Publishing type：Research paper (scientific journal)   Publisher：Informa UK Limited  

DOI： 10.1080/27705781.2024.2332037

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Publishing type：Research paper (scientific journal)   Publisher：Society of Rheology Japan  

DOI： 10.1678/rheology.52.37

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Language：English   Publishing type：Research paper (scientific journal)  

Dysphagia is a common symptom of Parkinson's disease (PD) associated with aspiration pneumonia, choking, malnutrition, and a decreased quality of life, and is a leading cause of death among patients with PD. Tongue dysfunction in patients with PD affects the oral phase of swallowing, including the formation and propulsion of a bolus into the pharynx. Assessing tongue pressure, generated between the tongue and palate, is a method that quantitatively measures tongue function and is related to dysphagia in PD. Two assessment methods are used to measure tongue pressure: tongue strength and tongue pressure during swallowing. Previous studies measuring tongue pressure in PD have reported decreased tongue strength and pressure during swallowing, as well as a prolonged tongue pressure rise time, which are symptoms associated with PD severity and dysphagia. In this mini-review, we present a method for measuring tongue pressure and discuss its relationship with dysphagia in PD. We also describe limitations and future perspectives in tongue pressure measurement research.

DOI： 10.3389/fneur.2024.1355627

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Society of Rheology Japan  

DOI： 10.1678/rheology.51.295

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

Abstract

Background

There is no clear objective indicator for selecting soft foods that are required for food bolus formation in older people with impaired oral function.

Objective

This study aimed to investigate the relationship between maximal isometric tongue pressure (MITP) and the mechanical properties of gels that can be crushed by the tongue.

Methods

This study included 65 healthy participants aged 22–96 (young group; 15 males, 15 females; older dentate group; 7 males, 8 females; older edentulous group; 10 males, 10 females). MITP was measured by the balloon‐probe device. Agar gel with 10 different kinds of fracture force from 10N to 100N was used. The limit of fracture force of gels (LFFG) that were crushed by the tongue was measured by the up‐and‐down method. In the older edentulous group, two items were measured with and without dentures. Spearman's rank correlation coefficient was used to evaluate the relationship between MITP and LFFG in each group (p < .05).

Results

There were positive correlations between MITP and LFFG in all groups (overall groups: r_s = .66, young group: r_s = .46, older dentate group: r_s = .61, older edentulous group with dentures: r_s = .60, older edentulous group without dentures: r_s = .47).

Conclusion

MITP and LFFG were positively correlated in young, older dentate and older edentulous groups, suggesting that MITP has the potential to be an objective indicator of the range of mechanical properties of soft food that can be crushed by the tongue.

DOI： 10.1111/joor.13627

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Publishing type：Research paper (scientific journal)   Publisher：Society of Rheology Japan  

DOI： 10.1678/rheology.51.219

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Publishing type：Research paper (scientific journal)  

Statement of the problem: Morphology of the residual ridge (RR) is expected to influence the masticatory performance (MP) of complete denture (CD) patients, but considerable details of this relationship are unknown. Purpose: We aimed to investigate the association between the objective MP and RR morphology of CD wearers and other contributory factors affecting their MP. Materials and methods: Sixty-five patients with well-fitting upper and lower CDs with no complaints of pain were enrolled. The objective MP was measured using test gummy jelly and a fully automated measuring device. The RR form was divided into U-type, V-type, I-intermediate, and F-Flat, then combinations of upper and lower RR forms (combined RR) were classified. The height was measured using CD's denture basal surface replicas, while occlusal contact of CDs was assessed using a tooth contact analysis system. The relationship between surveyed factors and MP was evaluated using Spearman's rank correlation, Kruskal-Wallis test, generalized linear regression, and analysis of covariance. Results: Participants with F–F and V–F combined RR forms had the lowest MP, while those with U–U and U–I forms had the highest MP, regardless of RR height. Participants with low RR height had the lowest MP, and those with high RR height had the highest MP, regardless of RR form. The analysis of covariance revealed that mandibular RR height, combined RR forms, and total occlusal contact area significantly affected the MP. Conclusions: Our findings confirmed that the mandibular RR height, RR form combinations, and occlusal contact influence the MP of CD wearers. Clinical Implications: The MP of CD wearers varied, depending on the height and form of the RR, as well as the occlusal contact area of the CDs. The results of this manuscript show that the morphology of the denture bearing area and the occlusion of the CDs are essential factors in predicting the treatment outcome of CD wearers. This allows the clinician to fabricate a complete denture with the denture basal surfaces adjusted and occlusion provided according to the patient. CD patients can be educated on how to chew to improve MP based on their own RR morphology.

DOI： 10.1016/j.heliyon.2023.e16238

Scopus

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Removable partial dentures have a wide range of applications as missing tooth prostheses, and the denture design can be quite diverse. However, the factors affecting masticatory function remain unclear. We investigated the effect of denture design, especially the use of indirect retainers and major connectors, on masticatory function in patients with mandibular bilateral distal extension dentures. METHODS: Fifty-three patients with mandibular Kennedy Class I and Eichner classification B occlusal support were included in this study. Masticatory performance (MP) was assessed using gummy jelly. For the dentures, the type of major connector (bar or apron), presence or absence of indirect retainers, number of rests, and number of artificial teeth were evaluated. The number of functional teeth and occlusal support, Eichner classification, maxillary denture usage, mandibular residual ridge height, and duration of denture use were also evaluated. The factors influencing on the MP were evaluated using the Mann-Whitney U test, Spearman's correlation coefficient, and logistic regression analysis. RESULTS: MP was significantly higher when the major connector was bar-type or when there was an indirect retainer than with an apron-type or no indirect retainer. MP was positively correlated with the number of functional teeth, occlusal support, and number of rests. Logistic regression analysis revealed that the number of functional teeth and the presence or absence of an indirect retainer were factors that significantly influenced the MP. CONCLUSIONS: An indirect retainer setting is useful for achieving good masticatory performance in mandibular bilateral distal extension dentures.

DOI： 10.2186/jpr.JPR_D_22_00135

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：JAPAN PROSTHODONTIC SOC  

Purpose: Removable partial dentures have a wide range of applications as missing tooth prostheses, and the denture design can be quite diverse. However, the factors affecting masticatory function remain unclear. We investigated the effect of denture design, especially the use of indirect retainers and major connectors, on masticatory function in patients with mandibular bilateral distal extension dentures.Methods: Fifty-three patients with mandibular Kennedy Class I and Eichner classification B occlusal support were included in this study. Masticatory performance (MP) was assessed using gummy jelly. For the dentures, the type of major connector (bar or apron), presence or absence of indirect retainers, number of rests, and number of artificial teeth were evaluated. The number of functional teeth and occlusal support, Eichner classification, maxillary denture usage, mandibular residual ridge height, and duration of denture use were also evaluated. The factors influencing on the MP were evaluated using the Mann-Whitney U test, Spearman's correlation coefficient, and logistic regression analysis.Results: MP was significantly higher when the major connector was bar-type or when there was an indirect retainer than with an apron-type or no indirect retainer. MP was positively correlated with the number of functional teeth, occlusal support, and number of rests. Logistic regression analysis revealed that the number of functional teeth and the presence or absence of an indirect retainer were factors that significantly influenced the MP.Conclusions: An indirect retainer setting is useful for achieving good masticatory performance in mandibular bilateral distal extension dentures.

DOI： 10.2186/jpr.JPR_D_22_00135

Web of Science

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：MDPI AG  

Evaluation of masticatory ability has become more important in an aging society because decreased masticatory ability has the potential to affect the general health of older people. A new masticatory performance test, intended for older people with low masticatory ability, has been developed using gummy jelly half the size of that used in the conventional masticatory performance test. This study aimed to investigate the compatibility between the new and conventional tests and the adaptation of the new test. The new test using the 8-grade visual score with half-size gummy jelly was performed among 137 removable denture wearers (mean age 75.8 ± 9.0 years) with low masticatory performance (a score of ≤4 on a conventional test). The correlation between the scores of half-size gummy jelly (VS-H) in the new test and those of full-size gummy jelly (VS) in the conventional test was evaluated. VS-H among the groups divided by VS were also compared. A strong positive correlation was detected between VS-H and VS (rs = 0.70). In groups with VS of 0 and 1, VS-H values were widely distributed from 0 to 7. There were significant differences in VS-H between the groups with VS of 0–2 but no significant differences in VS-H between the groups with VS of 2–4. Therefore, the masticatory performance test using half-size gummy jelly is suitable for a detailed evaluation of masticatory ability in older people with low masticatory ability when their visual score of full-size gummy jelly in the conventional test is 2 or less.

DOI： 10.3390/jcm12020593

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The state of food comminution caused by chewing is an important factor triggering the swallowing reflex. However, the impact of retronasal aroma released from comminuted food to the nose upon swallowing during food intake is poorly understood. OBJECTIVE: The present study investigated the relationship between aroma concentration and swallowing threshold while chewing a standardised test food. METHODS: Twenty healthy participants took part in this study. Concentration of retronasal aroma was measured over time through the nostrils using an odour sensor. The aroma concentration was measured while chewing an orange-flavoured gummy jelly until swallowing, and the number of chewing strokes was measured to determine the swallowing threshold. Next, the aroma concentration was measured while chewing the gummy jelly for 30 strokes, and 100% and 200% of swallowing threshold without swallowing. The surface area increase in the expectorated gummy jelly pieces was calculated using image analysis and defined as masticatory performance at 30 strokes. RESULTS: The average number of chewing strokes until the swallowing threshold was 45.1 ± 14.2. Higher masticatory performance was associated with a smaller number of chewing strokes at swallowing threshold, and a greater increase in surface area at the swallowing threshold. The number of chewing strokes and the aroma concentration were similar between the swallowing threshold and at the maximum aroma concentration while chewing at 200% of the swallowing threshold. CONCLUSION: The findings suggested that the swallowing threshold might be influenced by retronasal aroma concentration as well as the state of food comminution.

