Comparison of the Amount of Used and the Ease of Oral Care between Liquid and Gel-Type Oral Moisturizers Used with an Oral Care Simulators.

Oral care involving the removal of dry sputum is effective for older patients who require nursing care or hospitalization. However, safe and efficient oral care methods for such patients remain unclear. We aimed to simulate the oral cavity of older adults with dry mouth and elucidate the differences between two moisturization agents, water and gel-like oral moisturizer, and investigate the effect of occupation and experience on the amount of use and the ease of oral care. Using an oral care simulator (MANABOT®, Nissin Dental Products Inc., Kyoto, Japan), 42 students and 48 dental professionals (13 dentists and 35 dental hygienists) performed oral care using moisturization agents to facilitate dry sputum removal. The time required for oral care, amount of water or gel used, amount of pharyngeal inflow, and ease of oral care when using water or gel were compared. The simulations revealed that the amount of use and pharyngeal inflow for gel (2.9 ± 1.6 and 0.3 ± 0.3, respectively) were significantly lower than those for water (6.8 ± 4.1 and 1.2 ± 1.5, respectively) in all participants. Using a gel-like moisturizer might reduce the aspiration risk in older patients requiring nursing care or hospitalization, regardless of occupation and experience.

Association between Improvement of Oral Health, Swallowing Function, and Nutritional Intake Method in Acute Stroke Patients.

Stroke and poor oral health are common in older people, and the brain injuries associated with stroke are often accompanied by a decline in oral function. In this study, we investigated the characteristics of stroke patients who could not recover oral ingestion until discharge and the association between improved oral health, swallowing function, and nutritional intake methods in acute care. The subjects were 216 consecutive stroke patients who were admitted to Tokyo Medical and Dental University hospital and received oral health management. Nutritional intake, dysphagia, and oral health were evaluated using the Functional Oral Intake Scale (FOIS), Dysphagia Severity Scale (DSS), and Oral Health Assessment Tool (OHAT), respectively. Patients in the tube feeding group (FOIS level 1-2, N = 68) tended to have a worse general condition, fewer functional teeth, and a worse DSS level than those in the oral nutrition group (FOIS level 3-7, N = 148). Multiple analysis with improvement in FOIS score as the dependent variable showed that number of functional teeth (odds ratio [OR]: 1.08, p = 0.04) and improved DSS (OR: 7.44, p < 0.001) and OHAT values (OR: 1.23, p = 0.048) were associated with improvement in nutritional intake methods in acute care. Therefore, recovery of swallowing function and oral health might be important for stroke patients to recover oral ingestion in acute care.

Structural Equation Modeling of Tongue Function and Tongue Hygiene in Acute Stroke Patients.

In acute stroke patients, it is important to maintain tongue hygiene and tongue function for prognosis management. However, the direct relationship between these factors is unclear, since these are often assessed by multiple observables. In this study, we used structural equation modeling (SEM) analysis, a tool to analyze the relationship between concepts that cannot be measured directly, to analyze the relationship between tongue hygiene and tongue function. The subjects were 73 patients with acute stroke admitted to a university hospital who underwent dental intervention. Age, sex, nutritional intake method, clinical severity classification of dysphagia, number of current teeth, number of functional teeth, oral health, tongue movement, tongue coating, number of microorganisms on the tongue surface, tongue surface moisture level, and tongue pressure were measured at the first visit. SEM analysis showed that the relationship between tongue function and tongue hygiene was 0.05 between tongue function and swallowing function was 0.90, and that between tongue hygiene and swallowing function was 0.09. We found no statistical relationship between tongue function and tongue hygiene in acute stroke patients. However, it was reconfirmed that tongue function is strongly related to feeding and swallowing functions.