Factors related to masticatory performance in patients with removable dentures for jaw defects following oral tumor surgery.

Purpose In the treatment of oral tumors, extensive jaw defects due to surgical resection can reduce masticatory performance. Herein, we aimed to clarify the factors related to masticatory performance in patients with jaw defects.Methods In total, 76 patients (42 male and 34 female) underwent prosthetic treatment with a removable denture for a jaw defect following oral tumor surgery. Data on history of radiation therapy, period of time since surgery, period of use of the present denture, number of remaining teeth, and site of the jaw defect were collected. Masticatory performance was evaluated using test gummy jelly. In addition, maximum bite force, tongue pressure, tongue-lip motor function (oral diadochokinesis /pa/, /ta/, /ka/), and oral dryness were evaluated. Logistic regression analysis was performed with lower masticatory performance scores as the dependent variable. Since multicollinearity was suspected between the oral diadochokinesis /ta/ and /ka/ syllables, two logistic regression analyses were conducted: Model 1 with the /ta/ syllable as an explanatory variable, and Model 2 with the /ka/ syllable as an explanatory variable.Results In Model 1, a history of radiation therapy, maximum bite force, number of remaining teeth, tongue pressure, and oral diadochokinesis /ta/ were significant explanatory variables. In Model 2, a history of radiation therapy, maximum bite force, number of remaining teeth, and tongue pressure were significant explanatory variables.Conclusions A history of radiation therapy, maximum bite force, tongue pressure, number of remaining teeth, and motor function of the proglossis are related to decreased masticatory performance in patients with jaw defects.

Relationship between carotid intima-media thickness and periodontal disease in a Japanese urban population with and without hypertension: The Suita Study.

AIM: To investigate the association between periodontal disease and atherosclerosis and to examine whether the association is modified by hypertension status. MATERIALS AND METHODS: In this cross-sectional study, 1472 Japanese individuals aged 50-79 years who underwent a medical check-up, dental examination, and carotid ultrasonography were studied. Carotid atherosclerosis was expressed as the maximum and mean carotid intima-media thickness (max-IMT, mean-IMT) and the presence of stenosis (≥75%). Periodontal status was examined by the Community Periodontal Index (CPI, codes 0-4). The participants were divided into three groups according to the periodontal status (CPI0-2, CPI3, CPI4). RESULTS: A positive correlation was found between mean-IMT and periodontal disease after adjustment for cardiovascular risk factors in the entire cohort (mean-IMT in hypertensives: CPI0-2: 0.848 mm, CPI3: 0.857 mm, CPI4: 0.877 mm; normotensives: 0.782, 0.802, 0.826). In the entire cohort, the multivariable-adjusted odds ratio of stenosis based on mean-IMT significantly increased according to periodontal status in normotensives (odds ratio; CPI0-2: 1, CPI3: 1.39, CPI4: 2.53; p-value for trend = .004) but showed only marginal significant increase in hypertensives (1, 1.15, 1.55; p-value for trend = .063). No significant relationships were observed for max-IMT in all analyses. CONCLUSION: We observed an association between periodontal disease and atherosclerosis in normotensive and hypertensive participants.

Corrigendum: Lower Masticatory Performance Is a Risk for the Development of the Metabolic Syndrome: The Suita Study.

[This corrects the article DOI: 10.3389/fcvm.2021.752667.].

Lower Masticatory Performance Is a Risk for the Development of the Metabolic Syndrome: The Suita Study.

Objectives: Declined masticatory function has recently been receiving attention as a risk factor for poor general health. The present longitudinal analysis was conducted to clarify the relationship between decreased masticatory performance and the development of the metabolic syndrome (MetS) in a general urban cohort in Japan. Methods: We surveyed 599 participants (254 men, 345 women; mean age at baseline, 65.8 ± 7.8 years) who underwent physical health checkups in the Suita study. We evaluated masticatory performance at baseline using test gummy jelly and divided participants into two groups: a "Lower group," comprising participants in the lower 25% of the masticatory performance at baseline; and a "Normal group," comprising all others. We estimated hazard ratios (HRs) for the Lower group by using Cox proportional hazard regression analysis to develop the MetS and the components of the MetS at follow-up, adjusting for age, smoking status, and periodontal status. Results: On Cox proportional hazard regression analysis, the multivariable adjusted hazard ratio for the development of the MetS in the Lower group was 2.24 (95% confidence interval, 1.12-4.50) in men. The multivariable adjusted hazard ratio for the development of high blood pressure was 3.12 (1.42-6.87), for high triglycerides was 2.82 (1.18-6.76), and for high fasting plasma glucose was 2.65 (1.00-7.00) in men. Conclusions: Lower masticatory performance suggested to be a risk factor for the development of the MetS as well as MetS components such as high blood pressure, high triglycerides, and high fasting plasma glucose in Japanese men.

