Oral feeding is extremely important to maintain the oral function for bedridden individuals. However, tube feeding is occasionally inevitable for dysphagic bedridden patients. Considerable differences are anticipated in oral-pharyngeal hygiene between oral and tube-fed individuals due to several factors. Unfortunately, there are no guidelines for oral health care per feeding method. The purpose of this study was to analyze the differences in oral-pharyngeal hygiene between oral and tube fed individuals to identify the necessary care factors for feeding guidelines.
The subjects were 53 dysphagic individuals (13 males, 40 females, mean age 78). In this study, we selected 35 individuals (8 males, 27 females, mean age 77) who were non-denture wearers, of whom 9 were fed only by tube, and 26 by oral feeding alone (control). Evaluation methods included a questionnaire covering daily life activities, oral health care, and diet. Oral function and conditions were exemined clinically by dentists and a dental hygienist. Each patient was scored, and the results were analyzed by a Chi-Square test.
The results obtained were as follows:
1) Oral dyskinesia in oral fed individuals was significantly less than tube-fed individuals (p<0.05).
2) Mouth opening width in oral-fed individuals was significantly greater than in tube fed individuals (p<0.01).
3) Glotitis in oral fed individuals was significantly less than in tube fed individuals (p<0.01).
4) C. albicans on the tongue surface in oral-fed individuals was more prominent than in tube-fed individuals (p<0.01).
5) C. albicans on the palatine surface in oral-fed individuals was more prominent than in tube-fed individuals (p<0.05).
6) Glotitis demonstrated the highest correlation to feeding methods by the Quantification Theory II.
Based upon the results of the study, it is concluded that oral-fed individuals have factors that relate to the deterioration of intra-oral hygiene, while tube fed individuals have functional problems including mouth-opening difficulty. Therefore, appropriate oral health care is suggested per different feeding method.
This study was supported by the Japanese Welfare Ministry as a part of its research into elderly health care in 1997.

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Professional oral health care by dental health workers is needed for elderly patients who requir daily nursing care. In the present study, we evaluated the effectiveness of professional oral health care once a week for 24 months by dental hygienist to 88 elderly persons requiring daily care and living in a nursing home. The professional oral care reduced the cell numbers of Staphylococcus species and Candida albicans in samples obtained from the oral cavity (p<0.005). The methylmercaptan in the exhalation of the care group was significantly lower than that of the non-care group (p<0.005). It was found that professional care resulted in a significant reduction of the oral hygiene index compared with the non care group (p<0.001). The feverishness (more than 37.8°C) of the elderly groups was examined by a double-blind protocol. The professional care significantly reduced the feverishness (p<0.05). The present study showed that professional oral health care by dental hygienists for the elderly requiring daily nursing care reduced the bacterial cell number and resulted in reduced feverishness.

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The aim of this study was to gather data on the present status on diagnosis, treatment and prevention of root surface caries in the dental clinic. The respondents of this survey were 400 general practitioners who are members of Chiba-city Dental Association. The mail questionnaire survey was carried out in July and August, 1995. The contents of the questionnaire consisted of the methods of diagnosis and treatment, the selection of filling materials for root surface caries and the differences in treatment, prevention and etiology between root surface caries and wedge shaped defect.
Most respondents mentioned the tactile sensation and discoloration of lesions as the basis of root surface caries diagnosis. The major treatment of root surface caries was plastic fillings (98.3%), mainly composite resin and glass-ionomer cement. The etiology of root surface caries and wedge shaped defect was varied, including dental plaque, gingival recession and sugar intake for caries and brushing technique and toothbrush pressure for root surface defect. However, almost half of the dentists (43.8%) used the same treatment method in regard to both lesions. As for the preventive methods of root surface caries, brushing and sugar control were mainly mentioned. On the other hand, brushing, occlusal adjustment and brushing without dentifrice were listed for wedge shaped defect. These answers were classified according to etiology and prevention. The prevention and material selection for treatment of root surface caries were also related to the dentists' length of work experience since graduation from dental school.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Nifedipine is a calcium antagonist used for the treatment of angina, arrhythmia and hypertension. Gingival overgrowth as a side effect associated with the administration of nifedipine has been reported. Generally, dentists tend to ask physicians to change the drug regine, perform a gingivectomy, or use gentle treatment. It is considered that periodontal treatment for patients with diabetes is difficult. The patient (Male, 58 years old) in this report was administered drugs including nifedipine and diet treatment for hypertension, arrhythmia and diabetes. His chief complaint was gingival overgrowth. A gingivectomy and flap operation was performed under observation with pre-medication, and local anesthesia without epinephrine under oral sanitary conditions. This case had been administered calcium antagonists, but hypertension and arrhythmia were reported by his physician. Then, it was decided but to ask for a change of drugs. It is thought that periodontal surgery with pre-medication in the presence of decreased cardiac function and well controlled diabetes of HbAlc: 8.0%, did not produce an abnormal reaction post-treatment. Moreover recurrence of periodontitis and gingival overgrowth was not recognized during two years post-periodontal treatment as maintenance. This report suggests that plaque accumulation relates to drug induced gingival overgrowth.

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[in Japanese]

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[in Japanese]

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