Oral declines and mastication deficiencies cause alteration of food bolus properties

Pathways in formulating foods for the elderly

The growth of the elderly population worldwide is posing significant challenges to human society. The progressive physical and physiological changes occur with aging, including decreased appetite, incomplete digestion, and reduced absorption of nutrients. A common feature of many elderly people's diets is a deficiency in proteins (especially easily digestible ones) and micronutrients (e.g., vitamins, zinc, iron, and calcium). One of the solutions to this problem is the incorporation of these components into suitably texture-modified foods. There is a dearth of products that meet the needs of the elderly with special medical/health conditions such as dysphagia, osteoporosis, diabetes, and cardiovascular disease, as well as those who are in hospital and palliative care. Future research and development of foods for the elderly must address specific dietary needs of different subgroups of elderly people with underlying health conditions. The existence of different physical and physiological stages of the elderly means that their specific dietary requirements must be considered. This review summarizes current knowledge on nutritional requirements including those with underlying health problems and outlines the research and innovation pathways for developing new foods considering nutrition, texture, flavor, and other sensory aspects.

Food-Oral Processing: Current Progress, Future Directions, and Challenges

Oral processing refers to the series of physical, chemical, and biological processes inside the oral cavity when we consume food. This process affects the taste, quality, and nutrient absorption of the body. In the human diet, oral processing plays a crucial role because it impacts not only the food flavor and texture but also the absorption and utilization of nutrients. With the progress of science and technology and the increasing demand for food, the study of oral processing has become increasingly important. This paper reviews the history and definition of oral processing, its current state of research, and its applications in food science and technology, focusing on personalized taste customization, protein structure modification, food intake and nutrition, and bionic devices. It also analyzes the impact of oral processing on different types of food products and explores its potential in the food industry and science research.

Comparison of Child and Adult Mastication of a Sticky Processed Cream Cheese and Simulation with a Masticator

An advantage of masticators is the calibration and possible standardization of intra- and inter-individual mastication variability. However, mastication of soft, sticky and melting products, such as processed cream cheeses, is challenging to reproduce with a masticator. The objectives of this work were, for the cheese studied: (1) to compare child and adult mastication and (2) to find in vitro parameters which best reproduce their in vivo chewing. Five parameters influencing mastication (mouth volume, quantity consumed, saliva volume, mastication time and number of tongue-palate compressions) were measured in 30 children (5-12 years old) and 30 adults (18-65 years old) and compared between the two populations. They were then transposed to a masticator (Oniris device patent). The initial cheese, a homogeneous white paste, was surface-colored to investigate its in-mouth destructuring. In vivo boli were collected at three chewing stages (33, 66 and 99% of mastication time) and in vitro boli were obtained by varying the number of tongue-palate compressions and the rotation speed. In vivo and in vitro boli were compared by both image and texture analysis. Child masticatory parameters were proportionally smaller than those of adults. The in vivo child boli were less homogeneous and harder than adult ones. Comparison of in vivo and in vitro bolus color and texture enabled the successful determination of two in vitro settings that closely represented the mastication of the two populations studied.

Utilizing the influence of protein enrichment of meal components as a strategy to possibly prevent undernutrition in the elderly: an in vitro approach

Nutritional strategies are required to limit the prevalence of denutrition in the elderly. With this in mind, fortified meals can provide more protein, but their digestibility must be ensured. Using a dynamic in vitro digester, DIDGI®, programmed with the digestion conditions of the elderly, we evaluated the supplementation of each component of a meal and assessed protein digestibility, amino acid profile, micro-nutrients and vitamins bioaccessibility for a full course meal. Higher protein digestibility was evidenced for the fortified meal, with higher release of essential amino acids. Moreover the large increase of leucine released was comparable to the range advocated for the elderly to favour protein anabolism. This in vitro study underlines the interest of using dish formulations to meet the nutritional needs of seniors, which is why this work will be completed by a clinical study in nursing home.