Deterioration of periodontal status affects declines in masticatory performance: The Suita study.

AIM: We aimed to clarify the association between deterioration of periodontal status and masticatory performance in a longitudinal follow-up study of a general urban population. MATERIALS AND METHODS: This study investigated 663 participants in the Suita study with no changes in the number of functional teeth or occlusal support areas during a 5-year follow-up period. Participants were classified into three groups according to changes in periodontal status during the survey period: a recovered group; a stable group; and a deteriorated group. Rate of masticatory performance change was calculated by subtracting the value at baseline from the value at follow-up and dividing the resulting value by the baseline value. RESULTS: Median rates of masticatory performance change were -11.7% in the recovered group, -19.2% in the stable group, and -30.8% in the deteriorated group, and these values were significantly different (p < .001). Multiple regression analysis revealed periodontal status group (recovered group: reference; stable group: p = .029; deteriorated group: p = .006) as an independent variable was significantly associated with the rate of masticatory performance change. CONCLUSION: The present results suggest that deterioration of periodontal status increases the risk of age-related declines in masticatory performance.

A lower maximum bite force is a risk factor for developing cardiovascular disease: the Suita study.

Decreases in masticatory function are believed to be related to the development of cardiovascular disease (CVD) through inappropriate nutritional intake. This study focused on maximum bite force (MBF), which is an objective, quantitative index of masticatory function, and its association with the development of CVD (stroke and coronary heart disease) was investigated. The subjects were 1547 participants of the Suita study with no history of CVD who underwent medical and dental health examinations between June 2008 and June 2013. In addition to undergoing a basic physical examination at baseline, their MBF was measured. They subsequently underwent follow-up surveys for the development of CVD (mean follow-up, 3.5 years). The association between baseline MBF and the development of CVD was investigated by multivariate adjustment using a Cox proportional hazards model. CVD developed in 32 subjects during follow-up. The trend test showed a significant association between baseline MBF and CVD in a model that combined men and women. When analysed by sex, the trend test found a significant association between baseline MBF and CVD in women. Low MBF, which is an objective and quantitative index of masticatory function, may be a risk factor for the development of CVD.

Association between declines in objective masticatory performance and salivary stress markers: The Suita study.

Dentists often encounter patients suffering from psychological and social stress due to declines in masticatory performance, making this a critical issue to manage. We aimed to clarify the relationships between salivary stress markers as objective indices of chronic stress and objective masticatory performance in a general urban Japanese population. Data from 880 participants (mean age, 65.8 years) in the Suita study were used. Salivary interleukin (IL)-6 and cortisol concentrations were measured by enzyme-linked immunosorbent assay. Objective masticatory performance was determined by measuring the increase in surface area test gummy jelly after 30 times chewing. Participants were divided into two groups based on masticatory performance: a decreased group (lowest quartile) and a non-decreased group (second to fourth quartiles). Odds ratios (ORs) of higher salivary levels of stress markers (highest quartile) according to masticatory performance were estimated using logistic regression analysis adjusting for age, sex, periodontal status, salivary flow rate and smoking habit. Salivary IL-6 level was significantly higher in the decreased group than in the non-decreased group. Logistic regression analysis showed the adjusted OR for higher salivary IL-6 was significantly higher in the decreased group than in the non-decreased group (OR = 1.92; 95% confidence interval = 1.33-2.76; P < .001). No significant associations were found between salivary cortisol and decreased masticatory performance in any analyses. Declines in objective masticatory performance may correlate with higher salivary IL-6 level as an objective index of chronic stress.

