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Oral Frailty and Oral Health Management

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Oral Health".

Deadline for manuscript submissions: closed (31 January 2022) | Viewed by 35955

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Dr. Yutaka Watanabe

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Department of Oral Health Science, Faculty of Dental Medicine, Hokkaido University, Nishi-7, Kita-13, Kita-ku, Sapporo, Hokkaido 060-8586, Japan
Interests: oral frailty; oral function; healthy longevity; care prevention

Dr. Masanori Iwasaki

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Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
Interests: preventive dentistry; epidemiology of oral health; nutrition

Dr. Junichi Furuya

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Department of Geriatric Dentistry, Showa University School of Dentistry, Tokyo 145-8515, Japan
Interests: oral frailty; oral function; dysphagia; denture; mastication and swallowing; nutrition

Special Issue Information

Dear Colleagues,

Traditionally, the number of teeth has been considered the health indicator of dental oral health. However, the number of teeth itself does not affect oral health directly, whereas diet and oral functions such as articulatory and eating and swallowing functions directly influence it. It is true that the number of teeth has a remarkable impact on such functions, and there have been many reports on the relationships between the number of teeth and various health conditions. However, previous studies on this topic could not exclude the contribution of pre-existing pathological conditions and lifestyle habits to the health effects attributed to tooth loss. In addition, since it is impossible to regenerate lost teeth, the oral health of those who lost their teeth cannot be recovered. Therefore, the sole purpose of dental oral health is to prevent the loss of teeth.

The recent progress in dental treatment techniques is remarkable, and accordingly, people have now much fewer chances to lose their teeth. Further, it has become possible for people to replace their lost teeth with dental implants. Therefore, it is expected that the influence of the number of teeth on health will be reduced.

Many studies have been published on the relationships between oral functions and the occurrence of frailty, sarcopenia, need for nursing care, death, dementia, etc. The decline in oral functions in association with aging is referred to as oral frailty.

This Special Issue of the International Journal of Environmental Research and Public Health (IJERPH) will focus on the current state of knowledge of the links between oral frailty and human health. New research papers, reviews, case reports, and conference papers are welcome. Papers dealing with new approaches to prevent oral frailty and with risk assessment and management are also welcome. Other manuscript types accepted include methodological papers, position papers, brief reports, and commentaries.

Dr. Yutaka Watanabe
Dr. Masanori Iwasaki
Dr. Junichi Furuya
Guest Editors

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Keywords

oral frailty
oral function
healthy longevity
mastication
swallowing
tongue pressure
slightly choking
articulation
frailty
sarcopenia
preventive long-term care
social participation
cognitive function
nutrition
oral ingestion

Published Papers (11 papers)

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Research

12 pages, 1442 KiB

Open AccessArticle

Factors Predicting Tongue Pressure Decline among Community-Dwelling Older Adults: The Takashimadaira Study

by Chika Takahashi, Masanori Iwasaki, Keiko Motokawa, Yutaka Watanabe, Misato Hayakawa, Yurie Mikami, Maki Shirobe, Hiroki Inagaki, Ayako Edahiro, Yuki Ohara, Hirohiko Hirano, Shoji Shinkai and Shuichi Awata

Int. J. Environ. Res. Public Health 2022, 19(13), 7850; https://doi.org/10.3390/ijerph19137850 - 26 Jun 2022

Viewed by 1727

Abstract

A limited number of longitudinal studies have explored factors contributing to decreases in tongue pressure (TP). This longitudinal study aimed to clarify the factors affecting TP decline among community-dwelling older adults. We followed the Takashimadaira Study participants with a baseline TP ≥ 30 kPa for 2 years. A TP of <30 kPa at follow-up was defined as TP decline. We used Poisson regression with robust standard errors to explore the factors related to TP decline. The studied baseline variables were dental status, sociodemographic characteristics, health behaviors, appetite, medical conditions, physical function, cognitive status, and anthropometric and body composition characteristics. Inverse probability weighting (IPW) was used to adjust for selection bias. Overall, 357 individuals (159 men and 198 women) with a mean (standard deviation) age of 75.9 (4.1) years were included in the analyses. Of these, 59 study participants (16.5%) exhibited TP decline. After adjusting for baseline TP and applying IPW, poor appetite (incident rate ratio [95% confidence interval] = 1.58 [1.01–2.48]), low skeletal muscle mass index (1.66 [1.02–2.70]), and cognitive impairment (1.93 [1.12–3.33]) were associated with TP decline. In conclusion, we demonstrated that baseline appetite, body composition, and cognitive status could predict future TP decline among community-dwelling older adults. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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10 pages, 1430 KiB

