In the Nursing-Care System which was revised in 2006, great importance has been attached to the improvement of the oral function. This is redefined as the core of long-term care, due to the increase in the elderly population requiring some degree of long-term care. Also 2008 has witnessed establishment of Medical Services for the Elderly (over 75 years). The system puts emphasis on the assessment and control of the oral function so as to maintain their ability to eat, speak and laugh. It should be noted, however, that neither of these initiatives has led to the establishment of a comprehensive assessment method nor a concrete control method. Moreover, given the fact that the independent elderly make up a majority of the total elderly population in Japan, it is highly probable that they will require some form of care in the near future. Nevertheless, the present situation is characterized by the absence of any effective measure.
This research is focused on development of a comprehensive examination method for the oral function, an appropriate improvement method, and an assessment method in order to improve the oral health and to prevent further deterioration of oral problems for the independent elderly and those requiring nursingcare. This phase of the research has two aims studying the effectiveness of an oral examination method for the independent elderly and the development of a tot l system up to the assessment method.
To this end, a nursing home located in Sapporo City in northern Japan was chosen as the location to perform oral function examinations for 91 independent residents. The examinations focused on aspects of the oral cavity; the surrounding area, the front (concerning mastication), theinner part (related to Swallowing) and cleanliness. An improvement method based on the results has put into effect, in preparation for its assessment.
As resultof these measures, a significant improvement has been attained in their oral function. This was confirmed by the results of a chewing gum test for mastication, saliva wetness test, the Repetitive Saliva Swallowing Test, Oral Diadochokinesisand Candida Test. This suggests that the system developed on this occasion is effective in assessing and improving the oral function of the independent elderly.

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A retrospective study of the treatment for 22 geriatric patients (over 85 years old, 16 females, 6 males) with oral cancer was made, and the following results were obtained:
1) The primary sites were the upper or lower gingiva in ten cases, and the tongue in nine cases.
2) Twelve patients were in stage I-II, and ten were in stage III-IV. The histologic type wassquamous cell carcinoma in twenty patients and carcinoma originating from the salivary gland in two.
3) Fourteen patients had some general diseases, including heart disease (7 cases) dementia (5), and cerebral infarction (3).
4) Sixteen patients underwent surgery. Neck dissection was done in 6 cases and reconstructive surgery using myocutaneous pedicle flap in 3. Two patients could not undergo surgery because of locally advanced tumor, and the remaining four were complicated by dementia.
5) There was no treatment-related death or severe complication in the 16 patients who underwent surgery.
6) The sixteen patients who underwent surgery were cured of their tumor, but the six patients who did not undergo surgery could not obtain local or regional cure.
7) The three-year overall cumulative survival rate was 74. 8% in all patients, and 84. 4% inthe 16 patients who underwent surgery.
8) These results suggest that surgery is the optimal treatment method for geriatric patients over 85 years, when their general condition is tolerant of surgical stress.

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We treated a brainstem stroke dysphagia patient with poor tongue movement, and found that a palatal augmentation prosthesis (PAP) was helpful for dysphagia rehabilitation. The patient was a 76-year-oldmale who had been receiving PEG feeding following a brainstem stroke. He was referred to us for dysphagia rehabilitation after his general condition had stabilized. At the first examination, the patient was clearly conscious, had tetraplesia, severe hoarseness, and dysarthria. Videoendoscopy was performed to evaluate his swallowing function. Poor tongue propulsion, mild delay of swallowing, moderate pharyngeal residue after swallowing and silent aspiration when taking thin liquid were observed, but pharyngeal contraction itself was not damaged. We remodeled the upper denture to PAP using soft relining, and started direct exercise by jelly or thick liquid. As a result, after three monthsof rehabilitation he could eat soft meals orally.
Using videofluoroscopy and manofluorography, we compared the swallowing functionwith PAP and without PAP to examine the effects of PAP in terms of: 1) the oral transit time, 2) the pharyngeal transit time, 3) the tongue basepharyngeal wall contact time, 4) the pharyngeal airway closure time, 5) manofluorographic analysis at the upper esophageal sphincter, and 6) the pharyngeal residue.
Swallowing improved in all the items with PAP than compared withno PAP. We conclude that PAP can be considered effective for brainstem stroke patients with pharyngeal dysphagia.

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[in Japanese]

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[in Japanese]

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Purpose The aim of this study wasto clarify the efficacy of the management of oral health care carried out by dental hygienists at a nursing home.
Methods: A total of 142 subjects, living in twofacilities (facility A; 82 subjects, mean age 85.9±7.5 years, and facility B; 60 subjects, mean age 85.6±8.3 years) for dependent elderly persons in Yamanashi Prefecture, participated in this study. The intervention period was 8 months, and the evaluation of oral hygiene conditions by visual examination and oral bacteria test was performed three times: before intervention, after 4 months, and after the end of the intervention. In facility A, dental hygienists performed general oral cleaning for 20 randomly-chosen subjects directly, and gave advice aboutoral health care to the other subjects. In facility B, dental hygienists prepared an interventional oral care plan for the subjects, based on the risk assessment of each subject's oral condition, and conducted oral care intervention in cooperation with the facility staff. In addition, a survey of the attitude of nursing stuff toward the interventional plan was conducted.
Results: In subjects at facility A, there was no significant difference in the number of oral bacteria within the intervention period, while in subjects at facility B, the number of oral bacteria at the last intervention significantly decreased (p<0.05). The results of the survey indicated some differences between the two facilities in the attitude of the facility staff to the interventional plan.
Conclusion: Management of oral health care at a nursing home was proven to be mo t effective when a total oral health care plan was made, considering the facilities, equipment and the dental hygienists' interventional method. We confirmed the importance of the management of oral health care.

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The purpose of this study was to examine the inhibition of Candida albicans (C. albicans) adherence to the tongue in vivo by an oral care gel containing hinokitiol. Five-week-old female ICR mice were intraperitoneally administered with prednisolone and the entire surface of each animal's tongue was coated with gel using a disposable loop.The gel was applied every 12 hours until tongue isolation. We inoculated tongues with C. albicans 24 hours following prednisolone administration, collected tongues 3, 5, and 7 days after infection, and measured bacterial counts and inflammatory cytokine production. Cytokine production and bacterial counts were significantly lower in tongues that were coated with the gel compared to uncoated tongues. These results suggested that pre-coating tongues with the oral care gel could inhibit C. albicans adherence.

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