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To investigate the association between periodontal disease and atherosclerosis and to examine whether the association is modified by hypertension status.In this cross-sectional study, 1472 Japanese individuals aged 50-79 years who underwent a medical check-up, dental examination, and carotid ultrasonography were studied. Carotid atherosclerosis was expressed as the maximum and mean carotid intima-media thickness (max-IMT, mean-IMT) and the presence of stenosis (≥75%). Periodontal status was examined by the Community Periodontal Index (CPI, codes 0-4). The participants were divided into three groups according to the periodontal status (CPI0-2, CPI3, CPI4).A positive correlation was found between mean-IMT and periodontal disease after adjustment for cardiovascular risk factors in the entire cohort (mean-IMT in hypertensives: CPI0-2: 0.848 mm, CPI3: 0.857 mm, CPI4: 0.877 mm; normotensives: 0.782, 0.802, 0.826). In the entire cohort, the multivariable-adjusted odds ratio of stenosis based on mean-IMT significantly increased according to periodontal status in normotensives (odds ratio; CPI0-2: 1, CPI3: 1.39, CPI4: 2.53; p-value for trend = .004) but showed only marginal significant increase in hypertensives (1, 1.15, 1.55; p-value for trend = .063). No significant relationships were observed for max-IMT in all analyses.We observed an association between periodontal disease and atherosclerosis in normotensive and hypertensive participants.

This cross-sectional study aimed to investigate the associations between salivary testosterone concentrations and cognitive function in 70-year-old Japanese elderly people without dementia and stroke.Participants were 197 Japanese community-dwelling people aged 69-71 years. Their salivary samples were collected, and their cognitive function was assessed using the Japanese version of the Montreal Cognitive Assessment (MoCA-J). Participants were also administered a 10-item recall and a 24-item recognition test. The data for 179 (106 men and 73 women) individuals were analyzed, excluding individuals with a past history of stroke and dementia. Multivariate logistic regression analyses were performed after adjusting for lifestyle factors and analyzing data separately for men and women.MoCA-J scores showed that men with low testosterone concentrations had a significantly greater risk of low cognitive performance than those with high testosterone concentrations (adjusted odds ratio: 4.72, 95% confidence interval: 1.06-21.00), while no significant association was found in women. The 10-item recall test scores showed that higher testosterone concentrations were significantly associated with greater recall in the second trial in women (standardized beta = 0.24, P = 0.040), whereas no significant association was found in men. Salivary testosterone concentrations were positively associated with better cognitive performance in older men and women.The associations between salivary testosterone concentrations and cognitive function were shown by different tasks for men and women. Geriatr Gerontol Int 2022; 22: 1040-1046.

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

Objective To measure the occlusal force in the same group of patients with the Dental Prescale 50H type R and the Dental Prescale II, examine the association between them, and determine the reference value for Dental Prescale II that corresponds to the 50H type R 200 N reference value used to make a diagnosis of oral hypofunction. Background Reduced occlusal force, a measure of frailty in older persons, was previously determined with Prescale 50H type R pressure-sensitive film, but it has been replaced by the Prescale II. Materials and methods The study participants were 441 men and women aged ≥ 65 (mean, 71.8 ± 5.3) years. The occlusal force was measured with the two different types of pressure-sensitive film, and their association was examined. Receiver operating characteristic curves for the Prescale II measured values were created with the 200 N reference value used for the 50H type R film as the cut-off value. Results The analysis set included 391 participants for whom measurements were obtained using both the 50H type R and the Prescale II. Linear regression analysis produced regression equations, and a ROC curve analysis provided reference values of 500 N for the Prescale II (without pressure filter) and 350 N for the Prescale II (with pressure filter). Conclusion In occlusal force tests for making a diagnosis of oral hypofunction, reference values for the Prescale II (without pressure filter) and for the Prescale II (with pressure filter) were determined. The findings suggested that the Prescale II can be used as a diagnostic examination for oral hypofunction.

Objectives Clinical evidence demonstrating the effectiveness of implants in preventing tooth loss is limited because of the many risk factors involved in tooth loss. This retrospective cohort study investigated whether an implant in the molar region of a distal free-end edentulous space affects the loss of the most distal tooth after 6 years, adjusting for other risk factors associated with tooth loss using propensity score matching analysis. Material and methods A total of 571 subjects and 1,085 teeth adjacent to a distal free-end edentulous space were evaluated. At baseline, the 1,085 teeth were divided into two groups according to the presence or absence of a molar implant with a fixed dental prosthesis in the distal free-end edentulous space. Propensity score matching analysis was used to reduce the effects of bias by matching teeth with and without implants according to similar background factors at baseline. The adjusted variables were age group, occlusal support status, Kennedy classification, tooth position, tooth type, restoration status, dental caries, periodontal pocket depth, and condition of the opposing tooth. Results A total of 56 teeth (28 associated with a molar implant; 28 with no implant) were enrolled according to propensity score matching. Fisher's exact test showed that a molar implant significantly protected the tooth adjacent to the distal free-end edentulous space (p = .01). Conclusions Within the limitations of this retrospective cohort study, it was found that implants in free-end edentulous spaces may be beneficial in extending the longevity of adjacent teeth. Further research will be necessary to confirm this finding.

