Diet-related diseases mediate the effect of masticatory function on premature death in older adults.

AIM: Although poor oral health has been a potentially modifiable risk for mortality, the precise association between functional tooth units (FTUs) and premature death as well as the underlying mechanisms remains unclear. METHODS: This study used data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. Mortality details were obtained from the National Death Index (NDI). The number of FTUs was defined as pairs of opposing natural and artificial teeth in the premolar and molar area. Weighted logistic regression models were employed to assess the relationship between FTU and premature death. Demographic characteristics, lifestyle habits, and disease histories were adjusted as confounding factors. The propensity score matching (PSM) was conducted to further assess the association between FTU and premature death. Mediation analyses were conducted to assess the role of diet-related diseases in the association between FTU and premature death. RESULTS: The analysis included 4169 individuals aged between 60 and 74 years. Participants with 0 ≤ FTUs ≤ 3 had a significantly higher odds of premature death compared to the 10 ≤ FTUs ≤ 12 group (OR = 2.142, 95% CI 1.091-4.208). After missing data imputation, 0 ≤ FTUs ≤ 3 was still significantly associated with increased odds of premature death (OR = 2.115, 95% CI 1.125-3.975). The relationship between 0 ≤ FTUs ≤ 3 and reference group persisted (OR = 2.196, 95% CI 1.296-3.721) after PSM analyses. For mechanism, mediation analysis showed that diet-related diseases, including diabetes and hypertension, partially mediated the association between FTU and premature death with proportions of 5.089% and 8.437%, respectively. CONCLUSION: The findings revealed a link between impairment of masticatory function and a heightened odds of premature death among older adults. Notably, 0 ≤ FTUs ≤ 3 is significantly correlated to premature death among this demographic, with diabetes and hypertension partially mediating the effect of FTU on premature death. Further longitudinal studies are required to validate the findings.

Association between masticatory function and depression in older adults: Results from NHANES 2009 to 2018.

AIM: Depression is prevalent among older adults. Although the number of missing teeth is considered to be associated with depression, the relationship between masticatory function, which is usually indicated by functional tooth units (FTUs), and depression in older adults remains unclear. MATERIALS AND METHODS: This study used data from the National Health and Nutrition Examination Survey (NHANES) 2009-2018. The number of FTUs was defined as pairs of opposing natural and artificial teeth. Depression was accessed using the Patient Health Questionnaire (PHQ-9), and participants who scored ≥10 on PHQ-9 were diagnosed with depression. Logistic regression analyses, propensity score matching (PSM) analyses and subgroup analyses were conducted to assess the association between FTU and depression. RESULTS: The analysis included 5764 individuals over 60 years. An association between FTU and the risk of depression among older adults was detected (odds ratio [OR] = 0.951, 95% confidence interval [CI] 0.915-0.989), suggesting protective roles of more FTUs. Significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was observed compared with 10 ≤ FTUs ≤ 12 (OR = 1.819, 95% CI 1.157-2.858). However, no significant increase in the risk of depression in 4 ≤ FTUs ≤ 9 was found. After PSM, significant increase in the risk of depression in 0 ≤ FTUs ≤ 3 was still detected compared with 4 ≤ FTUs ≤ 12 (OR = 1.484, 95% CI 1.030-2.136). Subgroup analyses demonstrated consistent results in all subgroups, except for individuals aged 76-80 and drinking regularly. CONCLUSIONS: The findings suggested the association between impaired masticatory function and the risk of depression among older adults. Longitudinal studies are needed to elucidate the role of masticatory function impairment in the development of depression further.

Oral frailty is a risk factor for body weight loss after gastrectomy: a single-center, retrospective study.

BACKGROUND: Body weight loss (BWL) is a serious complication of gastrectomy in patients with gastric cancer (GC). Nutritional intervention alone is inadequate for preventing BWL, and a new approach is needed. Oral frailty among older adults has recently attracted attention. This study aimed to investigate masticatory ability and BWL after gastrectomy. METHODS: This was a single-center, retrospective study. Functional tooth units (FTU) were used to measure masticatory ability. Patients with FTU < 4 were defined as low FTU group and FTU ≥ 4 as high FTU group. The BWL was compared between the two groups. RESULTS: Sixty patients who underwent distal gastrectomy for GC from March 2022 to January 2023 were enrolled in this study. The median FTU was 3 (range 0-12). The low-FTU group (FTU < 4) included 29 patients, while the high-FTU group (FTU ≥ 4) included 31 patients. The %BWL in the low FTU group was significantly higher than that in the high-FTU group at 1 and 3 months (p = 0.003 and p = 0.017, respectively). The risk factors associated with a %BWL > 5 at 1 and 3 months after gastrectomy were analyzed using logistic regression analysis. Only FTU < 4 was an independent risk factor after gastrectomy for GC in univariate and multivariate analyses (p = 0.028 and p = 0.006, respectively). CONCLUSIONS: Low FTU in patients with preoperative GC was a risk factor for %BWL 1 and 3 months postoperatively. Appropriate oral interventions may be useful in improving the postoperative nutritional status after gastrectomy.

The Relationship between Dental Findings and Tongue Pressure: A Survey of 745 Community-Dwelling Adults and Elderly Persons in Japan.

