Functional tooth units and nutritional status of older people in care homes in Indonesia

Association Between Change in Prognostic Nutritional Index During Neoadjuvant Therapy and Dental Occlusal Support in Patients with Esophageal Cancer Under Neoadjuvant Therapy: A Retrospective Longitudinal Pilot Study

Background: A high prognostic nutritional index (PNI) is associated with good prognosis in patients with esophageal cancer. However, nutritional status often decreases during neoadjuvant therapy. Functional tooth units (FTUs) provide an index for the status of posterior occlusal support. We have previously reported that low PNI is related to low FTUs. Objectives: The purpose of this study was to retrospectively examine whether the status of occlusal support relates to changes in PNI during neoadjuvant therapy in patients with esophageal cancer. Methods: This study included 34 patients who underwent neoadjuvant therapy before esophagectomy (32 men, 2 women; age, 36-82 years) in 2012 at Okayama University Hospital. Patients were divided into the good occlusal support group (FTUs ≥ 11, n = 18) or poor occlusal support group (FTUs < 11, n = 16), and changes in PNI during neoadjuvant therapy were investigated. Results: PNI decreased significantly after neoadjuvant therapy, particularly in the good occlusal support group, and became more dispersed after neoadjuvant therapy. Decreases in PNI after neoadjuvant therapy showed a significant positive correlation with good occlusal support by multiple regression analysis (p = 0.03). The proportions of patients provided with nutritional intervention (p = 0.02) or early dental intervention (p = 0.04) were lower in the good occlusal support group than in the poor occlusal support group. Conclusions: Even in patients with esophageal cancer with good occlusal support experienced significant declines in PNI during neoadjuvant therapy, potentially due to delayed nutritional and dental interventions. Early multidisciplinary interventions are thus recommended for all patients, regardless of preoperative dental or nutritional status.

Malnutrition Prevalence and Nutrient Intakes of Indonesian Older Adults in Institutionalized Care Setting: A Systematic Review of Observational Studies

INTRODUCTION

Data on the prevalence of malnutrition and nutrient intakes among Indonesian older adults in institutionalized care setting are scattered and scarce. Thus, we conducted a systematic review of published and gray literature to estimate (1) the prevalence of malnutrition, (2) the level and distribution of habitual energy and nutrient intakes, and (3) the prevalence of inadequacy of energy and nutrient intakes among hospitalized and institutionalized older adults in Indonesia.

METHODS

This systematic review was written following the PRISMA 2020 checklist. The population of this review was Indonesian older adults in institutionalized care settings, including hospital wards, orphanages, nursing homes, residential facilities, and rehabilitation centers. Malnutrition was assessed using body mass index, the Mini Nutritional Assessment (MNA) score, or the subjective global assessment (SGA) score. The dietary intakes (from food recalls, food records, or food frequency questionnaire) were compared with the Indonesian Recommended Dietary Allowances for people aged 65-80. The prevalence of inadequacy was calculated using two-thirds of the Recommended Dietary Allowance as a proxy for the estimated average requirement.

RESULTS

The search yielded 330 studies from electronic databases, resulting in fifteen eligible studies. One report was obtained from an unpublished study. Based on the JBI criteria, most studies had low risk of bias and represented the target population. The prevalence of malnutrition in hospital, nursing home, and other institutionalized care ranged from 6.5% to 48.3% in hospitals and 3.2% to 61.0% in other institutionalized care units. In the hospital setting, there was a high prevalence of inadequacies for all nutrients, particularly protein (20%), calcium (more than 90%), and vitamin D intakes (more than 50%). In nursing homes, these proportions were exceptionally high for protein (66%) and calcium and vitamin D intakes (almost 100%).

CONCLUSION

The high risk of malnutrition in Indonesian older adults in institutionalized care setting is pronounced, along with poor intakes of macronutrients and micronutrients in both settings.

Association between occlusal supports and nutritional status in older adults: A systematic review

Background/purpose

Impaired masticatory performance results in nutritional deficiencies in older adults. This systematic review aims to investigate the following clinical question (CQ): Do occlusal supports impact nutritional intake or nutritional status in older individuals?

