Poor Oral Health as a Determinant of Malnutrition and Sarcopenia

Association between nutritional risk status and health related quality of life: An investigation on the aging patients with cardiovascular disease

Introduction

Acknowledging the considerable influence of undernutrition on health outcomes and HRQOL, this study sought to appraise the nutritional risk status of elderly patients with cardiovascular diseases (CVD) through the utilization of the Nutritional Risk Screening (NRS). Additionally, the investigation aimed to evaluate the correlation between NRS status and HRQOL within the context of patients referred to a cardiac hospital in Tabriz, Iran.

Methods

This cross-sectional study was conducted in Tabriz, Iran. The participants were selected randomly from patients referring to Shahid Madani Heart Hospital, a comprehensive university hospital during July to December 2018. A linear regression was used for control of confounding variables (age, gender, education level, marital status, and income levels) and predict the relationship between nutrition risk status and HQRL.

Results

Of the 200 patients with CVD participated in this study, 68 (34%) of participants had normal nutrition status, 108 (54%) were at risk for undernutrition, and 24 (12%) had undernutrition. A total of 24 aging patients with undernutrition, 13 (54%) were divorced or widowed. 86% of patients with diabetes were at risk for undernutrition and 13.9% had undernutrition. There were statistically significant relationship between undernutrition and HRQOL dimensions, age, gender, and marital status.

Conclusion

The study revealed a correlation between elevated undernutrition scores in patients and factors such as older age, female gender, and marital status of being divorced or widowed. Furthermore, the results imply that a notable elevation in the risk score for undernutrition in patients is significantly linked to impaired HRQOL among elderly individuals with CVD.

Oral Function for Diagnosing Oral Hypofunction in Healthy Young Adults: A Comparison with the Literature

This study investigated decline in oral function in healthy young adults and compared it with that observed in an earlier studies employing older adults. The participants comprised 130 young healthy adults (mean age 24.1±2.9 yr), all with complete dentition. All participants underwent the oral hypofunction test established by the Japanese Society of Gerodontology, which evaluates oral hygiene, oral dryness, occlusal force, tongue-lip motor function (oral diadochokinetic rate; ODK), tongue pressure, and masticatory and swallowing function. The average value for and rate of hypofunction of each parameter were calculated. In healthy young adults, the scores were 28.9±17.1% for oral hygiene; 28.8±2.2 for oral dryness; 959.9±499.8 N for occlusal force; 7.0±0.8 times/sec for ODK /pa/, 7.6±0.8 times/sec for /ta/, and 6.9±0.9 times/sec for /ka/; 41.8±8.4 kPa for tongue pressure; 249.8±94.1 mg/dl for masticatory function; and 0.2±0.7 for swallowing function. No sign or symptom of change in oral function was observed at a high rate in young adults. Occlusal force, tongue-lip motor function, and tongue pressure showed a large difference in the rate of hypofunction between younger and older adults, however.

Periodontitis and Metabolic Syndrome: Statistical and Machine Learning Analytics of a Nationwide Study

This study aimed to analyze the associations between periodontitis and metabolic syndrome (MetS) components and related conditions while controlling for sociodemographics, health behaviors, and caries levels among young and middle-aged adults. We analyzed data from the Dental, Oral, and Medical Epidemiological (DOME) record-based cross-sectional study that combines comprehensive sociodemographic, medical, and dental databases of a nationally representative sample of military personnel. The research consisted of 57,496 records of patients, and the prevalence of periodontitis was 9.79% (5630/57,496). The following parameters retained a significant positive association with subsequent periodontitis multivariate analysis (from the highest to the lowest OR (odds ratio)): brushing teeth (OR = 2.985 (2.739-3.257)), obstructive sleep apnea (OSA) (OR = 2.188 (1.545-3.105)), cariogenic diet consumption (OR = 1.652 (1.536-1.776)), non-alcoholic fatty liver disease (NAFLD) (OR = 1.483 (1.171-1.879)), smoking (OR = 1.176 (1.047-1.322)), and age (OR = 1.040 (1.035-1.046)). The following parameters retained a significant negative association (protective effect) with periodontitis in the multivariate analysis (from the highest to the lowest OR): the mean number of decayed teeth (OR = 0.980 (0.970-0.991)); North America as the birth country compared to native Israelis (OR = 0.775 (0.608-0.988)); urban non-Jewish (OR = 0.442 (0.280-0.698)); and urban Jewish (OR = 0.395 (0.251-0.620)) compared to the rural locality of residence. Feature importance analysis using the eXtreme Gradient Boosting (XGBoost) machine learning algorithm with periodontitis as the target variable ranked obesity, OSA, and NAFLD as the most important systemic conditions in the model. We identified a profile of the "patient vulnerable to periodontitis" characterized by older age, rural residency, smoking, brushing teeth, cariogenic diet, comorbidities of obesity, OSA and NAFLD, and fewer untreated decayed teeth. North American-born individuals had a lower prevalence of periodontitis than native Israelis. This study emphasizes the holistic view of the MetS cluster and explores less-investigated MetS-related conditions in the context of periodontitis. A comprehensive assessment of disease risk factors is crucial to target high-risk populations for periodontitis and MetS.

Relationship between oral frailty, health-related quality of life, and survival among long-term care residents

PURPOSE

We evaluated oral frailty (OFr) and its association with health-related quality of life (HRQoL), energy and protein intake, and survival among older long-term care residents.

METHODS

This cross-sectional study with a 3-year follow-up for survival assessed 349 residents in long-term care facilities (73% female, mean age 82 years). We defined OFr with six signs (dry mouth, food residue on oral surfaces, unclear speech, inability to keep mouth open or pain expression during the clinical oral examination, diet pureed/soft) and OFr severity was categorized as Group 1, (mild) = 0-1 signs, Group 2 (moderate) = 2-4 signs, and Group 3 (severe) = 5-6 signs. We measured HRQoL with 15D instrument, and energy and protein intake by a 1- to 2-day food record. Mortality was retrieved from central registers on March 2021.

RESULTS

Of the residents, 15% had 0-1, 67% 2-4 and 18% 5-6 OFr signs. HRQoL decreased linearly from Group 1 to Group 3. OFr correlated with such dimensions of HRQoL as mobility, eating, speech, excretion, usual activities, mental function, and vitality. We found no association between OFr categories and energy and protein intake. Survival decreased linearly from Group 1 to Group 3.

CONCLUSIONS

OFr was common among older long-term care residents and OFr severity predicts poorer outcomes. The six oral signs denoting OFr may be used at the bedside to screen residents at risk for OFr.

Association between muscle quality index and periodontal disease among American adults aged ≥ 30 years: a cross-sectional study and mediation analysis

OBJECTIVE

The muscle quality index (MQI) is a measurement of muscle quality that is directly related to overall health. There has been little study on the relationship between the muscle quality index and periodontitis in American people beyond 30 years. Therefore, this study aimed to explore the link between periodontitis and Muscle quality index (MQI) in older Americans.

METHODS

Three thousand two hundred fifty-eight individuals (aged 30 to 59) who participated in the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were considered eligible for the cross-sectional investigation. A hand dynamometer was used to determine the handgrip strength (HGS). Dual-energy X-ray absorptiometry was employed to calculate ASM (DXA). MQIArm was calculated by dividing the dominant hand's HGS by the dominant arm's ASM (in kg/kg). MQIApp was calculated by dividing the dominant hand's HGS by the ASM (in kg/kg). MQItotal was calculated by dividing the sum of the dominant and non-dominant hands by the ASM (in kg/kg). To investigate the link between muscle quality index and periodontal disease, the weighted multivariable logistic regression models were used. Using generalized additive models, it was determined if a nonlinear connection existed. Then, we developed a two-piece linear regression model and calculated the inflection point using a recursive approach. A mediation study was performed to determine how much of the impact of MQItotal on periodontitis was mediated by potential variables.