Decrease in posterior occlusal support area can accelerate tooth loss: The Suita study.

Purpose A decrease in posterior occlusal support is considered to increase the load on remaining teeth and thus accelerate tooth loss. Therefore, a follow-up study was carried out to perform a longitudinal analysis of the association between the posterior occlusal support region and tooth loss.Methods The participants of the study were 806 Suita Study participants who underwent physical health checkups both at baseline and at follow-up. The participants were classified into three groups by posterior occlusal support area (POSA) using the Eichner Index at baseline: Perfect POSA group, Eichner A; Decreased POSA group, Eichner B1-3; and Lost POSA group, Eichner B4 and Eichner C1-2. Participants were also classified into two groups according to whether they had tooth loss during the follow-up period. Tooth loss risk factors were investigated through the construction of logistic regression models with tooth loss as the dependent variable and posterior occlusal support, sex, age, periodontal disease, stimulated salivary flow rate, smoking habit, drinking habit, denture wearing, utilization of dental services, brushing habits, diabetes mellitus, osteoporosis and number of years of follow-up as independent variables.Results In the results of the logistic regression model, the adjusted odds ratio (95%CI) for tooth loss with the Perfect POSA group as the reference was 3.19 (1.98-5.14) for the Decreased POSA group and 4.57 (1.97-10.62) for the Lost POSA group.Conclusions This study showed that decreased POSA accelerated tooth loss in the general urban population.

A prediction model of masticatory performance change in 50- to 70-year-old Japanese: The Suita study.

OBJECTIVES: Declines in masticatory performance might be a risk factor for worsening nutritional intake and result in general frailty. The present study constructed and investigated a method to predict the extent to which objective masticatory performance declines with age in cases with poor oral health status. METHODS: Participants comprised 1201 participants in the Suita study with dental checkup at both baseline and follow-up (500 men and 701 women; age at baseline, 65.6 ± 7.8 years; mean follow-up, 5.1 ± 1.1 years). First, multiple linear regression analysis was performed with masticatory performance at follow-up as the dependent variable and sex as well as baseline age, number of functional teeth, maximum bite force, occlusal support, periodontal status, salivary flow rate, and masticatory performance as independent variables. Scores were assigned to each factor based on the standardized partial regression coefficient obtained from multiple linear regression analysis. Participants were divided into quintile groups (Q1-Q5) based on total scores for factors, and rates of masticatory performance change for each group were calculated and compared. RESULTS: Mean rates of masticatory performance change in groups Q1-Q5 from the model to predict declining masticatory performance were: Q1, -9.7%; Q2, -12.7%; Q3, -18.0%; Q4, -19.9%; and Q5, -29.8%.Thus there was a trend for masticatory performance to decrease with decreasing score. CONCLUSIONS: The model developed in this study quantitatively predicted declines in masticatory performance after approximately 5 years. CLINICAL SIGNIFICANCE: We developed a model for predicting the extent to which masticatory performance will change over the next 5 years. This model may offer a useful tool when taking measures to prevent declines in masticatory performance with aging.

Periodical utilization of dental services is an effective breakthrough for declining masticatory performance: the Suita study.

Masticatory performance of subjects from a general urban population was examined by measurement at baseline and again at follow-up, to clarify whether periodical utilization of dental services (PUDS) is effective in maintaining masticatory performance. Subjects comprised 1010 people (414 males, 596 females; mean age at baseline, 65.7 ± 7.8 years) who participated in the Suita study with dental checkups at both baseline and follow-up (mean follow-up, 5.2 ± 1.5 years). Number of functional teeth, occlusal support, periodontal status, masticatory performance, maximum bite force, and salivary flow rate were surveyed. Subjects were divided into a with-PUDS group (n = 430), who responded at both baseline and follow-up that they regularly utilized dental services, and a without-PUDS group (n = 580), who responded otherwise. To evaluate longitudinal changes in masticatory performance over the study period, the rate of masticatory performance change was calculated by dividing the difference in masticatory performance between follow-up and baseline by the masticatory performance at baseline. The relationship between the presence of PUDS and the rate of masticatory performance change was investigated by multiple linear regression analysis. Analysis was performed using a model with number of functional teeth as an independent variable (number of functional teeth model), and a model with occlusal support as an independent variable (occlusal support model). Multiple linear regression analysis identified PUDS as significantly associated with the rate of masticatory performance change in both the number of functional teeth model and the occlusal support model. PUDS is likely to prove effective in ameliorating reductions in masticatory performance over time.

Decreased masticatory performance is related to increased intima-media thickness in a general urban Japanese population: The Suita study.

PURPOSE: The association between periodontal disease and carotid atherosclerosis has been widely discussed, but to our knowledge, no population-based studies have been conducted on the association between masticatory ability and carotid atherosclerosis. We aimed to clarify the hypothesis that objectively accessed masticatory performance is related to increased intima-media thickness (IMT) in a general urban population. METHODS: We studied 1,484 Japanese (mean age: 66.9 y) from the Suita study. Masticatory performance was measured using test gummy jelly, and periodontal status was evaluated using the Community Periodontal Index (CPI). Carotid ultrasonography was performed to measure maximum IMT (max-IMT) in the entire area of the carotid arteries. Analysis of covariance was used to compare max-IMT according to quartiles of masticatory performance adjusted by cardiovascular risk factors and periodontal status. RESULTS: Multivariable-adjusted max-IMT (standard error) was significantly higher in the lowest masticatory performance quartile group (decreased group) (1.58 ± 0.03 and 1.44 ± 0.03 mm) than in the 2nd to 4th quartiles combined (non-decreased groups) in both sexes (1.48 ± 0.02 mm, trend P = 0.038) and in women (1.34 ± 0.02 mm, trend P = 0.013), respectively. In participants without cardiovascular risk factors (n = 250), multivariable-adjusted max-IMT was significantly higher in the decreased (1.54 ± 0.06, 2.08 ± 0.22, and 1.42 ± 0.06 mm) than in the non-decreased groups in both sexes (1.31 ± 0.04 mm, trend P = 0.006), in men (1.41 ± 0.12 mm, trend P = 0.028), and in women (1.28 ± 0.04 mm, trend P = 0.073). CONCLUSIONS: These findings suggest that decreased masticatory performance may be related to carotid IMT progression in the general urban Japanese population.

Tooth loss leads to reduced nutrient intake in middle-aged and older Japanese individuals.

Reductions in masticatory function as a result of tooth loss have a negative impact on nutrient intake, decreasing general health. In addition, studies have reported an association between lower socioeconomic status (SES) and both higher numbers of lost teeth and worse nutrient intake status. Nakamura et al. conducted a study to clarify the relationship between number of teeth and nutrient intake status in their paper "Having few remaining teeth is associated with a low nutrient intake and low serum albumin levels in middle-aged and older Japanese individuals: Findings from the NIPPON DATA", evaluating not only data obtained from a household-based dietary survey but also serum albumin levels as a nutritional biomarker. Importantly, the present study also took into account the individual SES of subjects in the analysis of number of teeth and nutrient intake. The present results show that the trend for poorer nutrient intake with lower number of teeth is more marked among individuals with low SES. It is therefore essential that individual SES is taken into account in efforts to improve nutrient intake and thus contribute to general health through oral health.

Relationship between Metabolic Syndrome Components and Periodontal Disease in a Japanese General Population: the Suita Study.

AIM: A positive association between metabolic syndrome (MetS) and periodontal status has recently been noted. However, no study has evaluated the relationship by sex and in a general urban population using the uniform definition proposed in the 2009 Joint Interim Statement. The aim of this study was to clarify the relationship between MetS and periodontal status using the uniform definition in a general urban Japanese population. METHODS: A total of 1,856 Japanese men and women (mean age: 66.4 years) were studied using data from the Suita study. Periodontal status was evaluated by the Community Periodontal Index (CPI). MetS was defined using the 2009 Joint Interim Statement. The associations of the MetS and its components with periodontal disease were investigated using multiple logistic regression analysis adjusting for age, drinking, and smoking. RESULTS: Among the components of the MetS, low HDL cholesterol level was significantly associated with periodontal disease in men and women [odds ratios (OR)=2.39 and 1.53; 95% confidence intervals=1.36-4.19 and 1.06-2.19]. Furthermore, the risk of periodontal disease showed 1.43-, 1.42-, and 1.89-fold increases in those with 2, 3, and ≥4 components, respectively, compared with those having no components (Ptrend ＜0.001). For the analysis by sex, the risk of periodontal disease was increased 2.27- and 1.76-fold in those with ≥4 components in men and women, respectively (both Ptrend=0.001). CONCLUSION: These findings suggest that MetS and lower HDL cholesterol are associated with periodontal disease. Subjects with two or more MetS components had a significantly higher prevalence of periodontal disease.

