Impact of Hospital Dentistry on Patients' Food Intake Status in Convalescent Rehabilitation Ward.

BACKGROUND: Treating oral problems with dentist intervention during hospitalisation may improve patients' food intake status. OBJECTIVES: This study aimed to clarify whether convalescent rehabilitation ward inpatients in a hospital with hospital dentistry (HHD) had a better diet at discharge than those in a hospital without hospital dentistry (HNHD). METHODS: Retrospective observational study including inpatients with dental involvement in a HHD with dentists and dental hygienists and HNHD with dental hygienist and visiting dental service between 1 March and 31 August 2022. Data included age, sex, body mass index (BMI), Functional Independent Measure (FIM) motor and cognitive, Oral Health Assessment Tool (OHAT) score, Food Intake LEVEL Scale (FILS), whether the FILS ≥8 (indicating that patient eats also a non-texture-modified diet), remained and functional tooth numbers and speech language hearing therapist (SLHT) and dentist interventions. Comparisons between the two hospitals and factors that affected the FILS ≥8 were examined. RESULTS: A total of 333 and 89 inpatients were included in the HHD and HNHD groups, respectively. After propensity score matching, the HHD group had a significantly higher rate of FILS ≥8, functional tooth numbers at discharge, and SLHT and dentist intervention rates. The multivariable logistic regression analysis for propensity score matching participants showed that the significant independent variables for FILS ≥8 were age, BMI, FILS, FIM motor (all at admission) and SLHT and dentist interventions. Odds ratio for dentist intervention was 14.46 (95% CI: 4.36-48.01). CONCLUSIONS: Dentists are necessary to improve patients' food intake status in convalescent rehabilitation wards.

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.

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.

The effect of multimodal comprehensive care methodology training on oral health care professionals' empathy for patients with dementia.

BACKGROUND: The prevalence of oral diseases in people with dementia has increased, and patients with dementia have worse oral health than people without dementia. However, in the provision of oral care, these patients often exhibit care-resistant behaviours. Empathy is important for health care professionals who provide dental care for people with dementia. A study was conducted to assess whether a multimodal comprehensive care methodology training programme, Humanitude™, was associated with an improvement in empathy for people with dementia among oral health care professionals. METHODS: This research was a pre-post prospective study. A total of 45 dentists and dental hygienists participated in a 7-h multimodal comprehensive care methodology training programme. Participants' empathy for their patients was evaluated with the Jefferson Scale of Physician Empathy-Health Professionals Version (JSPE-HP) before the training and 1 month after the training (primary outcome). Each participant listed 3 patients with poor oral health due to the refusal of usual oral care or dental treatment from his or her clinical practice. The oral health of the 3 care-resistant patients listed by each participant was evaluated by the Oral Health Assessment Tool (OHAT) before the training and 1 month after the training (secondary outcome). RESULTS: The post-training response rate was 87% (21 dentists and 18 dental hygienists). From pre-training to post-training, the multimodal comprehensive care methodology training significantly increased the mean empathy score (from 113.97 to 122.95, P < 0.05, effect size = 0.9). Regardless of gender, profession and years of clinical experience, all post-training subgroup scores were higher than the pre-training subgroup scores. The tongue, natural teeth, and oral hygiene scores of patients with dementia who resisted usual oral care or dental treatment, as assessed by the OHAT, were significantly improved compared with those before the training. CONCLUSIONS: The multimodal comprehensive care methodology training was associated with an improvement in oral health professionals' empathy for patients with dementia. These findings suggest that randomized controlled trials with large sample sizes will be needed. TRIAL REGISTRATION: UMIN Clinical Trials Registry (UMIN-CTR), UMIN000041687 . Registered 4 September 2020 - Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047586.

Development of a simple method to measure masseter muscle mass.

