Sarcopenia, which is observed in about half of elderly people aged over 80 years, is an age-related change and expected to appear in the oral and maxillofacial area. As a preliminary study, we investigated the relationships between nutritional condition and intraoral condition/oral function in independent elderly people who were participating in our program for the prevention of sarcopenia. Sixty-two independent elderly people were the subjects of this study (27 men and 35 women, aged 69〜92).We conducted a structured interview survey on intraoral condition and oral function by distributing a questionnaire. The oral examination and assessment of oral function were performed by one dentist. Furthermore, we investigated the relationships of serum albumin concentration (Alb) to the answers concerning oral condition, the outcomes of oral examination, and the findings of the oral function. The result of the average of Alb, 4.3±0.3 g/dl, was satisfactory. Oral conditions and functions of these subjects were favorable in general. Two of the questions on the oral function, self-rated oral health, and wearing lower denture or not, were related to Alb. The number of present teeth except for remaining roots, occlusal contacts of teeth and oral diadochokinesis (ODK) of the syllable /ka/ were weakly related to Alb, but denture-satisfaction ratings, oral hygiene, wearing upper denture or not, labial closure strength, repetitive saliva swallowing test (RSST), oral diadochokinesis (ODK) of the syllables /pa/ and /ta/, mucosal moisture measurement and saliva wet test were not related. This study suggests that the number of present teeth, occlusal contacts, wearing denture or not, and self-assessment of oral health and function were related to the satisfactory nutritional condition of independent elderly people.

View full abstract

The purpose of this study was to evaluate the optimal dental treatment time from a questionnaire for the elderly. The subjects were 100 outpatients aged≧65 years(elderly group)in the Tohoku University Dental Hospital and 100 in their 20 s(control group)after obtaining their informed consent. A questionnaire survey was performed about the desired dental treatment time and good/poor physical condition, their habit of napping, time going to hospital, systemic disease, and medicines. Finally, the optimal dental treatment time was evaluated. In the elderly group, the desired time for dental treatment was most frequently 10:00〜11:00 a. m. (42%), with 73% preferring treatment in the morning (9:00〜12:00). In the control group, the desired time varied widely, from 9:00 to 21:00. The distribution of the desired treatment time was significantly different between the two groups (Mann-Whitney U-test, p<0.01). In the elderly group, 56% complained of a poor physical condition immediately after waking up in the morning and from after lunch to the evening, however very few complained in the morning (9:00〜12:00), and 23% hadahabit of napping within a wide time zone between 11:00 and 17:00 with a peak at 14:00. In the control group, 21% complained of a poor physical condition, mostly immediately after waking up in the morning (14%). However, few controls had a habit of napping. Consequently, complaints of a poor physical condition showed significant differences in the number of subjects and the time distribution between the two groups(Mann-Whitney U-test, p<0.01). In the elderly group, 89% had medical treatment, however neither systemic disease, nor medicines affected the dental treatment time. The tendency to want dental treatment from 9:00 at 12:00 when their physical condition is stable was seen in elderly patients. A possibility that the optimal time zone reflects biorhythms was suggested.

View full abstract

Mechanical loading conditions result in alveolar bone resorption, which may be partly attributed to an imbalance in bone formation and resorption. To investigate the effects of mechanical loading on osteoblast and osteoclast differentiation, we used a stretch system for the cultured cells, simulating mechanical stress to culture MC3T3-E1 and RAW264.7 cells. Soluble RANKL (sRANKL) significantly enhanced the gene expressions of TRAP and cathepsin K mRNA, compared to that of controls (ANOVA,p<0.01). On the other hand, stretch system (5%) inhibited the enhanced expressions of TRAP and cathepsin K mRNA in RAW264.7 cells exposed to sRANKL (p < 0.05). The same phenomena were not observed in the presence of ionomycin, which is a calcium ionophore. Exposure of MC3T3-E1 cells to stretch in stretch system inhibited the expression of Osterix and ALPase, but enhanced that of RANKL and OPG genes. These results, taken together, demonstrate that 5% stretch loading inhibits the differentiation of MC3T3-E1 cells together with enhancement of RANKL and OPG gene expression, as well as the RANKL-dependent cellular fusion of RAW264.7 cells. Therefore, it is suggested that 5% stretch loading inhibits the differentiation of osteoclast and osteoblast cells.