DOI： 10.1111/joor.13389

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Japan Prosthodontic Society  

DOI： 10.2186/jpr.jpr_d_23_00117

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Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

Bolus volume is very important in the biomechanics of swallowing. By noninvasively characterizing swallow responses to volume challenges, we can gain more knowledge on swallowing and evaluate swallowing behavior easily. This study aimed to evaluate the impact of bolus volume on the biomechanical characteristics of oropharyngeal swallowing events with a noninvasive sensing system. Fifteen healthy male subjects were recruited and instructed to swallow 5, 10, and 15 ml of water. The sensing system consisted of a tongue pressure sensor sheet, bend sensor, surface electrodes, and a microphone. They were used to monitor tongue pressure, hyoid activity, surface EMG of swallowing-related muscles, and swallowing sound, respectively. In addition to the onset, the peak time and offset of the above four structures, certain characteristics, such as the duration, peak value, and interval of the structure motions, were measured during the different drinking tasks. The coordination between the hyoid movement and tongue pressure was also assessed. Although no sequence of the structural events changed with volume, most of the timings of the structural events were significantly delayed, except for certain hyoid activities. The swallowing volume did not affect the active durations of the monitored structures, the peak values, or intervals of tongue pressure and supra- and infrahyoid muscle activity, but certain hyoid kinetic phases were prolonged when a larger volume was swallowed. Additionally, sequential coordination between hyoid movement and tongue pressure was confirmed among the three volumes. These findings suggest that oropharyngeal structural movements change in response to bolus volume to facilitate safe swallowing. The noninvasive and quantitative measurements taken with the sensing system provide essential information for understanding normal oropharyngeal swallowing.

DOI： 10.1155/2022/7146947

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Other Link： http://downloads.hindawi.com/journals/abb/2022/7146947.xml

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Although many studies have shown the relationships between oral function and nutrition and health, few reports have investigated the masticatory behaviors of older people. This study aimed to clarify the relationships between oral function and the masticatory behaviors and features of masticatory behaviors with oral hypofunction. A total of 98 community-dwelling independent older adults participated. Seven oral conditions related to oral hypofunction were examined, and the masticatory behaviors when consuming a rice ball were measured. The participants were divided into two groups according to the criteria for oral hypofunction, and the masticatory behaviors were compared. Furthermore, the relationship between masticatory performance and the number of chews was investigated. The chewing rate of the oral hypofunction group was slower than that of the no oral hypofunction group, but there was no difference in the number of chews and chewing time. The decreased tongue-lip motor function group showed a slower chewing rate, and the decreased tongue pressure group showed a smaller number of chews and shorter chewing time. No significant correlation was observed between masticatory performance and behavior. In conclusion, older adults with oral hypofunction chewed slowly due to decreased dexterity, while, even if oral and masticatory function decreased, no compensatory increase in the number of chews was observed.

DOI： 10.3390/jcm11195902

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)  

Because a relationship has been reported between masticatory behavior, obesity, and postprandial blood glucose, it is recommended to chew well and take a longer time to eat. The purpose of this study was to examine the possibility of changing masticatory behavior using a small ear-hung wearable chewing counter, which can monitor masticatory behavior without disturbing daily meals. In total, 235 healthy volunteers participated in a 4-wk randomized controlled trial and were divided into 3 groups. All participants were instructed about the importance of mastication at the first visit. During the intervention, group B used the chewing counter without an algorithm during each meal (notification of the number of chews after meal), and group C used the chewing counter with a masticatory behavior change algorithm (setting a target value and displaying the number of chews in real time). Group A was set as the control group. The number of chews and the meal time when consuming 1 rice ball (100 g) were measured before and after the intervention using the chewing counter, and the rate of change in these values was evaluated. Participants also provided a subjective evaluation of their changes in masticatory behavior. The number of chews and the meal time of 1 rice ball increased significantly in groups B and C compared with before the intervention, and the rate of change was significantly higher in group C than in group A and group B. In addition, the subjective evaluation of the change in the number of chews was highest in group C. Self-monitoring of masticatory behavior by providing a target value and the degree of achievement for the number of chews using a wearable chewing counter with a behavioral change algorithm could promote effective change in masticatory behavior and lead to an increased number of chews. (Trial ID: UMIN000034476)

DOI： 10.1177/00220345221118013

Scopus

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A rise in tongue pressure coincides with an increase in the suprahyoid muscles activity. OBJECTIVES: The aim was to investigate the effects of holding a weighted plastic bottle on tongue pressure and the suprahyoid muscles activity. METHODS: Eighteen participants (8 men and 10 women; mean age 42 ± 16 years) participated in this study. All participants had no history of speech, language, hearing, or swallowing disorders and no tooth loss, and they did not require dentures. Healthy participants held gauzes connected with a plastic bottle with increasing resistive loads of 0 g, 250 g, 500 g, and 750 g, between their palate and tongue. The maximum tongue pressure and average tongue pressure were measured during a 5-second hold. The average tongue pressure was defined as the mean tongue-pressure data in each task. The suprahyoid muscles activity was measured using the electromyogram (EMG). The root mean square of the EMG signals measured while lifting different loads and while performing the head lifting exercises were compared. All variables were examined using the Friedman's test and Wilcoxon signed-rank test. RESULTS: The maximum tongue pressure (p < .05) and average tongue pressure values (p < .05) increased gradually in the anterior-median region with increasing resistive loads, and the root mean square amplitudes for 250 g, 500 g, and 750 g were not significant compared to head lifting exercises. CONCLUSION: These results indicated that Plastic bottle holding could be a potential strength-training tool for the tongue and the suprahyoid muscles.

DOI： 10.1111/joor.13365

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The purpose of this study was to investigate the effects of tongue-strengthening exercise (TSE) on tongue strength and effortful swallowing pressure in young healthy adults. METHOD: Thirteen young healthy volunteers (six men, seven women; M age = 20.5 ± 0.5 years) performed 8 weeks of isometric TSE 3 days per week. A tongue pressure measurement device was used to measure maximum isometric tongue pressure (MITP) and conduct the TSE, and a tactile sensor system attached to the hard palate was used to measure effortful swallowing pressure. MITP and effortful swallowing pressure were measured at baseline, after 4 and 8 weeks of training, and at 4 and 8 weeks after the last training session to examine the detraining effects. RESULTS: The results indicated that both MITP and effortful swallowing pressure increased significantly from baseline to 8 weeks after training. Although the improved MITP significantly decreased at 4 and 8 weeks after training cessation, no detraining effect was observed for effortful swallowing pressure. CONCLUSIONS: TSE is an effective method for increasing tongue pressure in wide tongue-palate contact areas during effortful swallow. The effortful swallowing pressure gained with TSE appears to be maintained for at least eight nontraining weeks.

DOI： 10.1044/2022_JSLHR-21-00331

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Language：Japanese   Publisher：(NPO)日本咀嚼学会  

背景:入院高齢者において、咀嚼・嚥下機能と食形態とのミスマッチは、低栄養や誤嚥性肺炎を引き起こす要因となる。本研究では、嚥下内視鏡検査や嚥下造影検査が行えない状況においても適切な食形態を決定するうえで参考となる因子を知ることを目的として、食形態と咀嚼・嚥下機能との関連性について検討した。方法:対象は、当院において2016年7月から2021年4月までの期間に嚥下障害の疑いで当科に紹介され、食事内容について助言を行った163名(男性104名、女性59名、平均年齢80.8±11.4歳)とした。各患者に対して、口腔内診査と口腔機能検査、嚥下機能検査を行い、誤嚥の予防または軽減を考慮して食形態を決定した後、常食群、刻み食群、嚥下調整食群に分類した。初めに、常食+刻み食群と嚥下調整食群との間と、常食群と刻み食群との間で比較した。次に、二項ロジスティック回帰分析を用い、食形態に関連する因子を検討した。結果:多変量解析の結果、常食+刻み食群(89名)と嚥下調整食群(74名)を分ける有意な因子として性別、機能的咬合支持、最大舌圧と舌口唇運動機能/ka/が、常食群(34名)と刻み食群(55名)を分ける有意な因子として咀嚼能率スコア、現在歯数がそれぞれ選択された。結論:性別、機能的咬合支持、舌口唇運動機能、最大舌圧が嚥下食か常食・刻み食かの選択に有用な因子であり、さらに現在歯数と咀嚼能率が常食を選択するための条件として考慮すべきであることが示唆された。(著者抄録)

