The study was to perform cost-effectiveness analysis of the oral health care for depended elderly.
The literature was reviewed to evaluate effectiveness of the oral health care for the elderly. Then, the cost of treating in-patients for aspiration pneumonia was estimated from the viewpoint of costbenefit analysis. Local effects of the oral care were reduction of bacterial flora in the oropharynx, mouth odor and gingivitis.
Systemic effects were reducing ratio of suffering fever, aspiration pneumonia and mortality. The cost-effectiveness of the oral care was 0.82 comparing cost for patients of aspiration pneumonia.
The oral health care was proved to be cost-effective with its local and systemic effects.

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The aim of this study was to evaluate the oral health status, the degree of independence for brushing, denture wearing and mouth rinsing and the physical status of the elderly residents at a special nursing home for the elderly, and to clarify the relations between these three factors.
The subjects were 72 residents (mean age 84 years) at a special nursing home for the elderly. Two general dental practitioners performed an oral examination and a nursing home helper investigated the status of life, the denture, oral by giene and systemic health status by means of a questionnaire.
Cerebro-vascular disease was the most prevalent disease, 9 residents had a history of pneumonia and the“Kizami” meal was the most common diet. Sixty-one % of the residents had dentures. As for the BDR index, over half of the subjects were independent in tooth brushing, but less than half were really capable. Dementia patients needed significantly more help with tooth brushing and with insertion, removal and of rinsing of dentures.
Subjects who took normal meals were independent on the BDR index. This showed the importance of normal meals.

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Being unable to chew, in another words suffering a decrease in masticatory ability, is known to have a close relationship with self-assessed health and depression. This study of the nationwide elderly population in Japan aims to investigate the relation between perceived health and the declining functionalities due to aging, such as decreased auditory perception, visual perception and masticatory ability.
As part of the Nihon University Japanese Longitudinal Study of Aging, by the Nihon University Center for Information Networking, of a panel interview survey of elderly individuals over 65 years old, was conducted in November 1999. 4, 948 answers were obtained through this survey. Multinomial logistic regression analysis was conducted on the survey results, using perceived health as a dependent variable, and age, gender, vision, hearing, chewable groups of food, the CES-D scale and the PGC morale scale as independent variables. Hayashi's quantification method of the third type was used to conduct a preliminary analysis, in order to grasp the inter-variable structure. Data from 3, 069 individuals, who had fully answered items was used for this analysis.
Vision had the strongest relation with perceived health, and had a significant relationship (p<0.05) with the varying perceived health level in every group.Hearing was related in two healthy groups of individuals, those who answered either “excellent” or “good”. Masticatory ability was related in two groups of unhealthy individuals, those who either answered “fair” or “poor.” The CES-D scale and the PGC morale scale was related in every group.No relationship with age was evident in any of the groups, but a gender relationship was evident in the two healthy groups of individuals who answered either “excellent” or “good.”In other words, vision, hearing, and masticatory ability, all of which are known to decrease as a function of age, each exhibited a unique relationship with perceived health. Speaking of mastication in particular, elderly persons should recognize even a slight decrease in masticatory ability as a sign of a potential decrease in their health rating in the near future. Conversely, the results indicated that the maintenance and recovery of masticatory ability in individuals who cannot chew is a basis for improvement from their current fair or poor health status rating.

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Overdenture abutment facilitates the emergence of root caries and periodontal disease on account of the degradation of self-purification by saliva and the difficulty of plaque control. The purpose of this study is to analyze the factors resulting from overdenture abutment teeth. The incidence of root caries and periodontal disease, the period from insertion, and the coping form and height were investigated. Forty three patients (16 men and 27 women) were selected.
The incidence of caries and periodontal disease did not show any difference according to the kind of tooth or the type of coping. There was a significant relation between the use period of abutment tooth and incidence of caries. The incidence of caries over 37-months, was higher than under 36-months.(p<0.01). However, there was no significant difference between the incidence of periodontal disease and the use period of abutment tooth.
As for the maintenance of abutment tooth of overdenture, firstly the installation of prophylaxis for dental caries was recommended, and then the necessity of the improvement and prevention of widespread periodontal disease was suggested.

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The purpose of this pilot study was to develop a new oral care system based on a new classification of oral care needs. An electrical oral brush combined with an automatic liquid supply/suction system (Dent. ERAC 910, LION DENTAL PRODUCTS) was used on four dentate dependent elderly in a general hospital by nurses. The effectiveness of oral cleaning was evaluated microbiologically. The mean value of the anaerobe count in gargling water was at the level of 108-1010 at the baseline. This valae decreased in 1/10·1/100 at 2 weeks after the start of oral care using the new brush system, and maintained the level of 106·107 with continuous care until the end of this study. No aspiration symptoms (choking or coughing) were observed in any subject during the test period. Other findings showed an improvement in oral malodor, activity of daily life and facial expression. On the other hand nurses complained at the increase in care work.

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Recently, the influences of oral microbes on various systemic diseases have been clarified, suggesting the importance of oral care. In our previous pilot study, we proposed a classification of oral care needs and the oral care system for various categories of the elderly. In addition, the effect of the system was microbiologically evaluated when tested by dental hygienists and nurses before routine use by general care providers for the elderly.
In this study, the oral condition of independent and dependent elderly at a private residential home was microbiologically evaluated, concentrating on candida, mutans streptococci (MS), Lactobacilli (LB), anaerobes and turbidity. On the base line before stating the system, the number of candida detected from the tongue and dentures was higher in the independent than in the dependent, with a statistical difference. The number of MS and LB were higher in the independent subjects than in the dependent with a statistical difference. The number of oral anaerobes and turbidity were slightly higher in the mean value in the independent subjects than in the dependent, but there was no statistical difference by Mann-Whitney's U test analysis.
The results at 1 month after using the new oral care system were as follows. The mean number of candida detected from the tongue slightly decreased in both the independent and dependent subjects, but there was no statistical difference by ANOVA. The mean number of candida detected from dentures decreased to 1/10 in the independent subjects, and slightly increased in the dependent subjects, but there were no difference by ANOVA. The number of MS and LB decreased in both the independent and dependent subjects, but there was no statistical difference by Chi-square test. The mean number of anaerobes decreased in both the independent and dependent subjects, but there was no statistical difference by ANOVA. The mean turbidity slightly decreased in both the independent and dependent subjects, but there was no statistical difference by ANOVA.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Recently, there has been a resurgence of interest in the interactions between oral conditions and a number of prevalent systemic diseases. The morbidity and mortality of the dependent elderly that result from aspiration pneumonia have been recognized as major geriatric health problems. The purpose of this study was to gain more information on the microflora of dental plaque and to assess the existence of oral infectious pathogens potentially causing respiratory disease in the dependent elderly.
The bacterial flora in the dental plaque of 97 dependent elderly were examined by the culture method to identify microorganisms.
Twenty one species of microorganisms were detected in dental plaque in this study. In 64 cases out of 97 (66%), potential respiratory pathogens colonized in the dental plaque.
The results of the present study revealed that bacteria that commonly cause respiratory infection colonized on the teeth of the dependent elderly, suggesting that dental plaque may function as a reservoir of potential respiratory pathogens to facilitate colonization on the oropharynx.

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[in Japanese]

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