mastication and obesity needed to confirm this association.

The relationship between tooth loss and hypertension: a systematic review and meta-analysis.

As tooth loss is the high end of periodontal problems and edentulous individuals are at higher risk of nutritional problems like obesity, understanding the association between tooth loss and hypertension is important for improving cardiovascular health. We searched for publications from the last two decades using three electronic databases (PubMed, Web of Science and Scopus) and conducted a systematic review and meta-analysis on the association between tooth loss and hypertension according to PRISMA-P guidelines. Quality assessments were performed using the Newcastle-Ottawa Scale and the GRADE approach. Twenty-four studies (20 cross-sectional, and 4 cohort) met the inclusion criteria for this review. Most cross-sectional studies showed that subjects with more tooth loss exhibited a greater proportion of hypertension and higher systolic blood pressure than those with less tooth loss. Meta-analyses revealed a statistically significant association between tooth loss and hypertension. The pooled odds ratios of hypertension for having tooth loss with no tooth loss and for edentulous with dentate were 2.22 (95% CI 2.00-2.45) and 4.94 (95% CI 4.04-6.05), respectively. In cohort studies, subjects with more tooth loss had a greater incidence of hypertension than those with less tooth loss during the follow-up period. The present systematic review and meta-analysis suggests that tooth loss is associated with an increased risk of hypertension and higher systolic blood pressure.

A quick statistically accurate diagnosis for caries risk in the elderly.

BACKGROUND: In the elderly, the necessity to promote oral health is increasing to improve their quality of life. The prediction of dental caries risk makes it possible to prolong the life span of teeth. To develop a quick diagnosis system for caries risk, two methods, the modified Saliva Check SM and Saliva Check sIgA, were investigated in elderly patients. METHODS: We developed a caries risk quick assessment system using Saliva Check sIgA that specifically recognizes secretory IgA (sIgA) in saliva against the binding site of the mutans streptococci (MS) to the salivary-coated tooth surface; and combined it with a modified Saliva Check SM to determine the number of MS. One hundred eighty three patients (80 females, 103 males) who participated in 2005 (average age 77 years) and in 2006 (average age 78 years) were assessed for caries risk using the systems in this cohort study. RESULTS: Subjects with a positive Saliva Check sIgA showed a significantly lower increment of decayed and filled teeth number (DFT) on the coronal surface; whereas those testing negative had root decay and increased filled teeth numbers (RDFT) at the root surface during the following year. The combination of Saliva Check sIgA and modified Saliva Check SM showed the subjects with Saliva Check sIgA positive and modified Saliva Check SM negative had less than half of the increment of DFT than other groups. In the other groups, Saliva Check sIgA negative and modified Saliva Check SM positive detected >90% of the subjects with an MS level of >5 x 10(5)/mL of saliva in patients that were assessed in 2006. This suggests these subjects may need extensive care. CONCLUSIONS: This new combination system significantly evaluates the caries risk to predict future incidence for dental caries on the coronal surface and may be useful for risk diagnosis of caries during a visit to the dental office.

The Relationship between Vitamin C and Periodontal Diseases: A Systematic Review.

Vitamin C is important for preventing and slowing the progression of many diseases. There is significant evidence linking periodontal disease and vitamin C. We aimed to systematically review the studies addressing the relationship between vitamin C and periodontal disease, and the preventive ability of vitamin C against periodontal disease. Electric searches were performed using PubMed, EMBASE, Cochrane Library, and Web of Science. Studies addressing the relationships between periodontal disease and vitamin C in adults aged over 18 years were included. Quality assessment was done using the Critical Appraisal Skills Program guideline and GRADE-CERQual. There were 716 articles that were retrieved and 14 articles (seven cross-sectional studies, two case-control studies, two cohort studies, and three randomized controlled trials (RCT)) were selected after reviewing all of the articles. The vitamin C intake and blood levels were negatively related to periodontal disease in all seven cross-sectional studies. The subjects who suffer from periodontitis presented a lower vitamin C intake and lower blood-vitamin C levels than the subjects without periodontal disease in the two case-control studies. The patients with a lower dietary intake or lower blood level of vitamin C showed a greater progression of periodontal disease than the controls. The intervention using vitamin C administration improved gingival bleeding in gingivitis, but not in periodontitis. Alveolar bone absorption was also not improved. The present systematic review suggested that vitamin C contributes to a reduced risk of periodontal disease.

Impact of routine oral care on opportunistic pathogens in the institutionalized elderly.