Materials and methods

An extensive systematic literature search was performed to summarize the currently available knowledge to address the CQ. The cohort and intervention studies with participants of ≧60 years old or a mean age of 65 years performed before May 2021 were included. Studies were required to measure the parameters related to occluding tooth pairs/occlusal units and food/nutrient intake and/or nutritional status. Bias risk was assessed using the Risk of Bias Assessment Tool for Nonrandomized Studies.

Results

After an independent screening of 1130 initial records, 24 reports from 22 studies were included. Participants (n = 8684) in the included studies were mainly residents of nursing homes or community-dwelling individuals. Following the assessment of bias risk, it is revealed that all studies had methodological weaknesses. Over half of the studies concluded that there was an association between occlusal support and nutritional intake or status. However, it was also revealed that various confounding factors are involved in the association between occlusal support and nutrition.

Conclusion

This systematic review concludes that occlusal support might be associated with nutritional intake or nutritional status in the older population, although there are methodological limitations of each study. The evidence is still insufficient, and more well-designed studies are required.

Awareness and Attitudes of Dental Students toward Older Adults in Indonesia

In this study, we aimed to analyse the awareness and attitudes of dental students (DS) toward older adults (OAs) in Indonesia. Compromised oral health (OH) among OAs is a significant public health problem that is a global health burden. Furthermore, appropriate education can provide DS with information about strategic and efficient treatments for OAs. An online invitation was provided to every dental student in Indonesia in the third to sixth year of study to answer a web-based questionnaire as a part of a survey on awareness and attitudes (14 questions) towards OAs. From 1288 valid forms submitted, it was evident that most students (87%) expressed a positive attitude toward OAs. Female students showed a more positive attitude compared to males, with an odds ratio of 1.539 (p = 0.036), and students who had a connection to an older adult demonstrated a more positive attitude than those who did not (OR = 2.076; p < 0.001). The majority of the DS (98%) were conscious of the importance of geriatrics in dentistry, with female students showing more awareness than their male counterparts (OR = 2.553; p = 0.033). Positive awareness and attitudes must be accompanied by knowledge so that DS can offer appropriate and effective oral care to geriatric patients.

Associations between Dentition Status and Nutritional Status in Community-Dwelling Older Adults

BACKGROUND/OBJECTIVE

Older adults are at higher risk of malnutrition. The aim of this study was to explore associations between nutritional status and dentition status among older adults seeking care in a dental clinic.

METHODS

This was a cross-sectional study of data from older adults (65-89 y) who received care at a northeastern US urban dental school clinic between June 2015 and June 2020 (N = 305). Clinical and demographic data were obtained from the electronic health record; nutritional status was determined using the Self-Mini Nutritional Assessment (Self-MNA), and odontograms and digital radiography were used to determine dental data. Adjusted multivariable models were used to explore associations between variables.

RESULTS

The sample was 53.8% female with a median age of 72.0 y. The median Self-MNA score was 13, reflective of normal nutritional status; 29.5% were at risk of or had malnutrition. Median numbers of teeth and posterior and anterior occluding pairs of teeth (POP, AOP) were 18.0, 2.0, and 5.0, respectively. Those with normal nutritional status had significantly more teeth, POPs, and AOPs than those at risk of or with malnutrition (P = 0.015, P = 0.015, and P = 0.039, respectively). Every additional unit increase in the number of natural or restored teeth or POP was associated with significantly lower odds of being at risk of or with malnutrition (3% and 13%, respectively). Having functional dentition was associated with 46% lower odds of being at risk of or with malnutrition.

CONCLUSION

This study demonstrated that older adults who had more teeth, better occlusion, and functional dentition were more likely to be of normal nutritional status than those who had less teeth, had poorer occlusion, and lacked functional dentition. Further research with larger, more diverse samples and varied measures of dentition are needed to better understand the associations between nutritional status and dentition status.

KNOWLEDGE TRANSFER STATEMENT

The findings from this study suggest that older adults with fewer teeth and therefore less efficient occlusion are at higher risk for malnutrition than those with more teeth and better occlusion. Health care professionals should include screening for dentition and malnutrition as part of their routine practice to identify patients who may have tooth loss and be at risk of malnutrition and refer them accordingly for interventions to optimize oral health and nutritional status.

