Toothache and inadaptation of dentures which results in soreness and looseness are frequently the chief complaints among patients who visit the Gerodontic Clinic of Tokyo Medical and Dental University. But on enquiry elderly patients have usually experienced dryness of the mouth as a regular symptom. The purpose of this study was to investigate the status of oral discomfort among dental patients.
The subjects were 389 patients, divided into four age groups: an aged group (seventy or over), and three young groups: one aged 30 to 39, one aged 40 to 49, and one aged 50 to 59. The aged group consisted of 260 patients (110 men and 150 women, average age 74.5yrs) who visited the Gerodontic Clinic of Tokyo Medical and Dental University. The young groups consisted of 129 patients (84 men and 45 women) who visited the Dental Office of the National Personnel Authority and Tokai-Sawa Clinic, Hitachi, Ltd.
At the first examination subjects were asked about their chief complaint and were given a questionnaire. The questionnaire included 12 items about subjective sensations of dry mouth, sticky mouth and taste impairment. Subjects were asked to rate each of the 10 items as to how it applied to them in following four quantitative terms: either “no, sometimes, often, always” or “no, slight, moderate, severe.” Two of the items related to the qualities of taste impairment.
The results were as follows:
1. The prevalence of the chief complaint of dry mouth was 4.0% in women of the aged group.The prevalence of the chief complaint of taste impairment was 0.9% in men of the aged group and 4.7% in women of the aged group.None of the young groups had the chief complaints of dry mouth and taste impairment.
2. There were no significant differences in the prevalence of subjective feelings of dry mouth, saliva diminution, sticky mouth, sticky saliva, impairment in taste and abnormal taste between men of the aged group and men of the other groups.
3. The prevalence of the subjective feeling of dry mouth was significantly higher in women of the aged group than in women of the group aged 40 to 49. The prevalences of subjective feel-ings of saliva diminution, sticky mouth, sticky saliva, impairment in taste and abnormal taste were significantly higher in women of the aged group than in women of the other groups.
4. The prevalences of subjective feelings of dry mouth, sticky mouth, sticky saliva, impairment in taste and abnormal taste were significantly higher in women of the aged group than in men of the aged group.The prevalence of the subjective feeling of saliva diminution was higher in women of the aged group than in men of the aged group, but not significantly.
5. Subjects who selected “always” and “severe” in the 10 items were all members of the aged group except one from one of the young groups.
6. Elderly patients, both men and women, who had the sensation of dry mouth had a tendency to have subjective feelings of saliva diminution, sticky mouth, sticky saliva, impairment in taste and abnormal taste.
These results indicate that dental practitioners should be aware that elderly patients may have oral discomfort even though they don't complain of it.

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The purpose of this study was to investigate the influence of aging on oral symptoms. The subjects were 15 male patients and 30 female patients with oral dryness and (or) other oral symptoms, who visited the Oral Discomfort Clinic of the Department of Oral Surgery, Nagoya University School of Medicine from May 1991 to March 1994. The influence of aging on oral symptoms is discussed in terms of age distribution, systemic disease, unstimulated whole salivary glow rate and subjective complaint.
The rate of systemic diseases and the their treatment in these patients increased with aging. No significant differences of age on the other variables were observed. The mean unstimulated whole salivary flow rate was lower in males as compared with that in females at different ages. Particularly, this difference between the sexes was significant with coated and rubor tongue. Our results suggest that oral mucosa and symptoms may conflict with the unstimulated whole salivary flow rate in women.

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The assessment of chewing function is needed for health promotion and for the mainte-nance of the physical, mental and social wellbeing of the elderly. The purpose of the present study was to develop and evaluate a simple screening method of the chewing function of the elderly using subjective questions on food choice and acceptance.
This investigation was performed on two different kinds of institutionalized elderly, those in a nursing home (56 persons) and home for the elderly (77 persons). Firstly, the relation between the degree of satisfaction of chewing and choice and acceptance of 26 foodstuffs was analyzed. Then, 10 kinds of representative foods (boiled fish, rice, broiled fish paste, boiled fish paste, konnyaku, chicken meat, apple, Chinese cabbage, rice crackers, peanuts) were selected from 26 foodstuffs according to the data analysis on nutrition and chewing ability.
The responses to the questions on acceptance of the 10 selected foods were distinguished as “easy to chew”, “good to chew”, “Questionable”, “poor to chew” and “impossible to chew”, and scores of 10, 7.5, 5.0, 2.5, and 0 were given respectively. This questionnaire and scoring system called the Masticatory Index Scale (MIS) were estimated for their use as a possible oral health screening method for elderly subjects with different oral health status.
These results indicate that MIS scores could be used both as a reflection of the oral health condition of each older person and also practicaly for oral health screening of the elderly.

