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Computational fluid dynamics （CFD） analysis is useful for quantitative assessment in patients with upper airway obstructions. We compared CFD analysis with rhinomanometry （RM） and acoustic rhinometry （AR）. Twenty patients with nasal and paranasal diseases who required computed tomography assessment underwent RM and AR. We measured the pressure and velocity at four parts of the upper airway using CFD analysis. Then we evaluated the correlation among CFD analysis, RM, and AR. CFD analysis detected obstruction sites in the nasal airway and pharynx in 14 and 2patients, respectively. High negative pressure accompanied the nasal obstruction, even behind the nasal cavity. Nasal airway pressure measured using CFD analysis strongly correlated with nasal resistance in RM （Spearman correlation coefficient＝0.853）. CFD analysis’s sensitivity and specificity to detect the obstruction were 84.6％ and 57.1％, respectively （compared to those of RM） and 83.3％ and 50.0％, respectively （compared to those of AR）. The CFD analysis’s ability to detect obstruction was comparable to that of RM and AR; therefore, it may help evaluate the upper airways in patients with nasal and paranasal diseases. We found impaired nasal ventilation also affected other parts of the upper airway. Further studies with a larger sample size are required to validate the use of CFD analysis for assessing the degree of upper airway ventilation disorders.

Aim Recent studies have suggested that oral bacteria induce systemic inflammation through the alteration of gut microbiota. We examined the relationship between oral and gut microbiota to evaluate the transition of oral bacteria to the gastrointestinal tract. Methods Oral samples from subgingival plaque and tongue‐coating and fecal samples were collected from 29 elderly subjects (age, 80.2 ± 9.1 years) and 30 adults (age, 35.9 ± 5.0 years). Genomic DNA was extracted from all samples, and DNA sequencing of bacterial 16S rRNA genes was performed for microbiota analysis. UniFrac distances were calculated to evaluate the similarity between microbial communities. Results Unweighted UniFrac distance indicated that the elderly group had a higher similarity between fecal and subgingival plaque microbiota than the adult group. Indeed, some bacterial taxa found in oral samples had a significantly higher prevalence in the feces of the elderly group than in that of the adult group. Conclusions The prevalence of oral bacterial transition to gut may be higher in the elderly than in adults, expecting that oral health care in the elderly will affect their gut microbiota composition and consequently promote human health.

Objective Oral mucositis (OM) caused by infection facilitated by myelosuppression and immunosuppression can be controlled through oral care. We investigated changes in oral anaerobic bacterial flora during the onset of OM with hematopoietic stem cell transplantation (HSCT). Methods This study included 19 patients who underwent HSCT. All received professional oral care before initiating the preparative regimen. We assessed OM, oral health and obtained microbial samples from the oral cavity during 5 assessment points: before initiating the preparative regimen; the day before HSCT (day 1); and at 7, 14, and 30 days after HSCT. Microbial species were identified by using a mass spectrometer. Results The number of patients with serious OM increased initially after HSCT and decreased thereafter. Many Streptococcus species were identified before HSCT, but these gradually decreased and were replaced by coagulase-negative staphylococci. An increase in Candida species after HSCT and the identification of Enterococcus species were significantly associated with OM. Nutritional status recovery and prognosis were significantly worse in patients who developed OM. Conclusions To the best of our knowledge, this study is the first which shows that anaerobic bacteria were identified in patients' oral flora before and after HSCT by using a mass spectrometer. These results indicate that Enterococcus species and Candida species may have been associated with OM. OM affected the patients' improvement in nutritional status and their prognosis. We concluded that it is important to provide more complete oral care instructions and interventions to prevent these bacterial infections.

The oral microbiota influences health and disease states. Some gram-negative anaerobic bacteria play important roles in tissue destruction associated with periodontal disease. Lactoferrin (LF) and lactoperoxidase (LPO) are antimicrobial proteins found in saliva; however, their influence on the whole oral microbiota currently remains unknown. In this randomized, double-blinded, placebo-controlled study, the effects of long-term ingestion of LF and LPO-containing tablets on the microbiota of supragingival plaque and tongue coating were assessed. Forty-six older individuals ingested placebo or test tablets after every meal for 8 weeks. The relative abundance of bacterial species was assessed by 16S rRNA gene high-throughput sequencing. Most of the bacterial species in supragingival plaque and tongue coating that exhibited significant decreases in the test group were gram-negative bacteria, including periodontal pathogens. Decreases in the total relative abundance of gram-negative organisms in supragingival plaque and tongue coating correlated with improvements in assessed variables related to oral health, such as oral malodor and plaque accumulation. Furthermore, there was significantly less microbiota diversity in supragingival plaque at 8 weeks in the test group than in the placebo group and low microbiota diversity correlated with improvements in assessed variables related to oral health. These results suggest that LF and LPO-containing tablets promote a shift from a highly diverse and gram-negative-dominated to a gram-positive-dominated community in the microbiota of supragingival plaque and tongue coating. This microbial shift may contribute to improvements in oral health, including oral malodor and state of the gingiva.