Aim The association between serum uric acid (UA) and atherosclerosis in old people is controversial. Therefore, in this study, we clarified this association by assessing serum UA and common carotid atherosclerosis examined by carotid ultrasound in community-dwelling older people in their 70s, 80s and 90s in the SONIC study. Methods A cross-sectional study was conducted involving 538 men and 577 women recruited from the community. The analysis was performed using serum UA as the explanatory variable and the maximum carotid intima-media thickness (max-CIMT) and mean-IMT as the dependent variables. The analysis was performed by multiple regression using traditional risk factors for atherosclerosis as adjustment variables. Results Analysis of the association between serum UA and IMT revealed a significant correlation only in women >70 years old. Max-CIMT (β = 0.081, 95% CI = 0.026, 0.136; P = 0.004) and mean-IMT (β = 0.015, 95% CI = 0.003, 0.029; P = 0.016) were significant. In the analysis of each age group, a significant correlation was only found in women in their 70s for mean-IMT (β = 0.031, 95% CI = 0.008, 0.053; P = 0.008). Conclusion In community-dwelling women aged about 70 years old, elevated serum UA may be an independent risk factor for IMT thickening as a surrogate marker for atherosclerosis. Geriatr Gerontol Int 2020; ••: ••-••.

AIM Heart diseases and social factors are associated with physical frailty, but there are few studies of older people living in the community. Consequently, the aim of this study was to examine the association between heart diseases, social factors and physical frailty in community-dwelling older populations including the oldest-old people. METHODS The cross-sectional study included 1882 participants of community-dwelling older and oldest-old people. The survey site assessed questionnaires on medical history, social factors, blood samples and physical examination. Physical frailty was based on slow gait speed or weak grip strength. Associations were analyzed using multiple logistic regression with adjustments for covariate factors. RESULTS Subjects with heart disease had a higher prevalence of physical frailty than those without heart disease. After adjusting the covariate factors, heart diseases were associated with a slow gait speed (odds ratio [OR] = 1.62; 95% confidence interval [CI]: 1.13-2.32, P = 0.009). Frequency of going outdoors and direct interaction with relatives or friends were associated with a slow gait speed (OR = 0.83, 95% CI 0.75-0.91, P ≤ 0.001 and OR = 0.87, 95% CI 0.81-0.94, P

Aim Previous studies have reported significant associations between tooth loss or periodontal status and cognitive function; however, animal experimental studies have shown that occlusion might be a more important factor in cognitive decline. The purpose of the present study was to investigate the influence of a lack of posterior occlusal support by residual teeth on the decline of cognitive function over a 3-year period among 80-year-old Japanese people. Methods Participants were community-dwelling older adults (n = 515, age 79-81 years). Cognitive function was measured using the Japanese version of the Montreal Cognitive Assessment. At baseline, participants were divided into two groups: those with and without posterior occlusal support. Participants whose Japanese version of the Montreal Cognitive Assessment score decreased by ≥3 points over the 3-year period were defined as the declined group. Logistic regression was carried out for the decline in Japanese version of the Montreal Cognitive Assessment scores, including dental status and possible risk factors as independent variables. Results More participants without posterior occlusal support tended to be in the cognitive decline group (49.4%) than in the maintained group (38.5%; χ2 -test, P = 0.02). Logistic regression analysis showed that a lack of posterior occlusal support was a significant variable (odds ratio 1.55, P = 0.03) for cognitive decline, even after adjusting for other risk factors. However, the number of teeth or mean periodontal pocket depth was not significantly correlated with cognitive decline. Conclusions The present findings suggest that a lack of posterior occlusal support predicted the incidence of cognitive decline, even after adjusting for possible risk factors in community-dwelling old-old people. Geriatr Gerontol Int 2018; 18: 1439-1446.

Objectives The purpose of our cross-sectional study was to investigate the relationship between gerotranscendence and oral health-related quality of life (OHR-QOL). To our knowledge, this is the first study to investigate the relationship between gerotranscendence and OHR-QOL. Methods Participants (total n = 1969; 70-year-old group, n = 999; 80-year-old group, n = 970) were drawn from resident lists in four areas of Japan: one urban area and one rural area in each of two geographical regions. OHR-QOL was measured using the Geriatric Oral Health Assessment Index (GOHAI). Measurement of occlusal force was performed using pressure-sensitive sheets. Gerotranscendence was assessed with the Japanese Gerotranscendence Scale Revised (JGS-R). We used multiple linear regression analysis to examine the relationships among OHR-QOL and other variables. Results Geriatric Oral Health Assessment Index score was significantly correlated with occlusal force, number of teeth, financial status and JGS-R score on linear regression analysis. Conclusion Degree of gerotranscendence was significantly and independently correlated with degree of OHR-QOL in our sample.