Open AccessArticle

Standard Values and Concurrent Validity of a Newly Developed Occlusal Force-Measuring Device among Community-Dwelling Older Adults: The Otassha Study

by Masanori Iwasaki, Ichinosuke Maeda, Yota Kokubo, Yoshitomo Tanaka, Tetsuji Ueno, Yuki Ohara, Keiko Motokawa, Misato Hayakawa, Maki Shirobe, Ayako Edahiro, Hisashi Kawai, Yoshinori Fujiwara, Kazushige Ihara, Hunkyung Kim, Yutaka Watanabe, Shuichi Obuchi and Hirohiko Hirano

Int. J. Environ. Res. Public Health 2022, 19(9), 5588; https://doi.org/10.3390/ijerph19095588 - 4 May 2022

Cited by 7 | Viewed by 2855

Abstract

Recently, an occlusal force-measuring device with a capacitive-type pressure-mapping sensor (OFMD-CPS) was developed. We aimed to establish age- and sex-specific standard values for OFMD-CPS-measured occlusal force (OF) and to assess the concurrent validity of the OFMD against another OF measuring system with a pressure-sensitive sheet (Dental Prescale II). Using data from a population-based study, we calculated the OFMD-CPS-measured OF means and deciles in 5-year age groups for each sex. The OFMD-CPS-measured OF was validated against the Dental Prescale II-measured OF with Spearman correlation coefficients. Furthermore, we calculated the area under the receiver operating characteristic curve (AUC) against the preexisting Dental Prescale II-measured OF cutoff value of 350 N. In total, 596 individuals (236 men and 360 women) with a mean (standard deviation (SD)) age of 73.7 (6.7) years were included in the analyses. The mean (SD) OFMD-CPS-measured OFs were 581.6 (284.6) N in men and 446.9 (209.9) N in women. There was a strong positive correlation (Spearman’s Rho = 0.73) between OFMD-CPS-measured and Dental Prescale II-measured OF. The diagnostic accuracy of the OFMD-CPS-measured OF for the Dental Prescale II-measured OF cutoff value was high (AUC = 0.88). In conclusion, we demonstrated standard values and concurrent validity of OFMD-CPS-measured OF in community-dwelling older adults. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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12 pages, 1040 KiB

Open AccessArticle

A Cross-Sectional Study on the Relationship between Oral Function and Sarcopenia in Japanese Patients with Regular Dental Maintenance

by Ryuichi Shirahase, Yutaka Watanabe, Tohru Saito, Yusuke Sunakawa, Yuya Matsushita, Hideki Tsugayasu and Yutaka Yamazaki

Int. J. Environ. Res. Public Health 2022, 19(9), 5178; https://doi.org/10.3390/ijerph19095178 - 24 Apr 2022

Cited by 4 | Viewed by 1894

Abstract

We aimed to clarify the relationship between oral function assessments regarding oral hypofunction and sarcopenia in patients who had completed treatment for organic dental problems, including oral pain, removable denture fit, and tooth loss. This cross-sectional study included 269 patients aged ≥65 years (mean age 74.9 ± 6.50 years, 133 men, 136 women) who visited a dental clinic between June 2019 and March 2021. We evaluated oral function and sarcopenia and analyzed their relationship using the Jonckheere–Terpstra test, Mantel–Haenszel trend test, and Poisson regression analysis. We diagnosed 132 (49.07%) patients with oral hypofunction, 30 (11.2%) with sarcopenia, and 24 (8.9%) with severe sarcopenia. The number of oral hypofunction items (prevalence rate ratio [PRR] = 1.39, 95%Wald = 0.11 to 0.56) was significantly associated with sarcopenia. For each of the items, tongue-lip motor function [ta] (PRR = 0.80, 95%Wald = −0.44 to −0.02)] [ka] (PRR = 0.76, 95%Wald = −0.53 to −0.03) and tongue pressure (PRR = 0.95, 95%Wald = −0.09 to −0.02) showed a significant association with sarcopenia. However, no significant association was found for other variables. Dentists should not only treat organic dental problems but also consider the relationship between oral function and sarcopenia. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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20 pages, 1185 KiB

Open AccessArticle

The Effect of a Masticatory Muscle Training Program on Chewing Efficiency and Bite Force in People with Dementia

by Julia Jockusch, Sebastian Hahnel, Bernhard B. A. J. Sobotta and Ina Nitschke

Int. J. Environ. Res. Public Health 2022, 19(7), 3778; https://doi.org/10.3390/ijerph19073778 - 22 Mar 2022