View full abstract

Since it was verified that oral health care was effective for the prevention of aspiration pneumonia of the elderly needing care in nursing homes, the importance of oral health care has been recognized by nurses in hospitals. However, it is said that there are several limitations such as the number of times and methods of carrying out oral health care daily as a part of nursing care. The purpose of this study was to make clear the problems with oral health care by nurses themselves in hospitals and cooperation with dental professionals. The subjects were 644 nurses working in the wards in four hospitals with oral surgery departments in Niigata Prefecture. The answers to a questionnaire on the consciousness of, the implementation and the problems of oral health care in nursing care were analyzed an correlated with the wards and the years of clinical experience. Most nurses recognized the importance of oral health care. Many nurses thought that it was necessary to do oral health care now. The ideal number of times of daily oral health care was the same as the actual one in acute-care wards, but not in chronic-care wards. The sponge brush was commonly used in both acute- and chronic-care wards, but interproximal cleaning tools were used very little. The nurses with longer clinical experience tended to haveahigher awareness of the importance of oral health care. There was a difference in educational background of learning oral health care according to the years of clinical experience after graduation from nurseing school. Many nurses wanted to know how to provide oral health care for patients with severe intraoral or general conditions. However, it is actually difficult for them to acquire oral health care skill for such cases from only continuing education and/or school education. From these results, it was concluded that further study was necessary to find the effective means to cooperate closely with nurses and dental professionals while respecting each specialty.

View full abstract

Echocardiography is a non-invasive test that enables morphological and functional diagnoses of the heart. Our department performs echocardiography as a preoperative test for elderly individuals aged ≥65 years receiving general anesthesia and offers examinations by cardiologists. The results and effectiveness of echocardiography for elderly patients are reported. The subjects were a total of 115 cases of elderly individuals aged ≥ 65 years who underwent preoperative echocardiography followed by oral surgery under general anesthesia at our department during the past three years (2009〜2011). In 31 cases (27%), no abnormalities were found. In 44 cases (38%), abnormalities such as valvular sclerosis and mild regurgitation were observed, but these findings were not significant. In 40 cases (35%), significant abnormalities, such as valve stenosis, valvular regurgitation, and wall motion abnormalities, were found. Among the 40 cases of significant abnormalities, the presence of abnormalities on echocardiography could be predicted based on history taking prior to the test and other methods in only 10 cases. Significant abnormalities were observed in 10 of the 40 cases with no history of cardiovascular disease. In addition, significant abnormalities were observed in 10 of the 40 cases with no abnormalities on electrocardiography. Vegetation was suspected in one case. For this patient, elective surgery was postponed, and detailed examination was performed. Echocardiography may be a useful, and even essential, preoperative test for elderly patients because it enables screening of heart diseases that cannot be detected based on history taking or electrocardiography alone.

View full abstract

[in Japanese]

View full abstract

The aim of this study was to investigate factors associated with the presence or absence of cooperation between home care support offices and dental clinics. In 2010, we randomly selected 2,820 home care support offices and mailed questionnaires to them. The contents of the questionnaire were:presence or absence of cooperation with dentists, physical condition of users of home care support services (HCSS), number of employees at home care support offices, number of HCSS users with oral health problems, and others. Using prefecture-level data (as of 2006) for the population, the elderly population, and the number of dentists, we conducted a logistic regression analysis to assess factors associated with the presence or absence of cooperation between home care support offices and dentists. The analysis showed that home care support offices in prefectures with larger elderly populations were less cooperative with dentists but home care support offices with larger numbers of employees were more cooperative.

View full abstract