Fava bean (Vicia faba L.) protein concentrate added to beef burgers improves the bioaccessibility of some free essential amino acids after in vitro oral and gastrointestinal digestion

The influence of partial replacement of animal protein by plant-based ingredients on the protein digestibility of beef burgers was investigated. Beef burgers were supplemented with fava bean protein concentrate (FB) or a mixture of FB and flaxseed flour (FBFS), both processed by extrusion, at different levels: 0 (control), 10, 15, and 20 % (w/w). A pilot sensory analysis was conducted to select the percentage of flour inclusion for further assays: control, 10 % FB, and 10 % FBFS. Protein digestibility, amino acid profile, and protein secondary structure of these burgers after in vitro oral and gastrointestinal digestion were studied. In vitro boluses were prepared with the AM2 masticator, simulating normal mastication, and static in vitro digestion of boluses was performed according to the INFOGEST method. Inclusion of 10 % FB in beef burgers did not alter their flavour or tenderness compared to the control, whereas tenderness and juiciness scored slightly higher for the 10 % FBFS burgers compared to 15 % and 20 % FBFS ones. Poor lipid oxidative stability during storage was observed with 10 % FBFS burgers. Total protein content was significantly higher (p < 0.05) in 10 % FB burgers than in control burgers after in vitro oral digestion. Additionally, 10 % FB burgers presented higher amounts of free essential amino acids like isoleucine, leucine, phenylalanine, and valine at the end of digestion, as well as methionine, tyrosine, and histidine. Partial substitution of meat protein by 10 % FB improves the nutritional profile of beef burgers, without altering their sensory qualities.

Influence of food oral processing, bolus characteristics, and digestive conditions on the protein digestibility of turkey cold meat and fresh cheese

During mastication, foods are progressively transformed to achieve swallowable boluses and their characteristics are crucial for the subsequent digestion events. The main goal of this work was to evaluate the impact of food oral processing, bolus properties, and different digestive conditions on the protein digestibility of turkey cold meat and fresh cheese. In vivo normal and deficient masticated food boluses were prepared by a young volunteer. Besides, three digestion models were used to simulate the different physiological conditions frequently observed in adults and the elderly, presenting good or poor oral health: i) Normal Masticated-Normal Digested model; ii) Deficient Masticated-Normal Digested model; and iii) Deficient Masticated-Elderly Digested model. The oral processing behaviour (number of chews, chewing time, chewing rate, and saliva uptake), bolus particle size, textural and viscoelastic properties of boluses, and protein digestibility of samples were determined. Results showed that deficient masticated boluses exhibited lower amounts of saliva uptake and greater particle sizes, hardness, stiffness, and rigidity, notably in deficient masticated turkey cold meat boluses. Moreover, the worst digestive scenario (Deficient Masticated-Elderly Digested model) negatively impacted on the proteolysis extend of samples, especially for total soluble proteins and soluble peptides contents. The current study demonstrates that the oral processing behaviour and degree of food fragmentation impacted on the granulometric, texture, and viscoelastic properties of both food boluses, whereas the worst digestive scenario commonly observed in the elderly reduced the proteolysis extend of the products evaluated.

Correlating instrumental measurements and sensory perceptions of foods with different textural properties for people with impaired oral and swallowing capabilities - A review

The rising global life expectancy has underlined the necessity of designing novel and tasty food products, suitable for seniors and people with impaired oral and swallowing functions. For developing these products, texture should be optimised from rheological, colloidal, tribological, and masticatory points of view. The current review provides an overview of different studies based on shear rheological, tribological, and in vitro mastication properties of model or real food systems intended for the elderly and/or people with swallowing dysfunctions, with special emphasis on the relation between the instrumental measurements and sensory perceptions of foods. Several works demonstrated that instrumental data from shear rheological and tribological tests complement the sensory evaluations of foods, providing useful information when designing food commodities for specific populations. Conversely, only few works correlated the instrumental data obtained from artificial mouths and/or simulated masticators with the sensory attributes generated by trained assessors. Broaden knowledge of these topics will help in formulating and adapting foods with enhanced functionalities for people with impaired oral and swallowing capabilities. Shear rheology, soft oral tribology, and simulated mastication tests are crucial in designing safe- and easy-swallowing food products.

