Essential assessment items to identify the risk of aspiration pneumonia are essential for oral health care management. In this study, the risk group for pneumonia was selected by the developed screening method among 172 institutionalized elderly (46 male and 126 female, mean age 84.0y) . The risk group consisted of 18 male and 38 female (mean age 84.0y) who were significantly dependent and who could not keep opening their mouths or perform rhythmical chewing compared with the others (p<0.05) . It may be concluded that assessment of oral function is the key for oral health care management.

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The present study was conducted in order to identify risk-factors for tooth loss among patients in a long-term maintenance program at dental clinics, as well as factors specifically related to the elderly. Subjects were selected from patients who had been in a maintenance program more than 15 years and who made their last dental visit between July and October 2004. The patients attended one of two private dental clinics where one of the authors has been working in Osaka. Annual tooth loss for each subject was calculated from the difference of tooth loss between the first visit and the last visit.
The average length of maintenance, between the base line and the last visit, was 27.5 years for those younger than 39 years, and 25.8 years for those older than 40 years at the base line. The annual average tooth loss was 0.040 for the younger group and 0.115 for the older group, not including wisdom teeth. Multiple regression analysis showed that individuals aged 40 and older with more non-vital teeth and more teeth with periodontal pocket depth at the first visit, as well as retaining a smoking habit and suffering diabetes mellitus during the maintenance period had a higher rate of annual tooth loss, whereas individuals with fewer teeth and more teeth with periodontal pockets showed co-relation with higher rate of annual tooth loss for the younger age group.
The results suggested that not only periodontal disease but also pulpectomy, as well as smoking and diabetes mellitus, could be the risk-factors of tooth loss in the later years even if a long-term maintenance program could be provided after 40 years of age.

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The purpose of this study was to evaluate the mastication disorders with motor dysfunction of dependent elderly people at nursing care facilities, through observation of the feeding movement and evaluation using a videoendoscopic evaluation (VE) system.
The subjects were 29 people residing in nursing care facilities (14 men and 15 women, mean age : 80.9 years old) . The evaluation period was one year from April 2007 to March 2008. We observed the feeding movement and performed VE for subjects while they were taking daily food at dysphagia rehabilitation. These evaluations were recorded on videotapes. The five evaluation items were : firstly and secondly, by the observation of feeding movement, the jaw rotary movement and the mouth corner pulling movement during mastication. Thirdly the lateral movement of the tongue base; fourthly the food residue in the pharynx and finally the penetration/aspiration after swallowing at VE. In addition, we analyzed the relationship between these items and the appropriate food texture by a retrospective study.
Ten of the 29 subjects (34.5%) had poor lateral movement of the tongue base. Food residue in the pharynx was observed in 18 of 29 (62.1%) , and penetration/aspiration was observed in 14 of 29 (48.3%) cases. There were significant correlations between the rotary movement of the jaw and the lateral movement of the tongue base (p<0.001) , and the pulling movement of the mouth corner and the lateral movement of the tongue base (p<0.001) . In the retrospective study, we confirmed that the food texture which we had recommended to the subjects at the past dysphagia rehabilitation time was appropriate for improvement of the subjects' feeding/swallowing functions.
The results of this study suggest that the combination of tongue base movement by VE and the observation of the feeding movement during meals is very useful for appropriate evaluation of the tongue function during mastication.

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The purpose of this study was to elucidate the relationship between vitality and the oral function of 140 dependent elderly individuals (28 men and 112 women ; mean age, 84.2±7.7 years old) residing at a care facility.
Vitality was determined using a vitality index evaluated by care givers. For the oral function, we evaluated the number of present teeth, the Eichner index, the simplified functional tooth units and a modified water swallow test. In addition, the parameters for physical and mental activities were age, sex, degree of long-term care needed, dietary form, diet related functional independence measure, body mass index, albumin level, comorbidity score and results of a mini-mental state examination.
The study showed that the factors related to vitality were in two groups as follows ; for the subjects rated from 1-3 in regard to their need for long term care-occlusal support in the molar region and diet-related independence ; for the subjects rated as 4 or 5- the swallowing and cognitive functions.
Our results suggest that vitality is correlated with the oral function in elderly individuals who require assistance with their long term care.

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The purpose of this study was to investigate the distribution of patients and to elucidate the effects of dysphagia rehabilitation in the University Hospital Dental Center. The clinical-statistical analysis was performed on 104 patients who visited an oral rehabilitation clinic for dysphagia rehabilitation from April 2007 to September 2008.
Dysphagia was mostly observed in the elderly, and was caused by head and neck cancer and cerebral vascular accident, and the oral and pharyngeal stage was often disordered. 70% of patients needed swallowing therapy and professional oral health care, while prosthodontic treatment was needed by 30% of patients. The level on the dysphagia severity scale (DSS) and the diet status were significantly improved by the intervention (p<0.001). Especially, level 2,3, and 5 on the DSS was improved prominently. DSS 1-4 (level with aspiration) accounted for 71%, and was decreased to 45% after the intervention. NPO (nothing per OS) accounted for 42%, and was decreased to 21% after the intervention. At the start of intervention, the coefficient of correlation between DSS and the diet status was 0.52 (p<0.001) . However, the coefficient of correlation was 0.76 at the end of the intervention, suggesting that the discrepancy between DSS and the diet status was reduced. The result of logistic regression analysis suggested that direct therapy had a positive impact on the improvement of the DSS and diet status (p<0.01) .
To start direct therapy, the oral health and function must be improved. Our results suggested that the most effect therapy was dysphagia rehabilitation in a dental clinic with oral health care, prosthodontic treatment and long-term follow up.

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Oral diadochokinesis is one of the oral functional indices. The following three methods are used to evaluate it : the IC method, in which the experimenter measures the recorded sound wave on a recorder ; the calculator method, in which the experimenter taps the memory function key of a calculator, synchronized with the syllables ; and the dot method, in which the experimenter dots with a pen, synchronized with the syllables. Recently, we developed a new measurement device, KENKOU-KUN, which automatically measures oral diadochokinesis. The purpose of this study was to compare the accuracy of oral diadochokinesis measurement by the IC-method, the calculator-method, and the KENKOU-KUN method.
Forty nine 79-year-old people (26 men, 23 women) participated in a cohort study conducted in 2007, and 355 elderly people (175 men, 180 women) participated in the 2008 study. They were instructed to repeat the syllables /pa/, /ta/, and /ka/ as well as possible for five seconds. The oral diadochokinesis was measured with the IC-method, the calculator-method, and the KENKOU-KUN method.
The average numbers of /pa/, /ta/, and /ka/ were 6.0±0.9, 6.0±0.9, and 5.7±0.8/sec, respectively. There was a strong positive correlation between the IC method and the KENKOU-KUN method (p<0.01) . On the other hand, the correlation between the IC method and the calculator method was weaker than that between the IC method and the KENKOU-KUN method. The number of miscounts with the calculator-method increased in cases over 7.0/s with the IC-method. This might relate the slower speed of finger tapping compared to oral diadochokinesis.
It was shown that the KENKOU-KUN method could precisely measure the oral diadochokinesis, while the calculator method was less accurate. Further studies are required to establish criteria by age and the degree of care needed.

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