Factors Influencing the Changes in Masticatory Performance: The Suita Study.

INTRODUCTION: Although previous studies have identified various factors related to masticatory performance, which factors affect longitudinal changes in masticatory performance have not been clarified. OBJECTIVES: We aimed to clarify factors involved in changes to masticatory performance and construct models from factors related to masticatory performance in a longitudinal study of a general urban population in Japan. METHODS: A total of 1,005 Japanese subjects (411 men, 594 women; mean age at baseline, 65.7 ± 7.7 years; mean follow-up period, 5.0 ± 0.9 years) were included in the Suita study. These subjects participated in dental checkups both at baseline (June 2008-December 2011) and at follow-up (June 2013-January 2017). The number of functional teeth and occlusal support areas was recorded and the latter assessed using the Eichner index. Subjects' periodontal status was evaluated based on the Community Periodontal Index. Masticatory performance was determined using test gummy jelly. Factors affecting masticatory performance at follow-up and the degree of their effect were investigated by multiple linear regression analysis. RESULTS: In multiple linear regression analysis with masticatory performance at follow-up as the dependent variable, baseline age, masticatory performance, number of functional teeth, and maximum bite force were significant independent variables. The results of multiple linear regression analyses by occlusal support at baseline identified only maximum bite force at baseline in subjects who were Eichner A and baseline age, masticatory performance, and number of functional teeth in subjects who were Eichner B as significant independent variables concerning masticatory performance at follow-up. CONCLUSION: Our study showed a relationship between longitudinal changes in masticatory performance and age, number of functional teeth, and maximum bite force and furthermore showed that the effects of these factors vary according to the residual number of occlusal support areas. KNOWLEDGE TRANSFER STATEMENT: Patients and clinicians should recognize the importance of objective and quantitative assessment for chewing efficiency and understand that various factors are related to longitudinal changes in masticatory performance. The results of this study can provide basic data for preventing or improving the decline in masticatory performance for elderly people with varying numbers of occlusal support areas.

A multifactorial model of masticatory performance: the Suita study.

Previous studies have identified various factors related to masticatory performance. This study was aimed to investigate variations and impacts of factors related to masticatory performance among different occlusal support areas in general urban population in Japan. A total of 1875 Japanese subjects (mean age: 66·7 years) were included in the Suita study. Periodontal status was evaluated using the Community Periodontal Index (CPI). The number of functional teeth and occlusal support areas (OSA) were recorded, and the latter divided into three categories of perfect, decreased and lost OSA based on the Eichner Index. Masticatory performance was determined by means of test gummy jelly. For denture wearers, masticatory performance was measured with the dentures in place. The multiple linear regression analysis showed that, when controlling for other variables, masticatory performance was significantly associated with sex, number of functional teeth, maximum bite force and periodontal status in perfect OSA. Masticatory performance was significantly associated with number of functional teeth, maximum bite force and periodontal status in decreased OSA. In lost OSA, masticatory performance was significantly associated with maximum bite force. Maximum bite force was a factor significantly influencing masticatory performance that was common to all OSA groups. After controlling for possible confounding factors, the number of functional teeth and periodontal status were common factors in the perfect and decreased OSA groups, and only sex was significant in the perfect OSA group. These findings may help in providing dietary guidance to elderly people with tooth loss or periodontal disease.

Fully automatic measuring system for assessing masticatory performance using ß-carotene-containing gummy jelly.

Despite the importance of masticatory performance in health promotion, assessment of masticatory performance has not been widely conducted to date because the methods are labour intensive. The purpose of this study is to investigate the accuracy of a novel system for automatically measuring masticatory performance that uses ß-carotene-containing gummy jelly. To investigate the influence of rinsing time on comminuted jelly pieces expectorated from the oral cavity, divided jelly pieces were treated with two types of dye solution and then rinsed for various durations. Changes in photodiode (light receiver) voltages from light emitted through a solution of dissolved ß-carotene from jelly pieces under each condition were compared with those of unstained jelly. To investigate the influence of dissolving time, changes in light receiver voltage resulting from an increase in division number were compared between three dissolving times. For all forms of divided test jelly and rinsing times, no significant differences in light receiver voltage were observed between any of the stain groups and the control group. Voltages decreased in a similar manner for all forms of divided jelly as dissolving time increased. The highest coefficient of determination (R(2)  = 0·979) between the obtained voltage and the increased surface area of each divided jelly was seen at the 10 s dissolving time. These results suggested that our fully automatic system can estimate the increased surface area of comminuted gummy jelly as a parameter of masticatory performance with high accuracy after rinsing and dissolving operations of 10 s each.

