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The time dental and nutrition meet歯科と栄養が出会うとき
Abstract
In recent years, sarcopenia prevention and flail prevention are regarded as important. As a way to achieve healthy longevity, dental care that incorporates a nutritional perspective is necessary. On the other hand, dentistry has not incorporated the viewpoint of masticatory disorders due to motor disorders in the diagnosis of masticatory disorders. Aging and diseases that develop with aging cause sarcopenia throughout the body and disturbance of the motor control system, affecting the masticatory function. Whether or not motor disorders are involved in the cause of masticatory disorders can be evaluated by tongue pressure or diadochokinesis. If motor disorders are involved, an approach to motor disorders is essential. At that time, the necessary outcome is nutrition, and the intervention content is nutrition guidance in addition to functional training.
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This report was written by the Japanese Society of Dysphagia Rehabilitation, the Japanese Association of Rehabilitation Nutrition, the Japanese Association on Sarcopenia and Frailty, and the Society of Swallowing and Dysphagia of Japan to consolidate the currently available evidence on the topics of sarcopenia and dysphagia. Histologically, the swallowing muscles are of different embryological origin from somatic muscles, and receive constant input stimulation from the respiratory center. Although the swallowing muscles are striated, their characteristics are different from those of skeletal muscles. The swallowing muscles are inevitably affected by malnutrition and disuse; accumulating evidence is available regarding the influence of malnutrition on the swallowing muscles. Sarcopenic dysphagia is defined as dysphagia caused by sarcopenia of the whole body and swallowing‐related muscles. When sarcopenia does not exist in the entire body, the term “sarcopenic dysphagia” should not be used. Additionally, sarcopenia due to neuromuscular diseases should be excluded; however, aging and secondary sarcopenia after inactivity, malnutrition and disease (wasting disorder and cachexia) are included in sarcopenic dysphagia. The treatment of dysphagia due to sarcopenia requires both dysphagia rehabilitation, such as resistance training of the swallowing muscles and nutritional intervention. However, the fundamental issue of how dysphagia caused by sarcopenia of the swallowing muscles should be diagnosed remains unresolved. Furthermore, whether dysphagia can be caused by primary sarcopenia should be clarified. Additionally, more discussion is required on issues such as the relationship between dysphagia and secondary sarcopenia, as well as the diagnostic criteria and means for diagnosing dysphagia caused by sarcopenia. Geriatr Gerontol Int 2019; ••: ••–••.
As Japanese aged society progresses, oral health condition in geriatric population deviated in a wide range from normal to malfunction including oral frailty and“deterioration of oral function”. As the official representatives of geriatric dentistry, we proposed the definition of“deterioration of oral function”in this position paper. This position paper aimed to gather evidence up to this time and to propose tentative diagnostic criteria in order to develop appropriate arguments about this issue efficiently.
“Deterioration of oral function”was expressed from seven oral symptoms：oral uncleanness, oral dryness, decline in occlusal force, decline in motor function of tongue and lips, decline in tongue pressure, decline in chewing function and decline in swallowing function. The criteria of each symptom were determined by the data of previous studies, and“deterioration of oral function”was defined if these criteria were matched in more than three symptoms. This position paper proposed the initial definition of“deterioration of oral function”, but would lead to further studies about this issue from various perspectives. More evidence should be accumulated with further clinical studies to clarify its definition, but we hope this paper presents the first step in the right direction.
This study was performed to ascertain the relationships between oral motor functions, such as those of the tongue and lips, and age in the community-dwelling elderly, as well as to investigate the effects of these factors on masticatory performance. The subjects were 268 healthy elderly Japanese living in Kyoto. They were divided into four age groups and further classified into the following two groups by the presence or absence of posterior occlusal support: Eichner A or B1-B3 (group A), and Eichner B4 or C (group B). They were wearing removable or fixed dentures if they had missing teeth. Oral function evaluation items included (1) masticatory performance and (2) oral motor skills. Significant differences were noted among the age groups in tongue pressure within group A (P < 0.01) and group B (P < 0.05), and in the number of repetitions of the syllables /ta/ and /ka/ in group B (/ta/: P < 0.05, /ka/; P < 0.01). The number of natural teeth (beta = 0.463, P < 0.001) in group A and tongue pressure (beta = 0.436, P < 0.001) in group B were the only predictors of masticatory performance when the data were analyzed by multiple regression analysis. The tongue may compensate for the missing teeth in masticatory performance of those elderly who have lost their natural teeth. The results of this study highlight the importance of tongue function in masticatory performance.
