Patients with mental disorders are reported to be at a high risk of choking. The provision of health education by a medical team to patients, including management of the oral cavity and nutrition, facilitates self-management of the oral cavity and helps prevent the recurrence of choking and aspiration pneumonia.

　The patient was a 65-year-old man admitted to the acute stage ward for treatment of bipolar disorder and alcohol dependence. The patient underwent a dental checkup to be assessed for the risk of food-related aspiration and choking. We diagnosed dysphagia owing to masticatory disturbance caused by his lowered consciousness level and mental state. Symptoms of extrapyramidal tract disorder were noted, and attention was then focused on management of the patientʼs dental hygiene and oral function.

　The consumption of bread was prohibited, owing to the associated high risk of aspiration and choking. The patient was advised not to put too much food in his mouth when eating.

　However, one month later the patient was readmitted to hospital having choked on his food；2 days later he was diagnosed with aspiration pneumonia.

　After improvement in the patientʼs mental state, he became receptive to following medical advice concerning his problem, and a partial set of dentures was made for him.

　Twenty-four months from this last choking episode, the patient has had no recurrence of choking or aspiration pneumonia. He is receiving medical treatment at the outpatient clinic. The continuous support of team medical care for neuropsychiatry hospital inpatients is important for preventing the recurrence of choking and aspiration pneumonia.

　Oral dyskinesia（OD）manifests as repetitive, rapid, short, stereotypical involuntary movements that appear in the oral cavity and jaw area. OD is generally categorized as idiopathic, drug-induced or extrapyramidal, based on localized symptoms. We encountered an 82-year-old woman with a history of cerebral infarction, hypertension, chronic gastritis, osteoporosis and insomnia. In May 2014 she noticed a canker sore at the right border of the tongue, and was prescribed a steroid ointment by the referring physician. In November 2014 she was referred to our department. A well-defined, nearly round ulcer 15 mm in maximum diameter was observed on the right border of the tongue, with mild protuberance in the surrounding area, but no induration or bleeding tendency. The patient was asked to keep her tongue immobile, but was unable to do so and the tongue constantly moved in a twisting motion. The right mandibular first molar was in alignment with the position of the tongue ulcer surface. The ulcer was diagnosed as decubital ulcer accompanied by idiopathic oral dyskinesia on the right border of the tongue. An oral appliance（OA）was manufactured with the aim of protecting the tongue and for deprogramming of the oral environment, and the patient was instructed to wear it only during the daytime, and to take it out at night when she went to bed. After using the OA for 2 months, the ulcer on the tongue border had completely healed, and the OD was alleviated after 3 months. After 4 months, use of the OA was discontinued. As of 1 year after discontinuing use of the OA, the patient has had no recurrences of decubital ulcer. She continues to come for monthly examinations, and although OD has persisted, it is in a much milder form.

　Elderly simulations have been reported to promote empathy for the elderly by developing an understanding of their physical changes, and to be useful for experience-based learning of support for the elderly. In the Department of Geriatric Dentistry, Osaka Dental University, an elderly simulation program has been provided since FY 2001 for students who have completed basic dental education programs to acquire preclinical experience prior to training in hospitals. This study analyzed their reports involving free descriptions that were submitted after the program to clarify its effects.

　A total of 253 reports, involving free descriptions and submitted by fourth-year students of the Department of Dentistry, Osaka Dental University（FY2013：63 males and 56 females, total 119；and FY2014：74 males and 60 females, total 134）after completing the elderly simulation program, were analyzed. Quantitative text analysis was performed using a combined approach and the text mining software KH Coder 2.00e.

　On morphological analysis, the total number of words was 37,522, with 1,947 of them being different. Through cluster and correspondence analyses, three coding rules were created. When aggregating the reports using these rules, codes related to“understanding of physical and psychological aspects”accounted for 71.15％, followed by“empathic understanding”（44.66％）and“changes in self-awareness”（34.78％）, supporting the usefulness of the elderly simulation program to enhance studentsʼ understanding of the elderly.

　In this study, a questionnaire survey was performed to investigate subjective symptoms focusing on physical frailty and oral frailty. A total of 1,214 subjects were enrolled with prior consent. The study was conducted with the approval of the Ethics Committee of Tokushima University Hospital（No. 2404）. Five questions, comprising weight loss, exhaustion, physical activity, walking speed and grip strength, for physical frailty were asked to assess physical frailty；seven questions, comprising symptoms on mastication, swallowing, remaining teeth, saliva and tongue, were asked to assess oral frailty. All questions were evaluated on a scale of 1 to 4, with a higher score representing greater functional decline. The total score for physical frailty was lowest in the 60s and highest in the 90s for both males and females, and the score for females in their 60s was significantly lower than that for females in their 70s. On the other hand, the total score for oral frailty gradually increased with age. Scores for most questions regarding oral frailty increased with age. Especially, scores of 3 or 4 for symptoms indicating a frail condition, such as spilled food and chewing difficulty, uniformly increased until the 90s, and significant differences were found between the 50s and 60s.

　The results suggest that the important age for oral frailty might be the 50s to 60s and that an assessment of spilled food and chewing difficulty might be significant.