Since its reform in 2006, the care insurance system has been able to provide preventive oral function care to patients. However, the number of actual recipients of this service is lower than that of preventive motor function service care recipients. The aim of this study is to clarify the awareness of the oral function service and the actual status of oral cavity assessment. Data is taken from a survey of staff members (planners) of community-inclusive medical centers. Furthermore, we determine the influential factors in planning oral function preventive care.
The study utilized mail-in anonymous survey results. The analysis was done based on returned questionnaires from 467 out of 707 planners.
47% of staff recognized service effectiveness, few practiced oral cavity evaluation (17-25%), and few had awareness as oral cavity raters (14%). Some positive factors affecting the number of oral service planning were the following; “evaluation results of teeth and gingiva”(p<0.001) and“evaluation of presence of food debris and plaque”(p<0.01). On the other hand, the negative factor, “detailed checks concerning cleaning methods of dentures or teeth” (p<0.001), showed a reduction in the number of applications for the preventive care program.
We assume that the planners, who were responsible for the initial screening, significantly influenced the decision-making process related to the application for preventive oral function care. The planners should not only be aware of their roles, and but also improve their assessment capability.

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The purpose of this study was to elucidate the one year-change of vitality index and factors related to the change of 118 dependent elderly individuals (men 25 and 93 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, simplified functional tooth units and conducted a modified water swallow test. 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 a mini-mental state examination.
The study showed that the vitality index for about 60% of the subjects declined after one year. The factor related to the decline of vitality index was the diet-related functional independence measure.
Our results suggest that the maintenance of functional independence for the diet is essential to prevent the decline of vitality for elderly individuals who require assistance with their long term care.

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Intraoral prosthetic devices have been used for patients with dysphagia for the assistance of motor or sensory function of the tongue, cheek, lips and soft palate, the stabilization of occlusion, and the maintenance or the improvement of mastication and swallowing. However, there has been no report about the application status or the number of the patients who needs these prosthetic devices. Accordingly, we investigated the current situation. A questionnaire was sent to 3,000 dental clinics, 29 university dental hospital, and 500 dental clinics by regular mail.
34.3% of both university hospital of dentistry and dental clinics had some experience of these prosthetic devices, but, 96.9% of dental clinic had no experience of these devices. There were several reasons for delaying application, including lack of funding from public health insurance, no interest in these devices, or lack of knowledge about these devices.
From our estimation, the number of patients who need these devices was 16,368 a year, but 11,922 were never applied. Roughly, these devices were never applied for 4.5% of the patients who need then in university hospitals, 53.8% in hospital dental clinics, and 82.1% in dental clinics. Furthermore, we investigated the eating function in 214 elderly dependent patients. This showed that 20% of them needed these devices. From these point of view, these devices should be applied for dysphagia not only for structural problems, but also for functional problem caused by stroke or dementia.

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We report a case of a severe dysphagia patient who, after an operation for the removal of a malignant tumor of the floor of the mouth, received balloon dilatation.
The tumor removal operation was performed by an oral surgeon in our hospital. The patient was referred to our department for detailed examination and treatment for severe dysphagia after the operation. At the first examination, dysfunction of mastication, food propulsion, laryngeal elevation and cricopharyngeal opening were observed. Therefore, his nutrition was changed from N-G tube to intermittent oral catheterization, and balloon dilatation was started. After 3 weeks of training, the pharyngeal residue after swallowing decreased, and the laryngeal elevation and cricopharyngeal opening improved. Then, he could start to take rice gruel and paste food and balloon dilatation was terminated. One year and three months later, the cricopharyngeal opening and swallowing pressure were decreased, but there was no pharyngeal residue after swallowing. We suggest that balloon dilatation is effective to improve the cricopharyngeal opening for the patients after the operation for the removal of the malignant tumor of the floor of the mouth. We noted that cricopharyngeal opening dysfunction did not recur in this case.

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[in Japanese]

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[in Japanese]

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