This study examined the effect of continuous intervention upon denture use in the elderly requiring long-term care. The subjects were elderly residents in five facilities for the aged located in the same ward of Tokyo, all of whom lacked occlusal support. The subjects were monitored continuously from April 2006 until March 2009. The subjects in two of the facilities received regular oral-function management by dentists and dental hygienists that aimed to maintain and to improve the residents’ dental condition. Intervention to the subjects, at facilities previously providing no intervention by dentists, was started at the request of the subjects. Among the 43 subjects who were using dentures at the start of the survey receiving intervention, the number using upper and lower dentures decreased from 24 to 19 and from 19 to 12 respectively (21% down for upper and 37% down for lower). By contrast, among the 35 subjects not receiving oral-function management intervention, the number using upper and lower dentures decreasing from 24 to 9 and from 22 to 7 respectively (62% down for upper and 68% down for lower).
Thus, denture use was maintained to a significant degree at the facilities providing intervention compared with those that did not. Parameters exhibiting a relation to denture use status included change in the degree of independence in daily activities on the part of the elderly with disabilities (upper : p<0.01, lower : p<0.01) and presence/absence of intervention (upper : p<0.01, lower : p<0.05). Presence/absence of intervention was chosen as a parameter related to denture use on the basis of the results of logistic regression analysis (upper : odds ratio 1.846, p=0.03, lower : odds ratio 1.301, p<0.05).
This study suggested that this kind of intervention improves the eating and swallowing function of elderly residents requiring long-term care. The results of this study thus demonstrate the potential of oral-function management to contribute to the improvement of dietary QOL.

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With the emergence of an aging society in Japan, the number of elderly cancer patients has increased. Systemic inflammatory response syndrome (SIRS) symptoms immediately after surgery have lately been regarded as potential warnings of impending postoperative complications and multiple organ failure. This study involved one hundred oral cancer cases who underwent neck dissection in Tokyo Dental College Chiba Hospital from January 1998 to March 2008. Especially we compared the SIRS positive rate of over 65 year-olds and younger than 65 year-olds. We assigned 35 cases who met two of the several diagnostic criteria for SIRS to the SIRS group and continued to meet them for at least 24 hours after surgery. The statistical significant between SIRS positive rate in operation time and amount of bleeding was evaluated. There was no statistical significance in age and gender between the SIRS positive rate. Postoperative complications such as pneumonia, wound infection, necrosis, and herpes zoster infection occurred in 54.3% of the SIRS group and 9.2% of the non-SIRS group (p<0.05). In six cases, the postoperative fluctuation of IL-6 level was evaluated. These results suggest the importance of careful management of postoperative SIRS patients to prevent complications.

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The present study was conducted in order to identify the taste receptor function at different temperatures in both elderly and elderly edentulous subjects, for extended healthy life expectancy.
The taste stimuli used were sucrose for sweetness, sodium chloride for saltiness, L+ tartaric acid for sourness and hydrochloric quinine for bitterness. The concentration of tastant varied from C0 to C13 in multiple dilution ratios and the temperature settings were 5°C, 15°C, 30°C, 45°C and 55°C. A full mouth taste test was performed both elderly subjects with elderly edenturous subjects under conditions of presence and absence of palatal plate and upper complete denture.
The results were as follows. For sweet stimuli, the values of the recognition thresholds at 30 and 45°C were significantly greater for elderly subjects compared with edentulous subjects without palatal plates or denture. For sweet stimuli, the values of the recognition thresholds at all temperature were significantly greater for elderly subjects compared with edentulous subjects without palatal plates or with denture. For bitter stimuli, the values of the recognition thresholds at 5 and 55°C were significantly greater for elderly subjects compared with edentulous subjects without palatal plates or with of dentures. For sweet stimuli, the values of the recognition thresholds at 5, 30, 45 and 55°C were significantly greater for elderly subjects compared with edentulous subjects without palatal plates or with dentures. For bitter stimuli, the values of the recognition thresholds at 5 and 55°C were significantly greater for elderly subjects compared with edentulous subjects without palatal plates or with dentures.
The present findings revealed that sweet and bitter gustatory thresholds were significantly elevated in edentulous subjects who wore dentures over a long term, suggesting that depression of taste sensation was compensated by changing tastant temperature in elderly subjects.

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Oral cleaning plays an important role in the care for prevention of aspiration pneumonia in the frail elderly. But“oral health care” is frequently performed by non-dental professionals, who may have a different understanding of oral cleaning from dental professionals. We clarify non-dental professionals’ concept of oral cleaning in order to give technical guidance for more effective oral cleaning in hospitals and nursing health care facilities for the elderly.
A survey questionnaire was conducted of 264 people, 93 elderly nursing health care facilities and 171 rehabilitation hospital staff, from July 1 through 21, 2008. The differences between the actual time of the oral cleaning and the desired time of cleaning per person were analyzed with a t-test.
The effective number of respondents was 195 (73.9%). Among them, 90 % know the relationship between systemic disease like aspiration pneumonia and oral cleaning. 71% are interested in oral cleaning. Eighty-five percent of respondents performed oral cleaning, and 64% felt their oral cleaning was inadequate. Respondent who have received the training courses for oral cleaning are 36% and 97% wish to receive the oral cleaning instruction. Also, the average of the time gap between the desired oral cleaning and the actual oral cleaning time per person is 2.1±5.2 minutes, showing a significant difference.
From the results above, it is suggested that further guidance is needed both in terms of awareness and of oral cleaning skills for staffs. Reform of oral cleaning practices will take time. In addition to this result, we also show the limit of oral cleaning by staff and suggest that the continued leadership and intervention by dental professionals are essential.

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[in Japanese]

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[in Japanese]

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The purpose of the present study is to depict hemodynamic variability patterns by age on a display using a PC monitoring system by graphically plotting circulation changes during oral surgery under intravenous sedation.
The subjects were 52 healthy patients who underwent oral surgery such as tooth extraction or cystectomy. They were divided into 3 groups according to age (20’s : Group 1, 40’s : Group 2, 60’s : Group 3).
The patients’ Systolic Blood Pressure (SBP) and Pulse Rate (PR) were measured during surgery using an automatic blood pressure/pulse measuring device. Regulation of perioperative SBP and PR were plotted on the coordinate display of the personal computer, with the rate of PR as the parallel axis and the rate of SBP as the vertical axis, quadratically. In this study, the coefficient of variation of perioperative SBP (CV_SBP), PR (CV_PR), and the gradient of the regression line from obtained trace coordinate points were used as an index of hemodynamic variability during intravenous sedation.
Intravenous sedation was performed using propofol. BIS monitor was used as an index of sedative state and the BIS value kept to around 80. For local anesthesia of the oral cavity, 2% lidocaine with 1 : 80,000 adrenalin was also used.
In the comparison of the values during surgery between the 3 groups, the values in Group 1 for CV_PR were significantly higher than those of Group 3, and the values in Group 3 for CV_SBP were significantly higher than those of Group 1 and 2. The gradient of the regression line between the rate of change of PR and the SBP for Group 3 is greater than that of Group 1. This indicated that the regulation of PR is greater than that of SBP in Group 1, and the rate of SBP is greater than that of PR in Group 3. In other words, the trace on the graphic was pictured differently: in the bilateral direction in younger subjects, and in the vertical direction by in older subjects.

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[in Japanese]

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