Aim There has been an increase in consultations related to eating and oral function of children, such as not chewing food properly and swallow without chewing; however, there have been few studies about oral function evaluation. We have devised a mouth rinsing function test (MRFT) to evaluate the oral function of children by grading mouth rinsing function into five stages. We aimed to investigate the effectiveness of MRFT for evaluating the oral function of children and to investigate factors relating to the MRFT scores. Methods The participants were 182 children (age 3–6 years; 98 boys and 84 girls) attending nursery school, who underwent an oral examination and evaluation of MRFT and occlusal force. Data on growth history and eating behavior were collected from parents through a questionnaire. Results The MRFT score significantly correlated with age and if breastfeeding or bottle-feeding was stopped earlier. Children whose parents worried about their eating habits tended to have lower MRFT scores. There was no significant correlation with occlusal force or the thickness and length of the masseter. Conclusions MRFT is effective for evaluating the oral function of children because the MRFT score increases with age. The MRFT score is related to eating behavior; hence, children with low MRFT scores should be supported appropriately. MRFT was not correlated with occlusal force or the thickness and length of the masseter muscle; therefore, it is necessary to examine the oral dexterity, using MRFT, when evaluating the oral function of children.

Objective This study aimed to examine relevant factors for subjective and objective assessment of masticatory functions and elucidate any differences between the two methods. Background Previous studies have reported that the results of subjective and objective assessment of masticatory function in older people do not necessarily agree. Materials and methods This study included 487 community-dwelling Japanese older people (205 male and 282 female; mean age 74.1±6.3 years) who participated in a comprehensive geriatric health examination. Basic information (gender and age), higher level of competence in daily living, depression, subjective masticatory function (SMF) and objective masticatory function (OMF) assessments, cognitive function, skeletal muscle mass, handgrip strength, gait speed and oral status (number of remaining and functional teeth, mouth dryness and occlusal force) were recorded. Results Multiple logistic regression analysis showed that depression (odds ratio [OR]: 1.181, 95% confidence interval [CI]: 1.094-1.275), mouth dryness (OR: 2.037, CI: 1.212-3.423) and occlusal force (OR: 0.997, CI: 0.996-0.999) were significantly associated with SMF, whereas higher level of competence in daily living (OR: 0.730 CI: 0.586-0.910), skeletal muscle mass (OR: 0.521 CI: 0.283-0.960), number of functional teeth (OR: 0.862 CI: 0.775-0.959), number of remaining teeth (OR: 0.868 CI: 0.810-0.930) and occlusal force (OR: 0.994, CI: 0.991-0.998) were associated with OMF. Conclusion Subjective masticatory functionSMF and OMF were associated with different factors, suggesting that both mental and physical factors should be taken into consideration when treating decreased masticatory function.

Oral sensory function is essential for the successful performance of a range of ingestion. Although the perception of object size is important in determining the degree of manipulation, evidence suggests that people does not always perceive the size of the object in oral cavity accurately. The purpose of this study was to investigate the factors affecting the intraoral perception of object size. Twenty-three healthy young volunteers detected the size of cylinders inserted into oral cavity blindly and identified it from the reference set. The diameter of cross section varied from 10 to 14 mm in a gap of 1 mm and had three different temperatures (5, 36, 50 °C) in each. The perceived size was recorded, and the difference with the actual size was assessed. The required time for identification was also measured and compared between gender and between temperatures. The results demonstrated that the direction of size illusion was significantly affected by the required time for identification. Long manipulation led to overestimation, and short manipulation led to underestimation of object size irrespective of temperature and size. Gender was the other factor affecting intraoral size perception. The rate of overestimation was low in female participants comparing with male participants in this experiment, although the number of participants was limited. We therefore concluded that in order to detect the other factors affecting intraoral size perception, regulating oral manipulation time is indispensable.

