Amyotrophic lateral sclerosis（ALS）is an incurable disease that leads to the loss of muscle movement, resulting in symptoms such as difficulty swallowing, communication disorders, and respiratory failure. Palliative care from the early stage of involvement is crucial for these patients, as it is necessary to alleviate the pain and suffering associated with treatment. 　The current ALS treatments aim to slow the progression of the disease, but are not curative. The average life expectancy of patients post-diagnosis is considered to be 3 to 5 years, and in Japan, many patients choose to pass away without opting for the use of ventilators. 　Due to the individual variability in the progression of ALS, particularly in dental care, customized care for each patient is necessary. From our experience, dental symptoms can appear as early signs of ALS, and failure to appropriately assess them can lead to delayed diagnosis. 　We believe that dental care for ALS patients must address various challenges such as difficulties in eating and swallowing, choking risks, communication barriers, and particularly respiratory issues in patients using ventilators. It is essential for dental professionals to function as part of a multidisciplinary home healthcare team, ensuring consistency in patient care. 　Ultimately, our research advocates for a comprehensive team-based approach in treating ALS patients, integrating dental care into a broader medical plan. This approach is vital in maintaining the quality of life and dignity of patients, and is aligned with the principles of narrative-based medicine.

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　We experienced a case of habitual temporomandibular joint dislocation in an older patient with dementia in whom open treatment was effective. The patient was an 84-year-old woman. Her medical history included right thalamic hemorrhagic dementia and hypertension. In late August 2022, she was diagnosed with a dislocated temporomandibular joint and was admitted to our department for a thorough examination and treatment. Imaging examination showed that both mandibular condyles were located anterosuperior to the articular tuberosity, indicating anterior temporomandibular joint dislocation. No obvious abnormal findings in bone morphology were observed.

　Manual reduction was performed. The reduction was easy, and the hospital staff and family were instructed to restrict her mouth with an elastic bandage for 2 weeks. The day after the reduction, the patient removed the bandage and re-dislocated the joint. She visited our department again and underwent manual reduction. She returned to the facility, and on the same day, she removed the bandage by herself in the evening. As she repeatedly dislocated the joint, she was rushed to our hospital and was hospitalized for nutritional management as oral intake was difficult for her. In consultation with facility staff and her family, an eminectomy under general anesthesia was scheduled.

　Postoperatively, she had no temporomandibular joint dislocation and was able to achieve sufficient oral intake. In the future, as the number of older patients with dementia increases, it is predicted that the number of patients with temporomandibular joint dislocation will also increase, but when choosing a treatment method, it is necessary to take into account the patientʼs general condition, a thorough examination of the clinical condition, and social background.

　Dentists play a central role and through interprofessional work, we are able to provide an environment where patients can return to their facilities or homes as soon as possible.

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　Purpose：Masticatory function is highly dependent on the number of remaining teeth and previous studies support the relationship between the number of remaining teeth and dietary intake status. However, in these studies, data on foods consumed are collected based on the memories of survey respondents and are not objective. Therefore, in addition to self-reported dietary intake surveys, recording and analyzing images of meals would enable more accurate measurement of dietary intake. The purpose of this study was to investigate the association between the number of remaining teeth and dietary intake among older adults using self-reporting records and images of meals.

　Methods：The number of remaining teeth and dietary intake of 31 participants were investigated. An analysis of covariance（ANCOVA）was performed on the two groups, and dietary and nutrient intakes were compared.

　Results：Intake of retinol and vitamin B12 was significantly higher in the group with ≥20 teeth than in the one with ＜20 teeth（Retinol：0-19；216.24（301.48）, 20≤；627.82（716.26）, p＝0.01）（Vitamin B12：0-19；3.13（1.63）, 20≤；5.87（1.63）, p＜0.01）. Regarding the average food intake, no significant differences were observed between the two groups.

　Discussion：The number of remaining teeth affects the ability of a person to chew and can prevent malnutrition. Within the same food group, the degree of difficulty of chewing varies greatly depending on the individual food. If food groups are classified in detail based on their hardness and properties, there is a possibility that differences in food intake may occur.

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