Impact of oral health guidance on the tongue-lip motor function of outpatients at a dental hospital.

OBJECTIVE: To clarify the effect of oral health guidance on tongue-lip motor function in the outpatients visiting the Showa University Dental Hospital (Tokyo, Japan). BACKGROUND: The management of the oral function of older people visiting a dental hospital is important. Previous studies have revealed that tongue-lip motor function is easy to improve. However, the impact of oral health guidance on tongue-lip motor function in the outpatients of dental hospital requires further elucidation. MATERIALS AND METHODS: The participants (n = 35) included patients who were diagnosed with low tongue-lip motor function on evaluation by oral diadochokinesis (ODK) at the outpatient clinic. They underwent a second examination approximately 6-12 months later. Their demographic characteristics were recorded. Oral health guidance was provided through an educational leaflet on oral hypofunction when the participants visited the clinic. It included content on tongue twisters, voice training and a range of movement and muscle training of the tongue and lip. RESULTS: Following oral health guidance on tongue-lip motor function, the ODK values changed from 5.6 at the first examination to 6.0 at the second for /pa/, from 5.6 to 5.8 for /ta/ and from 5.2 to 5.4 for /ka/. This improvement was not significantly associated with age, sex, measurement period or number of visits. CONCLUSION: The findings of this longitudinal study suggested that oral health guidance using an oral hypofunction educational leaflet may be effective in improving the tongue-lip motor function of outpatients who had low tongue-lip motor function, regardless of the measurement period or the number of visits to the dental hospital.

Comparison of oral hypofunction tests and determination of reference values for a subjective masticatory function test.

BACKGROUND: In Japan, oral hypofunction has been recognized as a disease since 2018. An alternative to occlusal force testing for assessing oral hypofunction is the evaluation of the number of natural teeth. Subjective masticatory function testing, which evaluates the ease or difficulty in chewing foods, is an effective alternative to occlusal force testing. However, no reference values have been established for this test. We determined the reference values of the subjective masticatory function test and evaluated its potential as a substitute for the number of natural teeth for assessing oral hypofunction. METHODS: The sample consisted of 184 older adults who visited the Department of Geriatric Dentistry, Showa University Dental Hospital, from July 2018 to January 2020. The subjective masticatory function test (table for evaluation of chewing function in complete denture wearers [Chewing Score 20]) was performed using 20 foods. The occlusal force test and a receiver operating characteristic curve were used to determine the reference values for Chewing Score 20. The sensitivity, specificity, and positive and negative predictive values were calculated and compared with the occlusal force test and the number of natural teeth. RESULTS: A significant correlation (r) was found between the occlusal force test and the Chewing Score 20 (r = 0.526, p < 0.001). The reference value for Chewing Score 20 was < 85. Although the Chewing Score 20 was less sensitive than the number of natural teeth, it demonstrated a higher specificity and a positive predictive value. CONCLUSION: Herein, a score of < 85 on the subjective masticatory function test was determined to be the optimal quantitative reference. The subjective masticatory function test may be used as an alternative for assessing oral hypofunction.

Experimental study on the factors affecting torque of beam-type implant torque wrenches.

BACKGROUND: Screw breakage and loosening are the most common mechanical complications associated with implant treatment, and they may occur due to excess or inadequate screw tightening torque. When fastening and fixing the implant superstructure, screws are tightened using a torque wrench, which is essential for an accurate tightening force. However, the characteristics of the torque wrench have not been fully verified. Therefore, we aimed to clarify the factors affecting the torque with a focus on beam-type torque wrenches, which are the main types of wrenches. METHODS: The torque values generated by beam-type torque wrenches from eight manufacturers were measured using a torque gauge. To investigate the influence of the location of the beam relative to the scale, measurements were performed with a scale aligned with the trailing edge, center, and leading edge of the beam respectively. Additionally, measurements were taken at 90°, 60°, and 30° to examine the effect of the angle at which the examiner read the torque value. Under each condition, a single examiner applied the recommended torque to each manufacturer's screws five times in a clockwise direction. The average measured torque, standard deviation, bias, and coefficient of variation were calculated and compared accordingly. RESULTS: Wrenches from six manufacturers demonstrated excellent accuracy for measurements at the center of the beam (bias within ± 4%). For measurements at 90°, equipments from five manufacturers displayed excellent accuracy (bias within ± 7%), and seven showed excellent repeatability (coefficient of variation ≤ 2%). CONCLUSION: The scale should be aligned with the center of the beam and read from 90° while using a torque wrench. The accuracy and repeatability torques generated by the wrenches differed according to the manufacturer, scale width, scale line width, beam width, and distance between the scale and beam center. Based on these results, we suggest that a torque wrench must be selected after determining the difference in the structure of the torque wrench.