[Purposes] Although it is recommended to develop a habit of physical activities, there is no easy way to measure skeletal muscle mass in preschool children, which cause the difficulty of evaluation. The purpose of this study was to examine the validity of body composition including the skeletal muscle mass assessment using multi-frequency bioelectrical impedance analysis by comparing body fat mass obtained by using multi-frequency bioelectrical impedance analysis method and body mass index formulas. [Subjects and Methods] Ninety-four children were surveyed for age, height, weight, grip strength, maximum occlusal force, thickness of muscle and fat mass (masseter and lower limb), body fat mass, skeletal muscle mass, and calf circumference. We assessed additional parameters, which were thought to be related to skeletal muscle mass, to ensure validity. [Results] A strong correlation was found in body fat mass values obtained using the multi-frequency bioelectrical impedance analysis method and those obtained using the body mass index formulas. Additionally, strong correlation coefficients were found between the skeletal muscle mass/height obtained using the multi-frequency bioelectrical impedance analysis method and grip strength and calf circumference. [Conclusion] Our results indicate that skeletal muscle mass can be reliably measured using the multi-frequency bioelectrical impedance analysis method in preschool children.

Aim Lactoferrin and lactoperoxidase have antimicrobial effects against oral pathogens. This randomized, double-blinded, placebo-controlled parallel group study tested the efficacy of a lactoferrin and lactoperoxidase-containing tablet (LF + LPO tablet) in improving the oral hygiene status of older individuals. Methods A total of 46 participants (31 nursing home residents and 15 healthy older individuals) were randomly assigned to receive either lactoferrin and lactoperoxidase-containing tablets or placebo tablets, and were asked to suck on a tablet after every meal for 8 weeks. Oral and bacteriological assessments were carried out at baseline, 4 weeks and 8 weeks. Results A total of 47 participants (test group n = 20; mean age 80.4 ± 6.4 years; placebo group n = 17; mean age 85.9 ± 6.7 years) were included in the efficacy analysis. In the test group, the total number of bacteria in the tongue coating was significantly reduced at 4 and 8 weeks compared with that at baseline, and the number of Porphyromonas gingivalis and Fusobacterium nucleatum was significantly reduced at 8 weeks. The total number of bacteria and the number of P. gingivalis in the supragingival plaque were significantly reduced at 8 weeks. Furthermore, there was a significant difference in the change in the number of P. gingivalis in supragingival plaque at 8 weeks between the two groups. Conclusions Lactoferrin and lactoperoxidase-containing tablet ingestion showed antibacterial effects on periodontal bacteria present in the tongue coating and supragingival plaque, indicating that long-term ingestion could improve the oral hygiene of older individuals. Geriatr Gerontol Int 2016; ••: ••–••.

Aim The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function. Methods We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function. Results Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52–30.20), body mass index

Aim Elderly individuals face the risk of reductions in saliva secretion and occlusal force caused by systemic diseases or medications that can eventually result in malnutrition and systemic complications. We tested the hypothesis that regular gum chewing exercises (GCE) would enhance saliva secretion and occlusal force in an elderly population. Methods A total of 12 community-dwelling elderly individuals (3 men and 9 women) participated in this study after providing informed consent. Participants carried out GCE regimens using a soft gum (GCE-S) or hard gum (GCE-H) for 2 weeks each, with a 2-week rest period between trials. Mucosal moisture on the tongue surface, resting saliva, and occlusal force were measured before and after each test gum, and changes in parameters at relevant time-points were statistically analyzed. Differences in each measurement item were assessed using the Friedman test for before and after the GCE. We used the Holm's correction for multiple comparisons if the Friedman test results were significant. The critical value for rejecting the null hypothesis was set at P

Background/purpose In order to obtain information for the design of foods for infants and other young children, we analyzed bite size and mastication of children eating test foods with their fingers. Methods Using baked stick biscuits (Food A: newly designed biscuits for children; or Food B: commercially available control biscuits) as the test foods, we analyzed how children grasped the foods themselves with their fingers, bit into the items, and finished swallowing. Among 79 children who went to nursery school or preschool in a specified prefecture and gave consent to the objectives of this study, there were 54 for whom three dimensional motion analysis data from two trials for each food were obtained. Results Bite weight was significantly larger for Food A, and the bite length was significantly greater for Food B. The number of jaw movements was about 25 for both foods, being the least in the primary occlusion completion period group (Hellman's dental age ⅡA) for Food B. The maximum mastication distance for Food A was significantly longer, by 1.25 times, in the early period of primary occlusion completion group (Hellman's dental age ⅠC) and was longer, by approximately 1.2 times, in the II A period group. The total trajectory distance was significantly longer for Food A, by 1.2 times, in the IC period group and by 1.1 times in the IIA period group. Conclusion In designing foods for children, it is considered necessary to examine the design by dividing the target ages into 1–2 years and 3–5 years. It is also suggested that Food A not only requires a greater number of jaw Q2 movements but also is likely to produce more dexterous mandibular movements.