Purpose/aim To summarize and discuss how geriatric dentistry has been addressed in dental schools of different countries regarding to (1) teaching students at the predoctoral level; (2) advanced training, and (3) research. Method and materials A convenience sample of faculty members from a selection of high, upper-middle and lower-middle income countries were recruited to complete the survey. The survey had 5 open-ended main topics, and asked about (1) the size of their elderly population, (2) general information about dental education; (3) the number of dental schools teaching geriatric dentistry, and their teaching methods; (4) advanced training in geriatric dentistry; (5) scholarship/research in geriatric dentistry. Results and conclusion (1) There is great variation in the size of elderly population; (2) duration of training and content of dental education curriculum varies; (3) geriatric dentistry has not been established as a standalone course in dental schools in the majority of the countries, (4) most countries, with the exception of Japan, lack adequate number of dentists trained in geriatric dentistry as well as training programs, and (5) geriatric dentistry-related research has increased in recent years in scope and content, although the majority of these papers are not in English.

Aim The objective of the present study was to investigate the association between frailty and plasma adiponectin levels in a general population of Japanese older adults. Methods The volunteer older adults, aged approximately 83 years, were recruited randomly from a general population in the Japanese Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study. We used the modified Cardiovascular Health Study criteria to assess the frailty status of the study participants. The study participants were classified as non-frail, pre-frail and frail according to their physical activities. We compared plasma adiponectin levels among these three groups and applied a multivariate logistic regression analysis including plasma adiponectin levels to clarify the factors associated with frailty status in the cross-sectional design. Results The mean age of the participants was 83.1 ± 0.9 years, and 51.8% were men. The frailty index was available to assess 353 participants, of whom 24.6% were classified as non-frail, 62.3% as prefrail and 13.0% as frail. The log-transformed plasma adiponectin levels increased stepwise in the following order: non-frail, pre-frail and frail. A multivariate logistic regression analysis showed that higher plasma adiponectin levels, a higher estimated glomerular filtration rate and lower hemoglobin levels were independent determinants for pre-frail/frail status compared with non-frail status. Conclusions The present study showed that higher plasma adiponectin levels were associated with frailty status in older Japanese adults in the general population. Further longitudinal study is essential to clarify the role of plasma adiponectin in the progression of frailty. Geriatr Gerontol Int 2018; 18: 839-846.

PURPOSE To establish the accuracy of measuring the gonial angle on an orthopantomogram (GAO), as defined by the anatomic relationship between the inferior and posterior borders of the mandible. Furthermore, to examine the relationship between GAO and maximum occlusal force (MOF) in the premolar and molar regions of healthy young adults. MATERIALS AND METHODS Orthopantomograms of dry mandibles were obtained in three orientations in the sagittal plane, to represent variation in image acquisition in clinical settings. The GAO was measured using image-processing software, and reliability was analyzed using the intraclass correlation coefficient. Then, GAO, MOF, gender, and body mass index (BMI) were measured in a cohort of healthy young adult volunteers. MOF was measured using an Occlusal Force Meter GM 10 device. The relationships between GAO, MOF, sex, and BMI were examined using the Pearson correlation coefficient and multiple regression analysis. RESULTS In five dry mandibles, there was a high correlation between the GAOs measured in the different orientations (p < 0.001). In 58 healthy volunteers (31 women and 27 men, mean age 24.6 years), the mean GAO was 123.3° ± 7.5°. The mean MOFs at the first premolar, second premolar, and first molar teeth were 256.4 N ± 128.3 N, 319.0 N ± 171.7 N, and 487.5 N ± 227.2 N, respectively. Men had significantly greater MOF than women at all teeth. The GAO was significantly inversely correlated with MOF at the second premolar (r = -0.376, p = 0.005) and first molar teeth (r = -0.479, p < 0.001). Multiple regression analysis showed that GAO was a significant explanatory factor for MOF at the second premolar and first molar teeth (p = 0.012 and 0.001, respectively). CONCLUSIONS GAOs were measured accurately on the orthopantomograms taken in this study and were a reliable predictor of MOF between the second premolar and first molar teeth. A smaller GAO was associated with a greater MOF at the second premolar and first molar teeth.

The sense of taste plays a pivotal role for personal assessment of the nutritional value, safety and quality of foods. Although it is commonly recognised that taste sensitivity decreases with age, alterations in that sensitivity over time in an old-old population have not been previously reported. Furthermore, no known studies utilised comprehensive variables regarding taste changes and related factors for assessments. Here, we report novel findings from a 3-year longitudinal study model aimed to elucidate taste sensitivity decline and its related factors in old-old individuals. We utilised 621 subjects aged 79-81 years who participated in the Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians Study for baseline assessments performed in 2011 and 2012, and then conducted follow-up assessments 3 years later in 328 of those. Assessment of general health, an oral examination and determination of taste sensitivity were performed for each. We also evaluated cognitive function using Montreal Cognitive Assessment findings, then excluded from analysis those with a score lower than 20 in order to secure the validity and reliability of the subjects' answers. Contributing variables were selected using univariate analysis, then analysed with multivariate logistic regression analysis. We found that males showed significantly greater declines in taste sensitivity for sweet and sour tastes than females. Additionally, subjects with lower cognitive scores showed a significantly greater taste decrease for salty in multivariate analysis. In conclusion, our longitudinal study revealed that gender and cognitive status are major factors affecting taste sensitivity in geriatric individuals.