RESULTS

Three thousand two hundred fifty-eight participants from the United States were enrolled. The OR (95% CI) for the relationship between MQItotal and periodontitis in the regression model with fully adjusted variables was 0.69 (0.53-0.91), for the connection between MQIArm and periodontitis was 0.90 (0.84-0.97), and for the association between MQIApp and periodontitis was 0.49 (0.30-0.80). MQItotal and periodontitis were shown to have a J-shaped relationship with a change point of 3.64. Before the change point, the OR (95% CI) was 0.69 (0.58, 0.82). In the analysis of drinking and married status, the interaction was statistically significant. Analysis of mediation showed that alcohol use was responsible for 0.4% (0.10 to 1.2) of the effect of MQItotal on periodontitis.

CONCLUSION

In American adults aged over 30, the Muscle Quality Index (MQI) exhibited an independent negative correlation with moderate to severe periodontitis, demonstrating a J-shaped relationship. Furthermore, alcohol consumption may act as a mediator in the association between MQI and periodontitis.

The Potential of Collagen Treatment for Comorbid Diseases

Collagen, the most abundant protein in our bodies, plays a crucial role in maintaining the structural integrity of various tissues and organs. Beyond its involvement in skin elasticity and joint health, emerging research suggests that collagen may significantly impact the treatment of complex diseases, particularly those associated with tissue damage and inflammation. The versatile functions of collagen, including skin regeneration, improving joint health, and increasing bone strength, make it potentially useful in treating different diseases. To the best of my knowledge, the strategy of using collagen to treat comorbid diseases has not been widely studied. This paper aims to explore the potential of collagen in treating comorbid diseases, including rheumatoid arthritis, osteoarthritis, osteoporosis, psoriatic arthritis, sarcopenia, gastroesophageal reflux, periodontitis, skin aging, and diabetes mellitus. Collagen-based therapies have shown promise in managing comorbidities due to their versatile properties. The multifaceted nature of collagen positions it as a promising candidate for treating complex diseases and addressing comorbid conditions. Its roles in wound healing, musculoskeletal disorders, cardiovascular health, and gastrointestinal conditions highlight the diverse therapeutic applications of collagen in the context of comorbidity management.

Relationships among oral hygiene behavior, toothache, and depressive symptoms in Chinese older adults

OBJECTIVES

The study aims to investigate the relationships among oral hygiene behavior, toothache, and depression among Chinese older adults.

METHODS

We used data came from the 2018 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). The Center for Epidemiologic Studies Depression Scale was used to evaluate depression. Binary logistic regression was performed to analyze the relationships among oral hygiene behavior, toothache, and depression.

RESULTS

A total of 12,172 older adults were included in the study, of whom 27.2% had depression. Compared with those who did not brush their teeth daily, those who brushed their teeth at least once daily exhibited lower odds of having depressive symptoms (odds ratio [OR] = 0.86, 95% confidence interval [CI] = 0.77-0.97 versus OR = 0.81, 95% CI = 0.71-0.93). Compared with those who did not have toothache, those who had toothache over the past 6 months exhibited higher odds of having depression (OR = 1.49, 95% CI = 1.33-1.68). Living arrangement had a significant effect on the correlation between toothache and depression (p = 0.049), who lived alone and had toothache exhibited higher odds of having depressive symptoms.

CONCLUSIONS

Oral hygiene behavior and toothache are associated with depression. Taking effective measures to maintain a daily toothbrushing pattern and reduce the occurrence of toothache may mitigate the risk of depression among older adults, especially among those living alone.

CLINICAL RELEVANCE

The present study reports that the potential relationship between different oral hygiene behavior, toothache, and depressive symptoms.

Diet, Nutrition, and Oral Health in Older Adults: A Review of the Literature

Diet, nutrition, and oral health are closely linked. Malnutrition is a challenging health concern in older adults that is associated with physical decline affecting their daily activities and quality of life. The aim of this review is to provide an evidence-based summary of the relationship between diet and nutrition and oral health in older adults and its implications. The World Health Organization has declared healthy ageing a priority of its work on ageing. The American Dental Association confirmed the bidirectional relationship between diet and nutrition and oral health. The literature shows that diet and nutrition are related to oral diseases, including dental caries, periodontal diseases, tooth wear, and even oral cancer. Insufficient nutritional intake and poor dietary habits increase the risk of oral diseases, such as dental caries, in older adults. On the other hand, in older adults, poor oral conditions such as periodontal disease may induce pain, infection, and tooth loss, affecting nutritional intake. Surveys have shown that older adults, in particular, those in disadvantaged communities, suffered from nutritional deficiencies or imbalances affecting their oral health. In addition, the current literature shows that malnutrition is associated with frailty, hospitalization, mortality, and morbidity. Good oral health and functional dentition are essential to maintain sufficient nutritional intake among older adults and reduce the risk of malnutrition. Therefore, integrating oral health into general health care service in older adults is imperative to improve their nutritional and oral health status to achieve healthy ageing.

Frailty index and ten oral conditions in the Coyoacan cohort study: A cross-sectional analysis

OBJECTIVES

To analyse the relationship between the Frailty Index and 10 oral conditions controlling for nutritional status among Mexican community-dwelling older people.

BACKGROUND

Studies suggest that the association between frailty and oral conditions are mediated by nutrition.

MATERIALS AND METHODS

This cross-sectional analysis includes 487 community-dwelling men and women aged ≥70 years old. Interview and clinical examinations were performed at participants' homes. Objective (number of natural teeth, root remnants, dental condition, utilisation and functionality of removable dental prostheses and periodontitis) and subjective (utilisation of dental services, self-rated oral health, chewing difficulties and xerostomia) oral variables were collected by trained personnel. The Frailty Index was calculated considering 35 deficits. Nutritional status measured with the Mini-Nutritional assessment (MNA), age, sex, education, and marital status were included as covariates. We fitted 11 multivariate generalised linear models (one for each oral condition), assuming gamma distribution for Frailty Index as the outcome.

RESULTS

Participants average age was 78.1 years, 52.1% were women. We observed a higher Frailty Index among those rating their oral health as worse than others their age (5.1%), reporting chewing difficulties often (4.9%) and fairly and very often (7.0%), and xerostomia (4.8%). Age, gender and MNA were consistently associated with the Frailty Index.

CONCLUSION

Subjective oral conditions are compatible with the Frailty Index after controlling for older people's nutritional status and covariates.

Mini Nutrition Assessment-Short Form score is associated with sarcopenia even among nourished people - A result of a feasibility study of a registry

Objectives

This study aims to identify a new barrier to the use of the Mini-Nutrition Assessment Short-Form (MNA-SF), which is a malnutrition assessment tool for the risk assessment of sarcopenia in a nourished population.

Methods

The MNA-SF was completed, and individuals with a score of > 11 were considered nourished in this cross-sectional feasibility study of a registry. Sarcopenia was assessed in 766 healthy, nourished adults (33.4% men, 64.9 ± 7.1 years) based on the European Working Group on Sarcopenia in Older People 2 (EWGSOP2).

Results

The MNA-SF scores for non-sarcopenia, pre-, confirmed, and severe sarcopenia were 13.59 ± 0.69, 13.73 ± 0.60, 12.64 ± 0.74, and 12.5 ± 0.71, respectively. The higher MNA-SF score association with pre-sarcopenia [odds ratio (OR): 1.41, 95% confidence interval (CI): 1.06-1.86, P = 0.02], confirmed sarcopenia (OR = 0.25, 95% CI: 0.13-0.49, P < 0.001), and severe sarcopenia (OR = 0.20, 95% CI: 0.09-0.46, P < 0.001) was as significant as in the MNA-SF categories. Individuals with a score = 13 (compared with 14), had a higher risk of confirmed sarcopenia (OR = 10.07, 95% CI: 1.92-52.71, P = 006) and severe sarcopenia (OR = 12.09, 95% CI: 1.24-117.50, P = 0.032). Individuals with a score of 12 had a higher risk of confirmed sarcopenia (OR = 30.94, 95% CI: 4.25-103.02, P < 0.001) and severe sarcopenia (OR = 35.90, 95% CI: 4.25-303.07, P = 0.001) compared with subjects with a score of 14. The models also showed that MNA-SF < 13 could predict sarcopenia.

Conclusion

There was a significant association between MNA-SF and confirmed and severe sarcopenia in nourished people. Sarcopenia assessment in people with MNA-SF < 13 can be beneficial. Developing a tool to identify the risk of malnutrition and sarcopenia at the same time based on MNA-SF can be considered.