Background A simple and predictable method of evaluating eating and swallowing has not been yet established; thus, it is difficult to implement advance care planning according to deterioration in this function. This study aimed to clarify the association between a simple evaluation of eating and swallowing function and 1-year mortality in advanced dementia patients in nursing homes in Japan. Methods The study included 325 residents with advanced dementia. In a baseline survey, we examined medical history, physical function, and eating and swallowing function. We recorded mortality for 1 year from baseline. Kaplan-Meier survival analysis and Cox proportional regression were performed to investigate the association between the simple evaluation of eating and swallowing function and mortality. Results Statistical analysis included data from 312 of the 325 residents who had completed the baseline survey (7 individuals with non-oral ingestion and 6 who were alive but did not reside in the nursing home 1 year later were excluded). The participants’ mean age was 85.2 years, and 79.5 % of participants were female. At the 1-year follow-up, 70 patients had died. According to Cox proportional regression analysis, age, male gender, history of cerebrovascular disorder, poor results of palpation of masseter muscle tension, and modified water swallowing test were significantly associated with 1-year mortality. Conclusion The results of palpation of masseter muscle tension and modified water swallowing test were associated with 1-year mortality. These routine observations can predict mortality, and may thus provide evidence of the opportunity to implement advance care planning.

The main components of oral malodour have been identified as volatile sulfur compounds (VSCs), including hydrogen sulfide (H(2)S) and methyl mercaptan (CH(3)SH). The lactoperoxidase (LPO) system (consisting of LPO, glucose oxidase, glucose and thiocyanate) was previously shown to exhibit antimicrobial activities against some oral bacteria in vitro and suppressive effects on VSCs in mouth air in a clinical trial. Here, we examined the in vitro effects of the LPO system on the activities of the bacterial lyases involved in the production of VSCs by oral anaerobes. The exposure of crude bacterial extracts of Fusobacterium nucleatum and Porphyromonas gingivalis or purified methionine γ-lyase to the LPO system resulted in the inactivation of their lyase activities through l-cysteine and l-methionine, which was linked to the production of H(2)S and CH(3)SH, respectively. The exposure of living F. nucleatum and P. gingivalis cells to the LPO system resulted in the suppression of cell numbers and lyase activities. The inactivation of the crude bacterial extracts of F. nucleatum and purified methionine γ-lyase by the LPO system was partly recovered by the addition of DTT. Therefore, the LPO system may inactivate bacterial lyases including methionine γ-lyase by reacting with the free cysteine residues of lyases. These results suggested that the LPO system suppresses the production of VSCs not only through its antimicrobial effects, but also by its inactivating effects on the bacterial lyases of F. nucleatum and P. gingivalis.

The objective of the present study is toassess risk factors" at the stage of proofs, including oral health status, with the development of VAP in perioperative patients, with the final aim of the establishing oral health management systems in acute care hospitals. Of the patients who were admitted to the Intensive Care Unit (ICU) of our university hospital from January to December 2011 and who underwent oral intubation, 11 patients who received a diagnosis of VAP (nine men and two women) and 11 control patients (eight men and three women) were selected as subjects for the present study. We first investigated the disease names listed in the medical records of subjects in the VAP group and then selected patients who had the same diseases as the control group subjects. Within one day after admission to the ICU, a dentist evaluated the oral health status of the patients and the lips, teeth, oral mucosa, gingiva, tongue and xerostomia were scored (0-12) based on the criteria of the Revised Oral Assessment Guide (ROAG). Furthermore, six items (operative duration, BMI, length of ICU stay, Acute Physiology and Chronic Health Evaluation (APACHE II) score and length of ventilator used) were extracted from patient medical records and investigated. The items were used as independent variables and their relationship with the development of VAP was examined by regression analysis. Oral health care was performed by a nurse four times per day, using a standard toothbrush or sponge brush. Moreover, this study was approved by the Ethics Committee of the Department of Dentistry in our university. When each factor was compared in the VAP group and the control group, the VAP group showed significantly higher scores for oral health status, length of ICU stay and length of ventilator used. Furthermore, when the development of VAP and the relationships with each factor were examined by regression analysis, a significant relationship with oral health status, operative duration, BMI and length of ventilator use was seen. The results of the present study suggest the possibility of various factors being involved in the development of VAP in orally intubated patients, such as the oral health status of the patient. Appropriate oral health care can aid the prevention of perioperative pulmonary infections.