Measuring masticatory performance using a new device and ß-carotene in test gummy jelly.

Objective methods for evaluating masticatory performance are invaluable for quantitative comparisons between various dental treatments as well as diagnosing masticatory disorder. The purpose of this study was to develop an accurate method for automatically measuring masticatory performance using a new measuring device consisting of light-emitting diodes and a photodiode and test gummy jelly. First, the relationship between six known ß-carotene concentrations in aqueous solution and the voltage values exhibited on a photodiode was investigated. Mean voltage obtained by red light incident on the photodiode indicated a significantly high correlation (r=0·999 in a cubic function, P<0·01) with ß-carotene concentration in the aqueous solution. Second, to establish the optimal measuring conditions for evaluating masticatory performance, factors influencing mean voltage were investigated, such as water temperature and times for rinsing the gummy jelly and dissolving ß-carotene from the jelly. A stable mean voltage was obtained by measuring under the following conditions: rinsing water temperature, 35°C; rinsing time, 30s; water dissolving temperature, 35°C; dissolving time, 10s. Finally, the relationship between seven surface area values of divided gummy jelly and ß-carotene concentrations dissolved from the divided jellies was investigated. The increase in surface area of divided test gummy jelly particles was accurately calculated (r=0·992, P<0·001) from mean voltage on the photodiode to change with ß-carotene concentration dissolved from the jelly surface. This new method using test gummy jelly and an automatic measuring device appears useful for precisely evaluating masticatory performance.

Association of symptomless TMJ sounds with occlusal force and masticatory performance in older adults.

This study investigated associations between temporomandibular joint (TMJ) sounds and occlusal force or masticatory performance stratified by posterior occlusal supports in older Japanese adults. The subjects consisted of 1646 independently living people over 60 years. Masticatory performance, occlusal force, TMJ sounds and maximal mouth opening were examined. Posterior occlusal supports were classified by the Eichner Index. The prevalence of TMJ sounds was 27.7%, limitation of mouth opening (< 40 mm) was 7.9% and TMJ pain was only 1.5%. In the Eichner C group, TMJ sounds were significantly associated with lower occlusal force (OR = 3.20, P = 0.046) and lower masticatory performance (OR = 3.18, P = 0.041) after controlling for gender and age. These associations were not found in the Eichner A and B groups. Within the limitations of this study, the presence of TMJ sounds, even if they were symptomless, was associated with impairment of masticatory function in older adults with reduced occlusal support.

Task-induced activation and hemispheric dominance in cerebral circulation during gum chewing.

In elderly persons, it is thought that maintenance of masticatory function may have a beneficial effect on maintenance of cerebral function. However, few studies on cerebral circulation during mastication exist. This study aimed to verify a possible increase in cerebral circulation and the presence of cerebral hemispheric dominance during gum chewing. Twelve healthy, young right-handed subjects with normal dentition were enrolled. Bilateral middle cerebral arterial blood flow velocities (MCAV), heart rate, and arterial carbon dioxide levels were measured during a handgrip exercise and gum chewing. During gum chewing, electromyography of the bilateral masseter muscle was recorded.MCAV and heart rate significantly increased during exercise compared to values at rest. During gum chewing, there were no differences in the rate of increase in MCAV between the working and non-working sides, but during the handgrip exercise, the rate of increase in MCAV was significantly greater for the non-working side than for the working side. During gum chewing,muscle activity on the working side was significantly greater than that on the non-working side. These results suggest that during gum chewing, cerebral circulation increases bilaterally and does not show contralateral dominance, as it does during the handgrip exercise.