Association of periodontitis with handgrip strength and skeletal muscle mass in middle-aged US adults from NHANES 2013-2014

OBJECTIVES

The relationship between periodontitis and sarcopenia parameters in middle-aged adults is largely unexplored. This study investigated the association between periodontitis and combined handgrip strength and skeletal muscle mass in middle-aged adults.

MATERIALS AND METHODS

A sub-cohort of 1912 individuals with complete periodontal and whole-body dual X-ray absorptiometry examinations from the 2013-2014 wave of the National Health and Nutrition Examination Survey (n = 10,175) were analyzed using fully adjusted multiple linear regression models for associations between periodontitis and skeletal muscle mass index (kg/m2) and combined handgrip strength (kg).

RESULTS

The mean age of the study cohort was 43 (± 8.4) years and 49.4% of the participants were male. In total, 612 participants (32%) were determined to have periodontitis, of which 513 (26.8%) had non-severe (mild or moderate) periodontitis, and 99 (5.2%) had severe periodontitis. In unadjusted regression models, both non-severe and severe periodontitis were associated with SMMI (βnon-severe = 1.01, 95% CI 0.50; 1.52 and βsevere = 1.42, 95% CI 0.59; 2.25) but not with cHGS. After adjusting for age, sex, education, body mass index, bone mineral density, diabetic status, education, total energy intake, total protein intake, and serum vitamin D2 + D3, periodontitis was associated with cHGS (βnon-severe = -2.81, 95% CI - 4.7; - 1.15 and βsevere = - 2.73, 95% CI - 6.31; 0.83). The association between periodontitis and SMMI remained for non-severe periodontitis (βnon-severe = 0.07, 95% CI - 0.26; 0.40 and βsevere = 0.22, 95% CI - 0.34; 0.78).

CONCLUSION

The present study highlights the need of further prospective research to investigate the nature and direction of the relationship between periodontitis and sarcopenia indicators. Future studies can support the screening, prevention and clinical management of sarcopenia and periodontitis, and emphasize the interdisciplinary and complementary approach between the disciplines of geriatric medicine and periodontology.

Oral conditions and other symptoms among older persons in long-term care facilities during the end of life

AIMS

The purpose was to examine the association between oral conditions and other symptoms in long-term care facilities during the last days of life.

METHODS

A retrospective case-control study approach was used in this study, with the Minimum Data Set (MDS, ver. 3.0 2015) that was maintained and administrated by the Centers for Medicare and Medicaid Services (CMS). Residents with oral conditions (n = 4304) were selected with any oral conditions (e.g., ulcers, inflamed/bleeding gums, mouth/facial pain). The control cases (n = 12 912) were selected using propensity analysis.

RESULTS

Oral conditions had significant impacts on depression, poor appetite, pain, shortness of breath, and constipation. Although no statistically significant differences in trouble sleeping, vomiting, internal bleeding, and dehydration were found between the cases with oral conditions and the control, more residents with oral conditions reported trouble sleeping and dehydration compared to the control.

CONCLUSIONS

It is important to provide preventive and proactive intervention for oral conditions, not only to minimize the negative effects of oral conditions on other symptoms in long-term care facilities, but also to share philanthropic support with people who might be suffering other symptoms due to oral conditions at the end of life.

Cooking skills modify the association between oral health and mortality

Poor oral health has been linked to an increased risk of mortality. People with good cooking skills may be able to cope with problems caused by oral dysfunction, such as restricted food choice. This study investigated whether cooking skills modified the association between oral health status and mortality. A 3-year follow-up was conducted among participants of the Japan Gerontological Evaluation Study, a population-based cohort study of Japanese adults aged 65-101 years. Oral health assessment comprised number of teeth and three oral functions (awareness of swallowing difficulty, decline in masticatory function, and dry mouth). Cooking skills were assessed using a valid scale adapted for Japanese participants. Mortality from 2016 to 2019 was analysed for 10,121 respondents. Cox regression models were used to estimate hazard ratios for mortality risk adjusting for potential confounders, including sociodemographic factors and health status. During the follow-up, there were 488 deaths (4.8% of all participants). Both fewer teeth and poor oral function were associated with a greater mortality risk. Cooking skills modified the association only for oral function. Stratification by cooking skill score showed that the hazard ratios for ≥2 oral difficulties (vs. none) was 2.06 (95% confidence interval: 1.43-2.96) among those with low cooking skills and 1.25 (95% confidence interval: 0.92-1.71) among those with high cooking skills after adjusting for potential confounders. Improving cooking skills may be key to mitigating health risks owing to poor oral functions.

Factors affecting oral and dental services` utilization among Elderly: a scoping review

BACKGROUND

Regular use of oral and dental services by the elderly is one of the important factors in reducing oral and dental diseases. This study aimed to identify the factors affecting oral and dental services` utilization among elderly.

METHODS

The published articles on the factors affecting oral and dental services` utilization among elderly were found through a scoping search and using related keywords in PubMed, Scopus, Embase, and Web of Science databases within January 2000 - December 2022 according to the PRISMA guidelines. The data were analyzed using the thematic analysis method.

RESULTS

Among the 2381 articles retrieved from the databases, forty-two were extracted. The factors affecting oral and dental services` utilization among elderly were classified into five main components as follows: access, demographic factors, social factors, health level, and mental factors. The results showed that income, education level, living area, number of teeth, and importance of care were the most frequent in the main components of access, demographic factors, social factors, health level, and mental factors, respectively.

CONCLUSION

Equitable utilization of oral and dental services is the right of all members of the society, especially the elderly. Therefore, it is necessary to provide the elderly with suitable conditions to utilize such services, which are mostly luxury items. Furthermore, increasing the elderly's awareness and encouraging them to use oral and dental services regularly can help reduce the burden of oral and dental diseases.

Factors Associated With Regular Dental Care in People With Spinal Cord Injury: A Secondary Analysis of Data From the FRASCI Study

Background

Oral health and regular dental care are critical to overall health. Research has found associations between oral health and infections, respiratory disease, and poor quality of life in the general population. While risks for all are increased in people with spinal cord injury (SCI), there is limited information on dental care after SCI.

Objectives

The purpose of this analysis was to examine factors associated with regular dental care in people with SCI.

Methods

We analyzed data from 348 individuals with traumatic and nontraumatic SCI who were enrolled in the Fracture Risk after SCI (FRASCI) study. The dataset included two variables on dental care, as well as demographics, injury-related characteristics, and secondary conditions. Bivariate relationships were determined using two-sided t tests and chi-square tests.

Results

Over 60% of the sample received regular dental care twice per year, and 71% reported seeing a dentist within the past year. Those participants receiving regular dental care twice a year were more likely to be female, be working, have more than a high school diploma, have private insurance, and need a caregiver compared to those who do not receive regular dental care. In addition, these participants were more likely to have had pneumonia since their SCI and have had a urinary tract infection in the past year and since injury.

Conclusion

More data on oral health are needed to make conclusions about the impact of oral health on secondary conditions and quality of life in people with SCI.

An Overview of Systemic Health Factors Related to Rapid Oral Health Deterioration among Older People

The oral health of older individuals can be negatively impacted by various systemic health factors, leading to rapid oral health deterioration. This paper aims to present an overview of the published evidence on systemic health factors that contribute to rapid oral health deterioration in older individuals, and to explore the implications of these factors for both general healthcare and oral healthcare provision. Older people are at risk of experiencing adverse reactions to medications due to multimorbidity, polypharmacy, and changes in pharmacokinetics and pharmacodynamics. Hyposalivation, a significant side effect of some medications, can be induced by both the type and number of medications used. Frailty, disability, sarcopenia, care dependency, and limited access to professional oral healthcare can also compromise the oral health of older people. To prevent rapid oral health deterioration, a comprehensive approach is required that involves effective communication between oral healthcare providers, other healthcare providers, and informal caregivers. Oral healthcare providers have a responsibility to advocate for the importance of maintaining adequate oral health and to raise awareness of the serious consequences of weakened oral health. By doing so, we can prevent weakened oral health from becoming a geriatric syndrome.