Routine oral hygiene is important for the control of opportunistic pathogens in the oral cavity of institutionalized elderly individuals. We evaluated the effects of routine oral care on opportunistic pathogens at various time points after admission to a nursing home. Twenty-five elderly subjects living in the nursing home (mean age: 86.0 +/- 10.4 years) participated in the study. Caregivers and dental hygienists cleaned the teeth, dentures, tongue, and mucosa after each meal using both routine and professional oral care techniques. Opportunistic pathogens were collected from the teeth, tongue, and mucosal surfaces using a cotton swab; and the species of microbes were determined and the numbers were counted following cultivation on selective agar. Regular oral care including professional oral care was found to be effective for reducing infections by many kinds of opportunistic pathogens on the teeth surfaces and the oral environment without food residue during a long-term study (6 months). Further, this care after 1 month significantly reduced infections by opportunistic pathogens on mucosal surfaces in subjects without dentures; however, this was not observed in those with dentures. Our data shows the importance of regular oral care in cleaning hard and soft surfaces of the oral cavity improves the oral health of the institutionalized elderly.

Psychological effects of exercise on community-dwelling older adults.

BACKGROUND: In recent years, there have been an increasing number of older adults who suffer from mental disorders globally. OBJECTIVE: The objective of this study was to examine the effect of an intervention that consisted of an exercise program to improve the mental health of community-dwelling older adults. PARTICIPANTS AND METHODS: The recruited participants of this study were community-dwelling older adults aged ≥60 years who participated in a comprehensive health promotion program in Kakogawa, Japan. Participants in the intervention group received an exercise program that was developed for older adults using Thera-Band. To measure participants' mental health status, a Japanese version of the short form of the Profile of Mood States (POMS-SF) was used. Stress markers were measured, such as salivary cortisol, alpha-amylase, and sIgA levels. All participants provided salivary samples and completed psychological questionnaires at baseline and 6-month follow-up. RESULTS: No significant differences were observed between the intervention and control groups with respect to POMS-SF score and salivary biomarker profile at baseline. After the intervention, the intervention group showed a significant decrease in the POMS-SF "fatigue" score and cortisol level. No significant changes were observed in the control group. CONCLUSION: Simultaneous changes in feelings of fatigue and cortisol levels were observed among subjects who had received the intervention of regular exercise. Further research is needed to investigate the effectiveness of exercise intervention in improving mental health among older adults.

Relationships of anti-PAc (361-386) peptide salivary IgA antibody, eosinophils and basophils with periodontal status in the elderly.

The amino acid residues 361-386 of Streptococcus mutans PAc includes an important region associated with the interaction between S. mutans and salivary components. We investigated the relationships between levels of the anti-PAc (361-386) peptide antibody (PPA) in saliva and periodontal status in 281 elderly subjects (mean age 77 years; 118 females, 163 males) by assessing dental calculus (CA), attachment loss (AL), pocket depth (PD), bleeding on probing (BOP) and various blood parameters. Enzyme-linked immunosorbent assay results revealed that subjects with a PPA level of greater than 0.1 (PPA detected group) showed a lower average value for number of sites with more than 6 mm of AL/6 points x 100/tooth (rAL6) than those with a PPA level of less than 0.1 (PPA not detected group). Furthermore, average values for rAL6 were significantly lower in the PPA detected group, and BOP, AL and rAL6 correlated positively and significantly with the percentage of eosinophils present in leukocytes in female subjects in both groups. PPA level had a negative correlation with percentages of basophils and eosinophils. The results indicate that systemic increases in numbers of eosinophils and basophils are associated with the development of periodontal diseases, while PPA level may be a useful indicator of periodontal status.

Role of salivary tumour necrosis factor alpha in HIV-positive patients with oral manifestations.

In HIV-1-infected patients, oral manifestations such as recurrent apthous ulcers are often seen. A total of 29 HIV-infected patients were examined to determine salivary tumour necrosis factor alpha (TNFalpha) concentrations by enzyme-linked immunosorbent assay, the amount of HIV-1 RNA copy by Amplicor HIV-1 Monitor test, number of CD4 cells by flow cytometry and oral manifestations by oral examination. TNFalpha concentration was significantly correlated with the amount of HIV-1 RNA, however, not with the number of CD4 cells in HIV-1-infected patients. Further, patients with oral manifestations showed significantly higher concentrations of TNFalpha in saliva and HIV-1 RNA copies in serum than those without oral manifestations. Following recovery from oral ulcers, TNFalpha concentration was decreased by half to 20 times lower than the level of that during ulcer incidence. Our results suggest that salivary TNFalpha is a good indicator for oral manifestations and HIV RNA amounts in HIV-1-infected patients.

Percentile curves for food acceptance response scores in assessing chewing functions in adults.