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: It has been widely recognized that mastication behaviors are related to the health of the whole body and to lifestyle-related diseases. However, many studies were based on subjective questionnaires or were limited to small-scale research in the laboratory due to the lack of a device for measuring mastication behaviors during the daily meal objectively. Recently, a small wearable masticatory counter device, called bitescan (Sharp Co), for measuring masticatory behavior was developed. This wearable device is designed to assess objective masticatory behavior by being worn on the ear in daily life. OBJECTIVE: This study aimed to investigate the relation between mastication behaviors in the laboratory and in daily meals and to clarify the difference in mastication behaviors between those with metabolic syndrome (MetS) and those without (non-MetS) measured using a wearable device. METHODS: A total of 99 healthy volunteers (50 men and 49 women, mean age 36.4 [SD 11.7] years) participated in this study. The mastication behaviors (ie, number of chews and bites, number of chews per bite, and chewing rate) were measured using a wearable ear-hung device. Mastication behaviors while eating a rice ball (100 g) in the laboratory and during usual meals for an entire day were monitored, and the daily energy intake was calculated. Participants' abdominal circumference, fasting glucose concentration, blood pressure, and serum lipids were also measured. Mastication behaviors in the laboratory and during meals for 1 entire day were compared. The participants were divided into 2 groups using the Japanese criteria for MetS (positive/negative for MetS or each MetS component), and mastication behaviors were compared. RESULTS: Mastication behaviors in the laboratory and during daily meals were significantly correlated (number of chews r=0.36; P<.001; number of bites r=0.49; P<.001; number of chews per bite r=0.33; P=.001; and chewing rate r=0.51; P<.001). Although a positive correlation was observed between the number of chews during the 1-day meals and energy intake (r=0.26, P=.009), the number of chews per calorie ingested was negatively correlated with energy intake (r=-0.32, P=.002). Of the 99 participants, 8 fit the criteria for MetS and 14 for pre-MetS. The number of chews and bites for a rice ball in the pre-MetS(+) group was significantly lower than the pre-MetS(-) group (P=.02 and P=.04, respectively). Additionally, scores for the positive abdominal circumference and hypertension subgroups were also less than the counterpart groups (P=.004 and P=.01 for chews, P=.006 and P=.02 for bites, respectively). The number of chews and bites for an entire day in the hypertension subgroup were significantly lower than in the other groups (P=.02 and P=.006). Furthermore, the positive abdominal circumference and hypertension subgroups showed lower numbers of chews per calorie ingested for 1-day meals (P=.03 and P=.02, respectively). CONCLUSIONS: These results suggest a relationship between masticatory behaviors in the laboratory and those during daily meals and that masticatory behaviors are associated with MetS and MetS components. TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry R000034453; https://tinyurl.com/mwzrhrua.

DOI： 10.2196/30789

PubMed

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Numerous studies have evaluated the relationship between eating behavior and obesity, however few studies have objectively assessed eating behavior. Additionally, the association of masticatory behaviors with masticatory performance remains unclear. This study aimed to verify the relationship between masticatory performance and behavior measured by a wearable masticatory counter, and BMI. 365 healthy adults participated. Mastication behaviors, i.e. number of chews and bites, chewing rate, and chewing time, were measured using wearable masticatory counter while consuming one rice ball (100 g). Masticatory performance was evaluated using testing gummy jelly. Lifestyle habits including exercise, walking, and breakfast, were surveyed by questionnaire. The correlation coefficients between masticatory behaviors and performance and BMI were analyzed. Furthermore, multiple regression analysis was performed. The number of chews showed positive correlation with chewing rate, number of bites and chewing time, but no correlation with masticatory performance. BMI had weak but significant negative correlation with number of chews, bites, chewing time, and masticatory performance, but had no correlation with chewing rate. Multiple regression analysis revealed that BMI was associated with sex, age, number of chews, bites, masticatory performance, and walking speed. In conclusion, masticatory behavior and performance were not interrelated, but both were independently associated with BMI weakly.

DOI： 10.1038/s41598-022-08084-5

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: This study aimed to verify the compatibility of masticatory performance tests using different two types of gummy jellies. BACKGROUND DATA DISCUSSING THE PRESENT STATUS OF THE FIELD: Compatibility between the glucose concentration measuring method (GC) and 10-steps visual scoring method (VS), which are masticatory performance tests for diagnosing decreased masticatory function (DMF) in oral hypofunction and the use of different types of gummy jelly, has yet to be confirmed. MATERIALS AND METHODS: The participants consisted of 134 Japanese older people (51 men and 83 women). GC, VS and the increased surface area measuring method (ISA), as an alternative analysis method for VS, were conducted to evaluate masticatory performance. Cohen's Kappa coefficient was used to verify the consistency for detecting DMF between GC and VS. Pearson's correlation coefficient was used to analyse the relationship between GC and ISA. Each masticatory performance was compared among three different groups for the number of residual teeth. Cut-off values of VS and ISA for DMF that were consistent with GC were identified. RESULTS: Glucose concentration measuring method and VS showed an excellent consistency (Kappa coefficient = 0.86). There was a high positive correlation between GC and ISA (r = .70). However, the change in masticatory performance according to the number of teeth was different between GC and VS/ISA. The cut-off values of VS and ISA were a Score of 2 and 1687 mm2 , respectively. CONCLUSION: Glucose concentration measuring method and VS/ISA remained fairly consistent for detecting DMF, which might be useful information to interconnect the various studies on masticatory performance.

DOI： 10.1111/ger.12601

PubMed

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Elsevier BV  

DOI： 10.1016/j.foodhyd.2021.107323

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(NPO)日本咀嚼学会  

咀嚼行動改善に対する啓発活動は多々行われているが、具体的な数値をもって咀嚼行動の改善を図る試みはほとんど行われていない。そこで、咀嚼回数計を使って自身の咀嚼行動を認識し、その問題点や改善点を考え、自発的な咀嚼習慣の行動変容を目指す「かむを測り、気づき、変えるための食育プロジェクト」を考案した。本研究の目的は、給食を用いて本プロジェクトを行い、発育期の児童に与える咀嚼行動変容効果を検討することである。対象は、新潟県内の1ヶ所の小学校5年生19名(男子7名、女子12名)とした。まず咀嚼回数計(シャープ社製bite-scan)を使用して3日間の給食時の咀嚼行動(咀嚼回数、一口あたりの咀嚼回数、食事時間、咀嚼テンポ、姿勢、動作の大きさ)を計測した。その後、咀嚼に関する授業を行うとともに最初の3日間の結果を配布して児童に自分の咀嚼行動の特徴について検討させた。さらに、各自が改善したい目標を掲げ次の5日間において咀嚼回数計を用いた介入を行った。最後に、3日間の給食を用いて再評価を行った。その結果、多くの児童たちは自身の咀嚼行動の長所と短所の両方に気づくことができた。また、介入後には咀嚼回数、食事時間、一口あたりの咀嚼回数、および咀嚼テンポは有意に増加し、姿勢、動作の大きさは有意に改善した。以上より、児童自身で立案した目標に向かって咀嚼行動変容を促した結果、効果的な行動変容を得ることができた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: During mastication, the tongue presses the bolus into the pharynx by a "squeeze-back" motion, known as stage II transport (St2Tr). However, the pressure of St2Tr tongue-palate contact has not been examined. OBJECTIVES: We aimed to clarify aspects of St2Tr occurrence and tongue-palate contact during mastication by measuring tongue pressure. METHODS: Ten healthy adults (eight men, two women, aged 26.8 ± 2.2 years) were enrolled. Tongue pressure was measured (Swallow Scan) during mastication. Sensors were placed on the palate near the incisive papilla (Ch.1), in the middle (Ch.2), at the posterior (Ch.3), and near the first molars on the habitual (Ch.H) and non-habitual (Ch.Nh) masticatory sides. Nasopharyngeal endoscopy confirmed St2Tr and swallowing. Tongue pressures were measured repeatedly, from mastication onset through the first swallow, until eight sets of data were obtained. Tongue-palate contact frequencies, integrated values of tongue pressure, and mastication times were recorded for St2Tr(+) and St2Tr(-) mastication conditions. RESULTS: St2Tr occurred in 43 of 80 trials (53.8%). St2Tr(+) exhibited the highest tongue-palate contact frequency at Ch.H; it exhibited higher contact frequencies at Ch.2, Ch.3 and Ch.H than St2Tr(-). St2Tr(+) exhibited higher tongue pressures at Ch.1, Ch.2 and Ch.H than at Ch.3; it exhibited higher tongue pressures at Ch.1 and Ch.2 than St2Tr(-). CONCLUSION: The study suggested that during St2Tr, the tongue frequently touched the palate at the central and posterior regions, as well as at its habitual masticatory side. It applies the strongest pressure at the anterior and central palate to transport the bolus to the pharynx.

DOI： 10.1111/joor.13252

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The tongue functions by modulating according to bolus volume when swallowing; however, associated tongue dynamics are unclear. OBJECTIVE: We aimed to clarify how tongue motion and tongue pressure change with bolus volume during swallowing. METHODS: Sixteen healthy volunteers (age 29.5 ± 3.8 years; 12 males, 4 females) were recruited. Two electromagnetic articulography markers were attached, one each on the anterior and posterior parts of the tongue, to measure motion. A sensor sheet, with five pressure-sensitive points, was attached to the hard palate to measure tongue pressure. Participants were asked to swallow 3 ml and 10 ml of water. Motion trajectory, maximum velocity, vertical displacement just before contact with the hard palate, and maximum magnitude and duration of tongue pressure were analysed. RESULTS: Tongue rotation was observed in the sagittal plane; its rate of appearance was significantly higher when swallowing 3 ml of water than when swallowing 10 ml, and the rate of rotation at posterior part was significantly higher than at the anterior part. The maximum velocity and vertical displacement were significantly greater when swallowing 10 ml of water than those when swallowing 3 ml of water. There was no significant difference in either the maximum magnitude of tongue pressure or maximum duration of tongue pressure between 3 ml and 10 ml. CONCLUSION: Bolus volume influenced the pattern of tongue motion; however, there was no difference in tongue pressure.