The association of dietary inflammatory potential with sarcopenia in Chinese community-dwelling older adults

BACKGROUND

Dietary-induced inflammation is potentially associated with sarcopenia. Nevertheless, few studies have investigated the structure of the inflammatory diet and its correlation with muscle function and performance in both the upper and lower limbs. This study was performed to explore the association of the dietary inflammatory index (DII) with sarcopenia and its diagnostic parameters.

METHODS

We conducted a cross-sectional survey on a sample of 515 Chinese community-dwelling older adults selected through multistage cluster sampling from three districts in Shanghai. DII scores were calculated using a validated food frequency questionnaire. Sarcopenia and its diagnostic parameters were determined based on the definition set by the Asian Working Group on Sarcopenia (AWGS).

RESULTS

The mean age of study participants was 71.31 ± 4.71 years. The prevalence of sarcopenia in the cohort was 12.4%. Older adults in the highest DII quartile had a 3.339 times increased risk of sarcopenia compared to those in the lowest quartile (OR _Quartile4vs1:3.339, 95%CI: 1.232, 9.052, p-trend: 0.004) after adjusting for confounding factors. Additionally, a more pro-inflammatory diet was associated with lower appendicular skeletal muscle index (ASMI) (OR _Quartile4vs1: 3.005, 95%CI: 1.275, 7.318, p-trend: 0.005), a higher 5-times sit-stand test time score (OR _Quartile4vs1: 4.942, 95%CI: 1.745, 13.993, p-trend: 0.005), and lower gait speed (OR _Quartile4vs1: 2.392, 95%CI: 1.104, 5.185, p-trend: 0.041) after adjusting for confounding factors. However, there was no significant association between DII, handgrip strength, and Short Physical Performance Battery (SPPB) score in either the unadjusted or adjusted model.

CONCLUSION

This study found that the association between consuming a more pro-inflammatory diet and sarcopenia in Chinese community-dwelling older adults was mainly due to underlying low intakes of dietary energy, protein, and anti-inflammatory foods, and not due to the high intake of pro-inflammatory foods. Meanwhile, DII was more highly correlated with lower limb muscle strength and performance compared to upper limb muscle strength.

Geriatric Phenotypes and Their Impact on Oral Health

Older adults have multiple morbidities that can impact oral, systemic, and psychological health. Although each disorder requires consideration from the provider before treatment, by assessing the common phenotypic presentations of older adults, we can better understand, select, and coordinate treatment modifications that would need to be considered and implemented for dental care.

Functional Neuroplasticity of Adults with Partial or Complete Denture Rehabilitation with or without Implants: Evidence from fMRI Studies

Tooth loss may affect food ingestion and, consequently, nutrition intake. The neuroimaging literature using functional magnetic resonance imaging (fMRI) was reviewed to summarize the changes in brain functions in response to denture rehabilitation in patients with partial or complete edentulous dentition. Overall, this review covered nine fMRI studies on denture rehabilitation. Eight recruited complete edentulous patients, whereas one recruited partially edentulous patients. The risk-of-bias assessment revealed concerns regarding all nine studies. Due to the heterogeneity of the studies and the lack of brain coordinates reported, a meta-analysis could not be conducted, and this review could only summarize the findings without statistical validation. The evidence from jaw-clenching studies suggested that implant-supported fixed dentures could be the best option, as compared to implant-supported overdentures and complete dentures, as it was associated with higher brain activity levels in various brain regions, including those corresponding to the primary sensory (postcentral gyrus) and motor cortices (precentral gyrus). Gum-chewing studies indicated that perhaps the medial and middle frontal gyri were associated with food comminuting and food mixing, which could be improved by the full replacement of the dental arch, instead of only partial replacement. All the fMRI studies described the functional neuroplasticity of the patients undergoing denture rehabilitation and suggested that certain rehabilitation options were more beneficial in restoring masticatory functions, as well as their associated brain activity levels.

Cytotoxicity Test of Active Compounds Natural Ingredients of Snail Mucus (Achatina fulica) Against BHK-21 Fibroblast Cells

Snails are unpleasant yet beneficial. Rural people have used one to treat illnesses like toothache for years. We will test snail's mucus Achatina fulica's cytotoxic activity against Baby Hamster Kidney (BHK-21) fibroblast cells at 12.5%, 25%, 50%, 100% and its resistance to Phorpyromonas gingivalis, Fusobacterium nucleatum, E. Faecalis, and S. aureus using Microtetrazolium (MTT) assay. The test and comparison solution was incubated with 5x103/100 l cells in 96-well plates. 5 mg/mL MTT completed the solution's incubation. ELISA readers measured purple color intensity. The formula transformed absorbance data at 595 nm into percent alive cells. ELISA readers read data. ANOVA, parametric Kolmogorov-Smirnov data normality test were performed. The cytotoxicity statistical test shows the following results: 12.5 % (0.76875 ±0.01117), 25% (0.49350 ±0.004796), 50% (0.30250 ±0.006658) and 100% (0.171 ±0.10488). The lowest cytotoxicity of Achatina fulica snail mucus is 12.5% with an average of 0.768. Achatina fulica snail mucus resists Phorpyromonas gingivalis, Fusobacterium nucleatum, E. Faecalis, and S. aureus at 12.5%.

COVID-19 and Frailty

Older age is a major risk factor for adverse outcomes of COVID-19, potentially due to immunosenescence and chronic low-grade inflammation, both characteristics of older adults which synergistically contribute to their vulnerability. Furthermore, older age is also associated with decreased kidney function and is consequently associated with an increased risk of cardiovascular disease. All of this in the course of COVID-19 infection can worsen and promote the progression of chronic kidney damage and all its sequelae. Frailty is a condition characterized by the decline in function of several homeostatic systems, leading to increased vulnerability to stressors and risk of adverse health outcomes. Thus, it is very likely that frailty, together with comorbidities, may have contributed to the high vulnerability to severe clinical manifestations and deaths from COVID-19 among older people. The combination of viral infection and chronic inflammation in the elderly could cause multiple unforeseen harmful consequences, affecting overall disability and mortality rates. In post-COVID-19 patients, inflammation has been implicated in sarcopenia progression, functional activity decline, and dementia. After the pandemic, it is imperative to shine a spotlight on these sequelae so that we can be prepared for the future outcomes of the ongoing pandemic. Here, we discuss the potential long-term consequences of SARS-CoV-2 infection and its possibility of causing permanent damage to the precarious balance existing in the frail elderly with multiple pathologies.

Quantifying Pharyngeal Residue Across the Adult Life Span: Normative Values by Age, Gender, and Swallow Task

PURPOSE

We quantified pharyngeal residue using pixel-based methods in a normative data set, while examining influences of age, gender, and swallow task.

METHOD

One hundred ninety-five healthy participants underwent a videofluoroscopic swallow study following the Modified Barium Swallow Impairment Profile (MBSImP) protocol. ImageJ was used to compute Normalized Residue Ratio Scale and the Analysis of Swallowing Physiology: Events, Kinematics and Timing (ASPEKT) pharyngeal residue measures. Reliability was established. Descriptive statistics were performed for all residue measures. Inferential statistics were performed using ASPEKT total scores (i.e., %C2-42). Logistic regression models explored predictors of residue versus no residue. Generalized linear mixed models explored predictors of nonzero residue. Spearman rho explored relationships between ASPEKT total residue scores and MBSImP Component 16 (Pharyngeal Residue) scores.

RESULTS

Majority of swallows (1,165/1,528; 76.2%) had residue scores of zero. Residue presence (%C2-42 > 0) was influenced by age (more in older [F = 9.908, p = .002]), gender (more in males [F = 18.70, p < .001]), viscosity (more in pudding, nectar, and honey [F = 25.30, p < .001]), and volume (more for cup sip [F = 37.430, p < .001]). When residue was present (363/1,528 = 23.8%), amounts were low (M = 1% of C2-42, SD = 2.4), and only increasing age was associated with increased residue (F = 9.008, p = .007) when controlling for gender and swallow task. Increasing residue was incremental (0.01% of C2-42 per year). As ASPEKT total residue values increased, MBSImP Component 16 scores also increased.