Objective Respiratory disease occurs frequently in children. The nasal cavity, trachea, and oral cavity are considered the primary routes of infection. We aimed to investigate the types of microbial pathogens present in the oral cavities of children with respiratory disease. In addition, we compared the detection rates of different pathogens between the oral cavity and the nasopharynx according to Hellman dental age. Materials and methods We included 32 children who were hospitalized for respiratory disease and classified them according to Hellman dental age. Furthermore, 32 control children were included as controls. Specimens were collected using two palate swabs: one taken at hospital admission and the other at discharge. The culture results of the samples were compared with those of the nasopharyngeal cultures. Results The following six bacterial strains were detected in both the palate and the nasopharynx: α-Streptococcus , Corynebacterium , Haemophilus influenzae , Haemophilus parainfluenzae , methicillin-resistant Staphylococcus aureus (MRSA), and Neisseria . In the comparison of the detection rates, Neisseria were significantly more frequently detected in the palate. MRSA was detected at a significantly higher rate in the nasopharynx. When the detection rates of different bacteria were compared according to Hellman dental age, significant differences were observed in the detection rates of α-Streptococcus in stage IA and Neisseria in stages IC and IIA. Discussion We noted that the bacterial load of specific bacteria in the palate increased with Hellman dental age. Furthermore, the increase in bacterial load in the oral cavity at stage IA, when teeth have not yet erupted, suggests the need for oral management.

The oral microbiota influences health and disease states. Some gram-negative anaerobic bacteria play important roles in tissue destruction associated with periodontal disease. Lactoferrin (LF) and lactoperoxidase (LPO) are antimicrobial proteins found in saliva; however, their influence on the whole oral microbiota currently remains unknown. In this randomized, double-blinded, placebo-controlled study, the effects of long-term ingestion of LF and LPO-containing tablets on the microbiota of supragingival plaque and tongue coating were assessed. Forty-six older individuals ingested placebo or test tablets after every meal for 8 weeks. The relative abundance of bacterial species was assessed by 16S rRNA gene high-throughput sequencing. Most of the bacterial species in supragingival plaque and tongue coating that exhibited significant decreases in the test group were gram-negative bacteria, including periodontal pathogens. Decreases in the total relative abundance of gram-negative organisms in supragingival plaque and tongue coating correlated with improvements in assessed variables related to oral health, such as oral malodor and plaque accumulation. Furthermore, there was significantly less microbiota diversity in supragingival plaque at 8 weeks in the test group than in the placebo group and low microbiota diversity correlated with improvements in assessed variables related to oral health. These results suggest that LF and LPO-containing tablets promote a shift from a highly diverse and gram-negative-dominated to a gram-positive-dominated community in the microbiota of supragingival plaque and tongue coating. This microbial shift may contribute to improvements in oral health, including oral malodor and state of the gingiva.

It is well known that children with autistic spectrum disorder possess various behavioral problems related to feeding, short attention span and maladaptation to surrounding environments. This study aimed to identify appropriate measures to address behavioral characteristics associated with eating and feeding in children with ASD by examining feeding behavior throughout the weaning period in rat pup models of autism. Male Sprague–Dawley (SD) rats and healthy SD rats were nursed with their mothers until 14 days after birth. Then, the pups were divided into the following three groups and related in separate cages without their mothers: group A, two model rats; group B, a model rat and a control rat; and group C, two control rats. The number of meals ingested together and the number of body contact made with other rats at mealtime in each cage were counted from the 15th day to the 21st day. During this period, the body weight of each rat and the amount of food intake in each cage were also measured. These were no remarkable differences in body weight gain between the model rats and control rats. In addition, the amount of food intake was not statistically different among the three groups. The number of body contacts made was not significantly different between group B and group C; however, the number of body contacts made was significantly lower in group A than in the other two groups. These findings indicate that the rat pup models of autism displayed a feeding behavior similar to that of children with autism. These behavioral problems were improved by the inclusion of healthy rat pups in the same cage at the time of feeding.

