Journal of oral rehabilitation最新文献

Background: Oral frailty in older adults can affect their eating efficiency, prolonging meal times, which can compromise food flavour.

Objective: This study explored the association between cooking methods and chewing-to-swallowing time on the basis of different oral functions in older adults.

Methods: This cross-sectional study involved 65 community-dwelling individuals aged ≥ 65 years. Chewing-to-swallowing time was measured as participants tested the textures of two ingredients-chicken breast and baby Chinese cabbage-prepared using four cooking methods (boiling, sous vide, confit and high-pressure). Oral frailty was determined by the following items: tooth count, bite force, saliva secretion rate, swallowing, tongue-lip motor function and oral hygiene. Regression models analysed the correlation between cooking methods and chewing-to-swallowing time under various oral functions.

Results: No differences in chewing-to-swallowing time were found for chicken prepared using the various cooking methods among older adults with oral frailty (all p > 0.05). However, for older adults without oral frailty had a shorter chewing-to-swallowing time for both sous vide (β = -1.06, p < 0.001) and confit chicken (β = -1.79, p = 0.003) than for boiled chicken. For older adults with oral frailty had a shorter chewing-to-swallowing time for sous vide (β = -0.06, p < 0.001) and high-pressure methods (β = -1.16, p < 0.001) than for boiled vegetable. For older adults without oral frailty had a shorter chewing-to-swallowing time for high-pressure methods (β = -0.83, p < 0.001) than for boiled vegetable.

Conclusion: Under different oral functional conditions, cooking methods are associated with the chewing and swallowing times of older adults.

Background: Surface electromyography (sEMG) has been used in a wide range of studies conducted in the field of dysphagia.

Objectives: The main aim of this case-control study is to obtain how submental and infrahyoid sEMG signals differ based on residue, penetration and aspiration.

Methods: A total of 100 participants (50 patients with suspected dysphagia and 50 healthy controls) were enrolled in the present study. Participants with suspected dysphagia underwent a detailed fibreoptic endoscopic evaluation of swallowing (FEES) to observe the efficiency and safety of swallowing using the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) and the Penetration-Aspiration Scale (PAS), respectively. Afterward, sEMG parameters, including submental muscle activity duration (SMM-AD), infrahyoid muscle activity duration (IM-AD), amplitude of submental muscles (A-SMM) and amplitude of infrahyoid muscles (A-IM) were obtained during three consecutive dry swallows from all study cohorts.

Results: There were significantly higher SMM-AD values in patients with a YPRSRS score of 1-2 and a YPRSRS score of 3-5 for residue in vallecula compared to the controls (p < 0.001 and p = 0.001, respectively). Both subgroups of patients with a YPRSRS score of 1-2 and a YPRSRS score of 3-5 for residue in piriforms showed significantly higher SMM-AD values compared to the controls (p < 0.001 and p = 0.048, respectively). The same prolongation of SMM-AD was also evident for the patients with airway invasion (penetration or aspiration) compared to the controls (p = 0.042 and p < 0.001, respectively). The other measured sEMG parameters (IM-AD, A-SMM and A-IM) did not differ significantly based on FEES outcomes (p > 0.05).

Conclusion: Since the availability of instrumental swallowing assessment methods in clinical practice is quite challenging, specific sEMG parameters may be useful to predict possible residue, penetration, or aspiration events in patients with dysphagia. SMM-AD can be considered as a first-line assessment parameter for possible residue, penetration, and aspiration events before referring patients for further instrumental methods.

Background: Previous research has highlighted the multifactorial nature of awake bruxism (AB), including its associations with stress, anxiety and other psychological factors. Dispositional mindfulness, known for its benefits in enhancing emotional regulation and reducing stress, has not yet been thoroughly investigated in association with AB.

Objective: This study aimed to investigate whether levels of dispositional mindfulness predict the efficacy of ecological momentary intervention (EMI) in reducing the frequency of AB behaviours.

Methods: This study employed a quasi-experimental design with a correlational component and involved 83 undergraduate dental students categorised into high and low mindfulness groups based on the Mindfulness Attention and Awareness Scale (MAAS). An EMI was implemented using the No Clenching mobile app, which sent 12 alerts per day over 1 month. The primary outcome measure was a 50% reduction in the frequency of AB behaviours.

Results: A significant positive relationship was found between dispositional mindfulness levels and the reduction in AB behaviours. Participants with higher mindfulness levels experienced a greater reduction in AB frequency compared to those with lower mindfulness levels. Mixed-effects regression analysis revealed that mindfulness levels were a significant predictor of bruxism reduction (β = 0.45, p < 0.01). The coefficient for MAAS was positive and significant (coefficient = 1.5305, p < 0.001), indicating that higher mindfulness levels are associated with greater reductions in AB frequency. Additionally, a significantly higher percentage of participants in the high mindfulness group (97.5%) achieved a 50% reduction in AB behaviours compared to the low mindfulness group (62%).