CONCLUSIONS

Pharyngeal residue amounts were very low in healthy adults. Residue presence can be influenced by age, gender, and swallow task. However, when present, the amount of pharyngeal residue was only associated with increasing age.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21957221.

New horizons in understanding oral health and swallowing function within the context of frailty

Frailty is a complex and multidimensional condition wherein declines in physiologic reserve and function place individuals in a state of heightened vulnerability and decreased resiliency. There has been growing interest in both research and clinical settings to understand how to best define, assess and characterise frailty in older adults. To this end, various models and clinical assessment tools have been used to define and measure frailty. While differences exist among these models and tools, a common unifying theme is a focus on physical function and activity. Notably absent across many available conceptual models and clinical tools are items directly related to oral and swallowing function. This is an important oversight as widespread changes to both oral and swallowing function are evident in older adults. Indeed, emerging evidence suggests many of the functional domains affected in frail older adults, such as nutrition and sarcopenia, have cyclical relationships with impairments in oral (oral hypofunction) and swallowing function (dysphagia) as well. The increasing appreciation for the interrelationships among oral hypofunction, dysphagia and frailty provides an opportunity for refinement of frailty assessment and characterisation in older adults to incorporate metrics specific to oral and swallowing function.

Masticaticatory muscles characteristics in relation to adiposity and general muscular fitness: a population-based study

There is still considerable controversy surrounding the impact of mastication on obesity. The aim of this study was to identify the interplay between the masticatory muscles, teeth, and general muscular fitness and how they contribute to body adiposity in a general German population. This cross-sectional study included 616 participants (300 male, 316 female, age 31-93 years) from the population-based Study of Health in Pomerania. The cross-sectional areas of the masseter, medial and lateral pterygoid muscles were measured using magnetic resonance imaging (MRI), muscular fitness assessed by hand grip strength (HGS) and body fat distribution was measured by bioelectrical impedance analysis (BIA) and MRI. The overall prevalence of obesity was high in our cohort. The cross-sectional area of the masseter muscles was positively associated with the number of teeth, body mass index (BMI) and HGS, and negatively associated with the BIA-assessed body fat when adjusted for age, sex, teeth, and BMI. Especially the correlation was strong (p < 0.001). Analogous relationships were observed between the masseter, HGS and MRI-assessed subcutaneous fat. These associations were most pronounced with masseter, but also significant with both pterygoid muscles. Though the masticatory muscles were affected by the number of teeth, teeth had no impact on the relations between masseter muscle and adiposity. Physical fitness and masticatory performance are associated with body shape, controlled and directed by the relevant muscles.

Association between Bone Mineral Density and Oral Frailty on Renal Function: Findings from the Shika Study

The association between oral frailty (OFr) and body action has been investigated, but its association with systemic function remains unclear. Therefore, this cross-sectional study examined the association between OFr with decreased bone mineral density (BMD) and renal function in residents of Shika town, Ishikawa Prefecture, Japan aged ≥40 years. This study included 400 inhabitants. The OFr total score was assessed using three oral domains in the Kihon Checklist (a self-reported comprehensive health checklist), the number of teeth, and brushing frequency per day. Measurements were the estimated glomerular filtration rate (eGFR) and the osteo-sono assessment index (OSI). Using a two-way analysis of covariance (p = 0.002), significantly lower OSI was indicated in the eGFR < 60 and OFr group than in the eGFR of < 60 and non-OFr group after adjusting for age, body mass index, and drinking and smoking status as confounding factors. Multiple logistic regression analysis confirmed this relationship (p = 0.006). Therefore, lower BMD seems to be associated with lower renal function only when accompanied by OFr. Further longitudinal studies are needed to confirm these results.

Association of self-rated chewing function and oral health status with metabolic syndrome

PURPOSE

The study aimed to examine the association of self-rated chewing function, the number of teeth and periodontal status with metabolic syndrome.

METHODS

The participants were 11,119 adults aged 40-74 years who underwent specific health checkups, including an oral health examination, in 2018 in Japan. This study used the standard questions of the specific health checkups to obtain information on self-rated chewing function. A multinomial logistic regression analysis was performed with metabolic syndrome status as the dependent variable, and age, sex, lifestyle questions, self-rated chewing function, number of teeth, and periodontal status as the independent variables.

RESULTS

Number of teeth and periodontal status were significantly associated with metabolic syndrome after adjusting for confounding variables. Self-rated chewing function was significantly associated with metabolic syndrome in the crude analysis, but not after adjustment for confounding variables. Both number of teeth and periodontal status were significantly associated with self-rated chewing function.

CONCLUSION

There was no significant direct association between self-rated chewing function and metabolic syndrome. Self-rated chewing function may be an indicator of poor oral condition that links to metabolic syndrome.

Association between Intrinsic Capacity and Sarcopenia in Hospitalized Older Patients

OBJECTIVES

This study aimed to clarify the association between intrinsic capacity (IC) and sarcopenia in hospitalized older patients.

DESIGN

A cross-sectional study.

SETTING

Hospital-based.

PARTICIPANTS

This study included 381 inpatients aged ≥ 60 years (225 men and 156 women).

MEASUREMENTS

IC was evaluated in five domains defined by the World Health Organization: cognition (Mini-Mental State Examination), locomotion (Short Physical Performance Battery test), vitality (Short-Form Mini Nutritional Assessment), sensory (self-reported hearing and vision) and psychological (5-item Geriatric Depression Scale) capacities. IC composite score (0-5) was calculated based on five domains, with lower scores representing greater IC. Sarcopenia was defined in accordance with the criteria recommended by the Asian Working Group for Sarcopenia (AWGS) 2019. Multiple linear and logistic regressions were performed to explore the associations between IC composite score and IC domains with sarcopenia and its defining components.

RESULTS

The mean age of 381 patients included was 81.95±8.42 years. Of them, 128 (33.6%) patients had sarcopenia. The median IC composite score was 1 (1, 2). Cognition, locomotion, vitality, sensory and psychological capacities were impaired in 22.6%, 63.5%, 18.9%, 27.3% and 11.3% of patients. Multiple linear regression analyses showed that favorable IC domain scores in cognition, locomotion and vitality were associated with a stronger handgrip strength. A higher vitality score was associated with a greater appendicular skeletal muscle mass index (ASMI), and a higher locomotion score was associated with a greater gait speed. The multiple logistic regression analysis showed that only vitality impairment was associated with sarcopenia. A higher IC composite score was associated with higher risks of sarcopenia, as well as low ASMI, handgrip strength and gait speed.

CONCLUSION

This study indicated that a more serious impairment of IC was associated with a greater risk of sarcopenia. Vitality was the domain most strongly associated with sarcopenia. IC may be employed to detect and manage sarcopenia.

The association between the number of teeth and frailty among older nursing home residents: a cross-sectional study of the CLHLS survey

BACKGROUND

Given that few studies have explored the association between oral health and frailty among older nursing home residents, the purpose of this study was to assess the association between oral health (i.e., the number of teeth and oral behaviors) and frailty in this population using the Chinese Longitudinal Healthy Longevity Survey (CLHLS).

METHODS

This was a national cross-sectional study derived from the seventh wave of CLHLS in 2018, consisting of 365 older nursing home residents aged 65 years or older. The frailty index was constructed based on 32 variables consisting of self-rated health status, anxiety, depression, ADL and IADL. Oral health was measured through the number of natural teeth and tooth brushing behavior. Multiple logistic regression was used to identify this association between the number of teeth, oral health behaviors, and frailty.

RESULTS

The mean age of this sample was 87.6 (SD = 9.5), with 154 (42.2%) males. The prevalence of frailty and edentulism was 71.2% and 33.4%, respectively. Multiple logistic regression analysis found that the likelihood of frailty decreased with an increased number of teeth, with an OR of 0.94 (95% CI: 0.91-0.98). Compared with participants with edentulism, older adults with 1 to 20 teeth had a lower likelihood of frailty (OR = 0.39, 95% CI: 0.17-0.88); these results were also found in older adults with more than 20 teeth (OR = 0.20, 0.07-0.57). Additionally, older adults who brush their teeth regularly have a lower likelihood of frailty than those who never brush their teeth (OR = 0.37, 95% CI: 0.13-0.99).