Associations between the composition of functional tooth units and nutrient intake in older men: the Concord Health and Ageing in Men Project

OBJECTIVE

Inadequate nutrient intakes have been linked with poor dentition in older adults. The aim of this study was to investigate the associations between the composition of functional tooth units (FTU) and nutrient intakes in older men.

DESIGN

A cross-sectional study with a standardised validated diet history assessment and comprehensive oral health assessments. FTU were categorised by dentition type: (i) Group A (Natural FTU Only), (ii) Group B (Natural and Replaced FTU) and (iii) Group C (No Natural FTU). Attainment of nutrient reference values (NRV) for sixteen micronutrients was incorporated into a micronutrient risk variable, dichotomised 'good' (≥ 12) or 'poor' (≤ 11), and for seven macronutrients into a macronutrient risk variable, dichotomised 'good' (≥ 5) or 'poor' (≤ 4).

SETTING

Subjects selected from the local Sydney geographical areas.

PARTICIPANTS

Community-dwelling older men (n 608).

RESULTS

32 % (n 197) of participants were categorised as Group A, 27 % (n 167) as Group B and 40 % (n 244) as Group C. In adjusted logistic regression analysis, being in Group C, compared with Group A, was associated with intakes below NRV recommendations for fibre (OR: 2·30, 95 % CI 1·30, 4·05). Adjusted analysis also showed that men in Group C, compared with Group A, were more likely to have poor intake of macronutrients (OR: 2·00, 95 % CI 1·01, 3·94).

CONCLUSIONS

Our study shows statistically significant associations between the composition of FTU and poor macronutrient intakes. Maintaining natural pairs of occluding FTU may be important for attaining adequate nutrient intakes in older men.

Evaluation of occlusal status of Japanese adults based on functional tooth units

OBJECTIVES

Although extensive national oral health data on dental caries and periodontal diseases in Japan are available, few studies have assessed the occlusal status of the Japanese population, and none are based on national survey data. The presence and prosthodontic conditions of the molar region are important for masticatory function, and the functional tooth unit (FTU) approach can be used to evaluate the occlusal status. Thus, using the national oral health survey data, this study investigated the occlusal status of the Japanese population using FTU.

METHODS

Overall, 3,605 adults (aged ≥20 years) who participated in the 2011 Japanese national oral health survey were included. FTUs were used as indices for evaluating the occlusal status. FTUs were calculated according to sex, age group, and the number of teeth present, and their associations were further analysed.

RESULTS

The number of teeth present, posterior teeth, and FTUs decreased with age in both men and women. In the age group of those ≥60 years, all only natural teeth-FTU (n-FTU) and natural teeth and artificial teeth from fixed prostheses or implant-supported FTU (nif-FTU) scores were <8. The total-FTU scores of all age groups, except the 60-69 and 70-79 years age groups, were >10.

CONCLUSION

This is the first study to use FTUs and national oral health survey data to investigate the occlusal status in the Japanese population. People aged ≥60 years who have low n-FTU or natural teeth and artificial teeth from fixed prostheses or implant-supported FTU scores or those aged 60-70 years who have the lowest total-FTU scores require careful evaluation of masticatory performance.

Pairs of natural teeth rather than use of dental prosthesis are associated with nutritional status in older adults: A cross-sectional study

OBJECTIVE

To evaluate the association between pairs of natural teeth and nutritional status among older adults.

METHODS

This cross-sectional study evaluated a total of 569 home-dwelling adults from two southern Brazilian cities aged ≥60 years. Present teeth were counted, and pairs of natural teeth were defined as antagonistic teeth. Nutritional status was assessed using Mini Nutritional Assessment. Sociodemographic, behavioral, medical and dental history were collected. Sample was dichotomized into well-nourished and at nutritional risk (including at risk of malnutrition and malnourished). Multiple multivariate models were performed considering different categorizations of pairs of natural teeth.