DOI： 10.1111/joor.13248

PubMed

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Language：Japanese   Publisher：Japanese Society of Gerodontology  

Background：There have been few reports on the relationship between tongue pressure and nutritional status. This study aimed to investigate the relationship between tongue pressure and nutritional status or diet modification in older patients admitted to a general hospital.

Method：One hundred sixty-five patients aged 65 years or older（96 males and 69 females；mean age 83.5±8.2 years）who were referred to the Department of Oral and Maxillofacial Surgery of a general hospital were included in this study, and divided into medium/severe nutritional risk and no/mild nutritional risk groups based on the Geriatric Nutritional Risk Index and normal/chopped diet and soft/paste diet groups according to the dietary patterns. Difference in maximal tongue pressure（MTP）between the groups was examined.

Results：MTP in the medium/severe nutritional risk group（n＝148, 14.1±9.6 kPa）was significantly lower than that in the no/mild nutritional risk group（19.8±10.8 kPa）（p＝0.043）. MTP in the soft/paste diet group（n＝88, 12.4±9.6 kPa）was lower than that in the normal/chopped diet group（16.9±9.6 kPa）（p＝0.001）. The cut-off values based on the ROC curve of MTP for the medium/severe nutritional risk and soft/paste diet were 18.6 kPa and 16.5 kPa, respectively.

Conclusion：Reduced maximum tongue pressure in general hospital elderly inpatients was associated with nutritional risk and low dietary patterns, and the cut-off values for predicting them were lower than that for “reduced tongue pressure” as one of the sub-symptoms of “oral-hypofunction.”

DOI： 10.11259/jsg.36.91

CiNii Article

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Language：Japanese   Publisher：新潟歯学会  

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Language：English   Publishing type：Research paper (scientific journal)  

(1) Background: The degree of satisfaction with dental treatment varies among patients, and the discrepancy may exist between the patient’s subjective evaluation and the objective assessment. Further, the optimal methods for increasing patient satisfaction with mastication remain unclear. This study aimed to identify factors affecting masticatory satisfaction in patients with removable partial dentures. (2) Methods: A total of 132 participants (71.0 ± 9.0 years) were included. Masticatory satisfaction was assessed on a visual analog scale. An oral health survey was conducted to assess the number of functional teeth, missing tooth classification: Kennedy classification, occlusal support: Eichner classification, and removable partial dentures wearing jaw. Objective masticatory performance was assessed using gummy jelly, while subjective masticatory ability was assessed using food acceptance status and oral health-related quality of life. The associations of these factors with masticatory satisfaction were assessed. (3) Results: Masticatory satisfaction among removable partial denture wearers was not significantly associated with gender, age, denture wearing jaw, Kennedy classification, and occlusal support. The degree of masticatory satisfaction was significantly greater with higher levels of masticatory function: masticatory performance, food acceptance score, and OHIP-14 score. The OHIP-14 score was the only significant explanatory variable for masticatory satisfaction in the multiple regression analysis; the strongest associations were with the “psychological discomfort” and “physical disability” subscales (p = 0.02 and p = 0.005, respectively). (4) Conclusions: Masticatory satisfaction among removable partial denture wearers was strongly associated with oral health-related quality of life, in which the ability to eat meals comfortably with removable partial dentures is the most important determinant of masticatory satisfaction.

DOI： 10.3390/ijerph18126620

Scopus

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Wiley  

BACKGROUND: Although various training methods have been reported for improving oral function such as occlusal force, there are few reports that show the training effect of eating hard food on the oral functions. OBJECTIVE: To examine the training effects of habitually ating hard gummy candies on oral functions. METHODS: Participants of this cohort study were recruited into a training (six women, eight men; mean age 27.6 ± 3.5 years) and control group (two women, seven men; mean age 28.3 ± 4.9 years). The training group ate nine custom-developed hard gummy candies three times per week for 3 months. Training effects were evaluated by measuring the maximal occlusal force, masticatory performance, maximal tongue pressure, number of chewing cycles until swallowing the candy, duration of chewing and cycle time before training, after 1, 2 and 3 months of training, and 1 month after stopping training. The iEMG/force, which evaluates masseter muscle hypertrophy with electromyograms (EMG), was calculated. RESULTS: Masticatory performance after 1 month (p = 0.01), maximal occlusal force after 2 months (p < 0.01) and maximal tongue pressure after 3 months of training were significantly increased (p = 0.02), and the cycle time after 2 months of training (p = 0.02) was significantly decreased compared to before the intervention. Except for masticatory performance, the other effects were maintained for 1 month after stopping training. Changes in iEMG/force were not significant, but a tendency for muscle hypertrophy was observed in the training group. CONCLUSION: Habitual eating of hard gummy candies is a task-specific training that can improve overall masticatory function, including tongue pressure.

DOI： 10.1111/joor.13208

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Although a food acceptance questionnaire is useful for subjective masticatory function assessments, its characteristics and limitations when applied to patients with removable dentures have been unclear. We therefore assessed the relationship between the subjective and objective masticatory function and explored whether or not a decreased masticatory function could be evaluated by food acceptance questionnaire. METHODS: One hundred and nineteen patients >60 years old with removable partial and/or complete dentures participated. Food acceptance score (FAS) was calculated by using Sato's questionnaire with 20 food items. Masticatory performance (MP) was assessed by a visual scoring method using a test gummy jelly (UHA Mikakuto). Simple/multiple regression analyses were performed to explain the objective masticatory function. The cut-off value of FAS was determined to predict a decreased masticatory function by sensitivity, specificity and receiver operating characteristics curve. RESULTS: No significant gender differences in MP or FAS were noted. Although both MP and FAS increased with the number of functional teeth, FAS was not significantly affected by age. The number of functional teeth, FAS and age had significant correlations with MP, with the number of functional teeth showing the strongest correlation. Multiple linear regression analyses identified the FAS as a significant explanatory variable for MP, and 70 was the optimal cut-off value for detecting a decreased masticatory function (MP score ≤ 2) in the diagnosis of 'oral hypofunction'. CONCLUSIONS: Using FAS to assess the MP was deemed appropriate, and a score of 70 was the optimal cut-off value for detecting a decreased masticatory function.

DOI： 10.1111/joor.13147

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Authorship：Lead author,　Corresponding author   Language：Japanese   Publisher：(NPO)日本咀嚼学会  

食生活の変化によって咀嚼回数が減っていることが指摘されており、それに伴う「早食い」が肥満・糖尿病などの生活習慣病に与える影響が報告されている。しかし、日々の食事における食行動をモニタリングするツールは少なく、咀嚼行動に関する客観的なエビデンスは不足している。近年、センシング技術や通信技術の向上により、ウェアラブルデバイスによる咀嚼行動をモニタリングする試みがみられるようになってきた。われわれは、シャープ株式会社が開発したbitescanを使用して、日々の咀嚼行動を測定する研究を行っている。本装置は、患者本人が右耳にかけて使用し、スマートフォンと連動させて日常の咀嚼活動をモニタリングする。アプリケーションに行動変容を促す機能を付与したり、インターネットを介したデータの収集を行うこともできる。本総説では、bitescanの概要、精度を解説するとともに、これまでに開発されているさまざまなウェアラブルデバイスを用いた咀嚼行動モニタリングの試みを概説した。さらに、ウェアラブルデバイスを用いた咀嚼行動モニタリングの応用の可能性について検討した。(著者抄録)

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02994&link_issn=&doc_id=20220607170003&doc_link_id=%2Fex2gakuk%2F2021%2F002701%2F004%2F0014-0015%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex2gakuk%2F2021%2F002701%2F004%2F0014-0015%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

To provide appropriate foods for elderly people with eating difficulties, it is necessary to take account of the ability of compensatory mastication such as tongue squeezing. However, the biomechanics of tongue squeezing is still unclear. The aim of present study is to investigate the effect of the initial mechanical properties of gels on the change in tongue pressure production during squeezing and swallowing. As test sample, nine kinds of gels with three fracture force and three fracture strain were prepared. Tongue pressure during squeezing and swallowing gels was measured by using an ultra-thin tongue pressure sensor with five measuring points attached on the hard palate in seven healthy participants, and analyzed at four phases; Initial squeeze, Middle squeeze, Last squeeze, and Swallowing. The maximal magnitude of tongue pressure was increased for gels with higher fracture force at most measuring points and was decreased for gels with higher fracture strain at some measuring points on the median line during Initial and Middle squeezing. However, no influence by fracture force and strain was found in magnitude during Last squeezing and Swallowing. The duration of tongue pressure increased for gels with higher force at most measuring points during Middle squeezing, although no influence by strain was found during each phase. The results clearly show how the initial fracture properties of gels influence on tongue pressure production during each phase of food oral processing, which clarified one aspect of squeezing with tongue, as the compensatory mastication.

DOI： 10.1111/jtxs.12593

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

To extract the variables which can well explain human textural perceptions during swallowing, the laryngeal movement was investigated dynamically and synchronously with the activities of the suprahyoid musculature and the tongue using gel-type foods. Nine gel samples were prepared by changing fracture force at constant fracture strain or by changing fracture strain at constant fracture force based on the uniaxial compression test. These gels were cut into 3 mm cubes for mimicking food bolus and then subjected to Texture Profile Analysis, sensory test, and in vivo physiological measurements. Sensory test and in vivo measurements were performed on 8 healthy adult subjects (all male of ay. 30.0 +/- 6.9 yr). After placing 10 g of the model bolus in his mouth and holding them for 3 sec, each subject was asked to swallow the whole amount of them at one time without chewing. Sensory test targeted perceived hardness, bolus uniformity, and swallowing ease at the time of swallowing and evaluated them on Visual Analog Scale. Results indicated that perceived hardness highly correlated with the activity of the suprahyoid musculature from electromyography. Also, perceived bolus uniformity and swallowing ease highly correlated with the duration of swallowing from the laryngeal movement and the tongue activity from the tongue pressure measurement, respectively. In vivo measurements evaluated swallowing-related textural perceptions better than the conventional mechanical measurements, and their predictions were successful with high accuracy by the combination of these 3 in vivo measurement variables.