Cited by 6 | Viewed by 2242

Abstract

Until now, no study has investigated the effects of masticatory muscle training on chewing function in people with dementia. This study aimed to investigate whether physiotherapeutic exercises for the masticatory muscles have an influence on chewing efficiency and bite force in people with dementia. In a clinical trial with stratified randomization subjects were assigned to three groups based on the Mini Mental State Examination (MMSE: group 1—28–30, group 2—25–27, group 3—18–24). Each group was divided into an experimental (ExpG, intervention) and control group (ConG, no intervention). As intervention a Masticatory Muscle Training (MaMuT) (part 1: three physiotherapeutic treatments and daily home exercises, part 2: daily home exercises only) was carried out. Chewing efficiency and bite force were recorded. The MaMuT influenced the masticatory performance regardless of the cognitive state. Bite force increased in ExpG 1 and 2. Without further training, however, the effect disappeared. Chewing efficiency increased in all ExpG. After completion of the training, the ExpG 2 and 3 showed a decrease to initial values. Subjects of ExpG 1 showed a training effect at the final examination, but a tendency toward the initial values was observed. ExpG 3 seemed to benefit most from the physiotherapeutic exercises in terms of improving chewing efficiency by the end of the intervention phase. ExpG 1 showed the greatest gain in bite force. The MaMuT program is a potential method of improving masticatory performance in people with cognitive impairment or dementia when used on a daily basis. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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9 pages, 2704 KiB

Open AccessArticle

Capacitive-Type Pressure-Mapping Sensor for Measuring Bite Force

by Masanori Iwasaki, Ichinosuke Maeda, Yota Kokubo, Yoshitomo Tanaka, Tetsuji Ueno, Wataru Takahashi, Yutaka Watanabe and Hirohiko Hirano

Int. J. Environ. Res. Public Health 2022, 19(3), 1273; https://doi.org/10.3390/ijerph19031273 - 24 Jan 2022

Cited by 4 | Viewed by 2919

Abstract

Bite force is an important indicator of masticatory performance. However, existing methods for measuring bite force are either ineffective or expensive. Hence, we developed a novel capacitive-type pressure-mapping sensor that converts mechanical forces into changes in capacitance and calculates bite force. A portable device was fabricated based on this sensor sheet, and the accuracy of the bite-force measurements provided by the device was evaluated. The sensor has a thickness of 1.6 mm and has 63 measurement points. It was inserted into a dental model, where the output value was measured and compared with that of a universal testing machine (AG-IS 100 kN). A regression equation to estimate the bite force was obtained based on the relationship between the output of the capacitive-type pressure-mapping sensor and that of the load cell of the universal testing machine. The estimated bite force from the sensor and the quadratic regression equation closely resembled the known load applied by the compression tester (R² = 0.992). We therefore conclude that the developed sensor can measure bite force accurately and effectively. A device with a built-in capacitive-type pressure-mapping sensor can potentially be a user-friendly tool for bite-force measurements in both clinical and epidemiological settings. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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13 pages, 353 KiB

Open AccessArticle

Oral Factors as Predictors of Frailty in Community-Dwelling Older People: A Prospective Cohort Study

by Noriko Takeuchi, Nanami Sawada, Daisuke Ekuni and Manabu Morita

Int. J. Environ. Res. Public Health 2022, 19(3), 1145; https://doi.org/10.3390/ijerph19031145 - 20 Jan 2022

Cited by 15 | Viewed by 4270

Abstract

The purpose of this prospective cohort study was to identify predictors for frailty among possible oral factors in community-dwelling older people. Ninety-seven participants (≥60 years old) without frailty at baseline were included and assigned to either the robust or the frailty group after 2-year follow-up. The frailty was defined using the Japan Cardiovascular Health Study index. The numbers of present and functional teeth and periodontal disease severity were recorded. Bacterial counts on the dorsum of the tongue, oral moisture, tongue pressure, occlusal force, masticatory ability, and the oral diadochokinesis (ODK) rate were measured. Swallowing function, along with psychosocial status, relationships with communities and people, nutritional status, medical history, and comorbidities were evaluated using a questionnaire. The newly identified frailty group at follow-up showed significantly lower values in the number of teeth present, ODK/ta/sound and ODK/ka/sound rates, and clinical attachment level at baseline compared to the robust group. A logistic regression model showed a significantly negative association between the ODK/ta/sound rate at baseline and the incidence of frailty. Articulatory oral motor skill was found to be a predictor of frailty after two years. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