Oral and gastrointestinal nutrient bioaccessibility of gluten-free bread is slightly affected by deficient mastication in the elderly

The main goal of this work was to investigate the impact of impaired mastication on nutrient bioaccessibility of gluten-free bread in the elderly. In vitro boluses were produced with the AM² masticator by using two types of programming: normal mastication (NM) and deficient mastication (DM). Static in vitro gastrointestinal digestion was performed with the digestive physiology conditions of the elderly. Subsequently, the granulometric properties of the in vitro boluses produced, their starch and protein digestibility, and lipid peroxidation after in vitro oral and gastrointestinal digestion were evaluated. DM boluses presented higher proportions of large particles, resulting in insufficiently fragmented boluses. A delay in oral starch digestion was observed in DM boluses, probably due to the presence of larger particles that limited the bolus-saliva exchanges. Furthermore, DM boluses exhibited a lower degree of protein hydrolysis at the end of gastric digestion, whereas no differences were observed for protein hydrolysis, sugar release, and lipid peroxidation at the end of digestion (intestinal phase). The results of this study show that impaired mastication somewhat delays the nutrient bioaccessibility of the gluten-free bread tested. Such understanding of the effect of oral decline on the nutrient bioaccessibility of foods is crucial when designing food commodities with enhanced functionalities for the elderly.

Peripheral Amino Acid Appearance Is Lower Following Plant Protein Fibre Products, Compared to Whey Protein and Fibre Ingestion, in Healthy Older Adults despite Optimised Amino Acid Profile

Plant-based proteins are generally characterised by lower Indispensable Amino Acid (IAA) content, digestibility, and anabolic properties, compared to animal-based proteins. However, they are environmentally friendlier, and wider consumption is advocated. Older adults have higher dietary protein needs to prevent sarcopenia, a disease marked by an accelerated loss of muscle mass and function. Given the lower environmental footprint of plant-based proteins and the importance of optimising dietary protein quality among older adults, this paper aims to assess the net peripheral Amino Acid (AA) appearance after ingestion of three different plant protein and fibre (PPF) products, compared to whey protein with added fibre (WPF), in healthy older adults. In a randomised, single-blind, crossover design, nine healthy men and women aged ≥65 years consumed four test meals balanced in AA according to the FAO reference protein for humans, matched for leucine, to optimally stimulate muscle protein synthesis in older adults. A fasted blood sample was drawn at each visit before consuming the test meal, followed by postprandial arterialise blood sampling every 30 min for 3 h. The test meal was composed of a soup containing either WPF or PPF 1-3. The PPF blends comprised pea proteins with varying additional rice, pumpkin, soy, oat, and/or almond protein. PPF product ingestion resulted in a lower maximal increase of postprandial leucine concentration and the sum of branched-chain AA (BCAA) and IAA concentrations, compared to WPF, with no effect on their incremental area under the curve. Plasma methionine and cysteine, and to a lesser extent threonine, appearance were limited after consuming the PPF products, but not WPF. Despite equal leucine doses, the WPF induced greater postprandial insulin concentrations than the PPF products. In conclusion, the postprandial appearance of AA is highly dependent on the protein source in older adults, despite providing equivalent IAA levels and dietary fibre. Coupled with lower insulin concentrations, this could imply less anabolic potential. Further investigation is required to understand the applicability of plant-based proteins in healthy older adults.

A dynamic in vitro oral mastication system to study the oral processing behavior of soft foods

A bolus-oriented artificial oral mastication system was developed to simulate the dynamics of food mastication in the human mouth. The system consists of a chewing unit, a bolus forming unit, and provisions for the dynamic incorporation of saliva during mastication. The system performance was validated with in vivo trials (n = 25) considering time-dependent changes in particle size, textural attributes and rheological behavior of the bolus. Idli, a fermented and steamed black gram-rice-based Indian food was considered the model soft food for all trials measured in triplicates. The mastication dynamics were evaluated by analyzing bolus properties during every 3 s of mastication. Large strain shear rheology tests revealed that the viscosity of the sample decreased over time. Results of in vivo trials follow close trends in particle size and rheological behavior and have no significant change in correlation with in vitro mastication results. Similar observations were made in the half softening time of idli during mastication as determined using the relative change in hardness (hardness ratio (H_t/H₀)) values fitted to the Weibull model. Also, a model to simulate the time-dependent changes in bolus adhesiveness was developed.