DOI： 10.1016/j.foodhyd.2020.106353

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Prosthodontic Society  

Purpose In recent years, the chewing frequency, i.e., the number of chewing cycles, has decreased owing to changes in dietary habits. Although these changes may be related to complete body health, there is no evidence-based tool to measure the dietary habits. We developed a small ear-hung wearable device for monitoring mastication behavior. The device, worn on the ear pinna, allows the counting of the number of chewing cycles, and data are collected on a smartphone via Bluetooth. In this study, the reliability of the novel device was verified.Methods A total of 22 healthy volunteers participated in the study. During measurement, the subjects wore the novel wearable device on their right ear pinna and were asked to chew gum, gummy jellies, and rice balls. The number of chewing cycles was counted by the device. A mandibular kinesiograph (MKG) was also recorded, and the chewing activity was recorded as a video. The accuracy, precision, and recall of the ear-hung device were calculated by comparing the data obtained from the MKG and the video recording. Additionally, the factors affecting reliability were examined.Results The accuracy, precision, and recall of the novel device were 101.6 ± 13.6%, 85.3 ± 11.0%, and 84.5 ± 9.5%, respectively. Although the accuracy was not affected by any factor, precision and recall of the novel device for women were significantly worse than that for men, and were greatest when the subjects were chewing gum.Conclusions Our findings suggest that the newly developed ear-hung wearable device for counting the number of chewing cycles was sufficiently reliable.

DOI： 10.2186/jpr.jpr_d_20_00032

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Mastication is a physiological process whereby food is comminuted and mixed with saliva to form a swallowable bolus; it is also the initial process for retronasal aroma that is released from foods to receptors in the nose. However, the influence of mastication state on retronasal aroma is poorly understood. The purpose of this study was to investigate the relationship between aroma concentration and factors related to mastication state. The study design was an analytical observational study. Twelve male volunteers (age, 26.5 ± 2.7 years) were recruited and divided into five and seven participants in the low and high masticatory performance groups, respectively. The stimulated salivary flow rate was measured while participants chewed paraffin wax. First, an odor sensor was placed in the nostril, and the aroma concentration was measured over time as participants chewed an orange-flavored gummy jelly standardized for masticatory performance assessment until swallowing; chewing strokes were counted to determine swallowing thresholds. Next, participants were instructed to chew the gummy jelly for a certain number of strokes (i.e., 50 or 100% of swallowing thresholds, as well as 30 strokes) and expectorate the jelly without swallowing. The surface area of comminuted jelly at 30 chewing strokes was defined as masticatory performance. Maximum and slope of aroma concentration, surface area, number of chewing strokes, and stimulated salivary flow rate were compared between low and high masticatory performance groups. Statistical significance was set at α = 0.05. At 30 chewing strokes, the maximum aroma concentration and the slope were significantly greater in the high masticatory performance group than in the low masticatory performance group. There was a positive correlation between the maximum aroma concentration and the number of chewing strokes with aroma release in both groups. No significant correlation was found between the maximum aroma concentration and the stimulated salivary flow rate. However, multiple regression analysis (with aroma concentration as a dependent variable) showed that the increase in surface area, the number of chewing strokes, and the stimulated salivary flow rate were significant explanatory variables. The results suggested that retronasal aroma was influenced by mastication state and salivary flow rate during chewing.

DOI： 10.3389/fnut.2021.623507

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Tongue motor biomechanics during swallowing was not fully elucidated due to the technical difficulty. OBJECTIVE: To evaluate the relationship between tongue motion and tongue pressure production by simultaneously measuring tongue motion and tongue pressure during water swallowing. METHODS: In 12 healthy male participants (mean age, 30.8 ± 4.2 years), tongue pressure and tongue motion trajectory during dipper- and tipper-type swallows of 3 mL of water were measured using a sensor sheet system equipped with five sensing points and an electromagnetic articulography, respectively. The temporal correlation between motion of anterior/posterior tongue and tongue pressure production during swallowing was evaluated on the synchronised waveforms. RESULTS: In the dipper-type swallow, a similar up-and-down motion pattern in vertical direction was observed among all participants before tongue pressure production. Those motion patterns were common at the anterior and posterior tongue locations with a temporal difference in some segment of tongue motion. On the other hand, tongue directly attached to hard palate with temporal synchronicity between the anterior and posterior parts. In both types of swallow, a strong temporal correlation was found between the timing of tongue-palate contact and the Onset of tongue pressure by intra-class correlation coefficients. CONCLUSION: From the simultaneous measurement of tongue motion and tongue pressure production, the tongue motion pattern during water swallowing and the temporal correlation between tongue motion and tongue pressure production were elucidated.

DOI： 10.1111/joor.13079

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: This study investigated the impact of the renewal of a removable prosthesis on the masticatory function by subjective and objective measures and its variation among the types of occlusal support. METHODS: Seventy-eight patients who received newly fabricated removable denture patients participated in this study. For the objective assessment, masticatory performance was measured using test gummy jelly. For the subjective assessment, standardized questionnaires about food acceptability and the oral health-related quality of life (OHRQoL) were used. Pre- and post-insertion assessments were performed for each subject. Subjects were divided into three groups according to their posterior occlusion: with posterior occlusion (w/PO), without posterior occlusion (w/o PO) and edentulous. Wilcoxon's signed rank test was used to compare the pre- and post-treatment measurements of each assessment. The analysis of covariance and a multiple comparison were used to assess the effect of new dentures and differences due to occlusal support. RESULTS: The masticatory performance, OHRQoL and food acceptability following prosthodontic treatment were significantly improved by new denture insertion. The masticatory performance among groups varied to a relative degree. The rate of masticatory performance improvement for edentulous subjects was twice that in w/PO subjects. The OHRQoL was significantly lower in the w/o PO and edentulous groups with old denture than patients w/PO. The food acceptability improved most markedly in the edentulous group. CONCLUSIONS: The improvement in the masticatory performance by new denture insertion varied among types of occlusal support. Re-establishing the occlusal support of edentulous patients may help restore their OHRQoL and improve food acceptability.

DOI： 10.2186/jpr.JPR_D_20_00045

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs. METHODS: Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence. RESULTS: Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP). CONCLUSIONS: The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

DOI： 10.1111/ger.12496

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: To measure masticatory performance (MP) in partially edentulous patients when wearing removable partial dentures (RPDs) versus when not wearing RPDs, and to identify factors that could enable clinical evaluations related to differences in MP. MATERIALS AND METHODS: This study consisted of 87 partially edentulous patients (57 females, 30 males; mean age, 69.41 ± 8.85 years) categorized as Eichner classification B who habitually wore RPDs. MP was evaluated while wearing versus while not wearing RPDs using test gummy jellies. The participants were categorized into four groups by the presence of occlusal contacts in one to three of the molar and premolar regions (occlusal support), or in the anterior region only, according to the Eichner index (B1-B4). The participants were also categorized according to the jaw on which the RPDs were worn and the Kennedy classification, and evaluated in regard to changes in MP resulting from wearing RPDs. Additionally, the rate of change in MP (MP-rv) was calculated for each participant using MP when not wearing RPDs as a reference, and factors affecting MP-rv were evaluated using single or multiple regression analysis and the Kruskal-Wallis test with multiple comparisons. RESULTS: Significant increases in MP-rv were observed for all participants and for those with occlusal support in two (p = 0.006) and three regions (p = 0.019); however, no significant differences were observed when wearing and not wearing RPDs in participants with (p = 0.090) and those without occlusal support in one region (p = 0.474). With respect to the jaw on which the RPDs were worn, only maxillary or both maxillary/mandibular RPDs tended to have higher MP-rvs than did only mandibular jaws. The results of the multiple regression analysis showed that Kennedy Class I edentulous arches were a factor in increasing MP-rv (standard partial regression coefficient = 0.46, p < 0.05). CONCLUSION: According to the results of this study, among various factors on the degree of improvement in masticatory performance by wearing RPDs, bilateral missing posterior teeth might be a predictor for achieving clinical improvement.

DOI： 10.1111/jopr.13265

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

＜文献概要＞本研究の目的は,若年健常者30名を対象に,吊り下げはかりを用いた舌-口蓋接触トレーニングが舌の運動機能に及ぼす影響を調べることである.準ランダム化比較試験を採用し,トレーニングを実施した群(介入群)と,実施しなかった群(対照群)に割り付けた.トレーニング方法は,対象者に吊り下げはかりに固定したガーゼを舌と口蓋の接触で保持させ,訓練者がはかりを水平面より約30度下方に牽引した.トレーニングの強度はガーゼを保持できる最大の力×80%で5秒間とし,5回×2セット/日,週3日×7週間実施した.介入期間前後で,両群の最大保持力,最大舌圧,努力嚥下時舌圧,oral diadochokinesisでの5秒間反復回数を比較した.対照群ではすべての項目において有意差は認められなかったが,介入群ではトレーニング前後で,最大保持力が2.44kg(+72%),最大舌圧が8.3kPa(+22%),努力嚥下時のCh.1舌圧が9.4kPa(+29%),Ch.2舌圧が8.6kPa(+30%),Ch.4舌圧が12.7kPa(+52%),Ch.5舌圧が10.0kPa(+36%)と有意な増加を認めた(p<0.05).舌の運動機能向上を目的とした筋力トレーニングとして,本法が有効である可能性が示唆された.