8 pages, 299 KiB

Open AccessArticle

Oral Functions Are Associated with Muscle Strength and Physical Performance in Old-Old Japanese

by Yuki Murotani, Kodai Hatta, Toshihito Takahashi, Yasuyuki Gondo, Kei Kamide, Mai Kabayama, Yukie Masui, Tatsuro Ishizaki, Ken-ichi Matsuda, Yusuke Mihara, Motoyoshi Fukutake, Yuichi Nishimura, Suzuna Akema, Hiromasa Hagino, Kotaro Higashi, Hitomi Togawa, Yoshinobu Maeda, Soshiro Ogata, Paula Moynihan and Kazunori Ikebe

Int. J. Environ. Res. Public Health 2021, 18(24), 13199; https://doi.org/10.3390/ijerph182413199 - 15 Dec 2021

Cited by 5 | Viewed by 3111

Abstract

Grip strength and walking speed are considered to be important indicators of physical frailty. However, no study has contemporaneously examined any association of multiple oral functions with grip strength and walking speed. The purpose of this study was to examine which oral functions are associated with muscle strength (grip strength), physical performance (walking speed) or both. The study participants were 511 community-dwelling people (254 men and 257 women) aged 77–81 years old. Six oral functions—oral wetness, occlusal force, tongue-lip motor function, tongue pressure, masticatory performance and swallowing function—were measured. Grip strength and walking speed were also measured. A partial correlation analysis, adjusted for gender, showed that occlusal force, tongue-lip motor function, masticatory performance and swallowing function were significantly associated with both grip strength and walking speed. In addition, tongue pressure was significantly associated with grip strength. A general linear model showed that tongue pressure and occlusal force were significantly associated with grip strength. Swallowing function and tongue-lip motor function were significantly associated with walking speed. It is suggested that there are different oral function measures for muscle strength and physical performance, and these oral function measures could be a useful proxy for physical frailty. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

18 pages, 1578 KiB

Open AccessArticle

Assessment of Age-Related Changes on Masticatory Function in a Population with Normal Dentition

by Seonhui Kim, Re-Mee Doh, Leegang Yoo, Sol-Ah Jeong and Bock-Young Jung

Int. J. Environ. Res. Public Health 2021, 18(13), 6899; https://doi.org/10.3390/ijerph18136899 - 27 Jun 2021

Cited by 20 | Viewed by 3033

Abstract

This study aimed to investigate the influence of changes in age-related physiological muscular and dental factors on masticatory function. This study was conducted in 211 healthy participants divided into four different age groups: 20–45 years (Gr1); 45–60 years (Gr2); 61–70 years (Gr3); and ≥71 years (Gr4). For objective evaluation of masticatory function, the masticatory performance, bite force, posterior bite area (PBA), functional tooth units (FTUs), the number of remaining teeth, tongue pressure, masseter muscle thickness (MMT), and handgrip strength were examined. Food intake ability (FIA) and the Oral Health Impact Profile-14 score were assessed subjectively using questionnaires. A significant decrease in the number of remaining teeth, FTUs, handgrip strength, and FIA was found in Gr4, and a significant decrease in the tongue pressure, PBA, and bite force was found in those aged ≥61 years. In groups 1 and 3, an association of the PBA with masticatory performance was observed. However, there was no significant decreasing trend in the MMT with respect to masticatory performance with aging. With sufficient FTUs and posterior tooth support, although age-dependent decreases in the bite force, tongue pressure and handgrip strength were observed, masticatory performance was maintained. Establishing the PBA by improving occlusion through dental treatment is thought to be important for masticatory function. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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9 pages, 308 KiB

Open AccessArticle

Association between Physical Frailty Subdomains and Oral Frailty in Community-Dwelling Older Adults

by Ryo Komatsu, Koutatsu Nagai, Yoko Hasegawa, Kazuki Okuda, Yuto Okinaka, Yosuke Wada, Shotaro Tsuji, Kayoko Tamaki, Hiroshi Kusunoki, Hiromitsu Kishimoto and Ken Shinmura

Int. J. Environ. Res. Public Health 2021, 18(6), 2931; https://doi.org/10.3390/ijerph18062931 - 12 Mar 2021

Cited by 17 | Viewed by 4221

Abstract

This cross-sectional study aimed to demonstrate the association between physical frailty subdomains and oral frailty. This study involved community-dwelling older adults (aged ≥65 years). Physical frailty was assessed with the Japanese version of the Cardiovascular Health Study criteria. Oral frailty was defined as limitations in at least three of six domains. Logistic regression analysis was used to analyze the association between physical frailty risk and oral frailty. In addition, we examined the association between physical frailty subdomains (gait speed, grip strength, exhaustion, low physical activity, and weight loss) and oral frailty. A total of 380 participants were recruited for this study. Overall, 18% and 14% of the participants were at risk of physical frailty and had oral frailty, respectively. Physical frailty risk (odds ratio (OR) = 2.40, 95% confidence interval (CI): 1.22–4.75, p = 0.012) was associated with oral frailty in multivariate analysis. In secondary analysis, among physical frailty subdomains, gait speed (OR = 0.85, 95% CI: 0.73–0.97, p = 0.019) was associated with oral frailty. The present findings suggest that physical frailty is closely related to oral frailty. Among physical frailty subdomains, decreased gait speed in particular is an important indicator related to the development of oral frailty. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

