The aim of this study is to survey the detection regarding microorganisms opportunistically infecting in the oral cavity among the disabled elderly individuals in geriatric health service facilities.
The subjects were 150 disabled elderly aged 65 and over residing in six geriatric health service facilities in one prefecture. We conducted a structured interview survey on basic attributes, methods and frequencies of daily oral hygiene, and subjective symptoms regarding dysphagia. We also examined representative microorganisms opportunistically infecting in the oral cavity. As a result, we detected some microorganisms such as Candida (30.0%), Pseudomonas aeruginosa (8.4%), and Klebsiella pneumoniae (4.7%). Furthermore, the detection rate of the microorganisms was significantly related to the existence of remaining teeth and the prosthetic situation. On the other hand, there were no significant relationships among microorganisms opportunistically infecting, the risk of dysphagia, and the performance of oral hygiene in the facilities. These findings suggest that oral hygiene, which is conducted by caregivers in geriatric health service facilities, does not, alone, reduce the risks of opportunistic infection.

View full abstract

Elderly individuals undergoing intravenous sedation must be carefully monitored for changes in hemodynamics and respiratory depression. We divided a total of 2,020 patients who received intravenous sedation at our department into four groups by age, and compared their changes in blood pressure, heart rate, and SpO₂. Based on the results, we discussed precautions for intravenous sedation performed for elderly individuals.
The results were as follows :
1. The drug dose required to achieve optimal sedation was low in elderly individuals.
2. Blood pressure of elderly individuals was kept at a higher level through anesthetic management. In addition, elderly individuals had a high ratio of intraoperative reduction in blood pressure.
3. No marked age-related differences were observed for heart rate.
4. SpO₂ decreased with age. In addition, the ratio of patients in whom SpO₂ reached \_mls2264\/93% was high among elderly individuals, and the minimum SpO₂ was most commonly observed after discontinuation of postoperative oxygen administration.
Therefore, as optimal sedation can be achieved with a low dose of sedatives in elderly individuals, it is necessary to carefully select the administration method and dose in order to avoid oversedation. In addition, because elderly individuals are more susceptible to intraoperative reduction in blood pressure compared to other age groups, continuous monitoring of the sedation level and hemodynamics is necessary. Moreover, as these individuals have an elevated risk of postoperative hypoxemia, prolonged postoperative oxygen administration may be beneficial.

View full abstract

Sjögren’s syndrome (SS) is a systemic autoimmune disorder characterized by serious lymphocytic infiltration into the lacrimal and salivary glands. This chronic inflammatory process leads to diminished function of the glands, resulting in the symptoms of dry eyes or dry mouth. In this study, we examined the relationships between salivary gland destruction and aging in patients with SS.
The subjects were 27 patients referred to the Department of Medicine II in Hokkaido University Hospital for evaluation of xerostomia from 2005 to 2009 (24 females and 3 males, mean age 50.1 years, age range 17~75). All patients satisfied at least two of the four items in the 1999 revised Japanese criteria for Sjögren’s syndrome. The diagnostic methods were Saxon test, magnetic resonance sialography (MRS) of parotid glands and a labial salivary gland biopsy.
There was a significant negative correlation between aging and the severity of the histopathological findings of the labial salivary glands (p=0.017). The histopathological grading of the labial salivary glands was lower with aging. However, aging did not correlate with the salivary volume assessed by the Saxon test or the stage of MRS score.
These results suggest that the progression of salivary gland destruction in SS is not necessarily associated with aging but also with other factors, such as immunological changes or environmental factors.

View full abstract

We present an autopsy case of bisphosphonate-related osteonecrosis of the jaw (BRONJ) occurring in a 77-years-old man with a medical history of multiple myeloma (smoldering type), diabetes mellitus and interstitial pneumonia. He had been receiving bisphosphonate therapy (pamidronate, incadronate, and zoledronate by injection) for 4 years and 4 months to prevent bone lesion from occurring due to multiple myeloma. However, treatment with bisphosphonates was discontinued because a maxillary right second premolar came out spontaneously and osteonecrosis occurred. Osteonecrosis additionally appeared at his mandible from right canine to second premolar, and a right maxillary first premolar. After 8 months, he died of interstitial pneumonia and an autopsy was performed. Histopathologically, the exposed maxilla and mandible exhibited osteonecrosis with bacterial infection and a part of the unexposed mandible showed chronic osteomyelitis without necrosis. These findings suggested that osteonecrosis may extend to an unexposed area of the maxilla or mandible beyond the exposed area in BRONJ\_p.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

As the population rapidly ages, there has been an increasing demand for home-visit dental services. We conducted a questionnaire to examine how home-visit dental services help patients achieve self-reliance and reduce the burden on family caregivers.
The subjects were 181 patients who received home-visit dental services between April 1999 and March 2005 and their family members. The question items included : 1) changes in the burden of nursing care in daily life (five items) ; 2) changes in oral function (three items) ; 3) evaluation of the services (three items).
The majority of the subjects were patients with cerebrovascular diseases, bone fracture, rheumatism, neurological diseases, or muscular disorders, and their chief complaints included: denture problems, eating disorders and dysphagia, decay, and periodontal problems.
We collected 66 responses (36.5%). The results of the questionnaire were as follows : 1) approximately 40% felt that the service helped reduce the burden of nursing care ; 2) about 40% recognized an improvement in their oral function ; 3) about 80% hoped that the services would be available on a regular basis. Most of the patients and their families were satisfied with home-visit dental services. Further research should be conducted to examine changes in their awareness of dental health after receiving home-visit dental services.

View full abstract

[in Japanese]

View full abstract