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In recent years there has been a growing concern for the oral care of the elderly, not only for the purpose of keeping the oral health well, but also for chasing how the oral care should be, that is, the attention focused on various aspects directly related to maintaining the quality of life, such as conversation and diet. This has in turn prompted a reassessment of oral health methods. Accordingly, simpler and more efficient ways of teeth brushing and denture cleaning have been devised and reported one by one. Currently these aspects of oral care are evaluated by the established oral condition indices: Greene and Vermillion's OHI (DI) and O'Leary et al's Plaque Control Record. However, the oral care of the elderly tends to be gradual one, and it is difficult to convey the dramatic variations. Also, in the early stages of oral care, there likely to be the attachment of plaque and there are just slight changes which cannot be shown by the current indices. A further problem is that because of the lack of objectivity of judgment, the results vary depending on who examines the patient. In order to overcome these weaknesses, we have devised a method (Iamage Analysis Index: IAI) using standardized imaging and analysis of the oral cavity, and have conducted trials of our standardized oral cavity imaging device.
On testing the accuracy of the standardized oral cavity imaging device and of the image analysis method, we found that both the device and the method were highly accurate.
A favorable correlation was found, after the validity tests were carried out by comparing the current indices with the oral hygiene data gathered by using the new standardized imaging device.
Furthermore, we carried out the practical examination of elderly patients' oral status by using IAI, and tried another examination by using the current indices at the same time. The results indicate that, compared with the current indices, IAI has good sensitivity to the slight changes in the poor oral status of the elderly.
It has thus been confirmed that the use of this evalution index could play an important role in oral care of the elderly and physically or mentally handicapped.

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One of most important objectives of the 8020 movement is to maintain people's masticatory ability. Many surveys have shown that a large number of remaining teeth is helpful in maintaining masticatory ability. However, clinical experience indicates that there have been many cases in which masticatory ability cannot be accounted for by the number of teeth alone. In other words, to maintain the masticatory ability of the elderly, we must investigate causes other than the number of teeth. Accordingly, in this study we report on an analysis of physical functions of the whole body, beyond the oral area, which influence masticatory ability. The data used in this study was gathered as a part or the project “Longitudinal Interdisciplinary Study on Aging, TMIG-LISA”. This is a ten-year longitudinal study by the Tokyo Metropolitan Institute of Gerontology, began at April 1991.
The subjects were 220 males, living in Nangai village, Yuhoku-gun, Akita Prefecture, who were all between the ages of 65 and 84 at the preseut on June 1, 1992. Of the aspects inves-tigated in this survey, the three oral aspects were the number of natural teeth, the number of functional teeth, and the masticatory ability, tested by G-1 jelly. Other physical functions inve stigated were movement (grasping, balance, walking speed) and age. The Hayashi's quan-tification method of the third type was used to analyze the results, to collect qualitative data on the masticatory function and to handle the data.
1. The defference between masticatory function level 1 (difficulty in chewing daily food) and masticatory function level 3 (able to chew daily food) appeared to be due to the difference in the number of functional teeth.
2. The defference between masticatory function level 5 (able to chew most kinds of food) and masticatory function level 3 seems to be related to the amount of exercise, and to the person's age.
Thus, the supply of dentures by the dentist, which effectively increases the number of functional teeth can move people from masticatory function level 1 to level 3. However, to maintain people in level 5, the most effective means is not only the maintenance of the number of natural teeth by oral care. The most important factor for people in level 5 appears to be their general physical condition, especially their mobility.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We investigated the general complications of patients at Dandelion Dental Clinic, a (stationed) dental clinic for aged bedridden people living at home managed by Katsushika-ward Dental association. The Safety control of these complications as well as their courses during the dental treatment period were studied. The risk of general complications in the dental treatment of aged bedridden people was thus investigated. The subjects were 319 patients treated at the clinic for a period of 4 years and 2 months from February 1990 to March 1994. Their average age was 77 and the eldest was 100 years old. The most common complication (27% of coses) before dental treatment was cerebral vascular disorders. Problems evoked during the dental treatment were hypertension (8 cases), arrhythmia (7 cases), bad feeling (3 cases), and 1 case each of thoracic pain and requirement of house call of a physiscian. During and after the dental treatment, 38 cases were admitted to hospital due to aggravation of the general condition and 45 ceased treatment. 15 cases died within 2days to 1month of the last dental treat ment. From the reasults of this investigatition, the following points were clarified: It is best to obtain Information from the physician irrespective of the patieat's apparent condition, and whether or not local anesthesia is needed, since the patients have high risks. The actual dental treatment including any invasive treatment is possible only when there are sufficient preliminary investigations as described above and with the help of a anesthesiolosist. Among notifications from physicians about dental treatment, more attention should be paid to deglutition.

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[in Japanese]

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