CONCLUSION

Older nursing home residents who maintain their natural teeth can help lower the risk of frailty, and regular toothbrushing also contributes to decreasing the risk of frailty. Our study emphasizes the importance of oral health, and cohort studies with large-scale samples to address this important issue are warranted in the future.

Understanding the role of smoking and chronic excess alcohol consumption on reduced caloric intake and the development of sarcopenia

This narrative review provides mechanistic insight into the biological link between smoking and/or chronic excess alcohol consumption, and increased risk of developing sarcopenia. Although the combination of excessive alcohol consumption and smoking is often associated with ectopic adipose deposition, this review is focused on the context of a reduced caloric intake (leading to energy deficit) that also may ensue due to either lifestyle habit. Smoking is a primary cause of periodontitis and chronic obstructive pulmonary disease that both induce swallowing difficulties, inhibit taste and mastication, and are associated with increased risk of muscle atrophy and mitochondrial dysfunction. Smoking may contribute to physical inactivity, energy deficit via reduced caloric intake, and increased systemic inflammation, all of which are factors known to suppress muscle protein synthesis rates. Moreover, chronic excess alcohol consumption may result in gut microbiota dysbiosis and autophagy-induced hyperammonemia, initiating the up-regulation of muscle protein breakdown and down-regulation of muscle protein synthesis via activation of myostatin, AMPK and REDD1, and deactivation of IGF-1. Future research is warranted to explore the link between oral healthcare management and personalised nutrition counselling in light of potential detrimental consequences of chronic smoking on musculoskeletal health outcomes in older adults. Experimental studies should investigate the impact of smoking and chronic excess alcohol consumption on the gut-brain axis, and explore biomarkers of smoking-induced oral disease progression. The implementation of behavioural change interventions and health policies regarding smoking and alcohol intake habits may mitigate the clinical and financial burden of sarcopenia on the healthcare system.

Factors Affecting Masticatory Performance of Older Adults Are Sex-Dependent: A Cross-Sectional Study

This cross-sectional study assessed the oral and physical factors contributing to improvement of the masticatory performance of community-dwelling older adults in South Korea. We enrolled 84 healthy older adults (38 men, 46 women; age, 71.40 ± 5.15 years) and assessed their skeletal muscle mass index (SMI), functional tooth units (FTUs), and mixing ability index (MAI). Associations between variables were analyzed using Spearman's correlation coefficient, and the effects of SMI and FTUs on the MAI were evaluated through linear multiple regression. FTUs were positively associated with the MAI in men and women (r = 0.339, p = 0.038 and r = 0.461, p = 0.001, respectively). SMI and FTUs were moderately associated in men (r = 0.459, p = 0.004). MAI showed an approximately 4.4 times increase for each FTU in men (B = 4.442, p = 0.037); however, after the SMI was added, this effect was no longer significant. In women, the MAI increased by about 6.7 times with each FTU (B = 6.685, p = 0.004). FTUs had a significant effect on the MAI only in women with low muscle mass. While there was no significant effect of the SMI on the MAI, its influence should not be overlooked.

Food Accessibility in the Suburbs of the Metropolitan City of Antwerp (Belgium): A Factor of Concern in Local Public Health and Active and Healthy Aging

Population aging and declining birth rates are key demographic trends of the 21st century. While the overall life expectancy and healthy life years increase, the quality of life and functional capacity worsens due to non-communicable diseases strongly related to aging. Therefore, aging citizens are often vulnerable to food insecurity. The aim of this paper is to provide insights into the physical accessibility of fresh food and possible alternatives within the setting of an aging society in Antwerp (Belgium), a metropolitan city at the heart of the EU Reference Site 'Three Rivers Food Delta'. We demonstrate that a large number of the Antwerp suburban areas in which 15 to 25% of current inhabitants are already over 65 years old are confronted with problematic physical accessibility of food due to long walking distances to the nearest food shop. E-commerce has the potential to provide better access to fresh food. This is especially relevant for people with specific needs, such as health-related diets, dysphagia, and/or limited mobility. However, e-commerce introduces new inequalities, as those who would benefit the most from digital accessibility currently use it least. Hence, the organization of fresh food access requires a more thoughtful organization of the 'last mile' and possible alternatives to home delivery. This makes food accessibility an urgent factor of concern in public health and healthy aging in the Antwerp suburban areas.

Dental Prosthetic Rehabilitation Interventions in Elderly Patients Hospitalized in the Nursing Homes of the Lombardy Region: A Retrospective Study

Background: The difficulty of frail, non-self-sufficient or non-ambulatory collaborating elderly residents in nursing homes to eat due to a lack of teeth or the absence of a dental prosthesis leads to an increasingly evident increase in the patients’ systemic pathological state, particularly in older patients who take a lot of medications. Total or partial edentulousness that is not filled with dental prostheses or that is filled with inadequate prostheses, associated with socioeconomic factors, depression, impaired motor functions, heart disease and a large number of chronic diseases including excessive use of drugs, often affects elderlies’ feeding. Aim: In this study, prosthetic rehabilitation was performed on some frail elderly residents in 10 nursing homes in the Lombardy district, and, subsequently, meal behavior and social activity were examined in two information questionnaires through compilation. Methods: The research was conducted on only 67 patients, 26 men and 41 women, aged between 75 and 99, who were guests in 10 health facilities (nursing homes) in the Lombard district; only 8 residents did not undergo prosthetic rehabilitation, as they did not cooperate. All the patients who were visited underwent oral prosthetic rehabilitation, and, subsequently, some aspects such as nutrition and socialization were assessed with other residents through the aid of two information dossiers. Results: the results showed that all the residents, despite difficulties in chewing with the new prosthesis, were fed and did not refuse more consistent foods; in addition, there was an improvement in social activity among the residents. Only 19.3% of men and 22% of women continued to eat little; there was an improvement in the participation in social activities among the residents, with a percentage of 73% of men and 88% of women; in particular, during meals 35 residents conversed with the other residents. Discussion: The dental problems of elderly people residing in social welfare homes are increasingly evident when other systemic pathologies are present. It would be desirable to introduce telemedicine in residences for the elderly for the monitoring of dental problems. Conclusions: From the information obtained and from the evaluation of the change in the elderly, it can be concluded that it would be desirable to include specific dental protocols to create a network, including a telematic one, to monitor and perform more dental checks in nursing homes.

Reply to Grant, W.B. Comment on "Coelho-Junior et al. Protein Intake and Frailty in Older Adults: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients 2022, 14, 2767"

We recently conducted a systematic review and meta-analysis to assess the association between protein consumption and frailty in older adults [...].

Characterization of Oral Veillonella Species in Dental Biofilms in Healthy and Stunted Groups of Children Aged 6-7 Years in East Nusa Tenggara

Impaired development that causes stunting is one of the most common health problems in Indonesia. In particular, the highest number of cases of stunting in Indonesia was reported in the East Nusa Tenggara (NTT) province. Previous studies have shown a tendency for deteriorating oral hygiene in children with a poor nutritional status. In addition, a higher proportion of oral Veillonella has been reported in children with poor oral hygiene. However, the relationship between populations of oral Veillonella and stunting has not been studied before. Therefore, this study aimed to analyze the oral Veillonella profile in the dental biofilms of healthy and stunted children aged 6-7 years. The participants were 60 elementary school students in the Nangapanda District, Ende, NTT, Indonesia. In this study, real-time polymerase chain reaction was used to examine dental biofilm samples from the healthy (n = 31) and stunted (n = 29) groups. The results revealed that seven oral Veillonella species were found in all groups. However, the number of four oral Veillonella species significantly differed between the healthy and stunted groups: V. denticariosi, V. infantium, V. rogosae, and V. tobetsuensis. This is the first study to demonstrate a potential association between oral Veillonella species and stunting in children.

Protein Intake and Oral Health in Older Adults-A Narrative Review

Oral health is vital to general health and well-being for all ages, and as with other chronic conditions, oral health problems increase with age. There is a bi-directional link between nutrition and oral health, in that nutrition affects the health of oral tissues and saliva, and the health of the mouth may affect the foods consumed. Evidence suggests that a healthy diet generally has a positive impact on oral health in older adults. Although studies examining the direct link between oral health and protein intake in older adults are limited, some have explored the relationship via malnutrition, which is also prevalent among older adults. Protein-energy malnutrition (PEM) may be associated with poor oral health, dental caries, enamel hypoplasia, and salivary gland atrophy. This narrative review presents the theoretical evidence on the impact of dietary protein and amino acid composition on oral health, and their combined impact on overall health in older adults.

