As Japanese aged society progresses, oral health condition in geriatric population deviated in a wide range from normal to malfunction including oral frailty and“deterioration of oral function”. As the official representatives of geriatric dentistry, we proposed the definition of“deterioration of oral function”in this position paper. This position paper aimed to gather evidence up to this time and to propose tentative diagnostic criteria in order to develop appropriate arguments about this issue efficiently.

　“Deterioration of oral function”was expressed from seven oral symptoms：oral uncleanness, oral dryness, decline in occlusal force, decline in motor function of tongue and lips, decline in tongue pressure, decline in chewing function and decline in swallowing function. The criteria of each symptom were determined by the data of previous studies, and“deterioration of oral function”was defined if these criteria were matched in more than three symptoms. This position paper proposed the initial definition of“deterioration of oral function”, but would lead to further studies about this issue from various perspectives. More evidence should be accumulated with further clinical studies to clarify its definition, but we hope this paper presents the first step in the right direction.

　Purpose：This study investigated the effect of the“thyroid cartilage part skin traction”maneuver on a sequence of swallowing events in elderly dysphagic patients.

　Method：Eighteen elderly dysphagic patients were asked to swallow 5 ml of moderately thick barium during videofluorography（VF）with and without the thyroid cartilage part skin traction. We analyzed the hyoid bone position（resting position, starting swallowing reflex position, highest position, and finishing swallowing reflex position）, we also measured the time of hyoid movement（first elevation phase, second elevation phase, standing phase, and descending phase）, opening width of the upper esophageal sphincter（UES）, and the UES opening duration. The data for these parameters were compared between traction swallowing and normal swallowing.

　Results：The thyroid cartilage part skin traction maneuver significantly changed in the hyoid position, decreased the total hyoid movement distance, increased the duration of the standing phase during hyoid movement, and increased the UES opening width and time.

　Conclusion：These results show that the maneuver may support hyoid movement and may aid swallowing in elderly dysphagic patients.

　The purpose of this study was to compare the characteristics of four types of healthcare professionals（HPs：registered nurses, assistant nurses, certified care workers, and care workers）who provide oral care services（OCS）which have a strong relationship to the prevention of illnesses such as pneumonia at welfare facilities for the elderly. In 2014, a questionnaire survey was conducted with 3,001 HPs in Niigata Prefectures；the collection rate was 51.6％.

　The four types of HPs were assumed to be responsible for OCS. The HPsʼ concern for and daily practice of their own oral care（HPOOC）, as well as their perception and level of execution of OCS for elderly residents, were analyzed by binary logistic regression analysis （b-LRA）. The scores of the eight items used to measure the perception and the level of execution of OCS for elderly residents were standardized and combined into a composite score, which was then was dichotomized at the mean and used as the dependent variable in the b-LRA. A total of 16 items were used as explanatory variables, including 11 items related to HPOOC and five items related to basic characteristics such as profession, gender, and age group. The results after adjusting for potential cofounding factors showed that registered nurses had a significantly lower level of execution of OCS compared with the other three types of HPs. The daily tooth brushing habits of the HPs themselves were very significantly related to their perception and level of execution of OCS for elderly residents. Also, HPs who had previously noticed improvement in the general condition of elderly residents demonstrated a statistically higher（p＝0.0258）level of execution of OCS.

　Based on these results, increasing registered nursesʼ perception of OCS should be considered a crucial step in improving the quality of OCS provided to elderly residents.

　Purpose：The effects of various oral functions on nutritional status and general conditions are not well elucidated, especially in frail or dependent elderly individuals. Thus, in the present study, we investigated the associations and relationships between deterioration of oral functions and malnutrition in hospitalized frail elderly patients.

　Methods：Patients who were admitted to an acute hospital and visited its dental clinic were prospectively recruited from October, 2015 to February, 2016. The variables related to oral functions and oral hygiene were collected. Nutritional status was measured using Mini Nutritional Assessment-Short Form（MNA-SF）. The nutritional level was divided into malnutrition and normal status based on the MNA-SF scores. The differences in the measures for oral and general conditions by nutritional level and aging were statistically tested.

　Results：Most of the measures related to oral functions were lower in the malnutrition group than in the normal group, which were affected by aging as well. The measures for QOL and ADL were also significantly lower in the malnutrition group than the normal group and the old-old group than the other groups.

　Conclusion：The findings in this study suggest that the assessment and treatment of deterioration of oral functions were useful to consider the nutritional status of frail hospitalized elderly patients. Moreover, adequate oral management before admission to a hospital can contribute to maintaining proper nutritional status during illness.

　There are many methods to treat recurrent temporomandibular joint dislocation which are invasive or noninvasive. But when we consider the risk of recurrence and invasion, our choice is limited to several methods. Especially, there are some possibilities of recurrence when we choose a noninvasive method. The method of Autologous Blood Injection according to Hasson & Nahlieli can be treated with minimum invasion. Several cases treated with this method were reported. In this paper, we report 3 cases of aged persons who were treated with Autologous Blood Injection . We followed them up for 3 to 4 months after operation and that there were favorable results. This method is considered effective for treatment of recurrent temporomandibular joint dislocation because it can be done simply with minimum invasion.

　The number of geriatric health service facilities has been increasing in recent years. Their managers need to know how dental care can contribute to their clientsʼ health. In this study, a survey of clients of a geriatric health service facility that has continuously provided oral health care for 10 years was conducted. The following results were obtained. First, there was no significant difference in history of aspiration pneumonia in relation to occlusal status or the presence of remaining teeth. Then, there were statistically significant relationships between history of aspiration pneumonia and care level, cognitive function, and food texture. Finally, use of a gastrostomy tube and use of a nasotracheal tube were related to care level and food texture. These results confirmed that there was no significant difference in history of aspiration pneumonia between clients with and without teeth related to adequate provision of oral health care at the facility. The results also suggest that a broad approach to oral health care（i.e., one that includes dental care and swallowing rehabilitation）prevents progression of dementia and escalation to a higher care level while improving activities of daily living by indirectly preventing aspiration pneumonia and the need for feeding measures such as a gastrostomy tube. It also appears that dental treatment and particularly wearing dentures to maintain occlusal function and enable continuation of a normal diet is another way to help prevent escalation to a higher care level.