The sense of taste is important, as it allows for assessment of nutritional value, as well as safety and quality of foods, with several factors suggested to be associated with taste sensitivity. However, comprehensive variables regarding taste and related factors have not been utilized in previous studies for assessments of sensitivity. In the present study, we performed cross-sectional analyses of taste sensitivity and related factors in geriatric individuals who participated in the SONIC Study. We analyzed 2 groups divided by age, 69 to 71 years (young-old, n=687) and 79 to 81 years (old-old, n=621), and performed a general health assessment, an oral examination, and determination of taste sensitivity. Contributing variables were selected by univariate analysis, then subjected to multivariate logistic regression analysis. In both groups, females showed significantly better sensitivity for bitter and sour tastes. Additionally, higher cognitive scores for subjects with a fine taste for salty were commonly seen in both groups, while smoking, drinking, hypertension, number of teeth, stimulated salivary flow salt intake, and years of education were also shown to be associated with taste sensitivity. We found gender and cognitive status to be major factors affecting taste sensitivity in geriatric individuals. This article is protected by copyright. All rights reserved.

Aim The present study examined sex and age differences in taste sensitivity among young adult, young-old and old-old Japanese. Methods Participants were divided into three groups comprising 477 men and 519 women in the young-old group (aged 69–71 years), 449 men and 500 women in the old-old group (aged 79–81 years), and 35 men and 35 women in the young adult group (aged 24–32 years). Recognition thresholds for the four basic tastes were measured using the 1-mL whole mouth gustatory test, in which taste solutions of the four basic tastes were tested in five concentrations. Results Young adults showed significantly lower recognition thresholds than the young-old group, and the young-old group showed significantly lower recognition thresholds than the old-old group. Among the young-old and old-old groups, women showed significantly lower recognition thresholds than males for sour, salty and bitter tastes, but there was no sex difference in the sweet taste threshold between the two groups. Conclusions The present study confirmed that there are age and sex differences in taste sensitivity for the four basic tastes among young adult, young-old, and old-old Japanese, and that the sensitivity of sweet taste is more robust than the other tastes. Geriatr Gerontol Int 2016; 16: 1281–1288.

Although the shortened dental arch (SDA) concept has been known to all over the world, acceptance of the SDA concept as an oral health standard can be questionable from the patients' point of view, even if it is biologically reasonable. Furthermore, because the health insurance system covers removable partial dentures (RPDs) for all citizens in Japan, SDA patients seem to prefer to receive prosthetic treatment to replace the missing teeth. However, there were few field surveys to investigate the usage rate of RPDs in Japan. The purpose of this study was to determine the usage rate of RPDs in older Japanese subjects and to investigate the factors related to the usage of RPDs. Partially edentate participants (n = 390) were included in this study. Oral examinations were conducted to record several indices. The Cochran-Armitage trend test was used to evaluate the relationship between the number of missing teeth and the usage rate of RPDs. Chi-squared tests and logistic regression analysis were conducted to evaluate the factors related to the usage rate of RPDs. Usage of RPDs had a significantly positive association with the number of missing distal extension teeth and bilaterally missing teeth. The usage rate of RPDs increased as the number of missing distal extension teeth increased (P for trend

Aim The 9p21 region has been pointed out by the genome-wide association studies as a hot spot for disease-associated variants. Most of the diseases linked with the locus are aging-related conditions, such us cardiovascular disease, diabetes and cancer. Centenarians are known to present a reduced risk and delayed onset for these conditions. Here, we aimed to assess if the 9p21 variants contribute to this protection by possibly altering basic aging mechanisms. Methods We genotyped 15 tag single-nucleotide polymorphisms (SNP) along the CDKN2A/B/ANRIL locus in 1505 individuals. The participants were divided in three groups: centenarians, septuagenarians and young controls. Centenarians were 593 participants (age range 100–116 years, mean 105.9 years), septuagenarians were 434 volunteers aged between 69 and 71 years (mean 70.1 ± 0.9 years) and the 478 young controls were under the age of 50 years (range 14–50 years, mean 41.8 years). We genotyped the SNP rs1333049 in an additional sample of 231 coronary artery disease patients to confirm the 9p21 association. Results The leading coronary artery disease-associated SNP rs1333049 was associated with coronary artery disease; however, none of the 9p21 SNP evaluated in the present study were associated with extreme longevity. Conclusions Our findings suggest that the 9p21 disease-associated polymorphisms do not contribute to the life-long protection from cardiovascular and other age-related diseases observed in centenarians. It is likely that this protection is mediated by mechanisms different from the ones underlying the 9p21 association. Geriatr Gerontol Int 2015; 15: 797–803.