Conclusion: Higher levels of dispositional mindfulness are associated with more effective EMI outcomes in reducing AB behaviours. Incorporating mindfulness-based approaches into intervention strategies for AB could lead to more personalised and effective treatments.

Background: For restorative demands, increased vertical dimension of occlusion (VDO) is sometimes necessary, as facial changes can be perceptible.

Objectives: This study aimed to evaluate the perception of facial change due to increased VDO and associated soft tissue changes using 3D-scanned facial images.

Methods: Forty participants with healthy dentition and no loss of VDO were recruited. The VDO was increased by 2, 4, 6 and 8 mm on a semi-adjustable articulator after maxillomandibular impressions. Facebow transfers were taken for each participant to create a personalised device. 3D facial scans were taken with the mandibular occlusal device in place, creating facial capture files from frontal, lateral and anteroposterior views for each scanned data. Sixty evaluators were recruited to consecutively cross-compare maximal intercuspal captures with increased VDO. To evaluate soft tissue changes with increased VDO, facial measurements, total face height, lower face height, lip width, lip height and nasolabial angle were measured thrice in 3D scan images using computer-aided design software. Statistical analysis entailed one-way repeated-measures analysis of variance (α = 0.05).

Results: A 4-mm increase in the VDO showed the highest perceptibility for facial change, varying among evaluator groups. Total face height, lower face height and nasolabial angle increased with VDO, while lip width and height decreased. Each soft tissue measurement differed significantly (p < 0.05).

Conclusion: For 3D-scanned facial changes, a 4-mm increase in VDO was the most perceptible difference. Increased VDO affects facial changes.

Background: Awake bruxism involves masticatory muscle activity during wakefulness, potentially leading to clinical concerns. Accurate electromyography (EMG) assessment is challenging with brief durations.

Objective: To establish a reliable, short-term measure for nonfunctional masseter muscle activity during wakefulness.

Methods: Thirty-four healthy participants completed the Oral Behavior Checklist (OBC) and were assessed with an EMG logger (FLA-500-SD) across three sessions. On Day 1, participants performed four tasks (reading, bead-grabbing, video watching and math) for 15 min each in random order. On Day 2, scheduled at least 1 week later, tasks were repeated in a different sequence. On Day 3, participants underwent a 7-h continuous EMG recording during daily activities while maintaining activity diaries. Main outcomes included the mean number of EMG bursts per hour, burst duration, burst peak value relative to maximum voluntary contraction (%MVC) and integral value (μV.s, %MVC.s).

Results: Participants (mean age: 28.0 ± 3.1) scored low on AB likelihood per partial OBC results, contrasting with EMG activity levels. Significant differences in EMG parameters were noted across tasks, with consistent values between Days 1 and 2. The reading, video, and math tasks showed strongest correlations with long-term EMG measurements (r_s = 0.62-0.66, p < 0.001). Reading task demonstrated high test-retest reliability (ICC > 0.9), with the highest specificity (100%) and positive predictive value, though sensitivity was limited compared with long-term AB measures.

Conclusions: EMG measurements during a 15-min reading task may correspond to prolonged monitoring, suggesting the potential for short-task EMG assessments in practice. Integrating such assessments might enhance diagnostic accuracy, although judgement remains essential.

Background: Approximately 30% of the adult population experiences symptoms under the concept of temporomandibular disorder (TMD). To identify patients with TMD who may require further evaluation, three screening questions (3Q/TMD) have been introduced.

Objectives: The aim of this study was to explore the prevalence of self-reported TMD and the amount of treatment received by patients in the Public Dental Service in Stockholm and how many were referred to an orofacial pain specialist.

Methods: Health declarations from 402 012 patients 18 and older were included. Answers to the 3Q/TMD, gender, performed treatment, and referrals were extracted from the patients' records.

Result: The prevalence of affirmative answers to 3Q/TMD was 4.6% and higher in the 20-29 age group compared to the 60-69 group. Affirmative answers in general led to more treatment, and an affirmative answer to Q1 gave the highest probability of treatment (OR 5.13; 4.87, 5.41) with occlusal splint therapy being the most common. Age did not significantly predicting the amount of treatment (p = 0.05), although there was a tendency towards less treatment in older age groups. In total, 0.74% of the study population were referred to an orofacial pain specialist, with a higher probability of referral for those who answered affirmatively (p < 0.001).

Conclusion: The prevalence of self-reported TMD among patients in the Public Dental Service aligns with findings from similar studies. Patients who answered affirmatively to one or more of the screening questions were more likely to receive treatment or a referral. The 3Q/TMD effectively identifies patients who may benefit from further evaluation and referral, although the rate of treatment remains low.

Background: Previous studies have indicated that older adults with the symptom of dry mouth have an increased risk of death. B vitamins are strongly linked to oral and systemic health. However, the relationship among dry mouth, vitamin B2 and mortality remains unclear.

Objectives: This study aimed to investigate the potential relationship among dry mouth, vitamin B2 and mortality.