Effect of reinforcement on overdenture strain.

Because the abutment becomes the fulcrum, and the denture base over the coping is usually thin, the overdenture is susceptible to fracture. We hypothesized that rational reinforcement can reduce strain and prevent deformation and fracture of the overdenture. We investigated the effect of reinforcement on overdenture strain around the copings and at a midline. A mandibular edentulous model with a 2-mm-thick artificial mucosa and abutment teeth installed bilaterally in the canine position was produced. The coping had a dome-shaped upper surface with a height of 6 mm. On the lingual polished surface, strain gauges were attached at the canine position and at the midline. A vertical load of 49 N was applied on the occlusal surface. Among several kinds of reinforcements, the cast metal reinforcement that covers both the midline and the coping top significantly reduced the strain on the overdenture. It is suggested that this simple reinforcement is effective in preventing deformation and fracture of the overdenture.

Factors associated with taste dissatisfaction in the elderly.

The purpose of this study was to investigate taste sensation in the elderly, and to determine relationships between subjective dissatisfaction with taste ability and factors such as age, gender and oral status among independently living elderly individuals. Participants were older adults (mean age, 66.0 +/- 4.2 years; 321 men and 319 women) voluntarily attending a Senior Citizen Educational Program supported by local government in 2003 and 2004. The questionnaire included self-assessed items on general health, dry mouth, chewing satisfaction and taste satisfaction. Respondents underwent investigation of salivary flow rate, dental status and gustatory testing using the filter-paper disc method for sweet, salty, sour and bitter. Chi-squared tests showed that the factors associated with dissatisfaction with taste ability were older age, dissatisfaction with chewing, dry mouth during eating and wearing dentures covering the entire hard palate. The sensation for each taste was not significantly related to taste satisfaction by chi-squared test. Multiple logistic regression analysis showed that dry mouth during eating, dentures covering the entire hard palate, dissatisfaction with chewing and discriminatory threshold for the sour taste were associated with dissatisfaction with taste ability. We found a significant association between subjective taste dissatisfaction and certain oral factors; hence, when patients complain about diminished taste, dentists must assess oral status as well as taste sensation.

Comparison of oral stereognosis in relation to age and the use of complete dentures.

The purpose of this study was to examine the age-related difference in oral sensory function by testing oral stereognostic ability (OSA) and to determine the effect of wearing complete dentures on OSA. Subjects were 20 dentate and 30 edentulous elderly patients free from oral symptoms and pathologies, and 30 younger dentate students as controls. The OSA tests were conducted with test pieces of 12 shaped forms. The duration time for recognition was noted and the answers were recorded using a three-point scale. anova and paired t-tests were used to examine significant differences. P-values <0.05 were considered to be statistically significant. The OSA score in older dentate participants and complete denture wearers was significantly higher than in younger dentate subjects. However, no significant difference was found in the OSA score between older dentate participants and complete denture wearers. When older edentulous subjects removed the maxillary and mandible complete dentures, the OSA score was significantly lower and the response time significantly longer than with dentures. Within the limitations of this study, an age-related difference in oral sensory function, as measured by OSA tests, was found. However, oral sensory function was not significantly different between fully dentate persons and complete denture wearers in the elderly.

Influence of human jaw movement on cerebral blood flow.

Temporal changes in cerebral blood flow induced by jaw movement have yet to be investigated. To assess the influence of pattern and intensity of muscle contraction during jaw movement on task-induced change in cerebral blood flow, we performed bilateral transcranial Doppler ultrasound examination during clenching, gum chewing, and tooth tapping in healthy volunteers. A random-effects model analysis revealed a significant increase in middle cerebral artery blood flow velocity during clenching (high muscle activity) and gum chewing (moderate muscle activity), compared with the preceding rest period; however, such an increase was not detected during tooth tapping (low muscle activity). Cerebral blood flow was greater on the working side during the intensive isometric contraction of the masseter muscle in clenching. These results suggest that task-induced change in cerebral blood flow during jaw movement is influenced by the change in peripheral circulation evoked by muscle contraction.