This cross-sectional study aimed to investigate the association of periodontal status with occlusal force and food acceptability. We hypothesised that mastication deteriorated with reduced periodontal support, even when posterior occlusal contacts with natural teeth were maintained and the patients remained clinically asymptomatic. Participants were 482 independently living 69-71-year-olds, classified as Eichner's group A, having no mobile teeth and no periodontal symptoms. The periodontal probing depth (PPD) and restoration status of each tooth were examined. Occlusal force in the intercuspal position was measured with pressure-sensitive films. Food acceptability was evaluated from the difficulty experienced in chewing apples, grilled beef, and hard rice crackers. Multivariate regression analysis was performed to investigate the association of periodontal status with occlusal force and food acceptability. A P-value of

Summary Because there are more elderly people than ever before and because they are living for longer periods of time, it is essential to understand the determinants of healthy ageing. This study examined changes in oral health-related quality of life (OHRQoL) among Japanese elderly over a 7-year period. A sample of independently living individuals (aged 60+ years) underwent a questionnaire and dental examination at baseline and 7 years afterwards. The Geriatric Oral Health Assessment Index (GOHAI) was used to assess the impact of oral conditions. Occlusal force and salivary flow were also assessed. Of the 411 participants assessed at baseline, 130 (31·6%) accepted to participate after 7 years. There were no significant differences between those lost to follow-up and those assessed at 7 years, except that a higher proportion of the latter rated their baseline general health as good. Among the latter, the overall mean GOHAI score did not change significantly (11·8 at baseline and 11·1 at follow-up; P = 0·16). However, after controlling for age, gender and baseline GOHAI score, participants who had lost teeth or experienced a decline in occlusal force after 7 years had higher follow-up GOHAI scores (indicating poorer OHRQoL). Unfavourable changes in clinical oral status over time are reflected in poorer self-rated oral health.

Background Hypertension and/or antihypertensive medication reportedly induce dry mouth; however, an immediate relationship between salivary flow and hypertension has not been elucidated. Objectives The purpose of the present study was to examine the association of hypertension and antihypertensive medication with salivary flow rate and pH in older adults. Subjects Subjects were independently living volunteers aged 60–78 years taking no medication (n = 138) or only antihypertensive medication (n = 27). Unstimulated saliva and stimulated saliva by the mastication method were collected, and salivary pH was measured. Hypertension was defined as systolic blood pressure of ≥140 mmHg and/or diastolic blood pressure of ≥90 mmHg. Results There was no significant correlation between either hypertension or intake of antihypertensive medication and unstimulated or stimulated salivary flow rate. However, multiple regression analysis showed that hypertension was significantly associated with pH of unstimulated saliva after controlling for other variables (β = −0.270, P = 0.003). Conclusion Hypertension regardless of antihypertensive medication was related to a lower pH of unstimulated saliva. Blood pressure might be a required consideration for maintenance of oral health in older individuals.

Objectives The aims of this study were to assess the correlations between the Geriatric Oral Health Assessment Index (GOHAI) and the Oral Health Impact Profile-14 (OHIP-14) and to examine which survey is more sensitive to objectively measured oral function in the Japanese elderly. Methods The subjects were 290 community-dwelling, cognitively healthy, and independently living people over the age of 60 years (mean: 66.3 years). Measures included the GOHAI and OHIP-14 questionnaires, as well as self-rating of general and oral health, dry mouth, number of residual teeth, and objective values of occlusal force, masticatory performance, and salivary flow rate. Bivariate and linear regression analyses were used to identify which of these variables predicted GOHAI and OHIP-14 scores. Results Spearman's correlation coefficient between the GOHAI and OHIP-14 scores was 0.728 (P

Purpose: The poor bone quality that exists in the posterior maxilla is associated with lower initial stability and higher failure rates in implants. This study examined the bone densities of edentulous posterior maxillae by computed tomography (CT). Materials and Methods: Based on CT images, the voxel values representing implant replacement in the posterior maxillary regions of 30 patients were calculated in the range from 150 to 2,000 Hounsfield units (HU). The bone densities of these regions were categorized according to Misch's classification and compared among individuals and between sexes. Results: The average of the median individual CT values was 495 HU (95% confidence interval: 442–547 HU) and was significantly higher in males than in females. Most of the bone in the posterior maxillae was classified as D3 (350–850 HU) or D4 (150–350 HU) according to Misch's classification, comprising 50% and 32% of the entire regions, respectively. Conclusions: More than 80% of the edentulous posterior maxillae consisted of porous cortical crest or no cortical bone according to CT, although the bone densities varied markedly among individuals. More detailed assessments of bone density may be useful to enhance initial stability of implants in the posterior maxilla.

doi: 10.1111/j.1741-2358.2011.00571.x Clinically acceptable restorations may be a hotbed for cariogenic microbes Objective: The aim of this study was to investigate the cross-sectional association of dental restorations with salivary cariogenic pathogens among the elderly to establish effective parameters of caries risk for this population. Materials and methods: Stimulated whole saliva was collected from 289 community-dwelling older adults (66.2 ± 3.9 years old) who had 20 or more teeth. Salivary levels of three cariogenic bacteria (Streptococcus mutans, Streptococcus sobrinus and lactobacilli) were estimated using quantitative polymerase chain reaction (real-time PCR) method. Results: The mean number of residual teeth was 26.4, and restored teeth with crowns, inlays and composite resin were 7.35, 3.88 and 0.68, respectively. The number of crowns correlated positively with salivary S. mutans, S. sobrinus and lactobacilli. Multiple linear regression analyses showed that the number of restored teeth with crowns was independently associated with salivary S. mutans, S. sobrinus and lactobacilli after controlling for age, gender, number of residual teeth and salivary flow rate. Salivary flow rate was independently associated with salivary S. mutans and lactobacilli. Conclusion: The number of crowns had an association with salivary levels of cariogenic bacteria, suggesting that this parameter may be a caries risk indicator for the elderly population.