Background Despite resolution of the symptoms of eating and/or swallowing disorders, prolonged tube feeding is maintained in some children. This study summarized the characteristics of children with tube dependence and investigated the causes of tube dependence. Methods Clinical and growth data were evaluated using medical records and referral forms for 35 tube-dependent children. Results The children in this study had a median age of 30 months (range, 17–37 months) on the first visit and 35.5 months (range, 21.3–44.8 months) at tube removal. Seven children were not weaned from the feeding tube within the study period. Twenty-two (63%) of the children were girls, 20 (57%) were able to walk, 24 (69%) had mild mental retardation, and 33 (94%) had underlying disease. Tube-dependent children tended to weigh less than age-matched normal children. Sixteen children (45.7%) were underweight. Children who had their feeding tubes removed before age 3 were significantly younger at the initial visit than those who had their tubes removed after 3 years of age. Increased finger feeding was observed during the period before tube removal. Conclusion Tube-dependent children tend to be close to normal in body growth and intellectual development. When weaning from tube feeding, interventions at earlier ages are more efficient. Reduction in or discontinuation of tube feeding and encouragement of self-feeding were effective to wean off tube feeding.

Recently airway blockage accidents have increased in Japan, and airway blockage accidents involving children account for 12% of the total. However, the causes of airway blockage accidents are not clear. The oropharynx plays an important role in feeding and swallowing by helping to prevent aspiration and airway blockage accidents. Few studies, however, detail the changes in volume of the oropharynx during growth. The relationship, therefore, between the volume of the oropharynx and growth was investigated in this study. The subjects, 50 males and 50 females aged 7 to 15 years, were grouped according to a dental development age index (Hellman Dental Age), resulting in a dental development range from IIC to IVA. Cone beam computed tomography (CB Mercuray, Hitachi) was used to scan each subject's head, and a three-dimensional modeling system was used to measure the oropharynx volume, height and other. The mean and standard deviation of the height of males was 35.48±6.85mm and of females, 34.78±7.42mm. In male and female subjects, the height of the oropharynx airway increased from IIC to IVA. The mean and standard deviation of the oropharynx volume of males was 5,570.79±3,790.30mm 3 and of females, 4,942.80±2,818.75mm 3 . In male and female subjects, the volume of the oropharynx airway increased significantly from IIIC to IVA. Therefore, this study suggests that there is a strong relationship between the increase of the oropharynx airway and the time and condition of eruption of the second molar teeth from period of IIC to IVA of the Hellman Dental Age index.

Lactoferrin and lactoperoxidase have antimicrobial effects against oral pathogens. This randomized, double-blinded, placebo-controlled parallel group study tested the efficacy of a lactoferrin and lactoperoxidase-containing tablet (LF + LPO tablet) in improving the oral hygiene status of older individuals.A total of 46 participants (31 nursing home residents and 15 healthy older individuals) were randomly assigned to receive either lactoferrin and lactoperoxidase-containing tablets or placebo tablets, and were asked to suck on a tablet after every meal for 8 weeks. Oral and bacteriological assessments were carried out at baseline, 4 weeks and 8 weeks.A total of 47 participants (test group n = 20; mean age 80.4 ± 6.4 years; placebo group n = 17; mean age 85.9 ± 6.7 years) were included in the efficacy analysis. In the test group, the total number of bacteria in the tongue coating was significantly reduced at 4 and 8 weeks compared with that at baseline, and the number of Porphyromonas gingivalis and Fusobacterium nucleatum was significantly reduced at 8 weeks. The total number of bacteria and the number of P. gingivalis in the supragingival plaque were significantly reduced at 8 weeks. Furthermore, there was a significant difference in the change in the number of P. gingivalis in supragingival plaque at 8 weeks between the two groups.Lactoferrin and lactoperoxidase-containing tablet ingestion showed antibacterial effects on periodontal bacteria present in the tongue coating and supragingival plaque, indicating that long-term ingestion could improve the oral hygiene of older individuals. Geriatr Gerontol Int 2017; 17: 714-721.