Influence of abutment height on strain in a mandibular overdenture.

The purpose of this study was to investigate the influence of coping heights on the strain around the abutment teeth and at the middle part of mandibular overdentures, using strain gauges. A mandibular edentulous model with a silicone artificial mucosa of thickness 2 mm was made. Two artificial roots were embedded on both sides in the canine position. The coping had a dome-shaped upper surface at a height of 0, 2, 4 and 6 mm. On the lingual polished surface of the overdenture, three strain gauges were attached in the left canine position at the vertical level corresponding to the top of the 6, 4 and 2 mm copings and two strain gauges were attached in the middle section (upper and lower). A vertical loading of 49 N was applied on the occlusal surface of first premolar, first molar and second molar. When loading on the first premolar adjacent to an abutment, the largest tensile strain was observed on the overdenture surface close to the top of each coping, independent of coping heights. When loading on the first premolar on the opposite side, the tensile strains around the coping were remarkably smaller. In the middle part of the overdenture, the compressive strains became larger by reducing the coping height or loading on distal point. The largest tensile strain was observed on the overdenture surface close to the top of copings, independent of coping heights.

Effect of adding impression material to mandibular denture space in Piezography.

The purpose of the study was to examine the effect of adding impression material on denture space using a piezographical record. Subjects were ten voluntary edentulous patients, aged from 61 to 84 years old. A maxillary trial denture with anterior artificial teeth and a mandibular base plate with a keel were inserted into the oral cavity. Three ml of tissue-conditioning materials was injected on the base plate for each trial. Afterwards, the patients were instructed to pronounce various phonemes, so that tongue, cheeks and lips conformed to the denture space. The impression complexes were cut at the level of the estimated occlusal plane. Occlusal analogues were made by duplicating the impression complexes. Measurements were performed for five analogues from the first to fifth additions for each subject. The data were compared using analysis of variance (ANOVA), and a Friedman's test followed by a Bonferroni test for multiple comparisons with a level of significance at 5%. At the molar and premolar positions, the bucco-lingual widths of the occlusal table increased significantly at incremental injection of impression materials from P1 to P4. The midpoints of the analogues were located at a distance of 1.5 mm buccally at the molar position and at a distance of 1.9 mm buccally at the premolar position from the top of the alveolar crest, independent of the addition of impression material. It was concluded that denture space was regulated by volume of material and was located slightly on the buccal side from the crest of the residual alveolar ridge.

Prevalence of root caries in a selected population of older adults in Japan.

In this study, the prevalence of root caries in a sample of Japanese elders was investigated along with various aetiological factors. Two hundred and eighty-seven independently living elderly people over the age of 60 years were examined for the prevalence of active, inactive, and filled root lesions as well as the number of teeth. General health, oral status and brushing habits were surveyed, and salivary flow was determined in terms of flow rate and subjective feeling of dry mouth during eating. About 39% of the subjects had one or more decayed roots and 53.3% had at least one decayed or filled lesion. Root caries was seen most frequently on canine teeth followed by the first premolar. The number of decayed or filled lesions increased with increasing number of residual teeth (Kruskal-Wallis test, P = 0.033), however, there was no association between the proportion of teeth with root decay and the number of teeth. For subjects with 20 or more teeth, the number of decayed roots is likely to be lower in subjects who reported brushing frequently (P = 0.058), and higher in subjects with low salivary flow (P = 0.059) or subjective feeling of dry mouth (P = 0.052) (Chi-squared). The presence of decayed lesions is likely to be related to dry mouth (P = 0.057, odds ratio 3.13) and brushing frequency (P = 0.088, odds ratio 1.76) (Multiple logistic regression analysis). The results indicate a high frequency of root surface caries in this Japanese community-dwelling older population. Oral hygiene status and low salivary flow or perceived dry mouth were potential risk factors for disease.

Coordination of tongue pressure and jaw movement in mastication.

