Since 2007, the Ministry of Health, Labour and Welfare of Japan and the Tokyo Metropolitan Government have carried out measures to promote domiciliary dental care in cooperation with medical care. However, there have been no studies that assess the impact of these measures on domiciliary dental care or medical cooperation. In this study, survey results gathered by the Tokyo Metropolitan Government and the Tokyo Dental Association in 2006 and 2011 were comparatively analyzed. The results showed that fewer dentists practiced domiciliary dental care in 2011 than in 2006 and fewer dentists cooperated with chief physicians compared to 2006. It was revealed that the measures by the national government of Japan and/or the Tokyo Metropolitan Government have not been effective. The most common reason for not practicing domiciliary dental care, which increased in comparison to 2006, was the “lack of requests”. The results suggested that the problem is the lack of communication between patients who need domiciliary dental care and dentists. On the other hand, dentists who have achieved positive results in domiciliary dental care are older and tended to have higher motivation for gathering related information or for attending training sessions. In many cases, domiciliary dental care started when a patient who had previously visited a dental office switched to home-based medical care. The fact that the number of such cases has increased since 2006 and the number of patient home visits by dentists for domiciliary dental care has also increased might indicate the future direction of domiciliary dental care.

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The aim of this study was to investigate factors associated with the participation rate in an oral function improvement program. We conducted a preventive care program in 2008 that dispatched dental hygienists to 12 community general support centers, and collected data. In total, 312 people participated in our study. Logistic regression analysis was used to determine the factors associated with the participation rate in the program. Tabulation was used to research the reasons for refusal to participate in the program. Multiple logistic regression analysis showed that people using oral function check sheets were 5.2 times more likely to participate in the oral function improving program than those not using them. Similarly, people requiring support were 3 times more likely to participate in the oral function improving program than those requiring the second prevention project. Tabulation showed the most common reason for refusal to participate in the oral function improving program to be that people could not understand the purpose of the program (86.4%). The next most common reason was that the people or their family members did not feel the need for this program (66.0%). This study revealed the use of oral function check sheets to be effective for improving the participation rate of an oral function improvement program.

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The purpose of this study was to clarify the effect of regular professional supra-gingival plaque control over 2 years on the dental hygiene status and periodontal conditions of elderly in need of care. The subjects were 88 nursing home elderly (mean age:81.8±9.1 years) in Taito-ku, Tokyo. Thirty nine subjects were excluded because they either moved away or died. Fifteen residents received weekly supra-gingival plaque control performed by dental hygienists in addition to habitual tooth brushing methods by themselves and/or helpers (intervention group) for a baseline. In another 34 subjects, self-performed tooth brushing and/or brushing by helpers were continued (control group). Probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), plaque index (PlI) were recorded at baseline and 2 years. Reduction of mean PlI in the intervention group was 0.3±0.4 in 2 years, while in the control group, mean PlI increased by 0.1±0.8. The differences were statistically significant (p<0.05). There were no statistically significant differences with respect to mean PPD, mean CAL and mean BOP between the groups. In the intervention group, 17 out of 199 teeth were lost (8.5%), while 36 out of 311 teeth were lost (11.6%) in the control group. These results demonstrated that systemic professional oral care performed by dental hygienist improved the oral hygiene status in elderly residents in nursing homes. A further large-scale study on the introduction of a meticulous oral hygiene program is necessary.

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[in Japanese]

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Depression of the equilibrium function is one of the causes of falls of the elderly. In dentistry, there are some reports that the occlusal supporting depletion influences the depression of the equilibrium function. The purpose of this study was to investigate the influence of prosthetic treatment on the rehabilitation of patients admitted to a convalescent rehabilitation hospital after bone fractures caused by falls. Twenty eight non-dementia elderly patients (5 males, 23 females, mean age of 81.6±9.47 years old) who had bone fractures by falls and were in the convalescent rehabilitation hospital were selected as subjects. They were divided into two groups. One group consisted of 18 patients who received prosthodontic treatment after the intraoral examination on admission, due to loss of a tooth or poor prosthesis (intervention group), and the another group consisted of 10 patients (non-intervention group) who did not receive any prosthodontic treatment. BMI and sera albumin value were used to indicate the nutritional improvement. The motor subtotal score, cognitive subtotal score and “walk” score in the Functional Independence Measure (FIM) were used to indicate the efficacy of the rehabilitation. Both groups data on admission and at discharge were compared and examined. While nutritional improvement showed no significant difference in the intervention group, there was a significant difference in the total FIM score. The non-intervention group showed significant difference in sera albumin value, but not in cognitive subtotal score and “walk” score. It was suggested that the intervention of prosthodontic treatment in a convalescent rehabilitation hospital had an important rehabilitation effect after bone fracture by fall.

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This study, focusing on the relationship between the occlusal/biting force and exercise, aimed to examine the effects of the introduction of exercises to enhance the occlusal force as well as the quality of life (QOL). The subjects were elderly people aged 70 years or older living alone. There were ten elderly who performed exercises (intervention group), and, we randomly selected thirty-one who did not (non-intervention group). The intervention period was from September 2009 to March 2012. A 30- to 40-minute session of full-body and other exercises to enhance the occlusal force was held twice a month. Body measurement and assessment of the oral function were performed in both groups to obtain objective data. Interviews were conducted to find the intervention groupʼs MNA® (mini nutritional assessment) scores, dietary life, ADL, and SF-8™ and also to gather data on the non-intervention groupʼs MNA® and dietary life. The data showed that two years after the start of the program the grip strength(p<0.01)and the occlusal force (p<0.05) of the intervention group was significantly higher than that of the non-intervention group. On the other hand, there was a decrease in the rate of change of the occlusal force between the beginning and one year and between the beginning and two years in the non-intervention group, whereas the rate in the intervention group significantly increased (p<0.05). It was seen from the imcrease in grip strength and occlusal force of the intervention group at two years compared with the non-intervention group that comprehensive support, incorporating measures to maintain and enhance the occlusal/biting force, not only promotes the health of the elderly, but also improves their QOL.

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