INTRODUCTION: Reduced tongue pressure is one of the causes of dysphagia. The purpose of this study was to investigate the relationship between dental findings and tongue pressure, and whether prosthetic treatment prevents reduced tongue pressure. METHODS: This was a cross-sectional study. Participants were 745 community-dwelling adults and elderly persons in the Goto Islands in Nagasaki, who underwent a health checkup for residents in 2015 and 2016. Data were collected on gender; age; grip strength; hemoglobin; Creatinine (Cr); glycated hemoglobin (HbA1c); history of stroke; smoking, drinking, exercise, and walking habits; number of teeth; wearing of removable dentures; functional units of natural teeth (n-FTUs), fixed prostheses (nif-FTUs), and removable dentures (t-FTUs); and tongue pressure. The associations between each variable and tongue pressure were examined using multiple regression analysis. Next, those with 3 or fewer n-FTUs were selected, and differences in tongue pressure were compared between those with 3 or fewer nif-FTUs and those with 4 or more nif-FTUs, using a propensity score matching method. RESULTS: Male gender, weak grip strength, low HbA1c, no drinking, and a low number of teeth were independent factors significantly associated with lower tongue pressure. Among participants with 3 or fewer n-FTUs, the 43 with 4 or more nif-FTUs showed significantly higher tongue pressure than the 43 with 3 or fewer nif-FTUs after propensity score matching, although the number of t-FTUs was not associated with tongue pressure. DISCUSSION/CONCLUSION: Tooth loss was significantly associated with lower tongue pressure. It was suggested that fixed prosthesis treatment might prevent the reduction of tongue pressure, but removable dentures did not have such an effect.

Oral health-related quality of life is associated with physical frailty: A cross-sectional study of Japanese community-dwelling older adults.

BACKGROUND: Physical frailty is related to adverse outcomes, and poor oral health has been linked to malnourishment. Subjective measures of oral health-related quality of life (OHRQoL) have been used as indicators of the oral health problems of older adults, and they have been associated with malnourishment. This study aimed to assess OHRQoL's association with physical frailty. METHODS: Cross-sectional study was conducted using data from the Nagasaki Islands Study that enrolled participants aged ≥60 years at Japanese national medical check-ups from 2014 to 2019. Physical frailty phenotype criteria were determined using the modified Fried frailty phenotype model. OHRQoL was assessed using the Geriatric Oral Health Assessment Index (GOHAI). Dentists conducted clinical dental examinations. Simple correlation and linear regression analyses were performed to investigate the associations of number of physical frailty phenotype criteria with GOHAI and other oral health indicators. RESULTS: Among 1341 participants with a mean age of 72 years, GOHAI score was significantly associated with number of physical frailty phenotype criteria (B = -0.01, 95% confidence interval: -0.02 to -0.01, p < 0.001). The association remained significant after adjustment for age, sex, body mass index, history of hypertension, history of diabetes mellitus, smoking status, Kessler-6 score, and number of remaining teeth. CONCLUSIONS: Oral health-related quality of life was associated with physical frailty in Japanese community-dwelling older adults.

Influential Factors of Masticatory Performance in Older Adults: A Cross-Sectional Study.

While appropriate nutrient intake is important for older adults, various oral problems cause decreased masticatory function. This cross-sectional study aimed to identify the factors associated with decreased masticatory performance in older adults. Oral examinations were performed on 80 participants (mean age: 75.10 ± 5.64 years) to determine the number of functional tooth units (FTUs). Symptoms of periodontal and temporomandibular diseases were evaluated via a questionnaire. The tone, elasticity, and dynamic stiffness of the masseter muscle were measured using the Myoton® PRO device. The mixing ability test was used to assess the masticatory performance, and the mixing ability index (MAI) was calculated. The analysis of covariance test was performed to adjust for confounding factors, and multiple logistic regression analysis was performed to identify the risk factors affecting MAI. A lower MAI was significantly associated with higher tone (p = 0.006) and lower elasticity (p = 0.013). The number of FTUs (adjusted odds ratio (OR) = 0.724, p = 0.029), tone (adjusted OR = 1.215, p = 0.016), and elasticity (adjusted OR = 4.789, p = 0.038) were independently associated with the MAI. Muscle function training and prosthetic treatments may help increase masticatory performance in older adults, which would improve overall health.

A Cross-Sectional Study of Perceived Dental Treatment Needs and Oral Health Status in Community-Dwelling Older Australian Men: The Concord Health and Ageing in Men Project.

BACKGROUND: Assessing perceived needs for dental treatment is important in understanding and predicting people's health behaviours. The purpose of this study is to examine older men's perceptions regarding dental treatment needs, and to investigate the disparity between perceived needs and the actual oral health of a population of community-dwelling older Australians. METHODS: Using cross-sectional data from the 4th wave of the Concord Health and Ageing in Men Project, logistic regression analysis of perceived needs for dental treatment was conducted for 596 men aged 78 and over, with functional tooth units (FTUs), number of decayed tooth surfaces, and periodontitis as independent variables. RESULTS: Thirty-six percent (n = 216) of the participants believed they required some form of dental treatment. The remaining participants did not perceive a need for treatment, yet 65.3% objectively required prosthodontic or restorative care. The regression model showed men with lower FTUs were significantly more likely to report a perceived need for dental treatment than those with 12 FTUs [0-6 FTUs: adjusted odds ratio (OR) 2.58, 95% CI 1.28-5.20; 7-11 FTUs: adjusted OR 2.43, 95% CI 1.16-5.10]. However, neither the number of decayed tooth surfaces nor the existence of periodontitis was associated with perceived dental treatment needs. CONCLUSIONS: Most older men viewed their oral health positively, and the majority of those with objectively assessed needs, did not perceive themselves as requiring dental treatment. Loss of FTUs appears to alert participants to seek treatment, but not the presence of dental caries or periodontitis.