OBJECTIVE: To develop a simple method to estimate masseter muscle mass. BACKGROUND: The masseter muscle is important for optimal oral function. A decrease in the masseter muscle mass may affect the oral and physical function of the whole body; therefore, it is an important entity to measure. However, to date, no easy measurement method has been developed for the same. Herein, we devised a simple method to estimate masseter muscle mass. In addition, we compared our method with magnetic resonance imaging (MRI) and skeletal muscle mass (SMM) to verify its validity. MATERIALS AND METHODS: We recorded the age, sex, masseter muscle mass (by MRI), number of retained natural teeth, number of functional teeth, length and thickness of masseter muscle, and skeletal muscle mass in 53 community-dwelling elderly people (21 men and 32 women, average age 72.9 ± 4.5 years). The estimated masseter muscle mass was calculated by multiplying the length, width and thickness of the muscle. RESULTS: The correlation coefficient between masseter muscle mass and estimated masseter muscle mass was r = .903; thus, a strong correlation was recognised. The correlation coefficient between the estimated masseter muscle mass and SMM was r = .279, considering age and sex. CONCLUSION: We obtained substantial results using our method for estimating the masseter muscle mass and verified its validity by comparing it with masseter muscle mass measured by MRI and SMM. We believe that our proposed technique is simple and useful for estimating masseter muscle mass.

One-leg standing time with eyes open: comparison between the mouth-opened and mouth-closed conditions.

OBJECTIVE: Many studies report a significant relationship between the one-leg standing time with the eyes open and the occlusal relationship. To determine the association between proprioception (the periodontal membrane vs muscle spindle) to the one-leg standing time, the authors compared the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. METHODS: The study participants were 107 healthy, elderly patients. The authors measured the one-leg standing time with eyes open between mouth-opened and mouth-closed conditions. RESULTS: The one-leg standing time was significantly shorter with the mouth opened (21·1±19·1 seconds) than with the mouth closed (25·1±21·4 seconds). Patients whose one-leg standing time was equal or shorter with the mouth opened than with the mouth closed were not different from the other patients with regard to age, handgrip strength, BMI, and the number of remaining teeth. DISCUSSION: The vertical mandibular position may affect body balance.

Association between Death or Hospitalization and Observable Variables of Eating and Swallowing Function among Elderly Residents in Long-Term Care Facilities: A Multicenter Prospective Cohort Study.

This 1-year multicenter prospective cohort study aimed to determine the association between observable eating and swallowing function factors and outcomes (death/hospitalization or survival) among elderly persons in long-term care insurance facilities in Japan. Baseline assessments of factors, such as language, drooling, halitosis, hypersalivation, tongue movement, perioral muscle function, coughing, respiration after swallowing, rinsing, and oral residue, among others, were conducted. A score of 0 was considered positive, and a score of 1 or 2 was considered negative. Patient age, sex, body mass index, Barthel index, and Clinical Dementia Rating were recorded. The death/hospitalization or survival rates over 1 year were recorded, and patients were allocated into groups depending on the respective outcome (death/hospitalization group or survival group) and baseline characteristics. A total of 986 residents from 32 facilities were included, with 216 in the death/hospitalization group and 770 in the survival group. Language, salivation, halitosis, perioral muscle, coughing, respiration after swallowing, rinsing, and oral residue were significantly associated with the outcomes (p < 0.05). Therefore, routine performance of these simple assessments by caregivers may allow early detection and treatment to prevent death, pneumonia, aspiration, and malnutrition in elderly persons.

[A retrospective study of outcome of percutaneous endoscopic gastrostomy in older adults with advanced cognitive impairment and severely reduced activities of daily living].

AIM: To investigate the outcome of percutaneous endoscopic gastrostomy (PEG) in elderly patients with swallowing difficulties who required high-level nursing care. METHODS: We extracted the data of 57 patients (24 men and 33 women) who were admitted to our hospital with a diagnosis of pneumonia over a 5-year study period between January 2006 and December 2010. Evaluation included activities of daily living (ADL), nursing care level (NCL) based on assessment of care requirement, pre-existing disease, blood test data, swallowing function before PEG, and outcome. RESULTS: The mean age of the patients was 84.7±8.3 years old. The mean total functional independence measure (FIM) score was 29.7±16.2 and the median NCL value was 4. The most frequently observed pre-existing diseases were degenerative central nervous system disorders including Alzheimer's disease and cerebrovascular disease, which occurred in approximately 80% of participants. A low serum albumin value and high c-reactive protein (CRP) level were also often observed, suggesting chronic inflammatory conditions. For swallowing function, the median value according to the Fujishima swallowing grading system was 5, and aspiration and pharyngeal residues were observed on videofluoroscopic examination of swallowing (VF) (82.5% and 100% of all cases, respectively). The median survival time after PEG was 451.0±79.7 days, with a one-year survival rate of approximately 56%. A total of 51 patients (89.5%) died after PEG and the mean duration from the PEG to death was 518.5±471.7 days. Of these 51, 45 (88.2%) died of pneumonia. CONCLUSIONS: In patients with advanced cognitive impairment and severely reduced ADL, there appears to be little benefit on ADL and the prevention of pneumonia by PEG, and most outcomes following PEG were not favorable in the current results.