Deciphering the protein digestion of meat products for the elderly by in vitro food oral processing and gastric dynamic digestion, peptidome analysis and modeling

The elderly population will increase sharply in the future, along with an emerging range of specific nutritional needs that include adapted food. We aimed to develop a workflow to study the fate of a food, objectify the bioavailability of nutrients in the case of the digestive physiology of the elderly, and model the fate of proteins in the stomach. Pork frankfurters were subjected to in vitro normal and deficient mastication and gastric digestion, mimicking adult and elderly food oral and digestive processing. Swallowable food boluses were characterized for granulometric and rheological properties. Biochemical analyses were conducted on the bolus and on the digesta. Macronutrients, label-free peptide quantification and identification were performed, and modeling was applied to protein digestion kinetics. After deficient mastication, the food bolus was harder with more large particles, lower free iron release and more protein oxidation. The amount of peptides released in the stomach progressively increased, but to a lower extent for the elderly digestive condition and irrespective of masticatory efficiency. 592 peptides were identified from 67 proteins. Different trajectories were observed for adult and elderly digestive conditions, and two groups of meat proteins were identified based on the rate of hydrolysis. Designing suitable foods requires in vitro tools to evaluate the possible benefit for the elderly. Besides the well-known notion of Food Oral Processing (FOP), our work broadens the concept by extending oral activity to digestion when working in a nutritional context. This new concept is named Food Oral and Digestive Processing, FODP.

Influence of Prebiotic Fructans on Retronasal Aroma from Elderly Individuals

This study investigates for the first time the role of fructans with prebiotic effects (oligofructose and inulin) on retronasal aroma among elderly individuals. The impact of oligofructose (20% w/w) on retronasal aroma release was investigated using proton transfer reaction-mass spectrometry (PTR-MS) after 73 elderly individuals consumed aqueous solutions aromatized with five aroma compounds (pentan-2-one, nonan-2-one, hexan-2,3-dione, octanal and linalool). The influence of oligofructose and inulin (10% w/w) on the perceived intensity (n = 26) of two aroma descriptors (butter and floral) was also studied together with the possibility of a dumping effect on aroma evaluation due to the sweetness provided by the fructans. The results showed that the presence of oligofructose produced a significant reduction in retronasal aroma release, which could be generally explained by the physicochemical properties of aroma compounds. The presence of prebiotic fructans did not significantly affect the perceived intensity of butter and floral notes, although a dumping effect for the butter descriptor in the presence of oligofructose was observed. To conclude, these findings suggest that although fructans can exert an impact on retronasal aroma, they can be used at precise concentrations to increase the prebiotic fibre content of food products without affecting the aroma profile of foods.

Impact of Cooking Preparation on In Vitro Digestion of Eggs Simulating Some Gastrointestinal Alterations in Elders

This study aimed to in vitro assess the impact of the cooking process of eggs (hard-boiled, poached, and omelet) on nutrients digestibility and vitamins A and D3 bioaccessibility under elderly gastrointestinal (GI) conditions. Three elderly digestion models were mimicked: oral (E1); oral and gastric (E2); and oral, gastric, and intestinal (E3), and a healthy adult model (C). Proteolysis extent reduced after digestion of omelet under the E3 model (p < 0.05) (up to 37% of reduction). Thus, hard-boiled and poached were more recommendable to enhance protein digestibility in elders. Altered GI conditions negatively influence neither the absorbable lipid fraction nor the cholesterol stability. Finally, vitamin A bioaccessibility was not affected but D3 slightly decreased with the elderly (E3). Hence, the digestion of nutrients was dependent on the resulting matrix, poached being the greater supplier of protein and lipid end-digestion products. Poached and omelet, however, offer a high net supply of bioaccessible vitamin D3 for elders.

Risk Factors of Dysphagia Among Community-Dwelling Middle-Aged Women: Focused on Oropharyngeal Phase

This study aimed to characterize a population of middle-aged South Korean women at risk of developing dysphagia and to identify relevant risk factors. This study describes a cross-sectional survey. Data on the general characteristics of the participants, risk factors for dysphagia, depression, and dental pain were collected and analyzed using descriptive statistics and logistic regression analysis. Among the 247 participants, 80 (32.4%) were assigned to the dysphagia "risk" group. Logistic regression indicated that perceived health status, low body mass index, dental pain, and depression were significant risk factors for developing dysphagia. A greater proportion of individuals were classified as having depression in the dysphagia "risk" group. Depression and dental pain were recognized as dominant risk factors for dysphagia. This work provides a basic reference that can be useful for the development of a general health education program for the prevention of dysphagia in community-dwelling middle-aged women.