9 pages, 2363 KiB

Open AccessArticle

Relationship between Chewing Ability and Nutritional Status in Japanese Older Adults: A Cross-Sectional Study

by Keiko Motokawa, Yurie Mikami, Maki Shirobe, Ayako Edahiro, Yuki Ohara, Masanori Iwasaki, Yutaka Watanabe, Hisashi Kawai, Takeshi Kera, Shuichi Obuchi, Yoshinori Fujiwara, Kazushige Ihara and Hirohiko Hirano

Int. J. Environ. Res. Public Health 2021, 18(3), 1216; https://doi.org/10.3390/ijerph18031216 - 29 Jan 2021

Cited by 42 | Viewed by 4199

Abstract

Objectives: This study aimed to determine the relationship between objective chewing ability and the nutritional status of Japanese community-dwelling elders. Design: A cross-sectional study. Participants: A total of 509 community-dwelling elders living in the Tokyo metropolitan area participated in a comprehensive survey conducted in October 2013. Measurements: The basic characteristics were sex, age, and body mass index. Undernutrition was examined through serum albumin levels. Chewing ability was examined through color-changeable xylitol gum by evaluating the color changes in chewing gum. Nutritional intake was examined using the semi-quantitative food frequency questionnaire. Results: In the poor chewing ability group, all nutrient intake levels were significantly low, except for carbohydrates, and intake levels for all food groups were significantly low, except for cereals, confectionery, sugars, seasonings, and spices. Additionally, after adjusting for covariates for sex, age, Tokyo Metropolitan Institute of Gerontology-Index of Competence (TMIG-IC) score, Mini-Mental State Examination (MMSE) score, body mass index (BMI), stroke, number of functional teeth, energy intake, and protein intake, chewing ability was found to be significantly associated with undernutrition. Conclusion: We concluded that chewing ability was closely associated with nutrient and different food groups’ intake, as well as undernutrition, among Japanese community-dwelling elders. Thus, to ensure comprehensive nutritional management, nutritionists and dentists should collaborate when treating the same patients. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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11 pages, 797 KiB

Open AccessArticle

A Two-Year Longitudinal Study of the Association between Oral Frailty and Deteriorating Nutritional Status among Community-Dwelling Older Adults

by Masanori Iwasaki, Keiko Motokawa, Yutaka Watanabe, Maki Shirobe, Hiroki Inagaki, Ayako Edahiro, Yuki Ohara, Hirohiko Hirano, Shoji Shinkai and Shuichi Awata

Int. J. Environ. Res. Public Health 2021, 18(1), 213; https://doi.org/10.3390/ijerph18010213 - 30 Dec 2020

Cited by 42 | Viewed by 3981

Abstract

Background: Limited longitudinal studies exist to evaluate whether poor oral health and functions affect the incidence of deteriorating nutritional status. We investigated if there were longitudinal associations between oral frailty, defined as accumulated deficits in oral health, and deteriorating nutritional status among community-dwelling older adults. Methods: The study population consisted of 191 men and 275 women (mean age, 76.4 years) from the Takashimadaira Study. Multifaced oral health assessment was performed at baseline, and oral frailty was defined as having ≥3 of the following six components: fewer teeth, low masticatory performance, low articulatory oral motor skill, low tongue pressure, and difficulties in chewing and swallowing. Nutritional status assessment was performed at baseline and two-year follow-up using the Mini Nutritional Assessment^®-Short Form (MNA^®-SF). Deteriorating nutritional status was defined as a decline in the nutritional status categories based on the MNA^®-SF score during the study period. The association between oral frailty and deteriorating nutritional status was assessed using logistic regression analyses. Results: Oral frailty was observed in 67 (14.4%) participants at baseline. During the study, 58 (12.4%) participants exhibited deteriorating nutritional status. After adjusting for potential confounders, oral frailty was significantly associated with deteriorating nutritional status (adjusted odds ratio, 2.24; 95% confidence interval, 1.08–4.63). Conclusion: Community-dwelling older adults with oral frailty had an increased risk of deteriorating nutritional status. Full article

(This article belongs to the Special Issue Oral Frailty and Oral Health Management)

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