Relationship between weight loss and regular dental management of older adults residing in long-term care facilities: a 1-year multicenter longitudinal study.

PURPOSE: This study aimed to determine the association between home visits by a dentist and regular oral hygiene management by a dental hygienist (regular dental management: RDM) and weight loss among older adults in long-term care facilities. METHODS: A total of 468 older residents from 26 Japanese long-term care facilities participated in two surveys in 2018 and 2019. Participants were divided into two groups based on their diet during the baseline survey (regular diet, n = 256; dysphagia diet, n = 212). Participants with a regular diet were further divided into those who exhibited a weight loss ≥ 5% over 1 year (weight loss group: n = 77) and those with a weight loss < 5% (consistent weight group: n = 179). The explanatory variables were age, sex, baseline weight, Barthel index, and clinical dementia rating, as well as the patients' medical history of pneumonia, stroke, diabetes, and depression (which is reportedly associated with weight). Additionally, a Poisson regression with robust standard error, was carried out to analyze the explanatory variables, namely the prevalence of RDM noted during the study and functional teeth (which seemed to affect weight loss). RESULTS: A multivariate analysis revealed that older residents' lack of RDM, clinical dementia assessment, and their history of pneumonia (prevalence rate ratio: 0.35, 95% confidence interval 0.24-0.95) were all significantly associated with weight loss when on a regular diet. CONCLUSION: Thus, weight loss and RDM were related to each other. Weight loss may be suppressed by incorporating RDMs during the early nursing care for older residents on regular diets.

Observational Variables for Considering a Switch from a Normal to a Dysphagia Diet among Older Adults Requiring Long-Term Care: A One-Year Multicenter Longitudinal Study.

This one-year multicenter longitudinal study aimed to assess whether older adult residents of long-term care facilities should switch from a normal to a dysphagia diet. Using the results of our previous cross-sectional study as baseline, older adults were subdivided into those who maintained a normal diet and those who switched to a dysphagia diet. The explanatory variables were age, sex, body mass index (BMI), Barthel Index, clinical dementia rating (CDR), and 13 simple and 5 objective oral assessments (remaining teeth, functional teeth, oral diadochokinesis, modified water swallowing test, and repetitive saliva swallowing test), which were used in binomial logistic regression analysis. Between-group comparison showed a significantly different BMI, Barthel Index, and CDR. Significant differences were also observed in simple assessments for language, drooling, tongue movement, perioral muscle function, and rinsing and in objective assessments. In multi-level analysis, switching from a normal to a dysphagia diet was significantly associated with simple assessments of tongue movement, perioral muscle function, and rinsing and with the objective assessment of the number of functional teeth. The results suggest that simple assessments can be performed regularly to screen for early signs of discrepancies between food form and eating/swallowing functions, which could lead to the provision of more appropriate food forms.

Impact of Progression of Parkinson's Disease on Swallowing Ability and Oral Environment.

This study investigated the impact of the severity and treatment of Parkinson's disease (PD) on the swallowing ability and oral environment of patients. Swallowing dysfunction increases the aspiration risk and may lead to poor oral health among patients with PD. We investigated the influences of PD progression and drug treatment on the swallowing ability and oral environment using simple noninvasive screening measurements. We recruited 87 patients with PD (mean age, 71.9 ± 8.0 years; mean Hoehn and Yahr score, 2.9 ± 0.9). The PD condition was assessed in each patient using the unified Parkinson's disease rating scale (UPDRS) part III, diet type and oropharyngeal function using the swallowing disturbances questionnaire (SDQ), maximum bite force (MBF), tongue pressure (TP), and oral bacterial count (OBC). Levodopa equivalent daily dose (LEDD) was also calculated for 56 participants. Based on an SDQ score of ≥11, 29.5% of patients were dysphagic, but almost all were still on a regular diet. The SDQ score was positively correlated with disease duration (rho = 0.228, p=0.047) and UPDRS part III score (rho = 0.307, p=0.007) but was negatively correlated with OBC (rho = -0.289, p=0.012). OBC was significantly higher among patients with an SDQ score of <11 (nondysphagic) (p=0.01), and the SDQ score was lower in patients with higher OBC requiring professional oral care (p=0.03). However, OBC was also negatively correlated with LEDD (rho = -0.411, p=0.004). These results indicated low self-awareness of dysphagia among the participants and an association between dysphagia and PD progression. Moreover, the oral environment could have deteriorated with swallowing dysfunction. Patients and clinicians should be aware that higher LEDD can increase xerostomia and associated deficits in oral health.