RESULTS

For each number of present teeth, a decrease of 1.8 % in the prevalence ratio (PR) for nutritional risk was detected (p = 0.040). For each pair of natural teeth, there was 4.4 % decrease in PR for nutritional risk (95 % confidence interval [95 % CI]: 0.917 - 0.997). No statistically significant association was found for pairs of natural anterior teeth (p = 0.222). For pairs of natural premolar, molar and posterior teeth, reductions of 15.4 %, 22.8 % and 11.5 %, respectively, in PR for nutritional risk were observed (p < 0.05). The presence of at least two pairs of natural molars or three pairs of natural posterior teeth was significantly associated with nutritional risk (p < 0.05).

CONCLUSION

Older adults with fewer teeth or pairs of natural teeth, especially posterior teeth, presented poorer nutritional status.

CLINICAL SIGNIFICANCE

Demonstrating threshold correlation between natural teeth and nutrition, data showed significant association between at least two pairs of natural molars or three pairs of natural posterior teeth and lower nutritional status.

Impact of occlusal force on decline in body mass index among older Japanese adults: Finding from the SONIC study

OBJECTIVES

To determine any independent influence of occlusal force and of number of natural teeth on decline in body mass index (BMI) among older Japanese adults.

DESIGN

Longitudinal study over a 3- to 6-year period.

SETTING

Urban and rural area in Japan.

PARTICIPANTS

Independently living Japanese adults aged 69-71 years and 79-81 years at baseline. This analysis excluded participants who were defined as underweight at baseline.

MEASUREMENTS

Information was collected on age, gender, occlusal force, the number of teeth, BMI, socioeconomic factors, medical history, the number of daily prescription medications, cognitive function, depressive symptoms, hand grip strength, and physical function. Maximal occlusal force was measured with a pressure-sensitive sheet. Nutritional status was assessed using BMI, and participants with BMI <21.5 were defined as underweight. Then, they were divided into two groups: a "BMI declined" group who were defined as underweight at either 3- or 6-year follow-up survey, and a "BMI maintained" group who were not defined as underweight at both follow-up surveys. Logistic generalized estimating equation (GEE) models were used to assess the effect of occlusal force and the number of teeth at baseline on decline in BMI over 3 or 6 years, after adjusting for possible covariates associated with nutritional status.

RESULTS

The final analysis included 704 participants. Eighty-six (12.2%) participants were classified into the BMI declined group. Logistic GEE models showed that the number of teeth was not significantly associated with decline in BMI. However, occlusal force was significantly associated with decline in BMI (odds ratio = 0.90, 95% confidence interval = 0.83-0.97) after adjusting for covariates.

CONCLUSION

Participants with lower occlusal force were more likely to be in the BMI less than 21.5 kg/m² . The findings suggest that to prevent decline in oral function is important to maintain nutritional status.

Posterior teeth occlusion is related independently to onset of fever in residents of aged person welfare facility: Perspective cohort study

BACKGROUND

Onset of fever is a common presentation of symptoms in older adults. Loss of posterior teeth occlusion provokes dysphagia, which is commonly related to infectious diseases of the respiratory tract. However, a correlation between posterior teeth occlusion and the onset of fever has not been studied. The aim of the present study was to investigate whether posterior teeth occlusion is correlated with the onset of fever in residents of aged person welfare facilities.

METHODS

This perspective cohort study was carried out from February 2019 to December 2019 in Kitakyushu, Japan. The follow-up period was 8 months. Overall, 141 residents aged ≥ 65 years from 10 aged person welfare facility were included. Dates when the body temperatures of participants were more than 37.2°C were recorded. Posterior teeth occlusion was evaluated by assessing functional tooth units (FTUs).

RESULTS

Data from 100 participants [median age, 89 (67-102)] were used for analysis. Total of 53 participants got a fever. The Kaplan-Meier analysis showed that the average period until onset of fever in participants with scores 0, 1-11 and 12 for FTU was 7.7 ± 0.6, 7.4 ± 1.0 and 3.9 ± 1.0, respectively. Cox's proportional hazards regression model revealed that participants with FTU = 0 were at higher risk of fever compared with those with FTU = 12 (hazards ratio: 3.2, 95% confidence interval: 1.4-7.7), adjusted for possible confounders.

CONCLUSIONS

Posterior teeth occlusion correlated with the risk of fever in older residents of nursing homes.

Occlusal support is associated with nutritional improvement and recovery of physical function in patients recovering from hip fracture

OBJECTIVE

This study aimed to elucidate the association between occlusal support and nutritional improvement and recovery of activities of daily living (ADLs) among elderly patients recovering from hip fracture.