doi: 10.1111/j.1741-2358.2010.00449.x Investigation of oral opportunistic pathogens in independent living elderly Japanese Objective: Pneumonia is reported to be associated with high morbidity in elderly and compromised individuals, with poor oral health demonstrated to be a significant risk factor for pneumonia. Several opportunistic pathogens, such as Streptococcus pneumoniae, Klebsiella pneumoniae, Escherichia coli and Staphylococcus aureus, have been detected in patients with pneumonia. We investigated the prevalence of opportunistic pathogens in the oral cavity of healthy independent living Japanese elderly subjects and analysed factors related to harbouring those pathogens. Materials and methods: We studied 265 subjects, each of whom received a dental examination, during which specimens were collected with a tongue swab and examined for the presence of 10 oral opportunistic pathogens using single or multiple selective media. Furthermore, the presence of occult blood in saliva was examined using test paper strips. Results: Oral opportunistic pathogens were detected in 13.6% of the subjects. Those positive for occult blood in saliva had a significantly higher rate of harbouring the pathogens (p

The purpose of this study was to determine how elderly Japanese people subjectively value treatment options for missing molars. Subjects were 528 independently community-dwelling elderly people. They were presented with photographs and descriptions of the process and expected outcomes of five possible treatment options: cantilever fixed dental prosthesis (FDP); resin or metal removable partial denture prosthesis (RPDP); implant-supported fixed prosthesis; and no replacement (shortened dental arch: SDA) for missing lower bilateral first and second molars. The participants filled in the questionnaire on subjective importance for treatment and indicated on a visual analogue scale how they valued the treatment (utility value: UV). Values were analysed by Mann-Whitney U-tests and multiple logistic regression analyses. Overall, the UVs for the FDP and the metal RPDP were the highest, and the UV for the SDA was the lowest. With respect to subjective importance, 'chewing ability' and 'no pain during function' were significantly selected more frequently. Multiple logistic regression analyses showed that the UV for the resin RPDP had significant positive associations with denture wearers and low treatment cost, whereas the implant had significant negative associations with denture wearers and older age. The SDA had significant positive associations with men and low treatment cost and a negative association with appearance. In conclusion, these elderly Japanese preferred cantilever FDPs and metal RPDPs to implants and 'no replacement.' It suggests that the SDA as an oral health goal can be questionable from the patients' point of view, even if it is biologically correct.

Summary The purpose of this study was to examine the prevalence of torus palatinus (TP) among Japanese elderly and to identify the factors associated with the formation of TP. The subjects were adults aged over 60, who lived independently in the community and attended lectures once a week at the Senior Citizens’ College in Osaka prefecture during 2007 and 2008. A total of 664 subjects, including 294 men and 370 women, were examined, and the mean age was 66·5 ± 4·2 (s.d.). After informed consent was obtained, participants responded to a questionnaire and underwent clinical examination consisting of dental status, temporomandibular symptoms and occlusal force. There were 113 (17·0%) subjects with TP. The prevalence of TP was more frequent in women than in men (24·6% versus 7·5%, P

Objective methods for evaluating masticatory performance are invaluable for quantitative comparisons between various dental treatments as well as diagnosing masticatory disorder. The purpose of this study was to develop an accurate method for automatically measuring masticatory performance using a new measuring device consisting of light-emitting diodes and a photodiode and test gummy jelly. First, the relationship between six known β-carotene concentrations in aqueous solution and the voltage values exhibited on a photodiode was investigated. Mean voltage obtained by red light incident on the photodiode indicated a significantly high correlation (r=0·999 in a cubic function, P

Gerodontology 2010; doi: 10.1111/j.1741-2358.2009.00357.x Subjective values of different age groups in Japan regarding treatment for missing molars Objective: To determine how patients and dentists in Japan value the outcomes of different treatment options for missing molars. Materials and methods: Elderly removable-denture wearers and dentate persons (senior group), preclinical dental students (young group), and prosthodontists were presented with five possible treatment options for missing lower bilateral first and second molars. The participants indicated on a visual analogue scale how they would value the treatment (utility value: UV), if they had received each of the treatments. Two-way repeated measures anova was used for statistical analyses. Results: The UV for the shortened dental arch (SDA) without replacement was the lowest in every group. The young group rated the value of cantilever fixed partial dentures (FPD) and implants significantly higher than removable partial dentures (RPD), while the senior group rated the value of FPD and RPD significantly higher than implants. Those having experience with removable dentures were likely to place a higher value on the acrylic RPD. The prosthodontists rated the value of implants significantly higher than any other options. Conclusions: The participants in every group placed the lowest value on the outcome from the SDA in Japan. The denture wearers preferred the RPD, while prosthodontists preferred implants.