Development of a Chewing Robot With Built-in Humanoid Jaws to Simulate Mastication to Quantify Robotic Agents Release From Chewing Gums Compared to Human Participants

Medicated chewing gum has been recognised as a new advanced drug delivery method, with a promising future. Its potential has not yet been fully exploited because currently there is no gold standard for testing the release of agents from chewing gum in vitro. This study presents a novel humanoid chewing robot capable of closely replicating the human chewing motion in a closed environment, incorporating artificial saliva and allowing measurement of xylitol release from the gum. The release of xylitol from commercially available chewing gum was quantified following both in vitro and in vivo mastication. The chewing robot demonstrated a similar release rate of xylitol as human participants. The greatest release of xylitol occurred during the first 5 minutes of chewing and after 20 minutes of chewing only a low amount of xylitol remained in the gum bolus, irrespective of the chewing method used. Saliva and artificial saliva solutions respectively were collected after 5, 10, 15 and 20 minutes of continuous chewing and the amount of xylitol released from the chewing gum determined. Bioengineering has been implemented as the key engineering strategy to create an artificial oral environment that closely mimics that found in vivo. These results demonstrate the chewing robot with built-in humanoid jaws could provide opportunities for pharmaceutical companies to investigate and refine drug release from gum, with reduced patient exposure and reduced costs using this novel methodology.

Coordination of surface electromyography activity in the posterior tongue region during mastication of differently textured foods

BACKGROUND

Masticatory movement occurs complicatedly and bilaterally. Although the tongue plays an important role in mastication, bilateral tongue function during mastication has not been clarified yet.

OBJECTIVE

To investigate the effect of food properties on posterior tongue activity and coordination of muscles bilaterally by electromyography (EMG).

METHODS

Twenty healthy adults (10 males and 10 females; mean age 28 years; range: 22-33 years) participated in this study. Three test foods, gummy jelly (hard food), sponge cake (soft food requiring crushing), and mashed potatoes (soft food not requiring crushing), were used. Bilateral masseter N-EMG (surface electromyography for measuring the muscle activity of posterior tongue) and submental EMG were carried out while the participants chewed three test foods. The participants were instructed to masticate three test foods only on the right side and only on the left side unilaterally.

RESULTS

In the case of gummy jelly, N-EMG activity on the mastication side was significantly larger than that on the non-mastication side (P < .01). Regarding temporal relationship between the masseter and N-EMG activity, in the case of gummy jelly, the percentage of cases where the N-EMG peak was observed during masseter muscle EMG bursts was significantly higher than those for sponge cake and mashed potatoes (P < .01).

CONCLUSION

N-EMG activity on the mastication side was significantly larger than that on the non-mastication side in the mastication of hard foods. Tongue showed activity pattern changes and coordinated with the masseter muscle depending on food texture.

Differences in oral processing behavior of consumers varying in age, gender and ethnicity lead to changes in bolus properties but only to small differences in dynamic texture perception of sausages

Consumer characteristics such as age, gender and ethnicity influence food oral processing behavior. The aim of this study was to determine the effect of age, gender and ethnicity on consumption time, bolus properties and dynamic sensory perception of sausages. Consumption time, bolus properties (saliva incorporation, particle size distribution and rheological properties) and dynamic texture perception (Temporal Dominance of Sensations, TDS) of sausages were compared between young Dutch, Caucasians (n = 21; 22 ± 2.8 years), young Chinese, Asians (n = 21; 23 ± 1.6 years), and elderly Dutch, Caucasians (n = 22; 70 ± 4.3 years). Elderly Dutch masticated the sausage 22% longer (25.6 s) than young Dutch consumers (21.0 s). Elderly Dutch produced sausage boli that were softer, more adhesive, less cohesive and contained more particles than those of young Dutch adults. Elderly females produced more adhesive and less cohesive sausage bolus than males. Young Chinese females had 75.6% longer consumption time (29.5 s) than young Dutch females (16.8 s). Young Chinese males masticated the sausages in less time (18.8 s) than young Chinese females (29.5 s). Young Chinese produced softer and less cohesive bolus with slightly smaller and more particles than young Dutch. Saliva incorporation and bolus particle size were not affected by age, gender and ethnicity. Mediation analysis revealed that the effect of consumer characteristics such as age, gender and ethnicity on bolus properties was mediated by consumption time. At the beginning and end of consumption time, dynamic texture perception of sausages was similar for all consumer groups and strongly correlated with bolus properties. Differences in dynamic texture perception between consumer groups were observed only during the middle stages of mastication with low dominance rates. We conclude that consumers differing in age, gender and ethnicity vary in oral processing time to produce bolus with textural properties optimized to their needs. Furthermore, consumption time is the underlying mechanism that explains the differences in bolus properties between the consumer groups. While variations in consumption time of sausages lead to considerable differences in bolus properties, it only leads to small differences in dynamic texture perception.