BACKGROUND

Many patients with hip fracture are malnourished, and malnutrition is associated with poor functional outcomes. Poor oral status is one reason for malnutrition because loss of occlusal support leads to masticatory disorders and can cause nutrient deficiencies.

METHODS

We evaluated 202 elderly patients aged 65 years and older (mean age, 84.9 ± 7.9 years). We assessed nutritional status using the Mini Nutritional Assessment-Short Form and ADLs using functional independence measure (FIM) scores. Occlusal support was recorded in accordance with the Eichner Index. We categorised participants into two groups according to the presence or absence of occlusal support, and statistical analyses were performed to investigate the differences between the groups.

RESULTS

One group contained 152 participants (mean age, 85.5 ± 7.4 years) with occlusal support, and the other group contained 50 participants (mean age, 83.0 ± 8.9 years) without occlusal support. The group with occlusal support had greater gain of FIM and higher FIM efficiency than did the other group. Multivariate analyses showed that occlusal support was independently associated with nutritional improvement [odds ratio (OR) = 4.00, 95% confidence intervals (CI) = 1.90-8.43] and motor FIM efficiency (R²  = .338, P < .001).

CONCLUSIONS

Our findings suggest that occlusal support is associated with nutritional improvement and the recovery of ADLs in patients recovering from hip fracture.

Masticatory behavior for different solid foods in preschool children according to their oral state

Gradual introduction of solid foods in early childhood takes part in the maturation of mastication. The impact of any oral state alteration on food oral processing development is poorly documented for this age group. This study investigated the masticatory behavior in 3 to 6 year-old children with or without early childhood caries (ECC) for three solid foods of different textures. Twenty-one children with healthy oral state and 23 children with severe ECC were observed during complete mastication of calibrated samples of raw carrot, cheese and breakfast cereals. Food refusals and kinematic parameters (Ti: chewing time, Nc: number of cycles and Fq: chewing frequency) were used to assess children masticatory behavior. Oral Health-related Quality of Life and orofacial dysfunctions were evaluated using, respectively the early childhood oral health impact scale (ECOHIS) and the Nordic orofacial dysfunction test screening (NOT-S). Children suffering from ECC exhibited significantly higher ECOHIS and NOT-S scores, in particular for the mastication domain. Accordingly, lower chewing frequencies values were recorded in children with ECC (i.e., carrot Fq: 1.21 ± 0.20 vs 1.35 ± 0.22, p ≤ 0.01), as well as more frequent refusals for carrots. Kinematic parameters were shown to be repeatable in all children for successive samples of the same food, and tended to vary depending on the proposed food. Some masticatory behavior regulation according to food properties could already be present in preschool children. Children with ECC developed alternative behavioral strategies to overcome feeding difficulties. Further studies should investigate food bolus properties according to oral health, as well as nutritional issues. PRACTICAL APPLICATIONS: During childhood, the way solid foods are processed in the oral cavity to be safely swallowed and then digested in available nutrients, is poorly documented. In this study, preschool children have been shown to repeatedly adapt their masticatory behavior to a given food. The collection of various food boli as recorded at the moment of swallowing could then be considered in further food bolus properties research investigations. Moreover, this study suggested that children with altered dentition modified their masticatory kinematic parameters and developed alternative strategies, including food or texture selection, to overcome their feeding difficulties. The development of a mastication evaluation protocol could help medical professionals to detect children masticatory deficiencies and then propose diet adaptations. Considering the importance of food diversity in mastication development and maturation, food industries may consider to develop a range of texture adapted foods for young children, especially designed to gradually rehabilitate the masticatory function.

The prevalence of edentulism and their related factors in Indonesia, 2014/15

BACKGROUND

Little information exists about the loss of all one's teeth (edentulism) among older adults in Indonesia. The aim of this study was to investigate the prevalence of edentulism and associated factors among older adults in Indonesia.

METHOD

This study examines the self-reported prevalence of edentulism and associated factors among older adults (50 years and older) in a cross-sectional national study using the Indonesia Family Life Survey IFLS-5, 2014/15. The community-based study uses a multi-stage stratified sampling design to interview and assess household members, with a household response rate of over 90%.

RESULTS

The overall prevalence of edentulism was 7.2, 29.8% in 80 years and older and 11.8% in those with no formal education. In adjusted Poisson regression analysis, older age, living in five major island groups and having functional disability were associated with edentulism. In addition, among men, having quit and current tobacco use and among women, having low social capital were associated with edentulism. Further, in adjusted analysis, among men, edentulism was positively associated with hypertension and negatively associated with diabetes, and among women, edentulism was associated with functional disability.

CONCLUSIONS

Results suggest that overall and/or among men or women that older age, living in five major island groups, having functional disability, tobacco quitters and users and those with low social capital was associated with edentulism. The identified associated factors of edentulism may be utilized in oral health programmes targeting older adults in Indonesia.

Dental and periodontal problems of elderly people in Vietnamese nursing homes

OBJECTIVE

To determine the oral health status and treatment needs of elderly residents in Vietnamese nursing homes.

METHODS

This study was conducted among 360 men and 431 women with a mean age of 72.9 ± 9.1 years in three nursing homes in Ho Chi Minh City. Demographic information on education, duration of stay, chronic diseases, tooth brushing and tobacco use were obtained from medical records and a questionnaire. The oral health of participants was clinically assessed by a dental examiner using WHO criteria. Oral health status included estimates of coronal and root caries, periodontal disease, denture status and dental treatment needs.

RESULTS

Nearly all (90.1%) of the participants had natural teeth. The mean numbers of teeth with coronal or root decay were 5.8 ± 4.0 and 6.0 ± 4.2, respectively, and almost everyone required at least one restoration for coronal or root caries. Most of the participants with natural teeth had bleeding gingiva on probing, 26.2% had deep periodontal pockets, 96.5% needed oral hygiene improvement plus scaling and 20.3% required complex periodontal treatment. None of the edentulous participants had dentures, and 86.6% required new or repaired dentures.

CONCLUSION

The prevalence of untreated oral diseases is very high and the need for dental care extensive among the residents of government-administered long-term care facilities in Ho Chi Minh City.

Influence of residential characteristics on the association between the oral health status and BMI of older adults in Indonesia

OBJECTIVE

To assess the possible effects of residential characteristics on the association between oral hygiene and body mass index (BMI) of elderly people in Indonesia.

METHODS

This cross-sectional study involved 186 participants (87 males, 99 females) aged ≥60 years who were randomly recruited from 8 community health stations for the elderly people. Dentition status, oral hygiene index (OHI), probing pocket depth (PPD) and clinical attachment level (CAL) were assessed in accordance with WHO guidelines. Salivary condition was assessed through the unstimulated whole saliva collection method. Education status and oral health behaviours were evaluated using a standardised questionnaire. BMI was calculated as weight in kilograms divided by height in metres squared. Participants were grouped in accordance with their OHI status (poor, moderate or good) combined with their residential characteristic (rural or urban) to assess the independent effect of OHI and residential characteristic on BMI through linear regression analysis with confounder adjustment.

RESULTS

In the crude model of linear regression analysis, the poor OHI group is associated with low BMI regardless of their residential characteristic (rural/urban) when compared to the "good OHI, urban" group with P-values of .045 and <.01 and regression coefficients (β) of -2.1 and -4.5, respectively. However, in the adjusted model, only the "poor OHI, rural" group showed a significant association with low BMI when compared to the "good OHI, urban" group (β = -3.4; P < .01).

CONCLUSION

Low BMI is significantly associated with poor OHI and rural residential characteristic among elderly people in Indonesia.

Masseter muscle tension, chewing ability, and selected parameters of physical fitness in elderly care home residents in Lodz, Poland

BACKGROUND

Maintaining good physical fitness and oral function in old age is an important element of good quality of life. Disability-related impairment of oral function contributes to a deterioration of the diet of older people and to the reduction of their social activity.

OBJECTIVES

Investigate the association between masseter muscle tension, dental status, and physical fitness parameters.