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BACKGROUND: Pharyngeal residue can trigger aspiration and choking after swallowing. Various studies to assess the amount of pharyngeal residue have been conducted; however, an easy and quantitative method is yet to be established. The aroma released from the pharyngeal residue is thought to be delivered from the pharynx to the nasal cavity via velopharynx by expiration, that is, retronasal pathway. OBJECTIVE: This study verified that the amount of pharyngeal residue could be estimated by aroma intensity. METHODS: Ten healthy adult subjects had tubes in from the oral cavity to the pharynx. Varying amounts of essence were dispensed into the pharynx through the tube either at rest or after swallowing the essence. Pharyngeal residue was simulated by retention essence in the pharynx without swallowing. An odour sensor was placed in the nostril, and the aroma intensity of the retained essence was measured over time. RESULTS: The aroma intensity level flattened after a certain period of time had elapsed, and a significant correlation was found between the amount of essence dispensed and the flattened aroma intensity, both at rest and after swallowing. Furthermore, to estimate in a short period of time, changes in aroma intensity over time were estimated by fitting to a decay curve. The estimated intensity at convergence, calculated from the fitted curve from 80 to 120 seconds after swallowing, was significantly correlated to the measured intensity. CONCLUSION: The amount of pharyngeal residue can be estimated in a short period of time by measuring the aroma intensity.

DOI： 10.1111/joor.12974

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Language：English   Publisher：ELSEVIER SCIENCE LONDON  

Background: The number of persons with difficulty in mastication and swallowing is increasing and causes a social problem. Commercially available soft gels for disadvantaged persons are known to be crushed between the tongue and the hard palate, but the detailed mechanism is not well understood.Scope and approach: After reviewing the safety and difficulty in eating, the significance of the tongue pressure is discussed. To avoid the complexity of the simultaneous action of the teeth and the tongue, squeezing with the tongue without teeth is studied. Squeezing of gels with different deformabilities between the tongue and palate is analyzed using an ultrathin sensor, and compared with the in vitro test using an artificial tongue and panellists' judgements of the strategy change from tongue-palate compression to chewing.Key findings and conclusions: It was clarified that the work of the tongue just before swallowing depends not only on the initial mechanical properties of foods but also on the oral processing before the swallowing. This poses a question on the prevailing view that the final mechanical properties just before swallow does not depend on the initial mechanical properties of ingested foods. The transition of the strategy from the tongue-palate squeezing to the teeth chewing was shown to be determined using an artificial tongue compression approach in combination with sensory evaluation to select the strategy. These findings can be a basis for understanding better the conditions necessary for designing food gels. The tangential force during squeezing should be analyzed in the future.

DOI： 10.1016/j.tifs.2020.02.023

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Movement of the hyoid and laryngeal complex is critical for preventing aspiration, as well as smooth bolus passage through the pharynx. We have developed a non-invasive system for measuring laryngeal movement during swallowing with a bend sensor and have already reported the time coordination between the signal waveform from the sensor and hyoid movement. OBJECTIVE: The aim of this study was to clarify the quantitative association between the output value of the sensor and hyoid movement during swallowing. METHODS: A small bend sensor was fixed on the skin surface along the midline of the neck of 13 healthy men (mean age, 30.8 ± 4.5 years). Laryngeal and hyoid movements during swallowing of 5 mL of water were recorded synchronously by the bend sensor and videofluorography. The relationship between the bend sensor output value (LM value) and hyoid position (x- and y-axis displacements) by videofluorography from the onset to the offset of the signal waveform was analysed for all tasks and for each task using Pearson's correlation coefficients. RESULTS: There was a positive correlation between the LM value and hyoid position for all tasks (x-axis displacement: r = .647, y-axis displacement: r = .233). In particular, there was a moderate to high correlation between the LM value and x-axis displacement for each task (.453 ≤ r ≤ .934). CONCLUSION: The LM value can be a quantitative parameter of anterior hyoid movement during swallowing that might be associated with bolus flow and upper oesophageal sphincter opening.

DOI： 10.1111/joor.12906

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The aim of this study was to evaluate tongue movement and its biomechanical effects during squeezing, one of the oral strategies for processing soft foods, by tongue pressure sensors, videofluorography, and surface electromyography. DESIGN: Fifteen healthy men (mean age, 31.0 ± 4.1 years) without dysphagia were recruited. A 0.1-mm-thick pressure sensor sheet with five measuring points, videofluorography, and surface electromyography were used for synchronous measurements of tongue pressure, hyoid movement, and suprahyoid muscles activity, respectively, while squeezing 5 mL of gels. Amplitude, duration, area, and their sequential order during initial squeezing were analyzed. Differences in hyoid position at the onset, peak, and offset of hyoid movement were also analyzed. RESULTS: At the beginning of initial squeezing, tongue pressure at the middle area of the hard palate, hyoid movement, and suprahyoid muscle activity appeared simultaneously, followed by tongue pressure at the anterior area and then at the posterior area. When the hyoid was in an elevated position, the amplitude of suprahyoid muscle activity and tongue pressure peaked. At the end of initial squeezing, the hyoid position at the offset of hyoid excursion was superior to that at the onset. All evaluation items of tongue pressure, hyoid movement, and suprahyoid muscle activity were modulated according to the texture of gels. CONCLUSIONS: During initial squeezing, tongue pressure, hyoid movement, and suprahyoid muscle activity were coordinated while being modulated by the food texture. At the end of initial squeezing, the hyoid was maintained in an elevated position, which might be beneficial for subsequent squeezing.

DOI： 10.1016/j.archoralbio.2019.104631

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Language：English   Publishing type：Research paper (scientific journal)  

Lip closing is an important motor act in food acquisition. Appropriate food capture in anticipatory and early oral stages of feeding is essential for mastication and swallowing. The aim of this study was to investigate the effect of food type and quantity on lip closing pressure during food capture with a spoon, and to identify normal lip function during food acquisition in healthy young adults. Twenty young healthy males (age range: 22-30 years) participated in this study. They were asked to eat the test food freely with a spoon. Test foods were yogurt and cream cheese, which were given in quantities of 3, 5 and 10 g in weight; 3 ml water was included as a reference. A strain gauge transducer was embedded in the spoon in advance, and lip closing pressures during food capture were measured and recorded. The Vicon motion analysis system was used to collect three-dimensional kinematic data of spoon operation. Positive pressure with lip closing during capture of adhesive food, such as cream cheese, significantly increased (P < 0.001). Moreover, positive pressure significantly decreased when food quantity increased (P < 0.01), irrespective of food type. Negative pressure that preceded positive pressure appeared more frequently during cream cheese intake and increased when food quantity on the spoon increased (P < 0.001). These findings indicated that participants sucked or squeezed the spoon further during capture of adhesive food. Maximum mouth opening occurred predominantly during the spoon insertion period, while mouth closing occurred predominantly during the spoon withdrawal period. After mouth closing, all subsequent lip pressure events appeared in the withdrawal period. Our results may be useful for comprehending normal lip function during food acquisition in healthy young adults. They may also aid in the diagnosis and management of abnormal lip function in oral hypofunction and dysfunction, which can be examined in future studies.

DOI： 10.1016/j.physbeh.2019.112743

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PURPOSE: Masticatory performance can be measured through elution of glucose or beta-carotene from comminuted gummy jelly. However, these methods require special devices. Additionally, occasional/unintentional swallowing or inadequate collection of comminuted particles of gummy jelly in the oral cavity may cause measurement errors. Therefore, we devised a new photographic method to estimate the increase in surface area and weight of comminuted gummy jelly. This study aimed to verify the accuracy of this method. METHODS: Initially, fifty images depicting the comminuted pieces in a special box were prepared. Then, the increase in surface area was measured using a fully-automated method, and the weight was measured. The size and angle of each image were adjusted based on markers located at the four corners of the box. From these photographic images, the area, perimeter, color average, color deviation, side area, and amount of surface roughness for each particle was calculated, and multiple regression analysis was performed to estimate the surface area and weight. The relationship between the estimated values and the values measured with the fully-automated device and by weight were analyzed. RESULTS: The intra-class correlation coefficient between the estimated value and the value from the fully-automated method was r = 0.956. This high correlation was also obtained under different photographic conditions. Furthermore, for determining whether 80% or less gummy jelly was collected, the sensitivity was 100% and the specificity was 91%. CONCLUSIONS: The newly developed photographic method is valuable because it is accessible and may assist in achieving reliable evaluation of masticatory performance.