Relationship between metabolic syndrome and objective masticatory performance in a Japanese general population: The Suita study.

OBJECTIVES: An association between metabolic syndrome (MetS) and periodontal status has recently been focused on. However, no study has investigated the relationship between the prevalence of MetS and the decline of masticatory performance. We aimed to clarify the relationship between MetS and objective masticatory performance using the standardized test food in a general urban Japanese population. METHODS: We studied 1780 Japanese men and women (mean age, 66.5 years) using the Suita study. MetS was defined using the uniform definition proposed in the 2009 Joint Interim Statement. Masticatory performance was evaluated by a chewing test using gummy jelly. Prevalence of MetS among quartiles of masticatory performance was compared using multiple logistic regression analysis adjusting for sex, age, drinking and smoking status, and periodontal status evaluated by the Community Periodontal Index. RESULTS: Compared to the highest quartile of masticatory performance, the 2nd quartile showed a 1.46-fold increase in the prevalence of MetS (trend P=0.159). In addition, Analysis by age showed 1.67-, 1.90- and 1.74-fold increases in the prevalence of MetS in the 3rd, 2nd and 1st quartiles among individuals in their 70s, respectively (trend P=0.094). However, individuals in their 50s and 60s showed no significant relationship between masticatory performance and MetS. CONCLUSIONS: These findings suggested that masticatory performance are inversely associated with the prevalence of MetS independent of periodontal disease, especially in the elderly. CLINICAL SIGNIFICANCE: Declines in objective masticatory performance might be associated with the prevalence of MetS, independent of periodontitis. Given our results, treatments aimed at maintaining and recovering masticatory performance may represent important dental care to mitigate the risk of MetS.

Does the utilization of dental services associate with masticatory performance in a Japanese urban population?: the Suita study.

There are numerous reports on the relationship between regular utilization of dental care services and oral health, but most are based on questionnaires and subjective evaluation. Few have objectively evaluated masticatory performance and its relationship to utilization of dental care services. The purpose of this study was to identify the effect of regular utilization of dental services on masticatory performance. The subjects consisted of 1804 general residents of Suita City, Osaka Prefecture (760 men and 1044 women, mean age 66.5 ± 7.9 years). Regular utilization of dental services and oral hygiene habits (frequency of toothbrushing and use of interdental aids) was surveyed, and periodontal status, occlusal support, and masticatory performance were measured. Masticatory performance was evaluated by a chewing test using gummy jelly. The correlation between age, sex, regular dental utilization, oral hygiene habits, periodontal status or occlusal support, and masticatory performance was analyzed using Spearman's correlation test and t-test. In addition, multiple linear regression analysis was carried out to investigate the relationship of regular dental utilization with masticatory performance after controlling for other factors. Masticatory performance was significantly correlated to age when using Spearman's correlation test, and to regular dental utilization, periodontal status, or occlusal support with t-test. Multiple linear regression analysis showed that regular utilization of dental services was significantly related to masticatory performance even after adjusting for age, sex, oral hygiene habits, periodontal status, and occlusal support (standardized partial regression coefficient ß = 0.055). These findings suggested that the regular utilization of dental care services is an important factor influencing masticatory performance in a Japanese urban population.

Salivary inflammatory cytokines may be novel markers of carotid atherosclerosis in a Japanese general population: the Suita study.