Methods: A total of 6183 participants from the US National Health and Nutrition Examination Survey (NHANES) 2011-2014 with information on dry mouth were included at baseline. 4324 normal individuals and 684 individuals with dry mouth were followed up until 31 December 2019. The Cox proportional hazard model was used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations among dry mouth, vitamin B2 and all-cause mortality.

Results: Compared to the population without dry mouth, the risk of all-cause mortality was significantly higher in the population with dry mouth. The multivariable-adjusted HR and 95% CI was 1.41 (1.05, 1.90). The intake of vitamin B2 can significantly reduce the risk of death in participants with dry mouth, but not in participants without dry mouth. The HR and 95% CI of all-cause mortality in the highest vitamin B2 intake group was 0.37 (0.19, 0.73) compared to the lowest intake group.

Conclusions: Individuals with dry mouth suffered a significantly higher risk of all-cause mortality compared to those without dry mouth. Higher intake of vitamin B2 was apparently associated with a lower risk of all-cause mortality in the population with dry mouth.

Background: Early identification of penetration/aspiration (P/A) risk in older adults with sarcopenia is crucial to prevent complications and maintain quality of life.

Purpose: To evaluate the diagnostic utility of orofacial muscle strength measurements for predicting the risk of P/A in older adults with sarcopenia.

Methods: In this observational and prospective study, we collated consecutive data from community-dwelling older adults diagnosed with sarcopenia at a musculoskeletal disorder clinic. Altogether, 54 participants underwent orofacial muscle strength measurements (the index test) using the Iowa Oral Performance Instrument and a videofluoroscopic swallowing study (VFSS) (the reference test) to evaluate for the presence of P/A. Receiver operating characteristic (ROC) curve analysis was performed to determine orofacial muscle strength based on P/A.

Results: Overall, 34 patients showed penetration in the VFSS, although none of the patients showed signs of aspiration. The cut-off for tongue strength to identify the risk of P/A was ≤ 20.5 kPa, with a sensitivity and specificity of 0.75 and 0.74, respectively; the area under the curve (AUC) was 0.88. The cut-off for buccinator strength was ≤ 19.5 kPa, with a sensitivity and specificity of 0.65 and 0.68, respectively, with an AUC of 0.69. The cut-off for lip muscle strength was ≤ 18.5 kPa, with a sensitivity and specificity of 0.65 and 0.71, respectively, with an AUC of 0.69.

Conclusion: The evaluation of buccinator and lip muscle strength did not demonstrate sufficient diagnostic utility for detecting the risk of P/A in older patients with sarcopenia; however, tongue strength showed reliable diagnostic utility for identifying the risk of P/A.

Background: The goal of dysphagia treatment is to ensure a safe and effective reduction in both dysphagia severity and medical staff workload.

Objective: To investigate the correlation of the Hyodo-Komagane score with dysphagia severity and medical staff workload.

Methods: This retrospective cohort study included 96 patients who were referred from other departments for swallowing evaluation from January to April 2021. The correlation between the Hyodo-Komagane score and dysphagia severity was assessed using the Food Intake LEVEL Scale (FILS) score, and its effect on the reduction in medical staff workload was examined using the feeding assistance level of the referred patients.

Results: This study included 96 hospitalised patients, comprising 15 patients with neuromuscular diseases, eight patients with cardiovascular diseases, 12 patients with head and neck diseases (excluding otolaryngological diseases), 34 patients with internal medicine diseases and 27 patients with cerebrovascular diseases, who underwent swallowing evaluation. The FILS score and feeding assistance level significantly improved at discharge compared with that at referral. A significant correlation was observed between the FILS score and feeding assistance level. The Hyodo-Komagane score was correlated with the feeding assistance level at discharge but not at referral.

Conclusion: The Hyodo-Komagane score may optimise rehabilitation and reduce dysphagia severity and medical staff workload, indicating its useful effect on dysphagia severity and medical staff labour.

Background: Smoking is presumed to cause a decline in masticatory performance by worsening the intraoral environment in various ways. However, no longitudinal study has examined the relationship between smoking and masticatory performance.

Objectives: To clarify how smoking affects future decline in masticatory performance through a 5-year follow-up study of a general urban population.

Methods: The study participants were 494 men (mean age at baseline: 65.8 years) who participated in baseline and follow-up dental examinations in the Suita Study. The masticatory performance of the participants was evaluated using a test gummy jelly. The rate of change in masticatory performance during the follow-up period was calculated by subtracting the masticatory performance at baseline from the masticatory performance at follow-up and dividing this by the masticatory performance at baseline. Logistic regression analysis was performed, with the presence or absence of a decline in masticatory performance as the objective variable and age at baseline, number of functional teeth, periodontal status, salivary flow rate, maximum bite force, smoking status, utilisation of dental services, and follow-up years as the explanatory variables.

Results: The rate of change in masticatory performance during the follow-up period was significantly higher in smokers than in non-smokers. Logistic regression analysis showed that age, maximum bite force, and smoking were significant explanatory variables for a decline in masticatory performance.

Conclusion: A 5-year follow-up study showed that smoking causes a decline in masticatory performance in men, even after adjusting for confounding factors.