DOI： 10.1016/j.jpor.2019.04.010

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

Older adults with disorders of mastication and swallowing are often fed soft foods such as jelly or puree. The texture of such semi-solid foods allows them to be squeezed between the tongue and palate rather than being chewed. However, it is difficult to visually identify such strategies for the oral processing of food. This study aimed to test the hypothesis that there is a difference in the sequential coordination between the masseter and supra-hyoid muscles, and to identify feeding behaviors such as chewing and squeezing using electromyography. Seventeen male subjects (mean age: 30.8 years) were recruited. Four kinds of gels were prepared (two kinds of fracture force and fracture strain) as test samples. Subjects were instructed to consume the gels in three ways: squeezing with the tongue, chewing with the teeth and eating freely until swallowing. The amount of squeezing/chewing and the consumption time was unlimited. The masseter and supra-hyoid muscle activity were recorded during the entire consumption time and videofluorography was simultaneously recorded during each ingestion. Lissajous figures were made from the electromyographic activity of the two groups of muscles during the first stroke, and a regression line was made to determine the gradient of each figure to compare squeezing and chewing using the Mann-Whitney U-test. The masseter and supra-hyoid muscles were active simultaneously during squeezing with the tongue. However, the masseter was active after the supra-hyoid during chewing. The gradient of the regression line from the Lissajous figures between the masseter and supra-hyoid muscle activity was positive during squeezing, but negative during chewing. Analysis of the ROC curve showed that the cutoff value of the gradient for differentiating feeding behaviors was 0.097, with a sensitivity of 95.3% and specificity of 98.4%. When we allocated 68 free intakes into squeezing and chewing according to this cutoff value, we could distinguish with good precision, and the accuracy, sensitivity, and specificity were 86.8, 91.1, and 66.7% respectively. These results suggest that certain aspects of muscle activity differed among oral processing methods. Lissajous analysis of muscle activity was useful for identifying ingestion behaviors.

DOI： 10.3389/fphys.2020.00618

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© 2020 Association for Dental Sciences of the Republic of China New lines of evidence suggest that the oral-systemic medical links and oral hypo-function are progressively transcending beyond the traditional clinical signs and symptoms of oral diseases. Research into the dysbiotic microbiome, host immune/inflammatory regulations and patho-physiologic changes and subsequent adaptations through the oral-systemic measures under ageism points to pathways leading to mastication deficiency, dysphagia, signature brain activities for (neuro)-cognition circuitries, dementia and certain cancers of the digestive system as well. Therefore, the coming era of oral health-linked systemic disorders will likely reshape the future of diagnostics in oral geriatrics, treatment modalities and professional therapies in clinical disciplines. In parallel to these highlights, a recent international symposium was jointly held by the International Association of Gerontology and Geriatrics (IAGG), Japanese Society of Gerodontology (JSG), the representative of USA and Taiwan Academy of Geriatric Dentistry (TAGD) on Oct 25th, 2019. Herein, specific notes are briefly addressed and updated for a summative prospective from this symposium and the recent literature.

DOI： 10.1016/j.jds.2020.09.007

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BACKGROUND: Tongue thrusting, which often occurs during swallowing in patients with anterior open bite, is considered to show different tongue dynamics from healthy individuals, but the details are still unclear. OBJECTIVE: This study aimed to identify the effect of tongue thrusting on tongue pressure production during swallowing in patients with anterior open bite. METHODS: The subjects were 11 patients with an anterior open bite and 8 healthy volunteers with individual normal occlusion. The patients were divided into a tongue-thrusting group (n = 8) and a non-thrusting group (n = 3). Tongue pressures while swallowing jelly (4 mL) were recorded by a sensor sheet system with five measuring points (Chs1-5) attached to the palatal mucosa. The time sequences, maximum magnitude and duration of tongue pressure, and swallowing time of tongue pressure were analysed. RESULTS: Tongue pressure waveforms in the tongue-thrusting group were quite diverse compared with the other two groups. The duration at the posterior-median part in the tongue-thrusting group was significantly shorter, and the maximum magnitudes at the mid-median, posterior-median and the peripheral part were also significantly lower than in the healthy group. These results suggest that the compensatory tongue thrust action by which the tongue closes the front part of the oral cavity may make it difficult to lift the tongue and transfer the bolus. CONCLUSION: Patients with an anterior open bite and tongue thrusting at swallowing showed diversity of tongue pressure waveforms and noticeably weaker tongue pressures from mid-median to posterior-median regions than healthy individuals.

DOI： 10.1111/joor.12820

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：(NPO)日本顎変形症学会  

顎矯正手術を施行した骨格性下顎前突症患者10名(全例女性)を対象に、舌圧センサシートを用いて舌の機能的特徴を解析し、過去に報告した個性正常咬合者10名および骨格性下顎前突症患者(顎矯正手術施行前)10名の結果と比較することで術後における嚥下時舌動態の傾向について検討した。術後6ヵ月経過した症例の舌圧波形は各Chの舌圧発現からそれぞれ約200〜400msec後にピーク値をむかえたが、その後もピーク値に近似した舌圧が持続的に働いた。術後群の舌圧発現順序は、舌圧発現開始時刻よりCh1、Ch4、Ch5、Ch2、Ch3の順となり健常群と同じ順序であった。舌圧発現開始時刻、舌圧ピーク発現時刻は健常群と比較し有意差を認めなかったが、Ch4、Ch5における舌圧消失時刻は遅延した。そのため、Ch4、Ch5の舌圧持続時間の延長という下突群と同じ特徴を有していたが、術後群と下突群を比較するとCh4、Ch5における舌圧消失時刻は有意に早期化していた。

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J03047&link_issn=&doc_id=20190507340006&doc_link_id=130007649442&url=https%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007649442&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

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This study investigated the relationship between tongue pressure during swallowing and dysphagia in patients with Parkinson's disease (PD). A total of 24 patients with PD (12 men and 12 women, mean age 70.4 years) were studied. Their mean Hoehn and Yahr scale was 3.0 ± 1.3 (range 1-5). All participants underwent tongue pressure measurement and videofluorography during swallowing. Tongue pressure when swallowing 5 mL of barium on videofluorography was measured using a sensor sheet with five sensors. Based on the findings of videofluorography, the patients were divided into two groups: dysphagic PD group (n = 9) and non-dysphagic PD group (n = 15). The maximal magnitude (kPa), duration (s), time to peak pressure (s), and pressure gradient (kPa/s) of tongue pressure were analyzed for each part. For duration, time to peak pressure, and pressure gradient, similar values were calculated from the total waveform. There was no significant difference in maximal tongue pressure between the groups. The dysphagic PD group had prolonged duration of tongue pressure and time to peak pressure and a reduced pressure gradient compared with the non-dysphagic PD group. These results indicate that there is a clear difference in the temporal aspects of tongue pressure between the non-dysphagic and dysphagic PD patients. These differences provide the characteristics of tongue movement during swallowing in PD patients with dysphagia, which may be useful for the diagnosis and treatment of dysphagia.

DOI： 10.1007/s00455-018-9916-5

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Our previous study regarding the tongue-hold swallow (THS) demonstrated that the tongue-to-palate contact during THS could be influenced by the maximum tongue protrusion length (MTPL) of individual subjects, resulting in two different patterns of pressure generation. The present study further analyzed the influence of MTPL on the tongue pressure production along with submental surface electromyography (sEMG) during THS, in order to establish an index to better control THS effects. Tongue pressure using a sensor sheet system and concurrent submental sEMG activities were measured during swallowing tasks in 18 healthy young adults. Task conditions comprised THS at two different degrees of tongue protrusion and dry swallow. Tongue pressures and sEMG activities were compared among three task conditions, and correlations of MTPL with tongue pressure were also investigated. Additionally, a ROC curve was used to find a cut-off value for MTPL to predict changes (increases and decreases) in tongue pressure during THS. The duration and the amount of submental muscle activity increased concurrently during THS. Two trends were shown on the change in tongue pressure at the posterior-circumferential part of the hard palate during THS compared to dry swallow; the maximal magnitude and the integrated value of tongue pressure increased in some subjects, while these values decreased in others. Thirty-two millimeters was found to be the cut-off value of MTPL, which distinguishes increase/decrease pattern of tongue pressure with sensitivities of 60.0-85.7%. The present finding suggests that more reliable THS effects should be attainable using MTPL to set the tongue-hold position.

DOI： 10.1007/s00455-017-9865-4

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The physiological mechanisms underlying Stage II transport (STII), during which comminuted solid food is transported from the oral cavity into the meso-pharynx for aggregation into a pre-swallow bolus, have yet to be clarified. The purpose of the present study was to investigate relationships between tongue-palate contact during mastication and incidence of STII by synchronised analysis of tongue pressure production on a hard palate and video-endoscopic (VE) images during mastication. Tongue pressure at 5 measuring points with an ultra-thin sensor sheet attached to the hard palate and trans-nasal VE images while masticating corned beef was recorded for 12 healthy subjects. All recordings were divided into 2 groups: mastication with STII and without STII. Tongue pressure duration was longer at the anterior-median part in the group with STII than in the group without STII. Integrated values of tongue pressure were greater at the anterior-median parts and posterior circumferential part in the group with STII. Integrated values of tongue pressure per second were greater in late-stage mastication than in early-stage mastication in the group with STII. These results suggest that the tongue-palate contacting at the anterior-median and post-circumferential parts of the hard palate is related with the incidence of STII.

DOI： 10.1111/joor.12654

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing Ltd  

Although dysphagia is a life-threatening problem in patients with Parkinson's disease (PD), the pathophysiology of oropharyngeal dysphagia is yet to be understood. This study investigated the tongue motor function during swallowing in relation to dysphagia and the severity of PD. Thirty patients with PD (14 males and 16 females
average age, 69.4 years), Hoehn and Yahr stage II-IV, in Osaka University Hospital are participated in this study. During swallowing 5 ml of water, tongue pressure on the hard palate was measured using a sensor sheet with 5 measuring points. The maximal tongue pressure at each measuring point during swallowing was compared between patients with PD and healthy controls. Subjective assessment of oropharyngeal dysphagia was performed using Swallowing Disturbance Questionnaire-Japanese. The maximal tongue pressure at each measuring point was significantly lower in patients with PD than in healthy controls (8 males and 12 females
average age, 71.6 years). Furthermore, the maximal tongue pressure was significantly lower in dysphagic PD patients than non-dysphagic PD patients. Loss of tongue pressure production at the anterior part of the hard palate was strongly related to dysphagia in the oral phase as well as in the pharyngeal phase. An abnormal pattern of tongue pressure production was more frequently observed in dysphagic PD patients than in non-dysphagic PD patients. The results suggest that tongue pressure measurement might be useful for early and quantitative detection of tongue motor disability during swallowing in patients with PD.