The aim of this study was to explore the relationship between patterns of missing occlusal units (OUs) and oral health-related quality of life (OHRQoL) in subjects with the shortened dental arches (SDAs). Subjects with SDAs were recruited consecutively for 1 month from six university-based prosthodontic clinics. In total, 115 SDA subjects participated (mean age, 58.5 +/- 10.0 years; 71% female). The location and number of missing teeth were examined and the number of missing OUs was calculated. To evaluate OHRQoL, the Japanese version of the Oral Health Impact Profile (OHIP-J) was administered and the summary score of OHIP-J was calculated. The SDA subjects were categorized depending upon the anterior-posterior lengths of the missing or remaining OUs. Regression analyses were performed to investigate the OHIP-J differences between groups of subjects with various anterior-posterior SDA lengths. The analyses revealed that subjects who only lost the second molar contact exhibited significantly better OHRQoL than those who lost more teeth [coefficient: 11.1, 95% confidence interval (CI): 2.8-19.2, P = 0.02]. Furthermore a statistically significant group difference was observed between the groups with and without the first molar occlusal contact (coefficient: 12.8, 95% CI: 1.4 to 24.1, P = 0.03). In conclusion, although our results are of exploratory nature and need validation, patterns of missing OUs are likely to be related to the OHRQoL impairment in SDA subjects with the presence of first molar contact having a particularly important role.

The purpose of this study was to investigate taste sensation in the elderly, and to determine relationships between subjective dissatisfaction with taste ability and factors such as age, gender and oral status among independently living elderly individuals. Participants were older adults (mean age, 66.0 +/- 4.2 years; 321 men and 319 women) voluntarily attending a Senior Citizen Educational Program supported by local government in 2003 and 2004. The questionnaire included self-assessed items on general health, dry mouth, chewing satisfaction and taste satisfaction. Respondents underwent investigation of salivary flow rate, dental status and gustatory testing using the filter-paper disc method for sweet, salty, sour and bitter. Chi-squared tests showed that the factors associated with dissatisfaction with taste ability were older age, dissatisfaction with chewing, dry mouth during eating and wearing dentures covering the entire hard palate. The sensation for each taste was not significantly related to taste satisfaction by chi-squared test. Multiple logistic regression analysis showed that dry mouth during eating, dentures covering the entire hard palate, dissatisfaction with chewing and discriminatory threshold for the sour taste were associated with dissatisfaction with taste ability. We found a significant association between subjective taste dissatisfaction and certain oral factors; hence, when patients complain about diminished taste, dentists must assess oral status as well as taste sensation.

Bone formation around an implant surface is indispensable for osseointegration of dental implants. Transcriptional factor Runx2 is essential for osteoblast differentiation and bone formation. However, little is known about the involvement of Runx2 in osseointegration. The purpose of this study was to investigate molecular interactions between Runx2 and implant titanium materials at the transcriptional level. Primary osteoblasts isolated from mouse calvaria and C3H10T1/2 cells were cultured on titanium plates or in the presence of titanium particles. Transcriptional activity of Runx2 was measured by reporter assay using osteocalcin gene promoter. We found significant increase (p < 0.05) in Runx2 transcriptional activity in cells cultured on titanium plates compared to plastic plates. Titanium particles also upregulated Runx2 transcriptional activity for over 2-folds compared to control and this effect was abolished by the specific inhibitor for ERK1/2, PD98059. Moreover, treatment with PD98059 clearly suppressed osteoblast mineralization cultured on titanium plates. These data suggest that osteoblast attachment to titanium enhanced Runx2 transcriptional activity and bone formation via MAPK pathway during the osseointegration of dental implants.

The purpose of the study was to examine the effect of adding impression material on denture space using a piezographical record. Subjects were ten voluntary edentulous patients, aged from 61 to 84 years old. A maxillary trial denture with anterior artificial teeth and a mandibular base plate with a keel were inserted into the oral cavity. Three ml of tissue-conditioning materials was injected on the base plate for each trial. Afterwards, the patients were instructed to pronounce various phonemes, so that tongue, cheeks and lips conformed to the denture space. The impression complexes were cut at the level of the estimated occlusal plane. Occlusal analogues were made by duplicating the impression complexes. Measurements were performed for five analogues from the first to fifth additions for each subject. The data were compared using analysis of variance (ANOVA), and a Friedman's test followed by a Bonferroni test for multiple comparisons with a level of significance at 5%. At the molar and premolar positions, the bucco-lingual widths of the occlusal table increased significantly at incremental injection of impression materials from P1 to P4. The midpoints of the analogues were located at a distance of 1.5 mm buccally at the molar position and at a distance of 1.9 mm buccally at the premolar position from the top of the alveolar crest, independent of the addition of impression material. It was concluded that denture space was regulated by volume of material and was located slightly on the buccal side from the crest of the residual alveolar ridge.

