To assess the effect of functional oral rehabilitation for elderly patients with cerebral disorders inacute, recovery and maintainable stages, we analyzed the oral functional change after functional oral health of 153 patients with cerebro-vascular disorder, as well as the specific outlines of 549 elderly patients who used visiting oral health care from T dental clinic during 1995 and 2003.
In the group of those who started functional oral rehabilitation from the acute stage, within 1 month from the admission, significant changes were found on direct functional items ; the interactive oral function of open mouth, mastication, action of the tongue, oral muscle, clearness of speech, and functional level of speech. In those who started functional oral rehabilitation in the maintainable stage, after 3 months from the setup and the admission, significant improvements on indirect oral functional items were observed; food resudue, plaque at the tongue and salivation, although no significant change on direct functional items was found.
The results suggest the validity of functional oral rehabilitation from the early stage of cerebrovaslu-car-disorder.

View full abstract

The purpose of this research was to survey the diet type and situation of denture wearing in the residents of 2 nursing homes and to investigate factors that were related to diet type and denture wearing. The subjects were 145 residents in nursing homes. We examined their oral status (caries, missing teeth and status of restorations), diet type and situation of denture wearing. Their activities of Daily Living (transferring, eating, toileting, bathing, dressing/undressing, grooming, communication, getting-up), ability of mouth rinsing, diet spillage and degree of dementia were reponted by dentists and caregivers. Eighty six percent of the subjects were in need of wearing dentures, and 58% of them were not using dentures. The residents' diet type was significantly associated with, ability of mouth rinsing, diet spillage, degree of nursing care, degree of dementia (Their spearman's correlation coefficient p<0.01), age, number of crowns and status of occlusal support (p<0.05). Situation of denture wearing was significantly associated with ability of mouth rinsing, diet spillage, the degree of nursing care, the degree of dementia, ability of communication, grooming, getting-up, dressing/undressing, bathing, transferring, toileting and eating (exact probability test: p<0.001). There was no significant association among denture use, age, number of crowns and status of occlusal support. Diet type and nonuse of dentures seemed to be related both to the degree of physical and mental disability, and to the impairment of oral functions.

View full abstract

As part of a study of the disinfection of impressions in dental treatment of elderly patients at home, the present study investigated the effect of storing alginate impressions after spraying with disinfectant solutions on the dimensional accuracy of edentulous working casts in relation to the type of tray for impressions.
Two brands of alginate impression materials characterized by smaller dimensional changes in 100% relative humidity and two disinfectants for spray: 2% glutaraldehyde and 1% sodium hypochlorite solutions were used. As for the impression tray, 4 types of experimental metal trays (perforated trays opened or closed mesio-distally, imperforated trays opened or closed mesio distally) were prepared. The impression was sprayed with disinfectant solutions and then stored in a sealed bag for 3 hours.
The results indicated that the storage following spray with disinfectant solution did not have serious effect on the dimensional accuracy of the stone model without regard to the type of impression tray, when the alginate impression characterized by smaller dimensional change in 100% relative humidity was used.

View full abstract

The frequency of the genus Candida, which is a microorganism that causes opportunistic infection was examined in the oral swab samples collected from 33 nursing home residents and 18 persons living in their own homes. To confirm the identification of Candida species and C. albicans serotypes, serological tests were performed. Further, isolated C. albicans were evaluated for Candida acid proteinase activity. The results obtained were as follows:
1. Genus Candida was detected in 25 cases (75.8%), whereas in the control subjects 9 cases (50.0%) wereisolated.
2. Genus Candida constituted a very small proportion of the total cultivable bacteria count. The average detection ratio of genus Candida was 0.086% in nursing home residents and 0.007% in control subjects who were Candida positive.
3. C. albicans alone was mainly found in the nursing home residents and control subjects with 9/25 and 5/8, respectively. The coexistence of C. albicans and C. glabrata was found in 7/25 of nursing home residents. Most of the isolated C. albicans were identified with serotype A.
4. No difference in Candida proteinase activity was revealed between the nursing home residents and control subjects, although the proteinase activities of each isolate were different.
These results suggested that oral care should be provided to the elderly to inhibit the potential of opportunistic infection in the oral cavity and systemic sites.

View full abstract

Oral functional improvement is very important as a preventative approach in long-term care. The aim of this study was to perform factorial analysis of the feeding/swallowing function during meals, and to issue guidelines for the maintenance of the oral function in the elderly needing care in facilities. The subjects were 95 elderly residents at a long-term care insurance facility for the elderly in Tokyo and at a geriatric medical facility in Shizuoka Prefecture. The subjects' feeding/swallowing dysfunction during lunch time was observed and evaluated. Three dentists and a speech-pathologist who specialized in feeding/swallowing rehabilitation evaluated the function by observational assessment. From the feeding/swallowing items, nine items that we hypothesized to relate to food drooling were analyzed. The items were; type of the meal, propriety of type of the meal, posture at meals, size of bowl of spoon, independence of eating, meal time duration with assumption of 30 minutes as a cut-off value, disorder of anticipatory stage, lip closing function and masticatory movements. The results showed 1. Food drooling was revealed to be related to the following five items by Chi-squared test: type of the meal, meal time duration, disorder of anticipatory stage, lip closing function and masticatory movements (p<0.05), 2. Multiplex logistic analysis was conducted with the above five items as a covariate, and food drooling as a dependent variable. As a result, lip closing function and masticatory movements showed significant correlations with food drooling (p<0.05). This study suggested that it is necessary to improve the feeding/swallowing function by educating the subjects on the feeding environment, by treatment of oral conditions, and by training of muscles related to the oral function.

View full abstract

Aim: The purpose of this study was to examine the effect of oral function training and feeding assistance on the nutrition of undernourished elderly people.
Subjects and Methods: Fifty-one subjects in a nursing home, who had a serum albumin level below 4.0 g/dl and understood the purpose of this study, were selected. They were divided into two groups; Group 1, the feeding assistance care group (27 people: mean age 82.7±6.7 years) and Group 2, the feeding assistance care plus oral function training group (24 people: mean age 82.4±7.6 years) according to the program of intervention. The Group 1 subjects were given feeding assistance care during their lunch twice a week by care givers and dental hygienists. The Group 2 subjects were given feeding assistance care during their lunch and oral function training before lunch time by dental hygienists twice a week. Oral function training includes; 1) breathing exercise, 2) neck range of motion exercise, 3) lip and cheek exercises, 4) tongue exercise, 5) soft palate exercise, 6) swallowing exercise, and 7) trunk exercise. The subjects' oral functions and nutritional status were assessed before and after the intervention.
Results: The results obtained were as follows:
1) In subjects of Group 1, serum albumin was 3.7±0.2g/dl and pre albumin was 18.2±4.7 mg/dl before intervention, but they significantly increased to 3.8±0.3g/dl and 20.5±5.5mg/dl after intervention (p<0.01). Correspondingly, in Group 2 subjects serum albumin was 3.7±0.3 g/dl and pre albumin was 19.3±4.3mg/dl before intervention, but they significantly increased to 4.0±0.4g/dl and 23.0± 5.8mg/dl after intervention (p<0.001).
2) The value of lingual pressure in both groups did not differ significantly after intervention.
3) The serum albumin level of Group 1 increased by 0.12±0.04g/dl, on the other hand, the value of Group 2 increased by 0.3±0.05 g/dl after intervention. There were significant differences between the two groups (p<0.05).
Conclusion: It was concluded that oral function training and feeding assistance care were effective for nutritional improvement for elderly nursing home patients, especially for those undergoing both interventions.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract