Relationship between maintenance of occlusal support achieved by home-visit dental treatment and prognosis in home-care patients-a preliminary study

AIM

To determine whether occlusal maintenance and reconstruction by dental intervention is associated with the prognosis of older home-care patients.

METHODS

The study participants were 289 older home-care patients (101 males, mean age 82.2 ± 7.7 years) who received visiting dental treatment from dental clinics in the region between 2012 and 2018. The participants were followed up for 1000 days after receiving the necessary dental treatment in a home-visit setting. The participants were divided into three groups: those with natural tooth occlusion, those whose molar occlusion was maintained or reconstructed by dentures, and those whose occlusion was not reconstructed. Factors associated with prognosis were determined using the Cox proportional hazard model, with occlusal status, comorbidities, the activity of daily living, and residence status as explanatory variables.

RESULTS

In the overall population, occlusal status (hazard ratio [HR] of those with occlusal disintegration versus those with natural tooth occlusion: 2.1, confidence interval [95% CI]: 1.18-3.82) and age (HR: 2.28, 95% CI: 1.44-3.61) were identified as significant factors. In the group of participants aged <85 years, only occlusal status (HR of those with occlusal disintegration versus those with natural tooth occlusion: 3.4, 95% CI: 1.34-8.68) was a significant factor. In the group of participants aged ≥85 years, occlusal status was not significantly associated with prognosis.

CONCLUSIONS

The maintenance and acquisition of occlusal support achieved by dental treatment contribute to improved prognosis in older patients younger than 85 years requiring home nursing care. Geriatr Gerontol Int 2022; 22: 976-981.

Relationship Between Oral Health and Fractures in Community-Dwelling Older Japanese Adults

OBJECTIVE

To investigate the relationship between poor oral health and the incidence of fall-related fractures in older Japanese individuals.

DESIGN

A 9-year prospective cohort study.

SETTING AND PARTICIPANTS

Participants comprised 937 community-dwelling older Japanese adults aged 70 years or older. They all lived in the Tsurugaya district, a suburban area of Sendai city, and underwent comprehensive geriatric assessment, including an oral examination, in a public facility.

MEASUREMENTS

The exposure variables were related to oral health status (posterior occlusal support, number of remaining teeth, and occlusal force). The outcome measure was the incidence of fall-related fractures, which was determined by National Health Insurance data. Analyzed covariates included age, sex, medical history, smoking, alcohol drinking, educational level, depressive symptoms, cognitive impairment, physical function, body mass index, and history of falls. Statistical relationships were examined by calculating hazard ratios (HRs) at 95% confidence intervals (CIs) using the Cox proportional hazard model.

RESULTS

In the multivariate analysis, the HRs of fall-related fractures were significantly higher in those with unilateral posterior occlusal support (HR, 2.72; 95% CI, 1.13-6.55) and no posterior occlusal support (HR, 2.58; 95% CI, 1.29-5.15) than in those with bilateral posterior occlusal support. The HRs (95% CIs) of fall-related fractures in individuals with 10-19 and 1-9 teeth and edentulous individuals were 1.77 (0.81-3.89), 2.67 (1.24-5.75), and 2.31 (1.01-5.28), respectively, compared to those with ≥20 teeth.

CONCLUSIONS AND IMPLICATIONS

Poor oral health status is a risk factor for the incidence of fall-related fractures in community-dwelling older Japanese individuals. The findings suggest that attention should be focused on oral health status to further understand the risk of fall-related fractures among community-dwelling older adults.

Factors Influencing Changes in Masticatory Performance as a Result of Wearing Removable Partial Dentures in Patients with Partially Edentulous Arches

PURPOSE

To measure masticatory performance (MP) in partially edentulous patients when wearing removable partial dentures (RPDs) versus when not wearing RPDs, and to identify factors that could enable clinical evaluations related to differences in MP.

MATERIALS AND METHODS

This study consisted of 87 partially edentulous patients (57 females, 30 males; mean age, 69.41 ± 8.85 years) categorized as Eichner classification B who habitually wore RPDs. MP was evaluated while wearing versus while not wearing RPDs using test gummy jellies. The participants were categorized into four groups by the presence of occlusal contacts in one to three of the molar and premolar regions (occlusal support), or in the anterior region only, according to the Eichner index (B1-B4). The participants were also categorized according to the jaw on which the RPDs were worn and the Kennedy classification, and evaluated in regard to changes in MP resulting from wearing RPDs. Additionally, the rate of change in MP (MP-rv) was calculated for each participant using MP when not wearing RPDs as a reference, and factors affecting MP-rv were evaluated using single or multiple regression analysis and the Kruskal-Wallis test with multiple comparisons.

RESULTS

Significant increases in MP-rv were observed for all participants and for those with occlusal support in two (p = 0.006) and three regions (p = 0.019); however, no significant differences were observed when wearing and not wearing RPDs in participants with (p = 0.090) and those without occlusal support in one region (p = 0.474). With respect to the jaw on which the RPDs were worn, only maxillary or both maxillary/mandibular RPDs tended to have higher MP-rvs than did only mandibular jaws. The results of the multiple regression analysis showed that Kennedy Class I edentulous arches were a factor in increasing MP-rv (standard partial regression coefficient = 0.46, p < 0.05).

CONCLUSION

According to the results of this study, among various factors on the degree of improvement in masticatory performance by wearing RPDs, bilateral missing posterior teeth might be a predictor for achieving clinical improvement.

Relationship Between the Number of Occlusal Supporting and Medical Cost: Analysis Using Large Claims Database from Employee Health Care Insurance in Japan

BACKGROUND

There are several previous reports suggesting that the number of remaining teeth is related to increase of total medical expenditure. However, the measurements of oral healthcare conditions used in the previous studies were the number of remaining teeth, and occlusal support was not assessed.

OBJECTIVES

The aim of this study was to evaluate the relationships between occlusal support and healthcare resource utilization.

METHODS

This study was a retrospective cohort study using a claims database. Measurements of occlusal support were defined by the Eichner and Miyachi classification systems based on dental formula information. Medical healthcare resource usage was measured by medical visit rate and 12-month medical expenditure.

RESULTS

Of the total population in the claims database, 1 288 713 patients were included in the analysis. The proportion of patients who had at least one medical visit and annual medical expenditure in the best condition classes in each classification measure (i.e. A1 for Eichner classification and Area I for Miyachi classification in both endpoints) were 58.2% and 61.1%, and JPY34 597 (US$314.52 at JPY110/US$) and JPY43 129 (US$392.08), respectively. Those in the poorest condition classes in each classification measure (i.e. B3 for Eichner classification and Area IV for Miyachi classification in the medical visit rate, and C1 for Eichner classification and Area III for Miyachi classification in medical expenditure) were 75.3% and 75.1%, and JPY149 339 (US$1357.63) and JPY120 925 (US$1099.32), respectively. We found a positive correlation with the outcomes by regression analysis adjusting for deterioration of occlusal support with age and gender.

CONCLUSION

We found significant relationships between occlusal support conditions and healthcare resource utilization. The maintenance of oral health or dental treatment may positively impact overall health, and active dental intervention may reduce the total medical expenditure.

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.

Duration and sequence of muscular activation in dentate individuals and complete denture wearers during simulation of activities of daily living

Occlusal support may influence muscular function during complex motor tasks. This study evaluated the duration and sequence of muscular activation of masticatory (temporal, masseter), postural head/neck (sternocleidomastoid, trapezius), postural trunk (rectus abdominis, paravertebrals), and low extremity strength (rectus femoris, gastrocnemius) muscles during simulation of activities of daily living (ADL) in edentulous women wearing complete dentures (n = 10) and in dentate women (n = 10). Electromyographic activity was recorded during tests of stand-up/sit down in the Chair, sit up/lie down in the Bed and lift/lower Bags. Occlusal support (dentures) had a significant effect on duration of muscular activation in the Chair Test: the masseter muscle activated longer with dentures during the standing movement. The masseter and sternocleidomastoid muscles showed significant alteration in their order of activation in non-denture-wearing women. For the Bed Test, dentures had significant effect for the gastrocnemius during the sitting-up phase and for the rectus abdominis during the lying-down movement. For the Bag Test, head/neck muscles were activated in a different order as a function of occlusal support. Anticipation of activation of the paravertebral muscles, rectus abdominis, and gastrocnemius was observed in dentate women compared with denture wearers. These findings suggest that occlusal support influences electromyographic activity of some muscles during simulation of ADL.

A multi-centre retrospective study of mandibular fractures: do occlusal support and the mandibular third molar affect mandibular angle and condylar fractures?

This retrospective study was performed to investigate the influence of occlusal support and the presence, state, and position of mandibular third molars on the incidence of mandibular angle and condylar fractures. The following variables were investigated: age, sex, cause of fracture, presence and state (impaction, angulation, and the number of roots) of the mandibular third molars, site of the mandibular fracture, presence of occlusal support, duration of intermaxillary fixation, and postoperative complications. Various risk factors for mandibular angle and condylar fractures were investigated by univariate analysis. The risk of mandibular angle fracture was significantly higher in patients with occlusal support and mandibular third molars. The risk of condylar fracture was significantly higher in patients without occlusal support or mandibular third molars. The position and angulation of the mandibular third molars were not significant risk factors in mandibular angle and condylar fractures. This study demonstrated the influence of occlusal support and the presence of mandibular third molars on the incidence of mandibular angle and condylar fractures. The presence of occlusal support may be a more important factor affecting mandibular angle or condylar fractures than the position of the mandibular third molars.

The relationship between occlusal support and maxillary development: An animal study

Objective:

To test the hypothesis that maxillary development may be affected by occlusal support.

Materials and Methods:

The sample was composed by Wistar rats (5 weeks old) divided into three groups: Control (n = 10), extraction of mandibular molar teeth – left side (n = 10), extraction mandibular molar teeth – left and right sides (n = 10). The rats were sacrificed 8 weeks postextraction. Cone beam computed tomography scan images were taken for posterior measurement of maxillary length and width. Data were analyzed by one-way analysis of variance (Tukey test as post-hoc test).

Results:

Maxillary length was significantly shorter (P < 0.005) in both groups after tooth extraction. No difference was observed regarding maxillary width and body weight.

Conclusion:

Reduced occlusal support may impair the development of the maxilla in rats.

The effect of periodontal status and occlusal support on masticatory performance: the Suita study

AIM

In this study, we investigated the effect of differences in periodontal status in the masticatory performance of dentate subjects with the same occlusal supporting area.

MATERIALS AND METHODS

The subjects of the analysis were classified into those of Eichner A1-3 (n = 1094) and Eichner B1-4 (n = 529). Subjects' periodontal status was evaluated on the basis of the Community Periodontal Index (CPI). The number of functional teeth and occlusal support were investigated, the latter on the basis of the Eichner Index. Furthermore, masticatory performance was investigated by means of test gummy jelly. For each group, periodontal status was classified in two different ways, either with/without moderate periodontitis (CPI Code ≤2/≥3) or with/without severe periodontitis (CPI Code ≤3/4), and masticatory performance was compared between the various groups.

RESULTS

In subjects who were Eichner A1 and B3, masticatory performance was significantly lower in subjects with moderate periodontitis compared with those without, and in subjects with severe periodontitis compared with those without.

CONCLUSION

Periodontal disease affects masticatory performance not only if occlusion is established by natural dentition with no tooth loss but also if occlusal support has decreased.