Purpose:
The purpose of this study was to examine how skeletal muscle mass influences the effectiveness of dysphagia rehabilitation.
Methods:
The cross-sectional study and the prospective cohort study were conducted in a clinic, specialized in rehabilitation of patients with dysphagia, located in Tokyo, Japan. Skeletal muscle mass measurement by bioelectrical impedance analysis and tongue strength measurement were performed on 178 outpatients with dysphagia. In addition, the Barthel Index, Mini Nutritional Assessment-Short Form, and Functional Oral Intake Scale values were measured. Dysphagia rehabilitation was performed, and 88 of the patients who were available for follow-up one year later were included in a follow-up study. In the cross-sectional study, the associations between tongue strength and other factors were examined. In the follow-up study, factors associated with rehabilitation effectiveness, shown by tongue strength, were examined.
Results:
Tongue strength and skeletal muscle mass were correlated, and both decreased as eating and swallowing function level decreased. After one year of dysphagia rehabilitation, tongue strength and skeletal muscle mass increased. The factors associated with the amount of increase in tongue strength were initial tongue strength and skeletal muscle mass.
Conclusions:
For patients with dysphagia, maintenance of skeletal muscle mass was associated with improvement of tongue strength in rehabilitation. This indicates that prevention of sarcopenia in dysphagia patients contributes to the effect of rehabilitation.
Purpose:
The aim of this study was to determine the influences of oral motor function such as tongue function and bite force on masticatory performance in the elderly.
Methods:
We randomly selected 245 subjects who has 28 natural teeth among community-dwelling elderly. We evaluated masticatory performance using a gummy jelly, and also measured bite force, tongue muscle force, and the speed of tongue movement.
Results:
We found that reduced masticatory performance to be associated with decreased the speed of tongue movement and/or tongue muscle force, indicating that reduced oral motor function also influences masticatory performance.
Conclusions:
These results suggest that keeping oral motor function, as well as maintenance of occlusal support, to be important for maintaining masticatory function in the elderly.
Purpose:
To clarify whether the occlusal state affects the masticatory performance of elderly adults.
Methods:
Elderly women were asked to chew a gummy jelly, and the amount of glucose extraction was measured as the parameter for masticatory performance. Subjects were divided into five groups depending on occlusal support on the habitual chewing side (G1: no occlusal support of posterior teeth, G2: occlusal support of first premolar, G3: occlusal support of premolars, G4: occlusal support from first premolar to first molar, and G5: occlusal support from first premolar to second molar). It was also investigated whether or not the subjects were wearing dentures. The amount of glucose extraction was compared among the five groups and then between subjects with removable denture and subjects without removable denture. The relationship between age and glucose extraction were also investigated.
Results:
The amount of glucose extraction progressively increased with increase in number of occlusal support. There were no fixed tendencies between age and glucose extraction, when occlusal state was taken into account. The amount of glucose extraction of subjects without removable denture was significantly larger than that of subjects with removable denture. It was also found that 67 % of subjects with removable denture were within the normal range when it was set based on G5 data.
Conclusions:
It was suggested that the occlusal state affected the masticatory performance of elderly adults.
It is important for the elderly to maintain their skeletal muscle mass, which in turn helps to maintain physical functions. This study aimed to clarify factors related to skeletal muscle mass maintenance. Home-bound elderly (94 men and 216 women), at least 75 years of age, attending a day-care center in Tokyo, were enrolled in this study. Dentists specializing in dysphagia rehabilitation evaluated skeletal muscle mass, occlusal status and swallowing function. Physical function, cognitive function and nutritional status were also evaluated by interviewing caregivers. Correlations of skeletal muscle mass with various factors were determined in each gender group. Multiple regression analysis revealed that skeletal muscle mass was significantly related to nutritional status in both men and women. In men, there was a significant difference in skeletal muscle mass between those with and without occlusion of the natural teeth. Our results suggest that dental treatments and dentures would be useful for maintaining skeletal muscle mass, especially in men.
Aim:
It has been reported that if nutrient intake is unbalanced, muscle mass, muscle strength and physical performance declines, and therefore it is important to maintain chewing ability to keep a balanced nutrient intake. However, the relationship between chewing ability and sarcopenia has not been previously reported. Therefore, the present study investigated the relationship between chewing ability and sarcopenia in addition to known sarcopenia-related factors.