Elderly individuals face the risk of reductions in saliva secretion and occlusal force caused by systemic diseases or medications that can eventually result in malnutrition and systemic complications. We tested the hypothesis that regular gum chewing exercises (GCE) would enhance saliva secretion and occlusal force in an elderly population.A total of 12 community-dwelling elderly individuals (3 men and 9 women) participated in this study after providing informed consent. Participants carried out GCE regimens using a soft gum (GCE-S) or hard gum (GCE-H) for 2 weeks each, with a 2-week rest period between trials. Mucosal moisture on the tongue surface, resting saliva, and occlusal force were measured before and after each test gum, and changes in parameters at relevant time-points were statistically analyzed. Differences in each measurement item were assessed using the Friedman test for before and after the GCE. We used the Holm's correction for multiple comparisons if the Friedman test results were significant. The critical value for rejecting the null hypothesis was set at P 0.05.Resting saliva secretion significantly increased after GCE-S, returned to baseline levels during the rest period and significantly increased again after GCE-H. Mucosal moisture and occlusal force followed a similar trend, with a significant rise after GCE-H.The results of the present study suggest that GCE can increase resting saliva secretion and occlusal force in elderly individuals. Further investigations are required on the appropriate use of soft and hard gums to address oral frailty in elderly individuals. Geriatr Gerontol Int 2017; 17: 48-53.

The present study verified the hypothesis that decreased skeletal muscle in older adults with Alzheimer's disease is related to Alzheimer's disease progression and decreased oral or swallowing function.We investigated 232 patients with Alzheimer's disease (31 men, 201 women, average age 85.4 ± 5.9 years) in two regions in Japan. The patients provided basic information (sex and age), and were assessed for skeletal muscle index, dementia severity (clinical dementia rating), activities of daily living, nutritional status, oral status and swallowing function.Stratification by clinical dementia rating was as follows: clinical dementia rating 0.5:21 patients (9.0%), clinical dementia rating 1:85 patients (36.6%), clinical dementia rating 2:88 patients (37.9%) and clinical dementia rating 3:38 patients (16.3%). Alzheimer's disease severity was significantly related to skeletal muscle index. Logistic regression analysis showed that clinical dementia rating 3 (odds ratio 11.68, 95% confidence interval 4.52-30.20), body mass index 18.5 (odds ratio 3.18, 95% confidence interval 1.27-8.00), calf circumference30.5 cm (odds ratio 9.33, 95% confidence interval 2.01-43.27) and poor swallowing function (odds ratio 4.93, 95% confidence interval 1.10-22.04) had a significant effect on decreased skeletal muscle index.Therefore, decreased skeletal muscle mass in patients with Alzheimer's disease requires strategies to manage swallowing dysfunction. Geriatr Gerontol Int 2016; 17: 402-409.

Aim The present study investigated the risk factors for dysphagia among older adults who require long-term care, and also examined their systemic decrease in skeletal muscle mass. Methods We evaluated 399 people who required long-term care and who were residing in Omori town, Yokote city, Akita prefecture, Japan. We then analyzed data from 255 participants who had complete information available regarding their sex, age, case history (stroke, Parkinson's disease and dementia), Barthel Index, Skeletal Muscle Mass Index, oral function test and modified water swallowing test results. Participants' water swallowing test results were used to create groups with good or poor swallowing function, and a univariate analysis was carried out for each parameter. Parameters with a P-value of