Association between the number of remaining teeth and disability-free life expectancy, and the impact of oral self-care in older Japanese adults: a prospective cohort study

Background

Tooth loss has been reportedly associated with shorter disability-free life expectancy (DFLE). However, no study has explored whether oral self-care offsets reduction in DFLE. The present study aimed to assess the association between oral self-care and DFLE in older individuals with tooth loss.

Methods

Data on the 13-year follow-up from a cohort study of 14,206 older Japanese adults aged ≥ 65 years in 2006 were analyzed. Information on the number of remaining teeth was collected using a questionnaire, and the participants were then categorized into three groups (0–9, 10–19, and ≥ 20 teeth). Additionally, “0–9” and “10–19” groups were divided into two subgroups based on whether they practiced oral self-care. DFLE was defined as the average number of years a person could expect to live without disability, and was calculated by the multistate life table method based on a Markov model.

Results

DFLE (95% confidence interval) was 19.0 years (18.7–19.4) for 0–9 teeth, 20.1 (19.7–20.5) for 10–19 teeth, and 21.6 (21.2–21.9) for ≥ 20 teeth for men. For women, DFLE was 22.6 (22.3–22.9), 23.5 (23.1–23.8), and 24.7 (24.3–25.1), respectively. Practicing oral self-care was associated with longer DFLE, by 1.6–1.9 years with brushing ≥ 2 times a day in people with 0–9 and 10–19 teeth, and by 3.0–3.1 years with the use of dentures in those with 0–9 teeth.

Conclusions

Practicing oral self-care is associated with an increase in DFLE in older people with tooth loss.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03541-2.

Chinese expert consensus on prevention and intervention for the elderly with malnutrition (2022)

Malnutrition is a state of altered body composition and body cell mass due to inadequate intake or utilization of energy or nutrients, leading to physical and mental dysfunction and impaired clinical outcomes. As one of the most common geriatric syndromes, malnutrition in the elderly is a significant risk factor for poor clinical outcomes, causing a massive burden on medical resources and society. The risk factors for malnutrition in the elderly are diverse and include demographics, chronic diseases, and psychosocial factors. Presently, recommendations for the prevention and intervention of malnutrition in the elderly are not clear or consistent in China. This consensus is based on the latest global evidence and multiregional clinical experience in China, which aims to standardize the prevention and intervention of malnutrition in the elderly in China and improve the efficacy of clinical practice and the prognosis of elderly patients.

Immunoglobulin Disorders and the Oral Cavity: A Narrative Review

The oral mucosa is a mechanical barrier against the penetration and colonization of microorganisms. Oral homeostasis is maintained by congenital and adaptive systems in conjunction with normal oral flora and an intact oral mucosa. Components contributing to the defense of the oral cavity include the salivary glands, innate antimicrobial proteins of saliva, plasma proteins, circulating white blood cells, keratinocyte products of the oral mucosa, and gingival crevicular fluid. General disturbances in the level of immunoglobulins in the human body may be manifested as pathological lesions in the oral mucosa. Symptoms of immunoglobulin-related general diseases such as mucous membrane pemphigoid (MMP), pemphigus vulgaris (PV), linear IgA bullous dermatosis (LABD), Epidermolysis Bullosa Aquisita (EBA), and Hyper-IgE syndrome (HIES) may appear in the oral cavity. In this review, authors present selected diseases associated with immunoglobulins in which the lesions appear in the oral cavity. Early detection and treatment of autoimmune diseases, sometimes showing a severe evolution (e.g., PV), allow the control of their dissemination and involvement of skin or other body organs. Immunoglobulin disorders with oral manifestations are not common, but knowledge, differentiation and diagnosis are essential for proper treatment.

Burden of Oral Diseases and Access to Oral Care in an Ageing Society

OBJECTIVE

The total years lived with disability among older people, and the concomitant burden of tooth loss in ageing societies have increased. This study is an overview of the burden of oral diseases and access to oral care in an ageing society.

METHODS

We selected key issues related to the burden of oral diseases and access to oral care and reviewed the relevant literature.

RESULTS

The rising number of older people with teeth increases their oral health care needs. To improve access to oral care, affordability of care is a great concern with respect to universal health coverage. In addition, accessibility is a crucial issue, particularly for vulnerable older adults. To improve oral care access, attempts to integrate oral health care into general care are being made in ageing countries. For this purpose, provision of professional oral care at home through domiciliary visits and provision of daily oral health care by non-dental professional caregivers are important. Oral health care for older people reduces general diseases such as pneumonia and malnutrition, which in turn could reduce further healthcare costs.

CONCLUSIONS

To address the growing burden of oral care in ageing societies, special provision of oral health care to vulnerable older people, and integration of oral care with primary care will be required.

Relationship between chewing ability and malnutrition, sarcopenia, and frailty in older adults

BACKGROUND

Several studies reported that impaired nutrition is associated with reduced muscle mass, muscle strength, and physical performance. Chewing ability is essential to maintain balanced oral nutrient intake. The study was designed to define the possible relationship between chewing ability and nutrition-related problems (malnutrition, sarcopenia, and frailty) in a holistic perspective.

METHODS

This cross-sectional study recruited adults aged ≥65 years. All patients were evaluated with comprehensive geriatric assessment. Sarcopenia was diagnosed according to European Working Group on Sarcopenia in Older People criterion. Malnutrition was determined according to body mass index, calf circumference, and Mini Nutritional Assessment short form (MNA-SF). Frailty status was diagnosed with the Clinical Frailty Scale. Masseter and gastrocnemius muscle thicknesses (MTs) were measured via ultrasonography imaging. Oral examinations were carried out by a dentist, and chewing performance was examined with a color-changeable chewing gum.

RESULTS

Overall, 135 older adults (76 females) were analyzed. Mean ± SD age was 75.7 ± 7.2 years; 37.0% of the patients were frail, 3.7% were malnourished, 12.6% were sarcopenic, and 20.0% had poor chewing function. In the poor chewing function group, age and frailty scores were increased and the MNA-SF scores, handgrip strength, skeletal muscle index, and masseter MT were reduced (all P < 0.05). After adjusting for confounders, regression analysis showed that low grip strength and low gastrocnemius MT were independently associated with poor chewing ability.

CONCLUSIONS

Chewing ability was related to sarcopenia. Age and low grip strength in females and low cognitive scores and having low gastrocnemius MT in males were independent variables affecting chewing ability.

Mechanisms Involved in Gut Microbiota Regulation of Skeletal Muscle

Skeletal muscle is one of the largest organs in the body and is essential for maintaining quality of life. Loss of skeletal muscle mass and function can lead to a range of adverse consequences. The gut microbiota can interact with skeletal muscle by regulating a variety of processes that affect host physiology, including inflammatory immunity, protein anabolism, energy, lipids, neuromuscular connectivity, oxidative stress, mitochondrial function, and endocrine and insulin resistance. It is proposed that the gut microbiota plays a role in the direction of skeletal muscle mass and work. Even though the notion of the gut microbiota-muscle axis (gut-muscle axis) has been postulated, its causal link is still unknown. The impact of the gut microbiota on skeletal muscle function and quality is described in detail in this review.

Eating problems among old home care clients

Aims

The purpose was to examine the prevalence and determinants of self‐reported eating problems in old home care clients, screened separately by a clinical nutritionist and a dental hygienist.

Methods and Results

The data came from the Nutrition, Oral Health and Medication (NutOrMed) study, the participants of which were ≥75‐year‐old home care clients living in Finland. The structured interviews were conducted at the participants' (n = 250) homes. Of the participants, 29% reported poor appetite, 20% had problems with chewing, and 14% had problems with swallowing when asked by a clinical nutritionist. Additionally, 18% reported oral health‐related eating problems when asked by a dental hygienist. Participants with continuous xerostomia (odds ratio [OR]: 3.0, 95% confidence interval [CI]: 1.0–9.0) or poor self‐reported oral health (OR: 4.3, 95% CI: 1.4–13.0) had a higher risk for problems with chewing when asked by a clinical nutritionist. Edentulous participants (OR: 3.5, 95% CI: 1.2–10.9) and participants with toothache or problems with dentures (OR: 10.3, 95% CI: 4.0–26.0) had a higher risk for oral health‐related eating problems when asked by a dental hygienist.

