The purpose of this prospective cohort study was to investigate the relationship between having a regular dentist and the incidence of long-term care in the elderly in the community. A community-based comprehensive geriatric assessment, including a dental examination and questionnaire about the utilization of dental services, was conducted with 834 elderly residents (52% women), aged≥70 years (mean, 75 years) in a suburban area of Sendai, Japan. The questionnaire recorded presence or absence of a regular dentist, the motive for using dental services, and the last time dental services were used. The association between having a regular dentist and the incidence of long-term care was examined using a Cox regression model adjusted for age, sex, current illness, smoking, alcohol consumption, duration of education, nutritional status, cognitive impairment, depressive symptoms, physical function, social support, and number of remaining teeth. In a baseline survey, 778 (86%) subjects had a regular dentist. The subjects with regular dentists had more positive behaviors associated with the utilization of dental services than those without a regular dentist. During a mean follow-up of 6.2 years, 304 (37%) incidences of long-term care were recorded. There was a significant difference in the incidence of long-term care between subjects with or without a regular dentist (Log-rank test, p＜0.01). Compared to the presence of a regular dentist, the adjusted hazard ratio was significantly higher for absence of a regular dentist (1.4, 95% confidence interval＝1.0〜1.9). On the other hand, the motive for using dental services and the last time of dental services were not associated with the incidence of long-term care. The absence of a regular dentist was independently associated with long-term care insurance certification. It was suggested that a regular dentist contributed to prevention of conditions requiring long-term care.

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[in Japanese]

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In dysphagia, it is presumed that there are about 260,000 patients with a gastrostomy in Japan and that the number has increased rapidly in the last decade. In gastrostomy, many reports have indicated the prevalence, trouble, prognosis and so on. In particular, the reports have focused on the care of patients with gastrostomy in healthcare centers and elderly facilities. However, there are few reports of findings from gastrostomy practitioners and from the patientsʼ side. The purpose of this study was to assess the current status of gastrostomy patients in two situations：those living with their families, and those in healthcare centers and elderly facilities. Furthermore, we discuss the contributing factors for effective gastrostomy care and the real problems of gastrostomy patients. We surveyed gastrostomy patients (including in hospital and in-home) in 833 clinics of the Japan National Health Insurance Clinics and Hospitals Association, in 138 long-term care insurance facilities (LTC) and in 485 intended facilities or clinics under direct management (IF). The results showed a decrease (53.1%) of patients with gastrostomy in the IF (on a declining trend in the past 3 years). However, there was a decrease (20.3%) in the LTCs, and there was a difference between the opinions of gastrostomy practitioners and of the patients. The patientsʼ degree of satisfaction was only-obtained with an explanation of the drawbacks and advantages of gastrostomy from related parties (not including medical doctor). The main causes of satisfaction were that patients could receive treatment in the home and they could live normally for three years from the initiation of gastrostomy.

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In previous study, we developed a jaw-opening sthenometer to assess the swallowing function and measured the jaw opening force of dysphagia patients. The aim of the present study is to validate the intra and inter reliabilities of a jaw-opening sthenometer for the jaw opening strength, using the interclass correlation coefficient (ICC). The raters were two dentists who made repeated measurements in 20 healthy volunteers as part of training prior to the present study. The eight healthy volunteers (mean age, 28.4±2.8 years; men, n＝5; women, n＝3) participated in the intra reliability study. Their jaw opening force was measured and then their ICC (1.1) was calculated. The ten healthy volunteers (mean age, 28.7±3.7 years; men, n＝6; women, n＝3) participated in the inter reliability study. Their jaw opening force was measured and then the ICC (2.1) was calculated. The ICC (1.1) was 0.96 and the ICC (2.1) was 0.94 in average data (measured twice). The jaw opening force is considered to reflect the strength of the suprahyoid muscles, and decreased jaw opening force can cause swallowing dysfunction resulting from decreased hyoid bone displacement. Therefore, measuring the jaw opening force is meaningful to assess the swallowing function. Since the jaw opening sthenometer showed high reliabilities, it could be useful muscle strength dyametar for assessing the swallowing function.

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[in Japanese]

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