The tongue plays an important role in mastication and swallowing by its contact with the hard palate. Using an experimental palatal plate with 7 pressure sensors, and recording jaw movement using mandibular kinesiography, we assessed, in healthy subjects, the coordination of tongue and jaw movements during the entire masticatory sequence of solids, by measuring tongue pressure against the hard palate. Tongue pressure appeared during the occlusal phase, reached a peak near the start of opening, and disappeared during opening. Specific patterns in order, duration, and magnitude of tongue pressure were seen at the 7 pressure sensors in each chewing stroke. Magnitude and duration were significantly larger in the late stage of chewing (8 strokes before initial swallowing) than in the early stage (until 8 strokes after starting mastication). The normal pattern of tongue contact against the hard palate, control of tongue activity, and coordination with jaw movement during mastication is described.

Association of candidal activity with denture use and salivary flow in symptom-free adults over 60 years.

The purpose of this study was to examine the amount of palatal mucosa Candida species associated with denture use and stimulated salivary flow in symptom-free adults over 60 years. The subjects were 351 (189 men and 162 women) independently living elderly people with a mean age of 66.7 +/- 4.3 (SD) years. Candidal activity of palatal mucosa was evaluated by the pH change in the medium that was associated with the acid production of the yeast. Subjects whose stimulated salivary flow rate was less than 0.5 ml/min were placed in the hyposalivation group. A multiple logistic regression analysis was used to determine if an independent variable was statistically significant after controlling for other variables. Candidal activity of the palatal mucosa was significantly associated with the dental status of the maxillae (Kruskal-Wallis test, P < 0.001), but was not significantly associated with age or drug intake. In maxillary denture wearers, Candidal activity of palatal mucosa had a significantly positive correlation with candidal activity of tissue fitting surfaces of maxillary dentures (r = 0.806, P < 0.001). A multiple logistic regression analysis showed that high candidal activity of the palate was significantly associated with being male and wearing maxillary removable dentures. Stimulated salivary flow rate was likely to be negatively related to high candidal activity (P = 0.07). This study suggests that the activity of Candida species in the oral cavity is associated with the wearing of removable dentures and stimulated salivary flow, independent of age or gender even in the relatively healthy elderly.

Effect of magnetic attachment with stress breaker on lateral stress to abutment tooth under overdenture.

Recently, a newly developed magnetic attachment with stress breaker was used in retentive components in overdentures. Excessive lateral stress has a more harmful effect on natural teeth than axial stress, and the magnetic attachment with stress breaker is expected to reduce lateral forces on abutment teeth and protect it teeth from excessive stress. However, the properties of this retainer have not yet been determined experimentally. This study compares the lateral forces on abutment teeth for three retainers under loading on the denture base in a model study. A mandibular simulation model is constructed to measure lateral stress. Three types of retentive devices are attached to the canine root. These devices include the conventional root coping, the conventional magnetic attachment and the new magnetic attachment with stress breaker. For each retentive device, load is generated on the occlusal table of the model overdenture, and the lateral stress on the canine root and the displacement of the overdenture measured. The magnetic attachment with stress breaker does not displace the denture and exhibits lower lateral stress in the canine root than conventional root coping and magnetic attachments.

Association between masticatory performance and maximal occlusal force in young men.

The purpose of this study was to examine the relationship between masticatory performance and maximal occlusal force in dentate subjects, using test foods of varying hardness. Subjects were 20 young males with natural dentitions. Gummy jellies with two different degrees of hardness have been used as test foods to evaluate masticatory performance. Masticatory performance was evaluated by the increase of the surface area of expectorated pieces of comminuted gummy jelly that was calculated from the concentration of gelatin. Maximal occlusal force was measured with pressure sensitive sheets (DENTAL PRESCALE 50H R type). The results suggested that maximal occlusal force had a significant positive correlation to the masticatory performance both with soft gummy jelly and hard gummy jelly. The correlation coefficient (r) with hand gummy jelly tended to be larger than with soft gummy jelly.

Perception of dry mouth in a sample of community-dwelling older adults in Japan.