Important determinants to take into account to optimize protein nutrition in the elderly: solutions to a complex equation

During ageing, skeletal muscle develops anabolic resistance towards the stimulation of protein synthesis induced by dietary amino acids. The stimulation of muscle protein synthesis after food intake remains insufficient, even with a protein intake recommended for healthy adults. This alteration is one of the mechanisms known to be responsible for the decrease of muscle mass and function during ageing, namely sarcopenia. Increasing dietary protein intake above the current RDA(0⋅83 g/kg/d) has been strongly suggested to overcome the anabolic resistance observed. It is also specified that the dietary protein ingested should be of good quality. A protein of good quality is a protein whose amino acid (AA) composition covers the requirement of each AA when ingested at the RDA. However, the biological value of proteins may vary among dietary sources in which AA composition could be unbalanced. In the present review, we suggest that the quality of a dietary protein is also related to several other determinants. These determinants include the speed of digestion of dietary proteins, the presence of specific AA, the food matrix in which the dietary proteins are included, the processes involved in the production of food products (milk gelation and cooking temperature), the energy supply and its nature, and the interaction between nutrients before ingestion. Particular attention is given to plant proteins for nutrition of the elderly. Finally, the timing of protein intake and its association with the desynchronized intake of energetic nutrients are discussed.

Assessment of the Miniature Kramer Shear Cell to Measure Both Solid Food and Bolus Mechanical Properties and Their Interplay with Oral Processing Behavior

This study assessed the usefulness of the miniature Kramer shear cell to determine relevant instrumental parameters of solid foods and bolus counterparts, examining their relationships with oral processing behaviors to obtain greater knowledge about the texture perception process. Six solid foods with different textural properties were tested. Bolus mechanical properties were also determined by means of cone penetration tests and rheological measurements, and their particle size distributions by sieving. Oral processing behavior (chewing time, number of chews, chewing rate, eating rate) and food saliva uptake (SU) of a young volunteer and a panel of 39 untrained participants were analyzed. The Kramer mechanical properties were very suitable for detecting different levels of food and bolus textural hardness and fracturability and the associated degrees of fragmentation achieved during mastication. Chewing time and number of chews were highly correlated with Kramer food and bolus mechanical properties for the single subject and for the panel's oral processing behaviors. For the single subject, SU and eating rate also showed strong correlations with food and bolus mechanical properties, unlike chewing rate and food moisture content (FMC). In contrast, eating rate, FMC, and SU did not vary with the oral activities of the panel.

Measuring the effects of in vitro mastication on bolus granulometry of shredded meat: A proposal for a new methodological procedure

People with poor oral status and/or neuromuscular deficiencies avoid eating meat because of chewing and swallowing difficulties. Consequently, they expose themselves to the risk of malnutrition and sarcopenia or nutrient deficiencies. To develop a new process for meat preparation, it is necessary to understand how meat is broken down during food oral processing to become a swallowable bolus. However, it is unknown whether the initial texture of meat impacts the meat bolus granulometry. As meat particles are fibrous, making the granulometry analysis with sieving methods is difficult. As the approach of meat bolus granulometry is necessary, it is of importance to control the methodological parameters that affect the measures. This study describes a procedure that allows granulometry analysis of shredded meat before and after in vitro mastication. Meat particles were dispersed in glycerol before image analysis. Granulometry curves were then drawn using generalized linear models, particle by particle, or after applying virtual sieves. Artificial meat bolus granulometry was also analyzed by manual sieving and the different methods were compared through several characteristics, including D₅₀. Image analysis in glycerol preserves meat particles and allows particle distribution characterization and shape descriptors analysis. This method is well adapted to shredded meat and could be performed to evaluate the mastication of meat preparations adapted for deficient mastication.