Conclusion

Eating problems are common in older adults, and interprofessional collaboration is required for their identification and alleviation.

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

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.

Memory decline in older individuals predicts an objective indicator of oral health: findings from the Sydney Memory and Ageing Study

Background

Growing evidence suggests that there is an association between poor oral health and cognitive function in late adulthood. However, most studies to date have relied on cross-sectional research methods that do not permit inferences about the temporality of any association. Moreover, the few longitudinal studies that do exist have typically relied on small samples and quite limited cognitive or oral health assessments. The aim of the present study was therefore designed to provide the first direct evaluation of whether cognitive function is predictive of poor oral health in older adults.

Methods

This longitudinal research included data from 339 participants aged 70 years or older from The Sydney Memory and Ageing Study (MAS), a large cohort of healthy community-dwelling older adults. Cognitive function was assessed using a battery of tests at baseline (Wave 1) in 2005 and six years later (Wave 4) in 2011. In 2015 (Wave 6), participants were assessed for oral health using the Oral Health Assessment Tool (OHAT), number of functional occluding pairs of natural teeth and sublingual resting saliva pH (SRSpH). Ordinal least squares regression analysis was used to model the effect of cognitive function on total OHAT score, and binomial logistic regression used for SRSpH and occluding pairs of functional teeth.

Results

Two models were tested. In the partially adjusted model, age, gender and years of education were included. The fully adjusted model additionally included medical conditions, general health, depression, smoking, alcohol consumption, functionality, and dental care utilization. The key finding to emerge was that a six-year change in memory (from Wave 1 to Wave 4) was associated with lower sublingual resting saliva pH at Wave 6 in partially (Odds Ratio (OR) = 0.65) and fully adjusted model (OR = 0.63).

Conclusions

This longitudinal study provides further evidence that a relationship between cognitive function and oral health exists, and also points to this relationship potentially being bi-directional, as previous evidence suggests. The findings from the study also suggest that older adults who present with greater than normal memory decline at an earlier point in life were more likely to experience poor oral health when this was evaluated at a later time-point, four years later.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-022-02128-y.

Sarcopenic Dysphagia, Malnutrition, and Oral Frailty in Elderly: A Comprehensive Review

Frailty is a highly prevalent condition in the elderly that has been increasingly considered as a crucial public health issue, due to the strict correlation with a higher risk of fragility fractures, hospitalization, and mortality. Among the age-related diseases, sarcopenia and dysphagia are two common pathological conditions in frail older people and could coexist leading to dehydration and malnutrition in these subjects. “Sarcopenic dysphagia” is a complex condition characterized by deglutition impairment due to the loss of mass and strength of swallowing muscles and might be also related to poor oral health status. Moreover, the aging process is strictly related to poor oral health status due to direct impairment of the immune system and wound healing and physical and cognitive impairment might indirectly influence older people’s ability to carry out adequate oral hygiene. Therefore, poor oral health might affect nutrient intake, leading to malnutrition and, consequently, to frailty. In this scenario, sarcopenia, dysphagia, and oral health are closely linked sharing common pathophysiological pathways, disabling sequelae, and frailty. Thus, the aim of the present comprehensive review is to describe the correlation among sarcopenic dysphagia, malnutrition, and oral frailty, characterizing their phenotypically overlapping features, to propose a comprehensive and effective management of elderly frail subjects.

Influence of oral health on frailty in patients with type 2 diabetes aged 75 years or older

Background

Poor oral health conditions are known to affect frailty in the older adults. Diabetes is a risk factor for both poor oral health and frailty, therefore, oral health status may affect frailty in diabetic patients more than in the general population. The purpose of this study was to evaluate the influence of oral health and other factors on frailty and the relationship among oral health, diabetes and frailty in older adult patients with type 2 diabetes.

Methods

Patients with type 2 diabetes aged 75 years or older were included in this cross-sectional study. Eligible patients were surveyed by questionnaire for frailty, oral health status, and cognitive and living functions. Factors influencing pre-frailty, frailty, and individual frailty screening index (FSI) classes were evaluated.

Results

Of the 111 patients analyzed, 66 cases (59.5%) were categorized as robust, 33 cases (29.7%) as pre-frailty, and 12 cases (10.8%) as frailty. The oral frailty index, the cognitive and living functions score, and BMI were found to be factors influencing pre-frailty or frailty. In the evaluation of individual FSI classes, BMI had an influence on those with a FSI ≤2. The cognitive and living functions score was a factor influencing those with FSI ≤3. The oral frailty index was found to have a significant influence on all FSI classes.

Conclusions

Poor oral health has an influence on frailty in patients with type 2 diabetes aged ≥75. In this patient population, as frailty progresses, the impact of oral health on frailty may increase.

Trial registration:

This study was retrospectively registered in UMIN-CTR (UMIN000044227).

Locational effects on oral microbiota among long-term care patients

Background

Dysbiosis of oral microbiota is the cause of many diseases related to oral and general health. However, few Asia-based studies have evaluated the role of oral microbiota in patients receiving long-term care. Thus, new indications are needed for early prevention and risk management based on information derived from the oral microbiota.

Methods

We used next-generation sequencing (NGS) to identify the oral bacterial composition and abundance in patients receiving long-term care: 20 from the outpatient department (OPD) and 20 home-care patients. Their microbial compositions, taxonomy, and alpha/beta diversity were characterized.

Results

Microbiota from the two groups showed different diversity and homogeneity, as well as distinct bacterial species. A more diverse and stable microbial population was observed among OPD patients. Our findings indicated that home-care patients had a higher risk of oral diseases due to the existence of dominant species and a less stable microbial community.

Conclusion

This work was the first in Taiwan to use NGS to investigate the oral microbiota of long-term care patients. Our study demonstrated the potential use of dominant bacterial species as biomarkers for the risk management of posttreatment complications.

Clinical Comparison of Diode Laser Assisted “v-Shape Frenectomy” and Conventional Surgical Method as Treatment of Ankyloglossia

(1) Background: Ankyloglossia, or tongue-tie is a condition, in which the tip of tongue cannot protrude beyond the lower incisor teeth because of short frenulum linguae, often containing scar tissue. Limitations of movement are the most important clinical symptoms of this condition, together with feeding, speech, and mechanical problems. (2) Methods: the present study included two groups of patients (group A and group B) including, respectively, 29 and 32 patients (61 patients total), aged from 8 to 12 and presenting ankyloglossia classified according to the Kotlow’s classification. The patients in group A underwent a common surgical procedure. For the patients of group B, a diode laser device (K2 mobile laser, Dentium, Korea) with a micro-pulsed wavelength of 980 ± 10 nm and power of 1.2 watts was used. The post-surgical discomfort of the patients (recording the pain perceived immediately after the end of the anesthesia and during the following week, using the Numeric Rating Scale (NRS) system) and healing characteristics (recorded using the Early Wound Healing Score or EHS) were evaluated. (3) Results: The results shows that the pain in the patients who underwent laser-assisted frenectomy is significantly reduced (p < 0.001) when compared to those who underwent conventional surgical frenectomy, both immediately after surgery (with a reduction in the average NRS of 80.6%) and after the first week (with a reduction in the average NRS of 86.58%). Additionally, in the same patients, an augmentation in the average value of the EHS of 45% was recorded, highlighting significantly (p < 0.001) better quality in the healing of the wound within the 24 h after surgery. Moreover, other advantages observed in the use of laser assisted-frenectomy are the absence of bleeding and, consequently, a clear operative field; no need to use sutures; no need to take painkillers or antibiotics after surgery; and having a faster recovery and less time needed to perform the operation. (4) Conclusions: within the limits of the present study, it seems possible to assert that the laser frenectomy performed using the v-shape technique presents a series of advantages if compared to the conventional surgical method.