The purpose of this study was to examine the amount of palatal mucosa Candida species associated with denture use and stimulated salivary flow in symptom-free adults over 60 years. The subjects were 351 (189 men and 162 women) independently living elderly people with a mean age of 66.7 +/- 4.3 (SD) years. Candidal activity of palatal mucosa was evaluated by the pH change in the medium that was associated with the acid production of the yeast. Subjects whose stimulated salivary flow rate was less than 0.5 ml/min were placed in the hyposalivation group. A multiple logistic regression analysis was used to determine if an independent variable was statistically significant after controlling for other variables. Candidal activity of the palatal mucosa was significantly associated with the dental status of the maxillae (Kruskal-Wallis test, P < 0.001), but was not significantly associated with age or drug intake. In maxillary denture wearers, Candidal activity of palatal mucosa had a significantly positive correlation with candidal activity of tissue fitting surfaces of maxillary dentures (r = 0.806, P < 0.001). A multiple logistic regression analysis showed that high candidal activity of the palate was significantly associated with being male and wearing maxillary removable dentures. Stimulated salivary flow rate was likely to be negatively related to high candidal activity (P = 0.07). This study suggests that the activity of Candida species in the oral cavity is associated with the wearing of removable dentures and stimulated salivary flow, independent of age or gender even in the relatively healthy elderly.

Recently, a newly developed magnetic attachment with stress breaker was used in retentive components in overdentures. Excessive lateral stress has a more harmful effect on natural teeth than axial stress, and the magnetic attachment with stress breaker is expected to reduce lateral forces on abutment teeth and protect it teeth from excessive stress. However, the properties of this retainer have not yet been determined experimentally. This study compares the lateral forces on abutment teeth for three retainers under loading on the denture base in a model study. A mandibular simulation model is constructed to measure lateral stress. Three types of retentive devices are attached to the canine root. These devices include the conventional root coping, the conventional magnetic attachment and the new magnetic attachment with stress breaker. For each retentive device, load is generated on the occlusal table of the model overdenture, and the lateral stress on the canine root and the displacement of the overdenture measured. The magnetic attachment with stress breaker does not displace the denture and exhibits lower lateral stress in the canine root than conventional root coping and magnetic attachments.

OBJECTIVES This study was designed to determine the factors influencing eating ability of old in-patients in a rehabilitation hospital. DESIGN Cross-sectional investigation. SETTING Forty-six in-patients in the rehabilitation ward of Hashimoto Hospital in Kagawa Prefecture in Japan were investigated using a multidisciplinary approach. MAIN OUTCOME MEASURES Age, gender, state of dentition, muscle activity of lip, cheek and tongue, biting force, salivary flow rate per a minute (SFR), masticatory ability for gummy jelly, swallowing ability, texture of meal, independency of walking (Functional Independence Measure = FIM) and ability to communicate. RESULTS Bivariate analysis for the relationship between surveyed items and masticatory ability (chi-square test) identified that better masticatory ability for gummy jelly was associated with age (< 85years), gender (male),state of dentition (dentate), SFR (high), activity of lip (good), biting force (high), swallowing ability (good) and activity of communication (high). Among these items, SFR (p = 0.001), gender (p = 0.004), ability to communicate (p = 0.005) and age (p = 0.012) were found having an influence on the masticatory ability (logistic regression analysis). On the other hand, age (< 85years), gender (male), SFR (high), activity of lip (good), activity of cheek (good), biting force (high), masticatory ability (good) and swallowing ability (good) had a relationship with normal texture of meal. In regression analysis, only two items, activity of lip (p = 0.003) and swallowing ability (p = 0.024) emerged as factors on texture of meal. CONCLUSIONS Masticatory ability for gummy jelly was influenced by cognitive function and was excluded from the factors on the state of meal. These results suggested the limitation of evaluation using test food, so dentists should observe eating behaviour of in-patients. In addition, dentists should pay attention to the activity of the lip and swallowing ability as well as dentition and prostheses in the rehabilitation of eating ability. As SFR was the most significant factor on masticatory ability, this emphasizes the necessity of care for dry mouth caused by side effects of multi-medication.

The purpose of this study was to examine the relationship between masticatory performance and maximal occlusal force in dentate subjects, using test foods of varying hardness. Subjects were 20 young males with natural dentitions. Gummy jellies with two different degrees of hardness have been used as test foods to evaluate masticatory performance. Masticatory performance was evaluated by the increase of the surface area of expectorated pieces of comminuted gummy jelly that was calculated from the concentration of gelatin. Maximal occlusal force was measured with pressure sensitive sheets (DENTAL PRESCALE 50H R type). The results suggested that maximal occlusal force had a significant positive correlation to the masticatory performance both with soft gummy jelly and hard gummy jelly. The correlation coefficient (r) with hand gummy jelly tended to be larger than with soft gummy jelly.

Objectives: The purpose of this study was to describe dental health services utilization and identify factors which influenced a group of independently living elderly persons in an urban area of Japan. Subjects: The study sample consisted of 2,990 participants, 83% of the total sample of the Senior Citizen's College, who were 60 years and over. Measurements: Their dental utilization and satisfaction with dental treatment were measured by a questionnaire from 1993 to 1998 Results: The mean age of the subjects was 66.5 years and 52% were male. Sixty percent of the subjects had visited a dentist within the previous year, and 33% of them had received a regular oral health check-up. The majority of the subjects (63%) were satisfied with their dental treatment. A multiple stepwise logistic regression analysis showed that dental services utilization had a significant positive association with presence of teeth (p