Exploring prosthetic screw rupture in titanium and zirconia superstructures under various conditions.

The fastening mechanics of prosthetic screws under various conditions is crucial to the maintenance of dental implants. This study comprehensively explores the prosthetic screw rupture in titanium (Ti) and zirconia (ZrO2) superstructures under wet and dry conditions. Superstructures were fabricated using digital technology and subjected to tightening torque trials. Experimental results suggested that the implications of the conventionally recommended torque of 15 N•cm differ significantly between dry and wet environments. Both Ti and ZrO2 exhibited preloads of >30 N•cm under dry conditions; however, differences emerged under wet conditions. In addition, screw rupture posed a prominent clinical challenge -particularly during long-term cyclic loading. Notably, the ZrO2 superstructures exhibited a greater resistance to breaking torque than that of Ti. This study underscores the importance of reevaluating torque recommendations with consideration to the distinct characteristics of Ti and ZrO2 in diverse environments.

Regular Oral Health Management Improved Oral Function of Outpatients with Oral Hypofunction in Dental Hospital: A Longitudinal Study.

This longitudinal study aimed to clarify the impact of regular oral health management for oral hypofunction on the oral function of older dental outpatients. The 68 participants enrolled in this study were older dental outpatients (mean age 78.5 ± 8.1 years). According to the number of declined oral examinations after the first exam, participants were assigned to the oral hypofunction group (Hypo group, ≥3), receiving regular oral health management with a leaflet at the dental clinic, or the pre-oral hypofunction group (Pre-hypo group, ≤2), which served as a control. At the second oral examination, after approximately 6 months to 1 year, the Hypo group showed significant improvement in the tongue-lip motor function (Oral diadochokinesis, ODK) /pa/, /ta/, and masticatory function, while the Pre-hypo group showed significant worsening in oral hygiene and oral wetness. Temporal changes in ODK /pa/, /ta/, and the number of declined examination items were significantly different between the groups. Multiple analysis revealed that the number of improved oral examination items were associated with presence of regular oral health management after adjusting for age, sex, number of visits, measuring period, and dental treatment. Regular comprehensive oral health management for oral hypofunction improves and maintains oral function among older dental outpatients.

Associations between Oral Hypofunction Tests, Age, and Sex.

Oral function declines in older individuals due to disease and age-related changes, making them vulnerable to oral and physical frailty. Therefore, it is important to manage the decline in oral function in older outpatients. Oral hypofunction is diagnosed by seven tests related to oral function, oral hygiene, oral moisture, occlusal force, oral diadochokinesis, tongue pressure, masticatory function, and swallowing function. However, sex or age were not factored into the current reference values of these tests. We included subjects attending the dental hospital clinic for maintenance, and recorded and analyzed oral hypofunction and the factors associated with its diagnosis. Of the 134 outpatients (53 males and 81 females, mean age 75.2 ± 11.2 years), 63% were diagnosed with oral hypofunction. Oral hypofunction prevalence increased significantly with age, and significant variations were observed in all tests. Furthermore, oral hygiene and swallowing function were not associated with oral hypofunction diagnosis. All examined factors decreased with increasing age, even after adjusting sex, except for oral hygiene and moisture. Occlusal force and masticatory function were higher in men after adjusting age. This study suggested that older outpatients were likely to be diagnosed with oral hypofunction, and that the test reference value and their selection for oral hypofunction should be reconsidered.