MATERIALS AND METHODS

Two hundred fifty-nine elderly care home residents (97 men, 162 women; mean age, 75.3±8.9 years) were involved in this cross-sectional study. Their chewing ability was evaluated by masseter muscle tension palpation, differences of masseter muscle thickness, self-reported chewing ability, number of present and functional teeth, and number of posterior tooth pairs. Masseter muscle thickness was measured by ultrasonography. To assess physical fitness, hand grip strength and the timed up-and-go test were performed. Nutritional status was assessed using body mass index and body cell mass index (BCMI), calculated on the basis of electrical bioimpedance measurements. Medical records were used to collect information on systemic diseases and the number of prescribed medications. Subjects were also evaluated for their ability to perform ten activities of daily living.

RESULTS

Ninety-seven percent of the subjects suffered from systemic diseases. The three most prevalent illnesses were cardiac/circulatory 64.5%, musculoskeletal 37.3%, and endocrine/metabolic/nutritional 29.3%. Of the participants, 1.5% were underweight and more than one third (34.4%) were overweight. Malnutrition (BCMI below normal) was found in almost half (45.2%) of the subjects. Only 5.8% had a sufficient number of functional natural teeth. Statistically significant correlations were found between palpation of masseter muscle tension and perceived chewing ability, number of present teeth, number of functional teeth, number of posterior tooth pairs, timed up-and-go, hand grip strength, body mass index, BCMI, and activities of daily living. In a multivariate model, after adjusting for age, sex, and education, subjects with higher BCMI, higher hand grip strength, and more present teeth had a significantly higher chance of strong masseter muscle tension.

CONCLUSION

There is a relationship between chewing ability and physical fitness in elderly people. Efficiency of masseter muscles is related to physical fitness in the elderly. Masseter muscle tension examined by palpation can be used in public dentistry as one of the indicators of quality of life.

Oral health-related quality of life and malnutrition in patients treated for oral cancer

Purpose

This study examined whether oral health-related quality of life (OHRQoL) is associated with nutritional status in patients treated for oral cancer.

Methods

A cross-sectional study was carried out on with patients treated for oral cancer at least 6 months after treatment. OHRQoL was measured using two questionnaires: Oral Impacts on Daily Performances (OIDP) and Oral Health Impact Profile (OHIP-14); malnutrition risk was assessed through the Mini Nutritional Assessment (MNA). Multivariable regression models assessed the association between the outcomes (OIDP and OHIP-14) and the exposure (MNA), adjusting for sex, age, clinical stage, social class, date of treatment completion, and functional tooth units.

Results

The final simple included 133 patients, 22.6 % of which were malnourished or at risk of malnutrition. More than 95 % of patients reported a negative impact on the OHRQoL for both measures used. Patients with malnutrition or risk of malnutrition had significantly worse OHRQoL than those with no malnutrition, even after adjusting for clinical and socioeconomic data (ß-coefficient = 8.37 (95 % confidence interval (CI) 1.42–15.32) with the OIDP and ß-coefficient = 2.08 (95 % CI 0.70–3.46) with the OHIP-14).

Conclusion

Being malnourished or at risk of malnutrition is an important longer-term determinant of worse OHRQoL among patients treated for oral cancer.

Chewing deficiencies in adults with multiple untreated carious lesions

Persons who have multiple untreated carious lesions are at high risk of chewing difficulties and consequently an unhealthy diet, but few data are available on the impact of untreated caries on mastication in adults. This study in adults with multiple untreated caries lesions aimed to evaluate chewing deficiencies using physiological and psychosocial indicators. Forty-five patients, mean (±SD) decayed teeth 11.5 (±5.2), and 20 fully dentate caries-free subjects were observed during mastication of raw carrot and two jelly model foods differing in hardness. Criteria for chewing evaluation were carrot bolus granulometry, food refusals, chewing activity (chewing time, number of chewing cycles, chewing frequency) and oral health-related quality of life (GOHAI). Dental status was characterized by caries experience (DMFT) and posterior functional pairs of teeth. Adults with multiple untreated caries lesions suffered from chewing deficiencies, demonstrated by a decrease in food comminution related to the number of posterior functional teeth, food selection and functional alterations in oral health-related quality of life. The ability to adapt chewing activity to food hardness was preserved in this group. Further studies should be conducted to determine whether chewing function could be improved after dental treatment.