The purpose of this study was to evaluate whether percentile curves for food acceptance response scores were useful in assessing oral and occlusal conditions. We used data obtained from Chiba City Patient Surveys (males: 1,276, females: 1,381, aged 20 to 64), which were conducted in 1998 and 1999. Subjects were assigned scores of between 1 and 4 for 31 different kinds of food based on their food acceptance responses. Occlusal conditions were measured with pressure-sensitive sheets. We calculated the percentile values from 5 to 95 at intervals of five years. We divided the subjects into two groups at the twenty-fifth percentile and statistically analyzed various oral conditions in the two groups. Significant differences were found between them in the mean numbers of present, sound, and missing teeth for almost all age groups. Moreover, there were significant differences in tooth-contact area and occlusal force between the two groups. The results of multiple regression analysis revealed that the scores had a stronger correlation with occlusal conditions than number of teeth in 55-year-olds, although the effect teeth-factors had on scores was more significant in 45- to 50-year-old males. Females' scores had a stronger correlation with occlusal conditions than number of teeth in all age groups. These results indicate that the questionnaire on the acceptance of 31 different kinds of food is useful in providing a basis for oral health instruction and dental treatment aimed at improving chewing ability in adults.

Factors affecting changes in compliance with infection control practices by dentists in Japan.

We surveyed compliance with infection control practices (ICPs) and factors associated with ICPs reported by dentists in Japan in 2008 and 2011. ICPs improved during this period as did the proportion of dentists specializing in oral surgery, the proportion of dentists reporting a willingness to treat HIV and AIDS patients, and the proportion of dentists reporting knowledge about universal and standard precautions. Stronger associations between ICPs and these 3 factors were found in 2011 than in 2008.

Relationship between the number of remaining teeth and physical activity in community-dwelling elderly.

The relationship between oral health and general health in the elderly has been much studied. However, further studies focussing on the influence of oral health on the quality of life (QOL) among the elderly are required. The goal of this study was to evaluate the relationship between oral health and physical or cultural activities. Subjects were 101 community-dwelling elderly persons who were functionally independent (mean age 70.3). Oral health status was evaluated according to the number of remaining teeth and the number of functional teeth. Physical and cultural activities were evaluated from self-reported information. The relationship between oral health and physical or cultural activities was examined by logistic regression analysis. About 60% of subjects took part in cultural activities, and less than half actively exercised (leisure sports, 33.6%; travel, 42.6%). Persons with 20 or more remaining teeth were more active in leisure sports (Odds ratio (OR)=4.86, 95% confidence interval (CI)=1.34, 17.38) and travel (OR=5.42, 95% CI=1.63, 18.08) than those with fewer than 20 remaining teeth. These results suggest that the number of remaining teeth is associated with physical activity in elderly persons.

Relationship between oral motor dysfunction and oral bacteria in bedridden elderly.

OBJECTIVE: The purpose of this study was to analyze the relationship between oral bacterial colonization and oral motor dysfunction. STUDY DESIGN: Oral motor dysfunction (swallowing and speech disorders) and detection of oral bacterial species from dental plaque in 55 elderly persons who had remained hospitalized for more than 3 months were investigated and statistically analyzed. RESULTS: The detection rates of methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Streptococcus agalactiae, and Stenotrophomonas maltophilia were significantly higher in subjects with than in those without a swallowing disorder. A similar result was found with regard to the presence of a speech disorder. About half of subjects who had oral motor dysfunction and hypoalbuminemia had colonization by MRSA and/or Pseudomonas aeruginosa. CONCLUSION: These results suggest that the combination of oral motor dysfunction and hypoalbminemia elevated the risk of opportunistic microorganisms colonization in the oral cavity of elderly patients hospitalized over the long term.

Relationship between oral health behaviors and general health behaviors in a Japanese adult population.

OBJECTIVE: The aim of this study was to analyze the relationship between oral health behaviors and general health behaviors in adults. METHODS: A total of 2,467 adults (1,208 men and 1,259 women aged 20-59 years) who consulted dentists in Chiba City were administered a questionnaire. RESULTS: Women, older participants, and those living with family had better health behaviors than the other subjects studied. Additive indices for oral and general health behaviors were significantly correlated. Toothbrushing frequency was significantly correlated with five items of general health behavior (smoking, drinking, exercise, eating breakfast, and having medical check-ups). Having dental check-ups was significantly correlated with having medical check-ups. There was a negative correlation between dental flossing and drinking. CONCLUSIONS: Of all oral health behaviors examined, toothbrushing frequency was the most predictive indicator of general health behavior.

Relationship between volatile sulphide compounds concentration and oral bacteria species detection in the elderly.

AIM: To evaluate the relationship between oral bacteria species detection and volatile sulphide compounds (VSC) concentration in the elderly. DESIGN: Cross-sectional microbiological and clinical VSC examination of elderly. PARTICIPANTS: Sixty-seven elderly people aged 75, who were functionally independent and dentate. METHODS: VSC (H2S and CH3SH) concentrations in the mouth air of subjects were measured using portable gas chromatography. Oral bacteria samples were taken from dental plaque and identification of bacteria species was accomplished using standard methods. RESULTS: Fewer than 20% of subjects showed more than 10 ng/10 ml of H2S (severe odour level). The detection rate of P. melaninogenica was significantly higher in elderly people with more than 10 ng/10 ml (p=0.043) levels. Fusobacterium had a tendency to be found in those with more than 10 ng/10 ml, but a significant relation was not found. CONCLUSIONS: The results suggest that Fusobacterium and P. melaninogenica may be involved in the production of H2S in the oral cavity of elderly people.