Device for easily measuring of the torque of an implant hand driver.

BACKGROUND: As one of the loads applied in implant dentistry, managing the torque is important for the success of an implant treatment. For this purpose, it is crucial to ascertain the level of torque being exerted with a hand driver. We have developed an adapter that makes it easy to measure torque by using a standard torque wrench in one's possession, rather than with a torquemeter. PROCEDURES: The head of an abutment screw is cut into a hexagon and pushed into and fixed to the hexagonal hole (for multi-unit abutments) of a machine driver. With this, a torque wrench adapter and torque wrench are assembled. A hand driver is rotated clockwise to the limit, and the torque value is read. RESULTS: It was possible to read the torque value during screw fastening. CONCLUSIONS: This technique makes it easy for each dentist to measure the maximum torque that can be exerted by a hand driver he or she is using. It is even possible to handle different implant systems.

Influence of occlusal loading force on occlusal contacts in natural dentition.

PURPOSE: Proper occlusal contact is important for the long-term success of prosthodontic therapy. We clarified the effects of occlusal loading force on occlusal contact in natural dentition by comparing measured values for occlusal loading and occlusal contact area. METHODS: Masseter muscle activity was measured in 10 subjects (2 male, 8 female; mean age, 27 years) with natural dentition using electromyography, with clenching at full strength with nothing interposed between the upper and lower teeth defined as 100% maximum voluntary contraction (MVC). Pressure-sensitive film (Occluzer) was used to examine occlusal contact points at 20, 40, 60, 80, 100 and 120% MVC. A material for checking accuracy of fit (BiteEye) was used to examine occlusal contact points at 20, 40, 60 and 80% MVC. ANOVA and the Bonferroni method were used to assess the results, with the level of significance set at 5%. Coefficients of variation (CV) were also calculated by dividing the standard deviation by the mean. RESULTS: Occlusal loading and occlusal contact area increased with clenching strength; however, CV showed differences between the methods at low and high MVC. CONCLUSIONS: With Occluzer, testing should be carried out at clenching strength ≥ 60% MVC. With BiteEye, testing should be carried out from light clenching strength at 20% MVC to moderate clenching strengths at 40-60% MVC. Occluzer and BiteEye (10 µm) gave similar occlusal contact areas at 60-80% MVC. These results suggest that combined use of Occluzer and BiteEye gives an accurate picture of occlusion from weak to strong clenching strength.

Occlusal status of implant superstructures at mandibular first molar immediately after setting.

BACKGROUND: Occlusal contact on the implant superstructures is important for successful treatment. The purpose of this study was to investigate the occlusal contact of single implant superstructures at the mandibular first molar immediately after seating from weak to strong clenching. METHODS: Subjects were nine patients who had just been fitted with an implant prosthesis in the mandibular first molar region, with no missing teeth other than in the implant region. First, while masseter muscle activity was monitored, maximum clenching strength (100 % maximum voluntary contraction (MVC)) was determined with an electromyogram. Next, occlusal load and occlusal contact area were measured three times at clenching intensities of 40, 60, 80, and 100 % MVC by the use of pressure-sensitive film for occlusal force diagnostic and Occluzer for occlusal force measurement. Finally, the occlusal contact area was measured once each at 20, 40, and 60 % MVC using a silicone testing material and BiteEye for occlusal contact measurement. A two-way analysis of variance (ANOVA) was used to determine occlusal loading and occlusal area as dependent variables, and clenching strength and presence or absence of implant as between-subject factors. A multiple comparison test was performed using the Bonferroni method. RESULTS: The occlusal contact area and occlusal load of the implant prosthesis increased with clenching strength, and the increases in occlusal contact area and occlusal load of the implant prosthesis were less than those of the contralateral tooth at high clenching strength. However, significant difference was not observed when compared with both sides of the molar region regardless of clenching strength. CONCLUSIONS: The occlusal contact area of the implant had a tendency to be adjusted smaller than the natural tooth by a dental technician and a dentist. On the other hand, despite the small tissue displaceability of the implant, occlusal load on the implant prosthesis was smaller than on the natural tooth at high clenching strength.