OBJECTIVE: Salivary biomarkers have been recently useful of periodontal disease, which is also risk factor of atherosclerosis. However, there are few studies of the association between salivary inflammatory cytokines and carotid atherosclerosis. We aimed to clarify the association between salivary inflammatory cytokines and periodontal disease and carotid atherosclerosis in a general urban population. METHODS: We studied 608 Japanese men and women (mean age: 65.4 years) in the Suita study. Carotid atherosclerosis was evaluated by high-resolution ultrasonography with atherosclerotic indexes of intima-media thickness (IMT). Periodontal status was evaluated by the Community Periodontal Index (CPI). Salivary levels of interleukin-1ß, interleukin-6, tumor necrosis factor-α (TNF-α), and prostaglandin E2 (PGE2) were measured by enzyme linked immunosorbent assay. The risks of carotid atherosclerosis (≥75th percentiles of mean- [0.88 mm] and Max-IMT [1.50 mm]) according to the quartiles of salivary inflammatory cytokines were compared using of adjusted-logistic regression models. RESULTS AND CONCLUSION: All salivary inflammatory cytokines were positively associated with CPI. The adjusted odds ratios for carotid atherosclerosis of mean-IMT in the highest quartile of interleukin-6 and TNF-α were higher than those in the lowest quartiles (OR = 2.32 and 2.88; 95% confidence intervals = 1.19-4.51 and 1.51-5.49, respectively). The adjusted odds ratio for carotid atherosclerosis of mean-IMT in the highest quartile of PGE2 was greater than those in the lowest quartile in women (OR = 2.78; 95% confidence intervals = 1.11-6.95). In conclusion, higher levels of salivary inflammatory cytokines were associated with both periodontal disease and carotid atherosclerosis. Selected salivary inflammatory cytokines may be useful screening markers for periodontal disease and carotid atherosclerosis.

The effect of periodontal status and occlusal support on masticatory performance: the Suita study.

AIM: In this study, we investigated the effect of differences in periodontal status in the masticatory performance of dentate subjects with the same occlusal supporting area. MATERIALS AND METHODS: The subjects of the analysis were classified into those of Eichner A1-3 (n = 1094) and Eichner B1-4 (n = 529). Subjects' periodontal status was evaluated on the basis of the Community Periodontal Index (CPI). The number of functional teeth and occlusal support were investigated, the latter on the basis of the Eichner Index. Furthermore, masticatory performance was investigated by means of test gummy jelly. For each group, periodontal status was classified in two different ways, either with/without moderate periodontitis (CPI Code ≤2/≥3) or with/without severe periodontitis (CPI Code ≤3/4), and masticatory performance was compared between the various groups. RESULTS: In subjects who were Eichner A1 and B3, masticatory performance was significantly lower in subjects with moderate periodontitis compared with those without, and in subjects with severe periodontitis compared with those without. CONCLUSION: Periodontal disease affects masticatory performance not only if occlusion is established by natural dentition with no tooth loss but also if occlusal support has decreased.

Additive interaction of oral health disorders on risk of hypertension in a Japanese urban population: the Suita Study.

BACKGROUND: This study assessed the relationship between different oral health markers-periodontitis, gingival bleeding, tooth number, and occlusal status-and hypertension in a Japanese urban population. METHODS: A total of 1,643 participants with no prior cardiovascular disease (mean age = 66.6 years; 43.4% women) underwent comprehensive health checkups, including a lifestyle questionnaire and dental examination in the Suita Study. RESULTS: In the multivariable-adjusted logistic model, none of the individual oral health markers, namely severe periodontitis, gingival bleeding, lowest quartile of tooth number, and malocclusion, were significantly associated with increased odds of hypertension. The additive effects of oral health markers on hypertension were examined and showed that, compared with subjects with no component of the oral health markers, the multivariale-adjusted odds ratio of hypertension in those with ≥3 components was 1.82 (95% confidence interval (CI) = 1.23-2.72; P = 0.003). In the subpopulation without antihypertensive medication (n = 1,148; 59.8% women), a significant graded relationship between multivariable-adjusted systolic blood pressure and the number of components was found (P trend = 0.03), and, compared with subjects with no component of the oral health markers, having ≥3 components was related to a higher systolic blood pressure (ß = 5.41; 95% CI = 1.16-9.66; P = 0.01). CONCLUSIONS: There is an additive relationship between oral health disorders and risk of hypertension. Our results suggest that the existence of moderate or severe oral health disorders-that is, several concomitant oral health disorders-is associated with risk of hypertension.