Introduction Approximately 70%-90% patients receiving hematopoietic stem-cell transplantation (HSCT) have oral mucositis (OM). HSCT-induced OM is a major complication of preparative regimens. The oral cavity of healthy individuals harbor several bacterial species. For example, the cheek and tongue harbor a number of Streptococcus species, while the predominant genera in the saliva are Prevotella, Streptococcus, and Veillonella. The resident flora are considered to be deeply linked with OM because they prevent colonization by exogenous organisms having pathogenic potential for local and systemic infections. However, the precise bacterial substitution occurring in HSCT patients with OM remains unclear. Here, we prospectively examined oral bacterial flora changes using VITEK MSTM (SYSMEX bioMérieux Co., Ltd., Tokyo, Japan)-an automated mass spectrometry (MS) microbial-identification system using matrix assisted laser desorption ionization time-of-flight (MALDI-TOF) technology. It can detect about 650 bacterial and 105 fungal species. We aimed to determine whether oral microbial in HSCT can be detected by VITEK MSTM. Patient and Methods This prospective study included 16 patients (10 males, 6 females; median age 52 years) who underwent HSCT for hematological malignancies (auto-PBSCT = 3 patients, allo-PBSCT = 3 patients, CBT = 10 patients; preparative regimen: MAC = 11 patients, RIC = 2 patients, auto = 3 patients) in our hospital between December 2015 and July 2016. All were treated in reverse isolation in a laminar airflow-equipped room and received drugs to prevent bacterial, fungal, and herpes virus infection. We used VITEK MS for analyzing oral bacterial flora. OM was diagnosed according to NCICTCAE v4.0 and WHO scale, and oral health was assessed using the Revised Oral Assessment Guide (ROAG). Microbial samples were obtained using swabs from bilateral buccal mucosa, palate, and tongue. Samples were then incubated at 37‹C for 72-96 hours both aerobically and anaerobically. Finally, VITEK MS was used to identify bacterial species in samples. We evaluated the patients before initiating preparative regimen (1st), day −1 before HSCT (2nd), 7 days after HSCT (3rd), 14 days after HSCT (4th), and 30 days after HSCT (5th). Results The percentage of patients with high-grade OM (CTCAE Grade 2-5, and WHO Grade 1-4) increased in days 7-14 and decreased at day 30 (Table). Total bacterial species numbers gradually decreased from days -1 through to 30. Many Streptococcus sp could be detected at the 1st or 2nd time point, but these speciesgradually decreased and were replaced with coagulase-negative staphylococci (CNS; Staphylococcus epidermidis in 10 patients, S. haemolyticus in 5 patients, S. lentus in 3 patients, andS.warneri in 3 patients). Before HSCT, Prevotella sp and Veillonella sp in the oral flora were detected in 10 and 9 patients, respectively. However, by 14 days after HSCT, Prevotella sp and Veillonella sp were isolated less often than other points. Candida sp was detected only after the preparative regimen. Discussion and Conclusion This is the first prospective study to demonstrate microbial substitution in oral bacterial spices in HSCT patients using VITEK MS. VITEK MS allowed for the reliable identification of clinically relevant bacteria. We found that the oral bacterial species changed from Streptococcus sp, Prevotella sp, or Veillonella sp to CNS or Candida sp after HSCT. Our results suggest that oral microbial substitution possibly underlies high-grade OM after HSCT. We also suspect that microbial substitution is partly modified by antibiotics, considering that all study patients were treated with antimicrobial agents (including beta-lactam antibiotics). Indeed, the presence of many beta-lactam sensitive Streptococcus sp decreased, whereas that of beta-lactam resistant strains (CNS and Candida sp)increased. Finally, this study involved a small and heterogeneous patient population with varying characteristics. Therefore, our results require confirmation in a larger number of patients over a longer period. Disclosures Hironaka: MEXT Supported Program for the Strategic Research Foundation at Private Universities: Research Funding.

We investigated feeding-associated activation of neurons in the medulla oblongata during the suckling period in rats, using the c-fos gene-encoded protein (Fos) immunohistochemistry. After an isolation from mothers for 12 h, neonates were either breast-fed intensively or further isolated for another 3 h, and sacrificed on postnatal day 1, 3, 5, 7 and 14 (P1-14). In the former pups, Fos-immunoreactive (FI) neurons were predominantly localized in the nucleus of the solitary tract (NST) and in the dorsal medullary reticular formation (RF). The number of FI cells peaked on P5-7 and decreased on P14 in the NST, and increased remarkably on P3 and was consistently high until P14 in the dorsal RF. In contrast, much fewer FI cells were found in the NST and RF in the latter pups. The results indicated that not only the NST but also the dorsal RF were implicated in feeding behavior in the suckled pups.

In the present study we examined the effects of neonatal orosensory deprivation on taste-elicited gustatory activity in the rat parabrachial nucleus (PBN) using the functional anatomical marker c-Fos. Animals in three groups (GG, GO and GM) received gastric cannula implantation surgery on postnatal day 9 (P9). Animals in the fourth group (MR) did not receive any surgery. GG rats were fed by infusion of artificial milk directly into the stomach. GO rats were fed by intraoral infusion of artificial milk. GM and MR rats were reared by their mother with free access to mother's milk, water and rat chow. Rats from all groups were similar in body weight and length by P21. On P21 rats in all groups were intraorally presented with 0.5 M sucrose solution and the brains were extracted and processed for c-Fos immunohistochemistry. Taste-elicited c-Fos expression in both the gustatory waist area, and the external lateral subnucleus of the PBN in rats in the GG group was significantly more robust than in the other three groups. These findings suggest a substantial alteration in orosensory-evoked neuronal response in this nucleus, due to sensory or motor deprivation during a critical developmental stage.