Prevention of aspiration pneumonia (AP) with oral care.

AP is a major cause of morbidity and mortality in elderly patients, especially frail elderly patients. The aim of this article is to review effect of oral care, including oral hygiene and improvement of oral function, on the prevention of AP among elderly people in hospitals and nursing homes. There is now a substantial body of work studying the effect of oral care on the prevention of respiratory diseases. Oral hygiene, consisting of oral decontamination and mechanical cleaning by dental professionals, has resulted in significant clinical effects (decreased incidence of pneumonia and decreased mortality from respiratory diseases) in clinical randomized trials. Moreover, studies examining oral colonization by pneumonia pathogens have shown the effect of oral hygiene on eliminating these pathogens. In addition, swallowing training has been shown to improve the movement and function of swallowing-related muscles, also resulting in decreased incidence of pneumonia. These findings support the contention that oral care is effective in the prevention of AP.

Quantification of periodontopathic bacteria in saliva using the invader assay.

When quantifying periodontopathic bacteria, it is important to use a convenient method that does not produce false negative results. The Invader assay is a convenient method because it does not involve gene amplification. The purpose of this study was to evaluate the validity of the Invader assay to quantify periodontopathic bacteria. The Invader technology was applied in quantifying five periodontopathic bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella intermedia, and Treponema denticola). The Invader assay produced a linear quantitative detection range over concentrations spanning seven exponential values, with a detection limit of 10(3.7) copies/tube and intra-day and inter-day variance of 0.1% to 4.7% and 0.1% to 3.4%, respectively, in quantifying five periodontopathic bacteria. We compared the results of the Invader assay with those of real-time polymerase chain reaction (PCR) performed for quantifying five periodontopathic bacteria in 22 patients with periodontitis. Among the Invader-detectable bacterial strains of each species, significant correlations were observed in the counts of concerned bacterial species between these two methods, with correlation coefficients ranging from 0.757 to 0.996. This study validated repeatability and reproducibility of the Invader assay in quantifying periodontopathic bacteria and demonstrated consistent agreement between the Invader assay and real-time PCR in quantifying periodontopathic bacteria.

Relationship of cariogenic bacteria levels with periodontal status and root surface caries in elderly Japanese.

OBJECTIVE: The relationship of the levels of cariogenic bacterial species with periodontal status and decayed root surfaces was investigated in elderly Japanese subjects. METHODS: Three hundred and sixty-eight individuals (each 75 years old) were examined for periodontal status (pocket depth, attachment loss), root surface caries and salivary levels of mutans streptococci (MS) and lactobacilli (LB). RESULTS: Values >4 mm of attachment loss (rAL4) and for average attachment loss (aAL) of sites measured were significantly higher in subjects with LB than those without. Multiple regression analysis also showed a correlation between aAL and rAL4 values with the presence of LB (aAL p = 0.003; rAL4 p = 0.002). Further, multiple regression analysis of interacting factors regarding decayed root surfaces showed that LB carriers had a greater incidence of decayed root surface caries (p = 0.003), while MS and LB levels were correlated to the number of decayed root surfaces (LB p = 0.010; MS p = 0.026). CONCLUSION: Our results indicate that considerable attachment loss elevates the possibility of having LB, thus increasing the risk of root surface caries. It was also found that LB and MS measurements may be useful indicators of decayed root surfaces in elderly individuals with attachment loss.

Sexual differences in oral health behaviour and factors associated with oral health behaviour in Japanese young adults.

The aim of this study is to compare the state of oral health behaviour between genders and to analyse factors associated with oral health behaviour by gender in young adults. Anonymous questionnaire data were collected from 527 adults (245 men and 282 women) aged 20-29 years who consulted dentists in Chiba City. The Chi-square test, Mann-Whitney analysis, and logistic regression analysis were used to examine the differences in oral health behaviour and determinants of oral health behaviour between young men and young women. The rate of good behaviour among women were significantly higher than those among men in each oral health behaviour item (toothbrushing frequency p < 0.001; using dental floss p = 0.042; dental check-ups p < 0.001). In women, factors associated with each oral health behaviour were as follows: toothbrushing frequency (family composition p = 0.030); using dental floss (dental health knowledge p = 0.025, employment status p = 0.031), and dental check-ups (age group p = 0.024). In men, a significant relationship was seen only between using dental floss and age group p = 0.025). This study indicated that young women had better oral health behaviour and that more factors were associated with their oral health behaviour in comparison with young men.