Methods:
We examined 761 participants (average age 73.0 ± 5.1 years), who lived in the Itabashi city of Tokyo. Our research was designed to examine the relationship between chewing ability and sarcopenia. We carried out regression analysis to analyze the relationship with sarcopenia-related factors with consideration of the age of the participants.
Results:
The 761 participants were divided into two groups in terms of the stage of sarcopenia according to whether there was a deterioration of muscle strength or physical performance. Furthermore, we carried out logistic regression analyses on the value as a dependent variable, including known sarcopenia-related factors. There were significant correlations of sarcopenia with age (odds ratio 2.37, 95% confidence interval 1.52-3.70), body mass index (odds ratio 0.75, 95% confidence interval 0.69-0.81) and chewing ability (odds ratio 2.18, 95% confidence interval 1.21-3.93).
Conclusions:
The present study shows that chewing ability is related to sarcopenia, which is equal to the relationship with the known factor of age by odds ratio. Geriatr Gerontol Int 2014; ●●: ●●-●●.
PurposeThe present study examined the relationship between oral function, such as eating/swallowing, and life prognosis among a homebound elderly population, considering physical and mental function.Methods
The participants were 511 homebound older adults aged 65 years or older living in four Japanese prefectures. Sex, age, activities of daily living (ADL), cognitive function, underlying disease, nutritional status as Mini-Nutritional Assessment-Short Form (MNA®-SF), swallowing function, dietary modification and occlusal status were examined at baseline. Participants were categorized into poor outcome (died or admitted to hospital or nursing home) and good outcome (still under home care) groups at 1-year follow up, and significant related baseline factors were analyzed. In addition, these groups were compared by the ADL subgroup divided into <60 (lower) and ≥60 (higher) by Barthel Index.ResultsIn total, 473 participants were followed up (poor outcome group 177 [37.4%], good outcome group 296 [62.6%]). Sex, age, ADL, MNA®-SF, swallowing function, dietary modification and occlusal support were significantly different between these groups. Logistic regression analysis showed that sex and MNA®-SF score were significantly related to prognosis in the lower ADL group, and sex, age, Charlson Comorbidity Index and occlusal support were significantly related in the higher ADL group.ConclusionsADL was strongly correlated with life prognosis in homebound older adults. Within the higher ADL participants, occlusal support was related to this outcome. Geriatr Gerontol Int 2014; ●●: ●●–●●.
The purpose of this study was to clarify the correlation between dental and nutritional status among community-dwelling elderly Japanese people.
The subjects were 182 elderly individuals, aged 65-85 years, who voluntarily participated in a health seminar at Kyoto Prefectural University of Medicine. These subjects were divided into two groups according to the occlusion. The subjects in the retained contact group were those who had retained molar occlusion with natural teeth. The lost contact group were those who retained molar occlusion with removable partial dentures. Anthropometric variables such as body mass index (BMI) were collected and dietary intake was assessed using a brief self-administered diet history questionnaire (BDHQ).
No statistical difference in BMI or intake of macronutrients was found between these two occlusal groups. The lost contact group reported significantly lower consumption of vegetables and higher consumption of confectionaries (foods rich in sugar) than did the retained contact group (P < 0.05), and therefore had significantly lower intake of vitamin C and dietary fiber (P < 0.05).
It can be concluded that natural tooth contact loss in the posterior region affect the intake of vitamins and dietary fiber. .
Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.
Tongue muscle mass and strength relate to whole-body muscle in the community-dwelling elderly
- H Furuya
- F Tamura
- M Yoshida
- H Hirano
- K Iijima
- T Kikutani
Furuya H, Tamura F, Yoshida M, Hirano H, Iijima K,
Kikutani T. Tongue muscle mass and strength relate
to whole-body muscle in the community-dwelling
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Rehabilitation 2016; 29: 1-9.
Tongue function is important for masticatory performance in the healthy elderly: a cross-sectional survey of community-dwelling elderly
- K Sagawa
- H Furuya
- Y Ohara
- M Yoshida
- H Hirano
- K Iijima
- T Kikutani
Sagawa K, Furuya H, Ohara Y, Yoshida M, Hirano
H, Iijima K, Kikutani T. Tongue function is important
for masticatory performance in the healthy elderly: a
cross-sectional survey of community-dwelling elderly.
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