Number of teeth, denture wearing and cognitive function in relation to nutritional status in residents of nursing homes.

BACKGROUND: Although statistical associations between tooth loss and cognitive decline have been reported, there are few previous studies on denture wearing. Additionally, it remains unclear whether nutritional status mediates this association. OBJECTIVE: Our purpose was to test for the hypothesis that the association between the number of teeth and denture wearing with cognitive function is mediated by nutritional status in residents of nursing homes. MATERIALS AND METHODS: We enrolled 162 participants who required long-term care (mean age: 87.7 ± 7.5 years, 26 men and 136 women) and were admitted to eight nursing homes in Fukuoka city, from September 2013 to March 2014. A trained dentist conducted dental and swallowing examinations, and the care-staff assessed nutritional status, comorbid conditions and cognitive function using the Clinical Dementia Rating (CDR). RESULTS: Poisson regression analysis showed that 0-19 teeth without dentures were associated with severe cognitive impairment (CDR 3) (prevalence ratio = 2.00; 95% confidence interval: 1.13-3.55) after adjustment for sex, age, suspected swallowing dysfunction and comorbid conditions. Mediation analysis confirmed that the nutritional status as a mediator of this association (the percentage mediated effect through nutritional status was 23.1%). CONCLUSION: There is an association between dental status and cognitive impairment in elder individuals, and dentures and poor nutrition are involved in this association. However, due to the cross-sectional design of this study, there is a possibility that this association is bidirectional.

Microfloral characterization of the tongue coating and associated risk for pneumonia-related health problems in institutionalized older adults.

OBJECTIVES: To characterize a comprehensive outline of the oral microflora related to pneumonia in older adults. DESIGN: Prospective and retrospective longitudinal study. SETTING: Community. PARTICIPANTS: Long-term hospitalized patients and people in nursing homes (343 subjects, aged > or =65). MEASUREMENTS: Subjects were assessed at baseline for pneumonia-related health problems. The flora of the tongue coating was characterized according to terminal restriction fragment length polymorphism (T-RFLP) analysis. All subjects were followed prospectively for 6 months for a diagnosis of pneumonia. The number of febrile days (>37.5 degrees C) was assessed in 299 subjects who were observed for 12 months (retrospectively for 6 months and prospectively for 6 months). The follow-up data were analyzed using multivariate regression analyses in relation to the baseline data, including T-RFLP patterns. RESULTS: T-RFLP patterns outlining the floral composition of the tongue coating were grouped into Clusters A, B, C, and D. According to Cox regression analysis, the subjects in Clusters C (hazard ratio (HR)=4.0, 95% confidence interval (CI)=1.1-15.1) and D (HR=4.9, 95% CI=1.2-21.1) were at a significantly greater risk of pneumonia than those in Cluster A, independent of other confounding factors. Logistic regression analysis adjusting for the same covariates indicated that the number of subjects with more than 9 febrile days per year was significantly lower in Cluster A than in the other clusters. CONCLUSION: The comprehensive microfloral profile of the tongue coating is closely related to pneumonia-related health problems in institutionalized older adults.

Influence of oral health on febrile status in long-term hospitalized elderly patients.

Many elderly patients have various health problems and are susceptible to recurrent fever. We examined the influence of oral health on the febrile status of 271 long-term hospitalized elderly patients over 1 year. In dentate patients, those with > or =20 teeth had a significantly higher risk for fever than those with 1-9 teeth; multivariate logistic regression analysis: odds ratio (OR)=5.44, 95% confidence interval (CI)=1.37-21.66. In edentate patients, those with moderate or much tongue plaque had a significantly higher risk for fever than those with no or slight tongue plaque; multivariate analysis: OR=5.14, 95% CI=1.77-14.88. These results suggest that oral health status related to febrile status differs between dentate and edentate patients in the elderly population.

Subjective assessment of chewing function of obturator prosthesis wearers.

PURPOSE: Assessments of masticatory performance and occlusal force for wearers of obturator prostheses were performed as clinical objective assessments and reported in an earlier study. The purpose of the present study was to evaluate clinically the chewing function of obturator prosthesis wearers by self-evaluations and to examine their relationship to the objective assessments. MATERIALS AND METHODS: Twenty patients with maxillofacial obturator prostheses who were having a periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Chewing function was evaluated by 3 assessment tools: a self-assessment mastication scale, a chewing function score, and a mastication score. In addition, correlations among these assessments and objective tests--ie, masticatory performance and maximum occlusal force--were analyzed by the Spearman rank correlation coefficient. RESULTS: The mean self-assessment mastication scale was 63.2 (SD 31.8), the chewing function score was 54.0 (SD 30.2), and the mastication score was 51.4 (SD 33.3). There was no statistically significant relationship between the self-assessment mastication scale and each objective test. However, there were significant correlations between each semisubjective score--the chewing function score and the mastication score--and masticatory performance. There was no relationship between each semisubjective score and maximum occlusal force. CONCLUSION: A self-assessment mastication scale was not always in agreement with objective assessments, and assessments made by patients should be taken into consideration when arranging maxillofacial rehabilitation. Conversely, both chewing function and mastication scores corresponded with masticatory performance, and these would be useful as screening tests before performing objective tests.

Clinical assessment of chewing function of obturator prosthesis wearers by objective measurement of masticatory performance and maximum occlusal force.

PURPOSE: Eating, which includes chewing and swallowing, is an oral function that influences quality of life. Though the swallowing ability of maxillectomy patients was reported in our previous study, the chewing function has not been fully reported to date. Thus, the purpose of this study was to evaluate the chewing function of obturator prosthesis wearers by measurement of masticatory performance and occlusal force. The relationship of these 2 measurements was also investigated. MATERIALS AND METHODS: Twenty maxillofacial obturator prosthesis wearers undergoing periodic checkup at the maxillofacial rehabilitation clinic in Kyushu University Hospital were recruited for this study. Additionally, 20 young, healthy individuals were recruited as controls. Data on masticatory performance, which was measured by a sieve method using hydrocolloid material, and maximum occlusal force, which was measured by the Dental Prescale System (Fuji Film), were obtained for each participant. RESULTS: The mean of masticatory performance was 2.6 (SD 1.2) on a 1.40-mm mesh. There was no significant difference in masticatory performance between the patient group and the controls. The mean maximum occlusal force of the patient group was 625.9 N (SD 299.1 N), which was significantly lower than that of the control group. There was no significant correlation between masticatory performance and maximum occlusal force for the patient group in this study (P = .3726). CONCLUSION: Masticatory performance of obturator prosthesis wearers with dentate or partially edentulous maxillae was not different from that of young, healthy individuals, though maximum occlusal force of these patients was lower than that of controls.