The purpose of this study was to examine the prevalence of perceived dry mouth among a group of independently-living elderly persons in Japan, and to determine its association with general disease, medication, and dental status, as well as its effect on oral function. The study population consisted of participants of the Senior Citizens' College. The subjective sensations of oral dryness on waking and while eating a meal were measured by a questionnaire. The number of usable questionnaires was 1003 or 77.9%. The mean age of the subjects was 66.3 +/- 4.2 years, and 53.0% were male. More than one-third (37.8%) of the subjects reported oral dryness on waking. Only 9.1% of them noticed a subjective feeling of dry mouth during eating. Persons who had at least one of these symptoms made up 41.0%. A multiple stepwise logistic regression analysis indicated the following results: Perception of dry mouth on waking was more frequent among males (p < 0.001), persons who had a low BMI (p < 0.05), and those taking two or more prescribed drugs (p < 0.01). Sensation of dry mouth when eating was more frequent among subjects with a low BMI (p < 0.001) and those who wore a denture in the maxillary arch (p < 0.05). Perception of dry mouth when eating was associated with self-assessed chewing ability (p < 0.01) and dissatisfaction with speaking clearly (p < 0.05), as well as dental status. However, dissatisfaction with tasting a meal had a significant relationship with the reports of mouth dryness on waking (p < 0.01). Our findings suggest that a substantially higher percentage of persons have the perception of dry mouth on waking than when eating, which was associated with medications, being male, and having a low BMI. This perception may influence oral function, especially the reported dissatisfaction with tasting foods.

Effects of intrathecal c-fos antisense oligodeoxynucleotide on adjuvant-induced thermal hyperalgesia.

We examined the effects of intrathecally preadministered injections of a phosphorothioate analog of c-fos antisense and mismatch oligodeoxynucleotides (ODNs) on the withdrawal latency to a thermal stimulus following unilateral injection of complete Freund's adjuvant (CFA) into the hind footpad of rats. Pretreatment with the c-fos antisense ODN significantly decreased the CFA-induced expression of c-Fos protein dose-dependently in ipsilateral laminae I/II (LI/II) of the dorsal horn (mean +/- SEM per section: 10 nM ODN, 43.9+/-1.3; 25 nM ODN, 19.4+/-4.1) compared with pretreatment with the mismatch ODN (63.6+/-2.9; 60.6+/-4.0) or saline (56.6+/-5.5). Animals pre-treated with 25 nM of the c-fos antisense ODN significantly increased the withdrawal latency to the noxious thermal stimulation (63.0-70.5%; compared with contralateral to the CFA injection) compared with animals pretreated with mismatch ODN (28.5-42.6%) or saline (26.4-45.3%) from 0 to 5 h after unilateral injection of CFA into the hind footpad. Pretreatment with 10 nM antisense ODN had a less significant effect. These results indicate that the expression of CFA-induced c-Fos in the dorsal horn might facilitate thermal nociception.

New method for divesting cobalt-chromium alloy castings: sandblasting with a mixed abrasive powder.

STATEMENT OF PROBLEM: Because the conventional divesting method for cobalt-chromium (Co-Cr) alloys is laborious, a more convenient method is desirable. PURPOSE: This study compared sandblasting with a mixed powder composed of aluminum oxide and glass beads to sandblasting with single powders (carborundum, aluminum oxide, and glass beads) when a Co-Cr casting was removed from the investment mold. MATERIAL AND METHODS: Rectangular plates with the 2 surfaces simulating the inner and outer surfaces of a removable partial denture framework were fabricated with Co-Cr alloys. Four kinds of sandblasting powders were used to remove the remnants of investment molds. Total time (seconds) required for each procedure was measured, as was the surface roughness (Ra) of each specimen after sandblasting. SEM was used to analyze the powders themselves and the sandblasted specimen surfaces. RESULTS: Glass beads alone and the mixed powder of aluminum oxide and glass beads generated a smoother surface compared with aluminum oxide and carborundum powders. The use of the mixed powder significantly reduced the time of the sandblasting procedure. SEM revealed that glass beads generated fewer scars, followed by the mixed powder and then aluminum oxide. The surface sandblasted by carborundum powder was always the roughest. CONCLUSION: Sandblasting Co-Cr castings with the mixed powder effectively decreased treatment time and resulted in smooth, clinically acceptable casting surfaces.