Association between Weight Loss and Food Form in Older Individuals Residing in Long-Term Care Facilities: 1-Year Multicenter Longitudinal Study.

Changing the food form for older adults requiring nursing care from a regular to dysphagia diet is thought to impact their nutritional status. We assessed the association between changes in food form and weight loss over 1 year in older adults. Older adults residing in long-term care facilities in Japan (n = 455) who participated in the baseline (2018) and follow-up (2019) surveys were divided into two groups (regular diet, n = 284; dysphagia diet, n = 171). The regular diet group was further divided into the weight loss (n = 80; weight loss ≥5% over 1 year) and weight maintenance (n = 204; weight loss <5%) groups. After 1 year, the Barthel Index significantly decreased, and the proportion of participants who switched from a regular diet to a dysphagia diet significantly increased in the weight loss group than in the weight maintenance group. Multivariate logistic regression analysis found that Barthel index variation (odds ratio (OR): 0.97, 95% confidence interval (CI): 0.94‒0.99), change from a regular diet to a dysphagia diet (OR: 4.41, 95% CI: 1.87‒10.41), and body weight at baseline (OR = 1.06, 95% CI: 1.01‒1.11) were significantly associated with weight loss. Our results suggest that maintaining the food form inhibits weight loss and improves health outcomes in older adults.

Association of dry tongue to pyrexia in long-term hospitalized patients.

BACKGROUND: The oral care of hospitalized elderly patients is thought to have a preventive effect on aspiration pneumonia, which is one of the main causes of fever. Although the decreased secretion of saliva is frequently observed in elderly people, no study has examined how a dry oral cavity affects aspiration. OBJECTIVE: This study was performed to assess the association of dry tongue to pyrexia. As the main outcome measure, pyrexia of hospitalized patients with dry tongue was adjusted for dysphagia and other variables. METHODS: We performed a 6-month cohort study on 106 hospitalized patients. Tongue dorsum moisture was measured using a simple method with a membrane filter (L-Salivo) at baseline examination. Dysphagia and other covariates which could cause fever were also examined. Pyrexia of the subjects during the 6-month study period was analyzed with baseline data of dry tongue adjusted for dysphagia and other variables. RESULTS: Patients with a dry tongue (odds ratio 5.76; 95% confidence interval 1.72-19.30; p = 0.005) and those with severe dysphagia (odds ratio 19.47; 95% confidence interval 5.13-73.88; p < 0.0001) had an increased risk of having >or=2 febrile days in multivariate analysis. CONCLUSION: The result suggests that a dry tongue dorsum is a significant risk factor for pyrexia, independent of dysphagia. Checking for a dry tongue and dysphagia can be useful for identifying patients who need intensive oral care.

Relationships of Variations in the Tongue Microbiota and Pneumonia Mortality in Nursing Home Residents.

Background: Aspiration of oral debris, containing dense oral bacteria, is a major cause of pneumonia in elderly adults. This study investigated the relationship between tongue microbiota composition and incidence of pneumonia-related deaths, in nursing home residents. Methods: The subjects were assessed for health conditions, including their tongue microbiota, at baseline. We determined tongue microbiota profiles by 16S ribosomal RNA gene sequencing and clustering approach. All subjects (n = 173) were followed prospectively for a median of 19 months to assess the incidence of all-cause death, including pneumonia-related death. We evaluated risk estimates of microbiota effects on death using multivariate Cox proportional hazards regression analysis. Results: Tongue microbiota were classified into two community types: type I was dominated by Prevotella and Veillonella species, while type II was dominated by Neisseria and Fusobacterium species. The subjects with type I microbiota exhibited a significantly greater risk of all-cause death (adjusted hazard ratio [aHR] = 3.79, 95% confidence interval [CI] = 1.38-10.39) and pneumonia-related death (aHR = 13.88, 95% CI = 1.64-117.21), than those with type II microbiota. There was no significant association between microbiota type and other-cause death. Conclusions: The tongue microbiota type was significantly associated with an increased mortality risk from pneumonia in nursing home residents.