DOI： 10.1111/joor.12626

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

＜文献概要＞簡易な機器で舌挙上に負荷を加えることを目的とし,ばねばかりを用いた簡易な舌-口蓋接触トレーニングを考案した.本研究では,ばねばかりにより調節した牽引負荷が舌圧に与える影響を検討した.対象は最大押し付け舌圧が各年代の平均値未満であった嚥下障害を呈する患者20名とした.方法は,はかりに固定したガーゼを舌-口蓋接触の力のみで10秒間保持するように指示し,評価者がはかりを牽引した.負荷量は50g,100g,200g,300gの4条件を設定した.牽引時の舌圧最大値,舌圧積分値を舌圧センサシートで記録,解析し,負荷量の増加に伴う舌圧の増加傾向の有無の検定,各条件間での比較を行った.口蓋の正中前方部,左右後方周縁部では,牽引力の増加に伴い,舌圧最大値,舌圧積分値は有意な増加傾向を認めた.また正中前方部の舌圧最大値,舌圧積分値は各条件間で有意差を認め,牽引力の増加に伴って舌圧が増加した.ばねばかりを用いた簡易な舌-口蓋接触トレーニングは舌前方部へ負荷を加えるトレーニングとして利用できる可能性が示唆された.

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04306&link_issn=&doc_id=20180703130003&doc_link_id=%2Fdz7jslhr%2F2018%2F001502%2F002%2F0062-0070%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz7jslhr%2F2018%2F001502%2F002%2F0062-0070%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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The effects of bolus volume and flow time on the sequential coordination of tongue pressure (TP) and pharyngeal pressure (PP), which are important in the biomechanics of swallowing, are unclear. In this study, we measured TP and PP simultaneously in 10 healthy adults at multiple points during dry swallowing and the swallowing of 5 ml and 15 ml of liquids with different viscosities, and investigated changes in the timing of the onset, peak, and offset of these pressures. TP was measured using a sensor sheet system with five measuring points on the hard palate, and PP was measured using a manometry catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. We found that the differences between the TP and PP onset times decreased when the bolus volume was larger. The change in bolus volume had very little effect on peak time or offset time. The flow time of the bolus affected the appearance of onset and peak time for both TP and PP. A time difference between TP and PP emerged as the flow time increased, with TP starting to appear before PP. This may be the first detailed analysis of pressure-flow dynamics that treats the mouth and pharynx as a single functional unit. We believe that our analysis is an important step toward extending future research to include a wider range of age groups and dysphagia patients.

DOI： 10.1016/j.physbeh.2018.03.006

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing Ltd  

The purpose of this study was to help provide data to help to implement effective rehabilitation following surgery for oral cancer by comparing tongue pressure production for water and thickened water from the anterior and posterior parts of the tongue during swallowing. Ten healthy volunteers (7 men, 3 women
age 27.6 ± 1.5 years) participated in the experiments. Tongue pressure during 3 mL water and 3 mL thickened water at the anterior and posterior tongue during swallowing was measured using a sensor sheet system with five measuring points on the hard palate. The sequential order of the points, maximal magnitude and duration of tongue pressure at each point were compared based on water viscosity and tongue ingestion site. There was a common pattern in the sequential order of tongue pressure generation among the two swallowing conditions. The maximal magnitude of tongue pressure was significantly higher when swallowing thickened water than when swallowing water at all points except for the anterior-median and mid-median part. Moreover, the pressure at all sites during posterior ingestions was significantly lower than that during anterior ingestion. The present results provide mean values of tongue pressure during voluntarily triggered swallowing in anterior ingestion and posterior ingestion in young, healthy dentate individuals
these values can be clinically referenced for tongue pressure measurement in the evaluation of patients with dysphagia. The use of reference values may help streamline the diagnosis, treatment and rehabilitation of dysphagia.

DOI： 10.1111/joor.12623

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This study aimed to ascertain the influence of various amounts (0-30%) of carrot puree (CP) in vegetable juice on linguapalatal swallowing pressure in healthy volunteers. Twenty healthy women (age range: 20-22 years) swallowed a 17-ml drink in a natural state, and linguapalatal swallowing pressure was measured using a special sensor sheet. Peak magnitude (maximum pressure of the tongue pushing on the hard palate), integrated values of linguapalatal swallowing pressure on the waveform, and duration of linguapalatal swallowing pressure were increased with increases in CP concentrations. The total integrated value for 30% CP vegetable juice was larger than that of vegetable juice with no CP. The apparent viscosity of the vegetable juice with a low CP concentration was smaller than that with a high CP concentration at the same shear rate. These results suggest that vegetable juice containing CP affects mechanoreceptor activity in the mouth and generates a neuromotor response. PRACTICAL APPLICATIONS: This study aimed to ascertain the influence of various amounts of carrot puree (CP) in vegetable juice on linguapalatal swallowing pressure measured by using a special sensor sheet in healthy volunteers. Obtained results of this study clearly showed that vegetable juice containing CP affects the movement of the tongue in maneuvering the bolus. Moreover, the results demonstrated that this effect depended on the concentration of CP in the vegetable juice. These findings are expected to provide clinically valuable data on the effect of mechanical stimulation during the oral stage of swallowing.

DOI： 10.1111/jtxs.12315

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Surface electrical stimulation of the laryngeal region is used to improve swallowing in dysphagic patients. However, little is known about how electrical stimulation affects tongue movements and related functions. We investigated the effect of electrical stimulation on tongue pressure and hyoid movement, as well as suprahyoid and infrahyoid muscle activity, in 18 healthy young participants. Electrical stimulation (0.2-ms duration, 80 Hz, 80% of each participant's maximal tolerance) of the laryngeal region was applied. Each subject swallowed 5 ml of barium sulfate liquid 36 times at 10-s intervals. During the middle 2 min, electrical stimulation was delivered. Tongue pressure, electromyographic activity of the suprahyoid and infrahyoid muscles, and videofluorographic images were simultaneously recorded. Tongue pressure during stimulation was significantly lower than before or after stimulation and was significantly greater after stimulation than at baseline. Suprahyoid activity after stimulation was larger than at baseline, while infrahyoid muscle activity did not change. During stimulation, the position of the hyoid at rest was descended, the highest hyoid position was significantly inferior, and the vertical movement was greater than before or after stimulation. After stimulation, the positions of the hyoid at rest and at the maximum elevation were more superior than before stimulation. The deviation of the highest positions of the hyoid before and after stimulation corresponded to the differences in tongue pressures at those times. These results suggest that surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. NEW & NOTEWORTHY Surface electrical stimulation applied to the laryngeal region during swallowing may facilitate subsequent hyoid movement and tongue pressure generation after stimulation. Tongue muscles may contribute to overshot recovery more than hyoid muscles.

DOI： 10.1152/japplphysiol.00512.2017

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Pharyngeal electrical stimulation (PEStim) has been found to facilitate voluntary swallowing. This study investigated how PEStim contributed to modulation of swallowing function in 15 healthy humans. In the involuntary swallowing test, water was injected onto the pharynx at 0.05 ml/s and the onset latency of the first swallow was measured. In the voluntary swallowing test, subjects swallowed their own saliva as quickly as possible for 30 s and the number of swallows was counted. Voluntary and involuntary swallowing was evaluated before (baseline), immediately after, and every 10 min after 10-min PEStim for 60 min. A voluntary swallowing test with simultaneous 30-s PEStim was also conducted before and 60 min after 10-min PEStim. The number of voluntary swallows with simultaneous PEStim significantly increased over 60 min after 10-min PEStim compared with the baseline. The onset latency of the first swallow in the involuntary swallowing test was not affected by 10-min PEStim. The results suggest that PEStim may have a long-term facilitatory effect on the initiation of voluntary swallowing in healthy humans, but not on peripherally-evoked swallowing. The physiological implications of this modulation are discussed.

DOI： 10.1371/journal.pone.0190608

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Biorheology  

This paper describes a spatiotemporal analysis of tongue behavior while eating a nursing-care gel-like food. First, tongue pressure while eating the gel-like food is measured using a multipoint pressure sensor attached to the palate. By considering a pressure waveform as a half sinusoidal wave, a Lissajous curve drawn with two pressure waveforms measured at two points can be used to analyze tongue behavior. Based on the curve, three feature values can be designed to characterize tongue behavior: pressure level, pressure distribution, and pressure phase difference. Finally, correlations between the feature values and the sensory evaluation of the texture are visualized. The proposed method is a potentially useful tool for investigating the relationship between tongue behavior and the texture of food.

DOI： 10.17106/jbr.32.39

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

This research aimed to investigate the relationship between in vivo measurement of swallowing and sensory evaluation using thickened liquids as model foods. Healthy subjects (8 male and average 29.6-year old) participated in both tests, in which the subjects were asked to swallow the whole amount of sample (10 ml) at one time. In vivo measurement monitored thyroid cartilage movement during swallowing using a bendable pressure sensor synchronously with suprahyoid electromyography, whereas sensory evaluation measured perceived cohesiveness and adhesiveness on a visual analogue scale. Two variables from the pressure sensor analysis; activity of the thyroid cartilage and the maximum displacement of the thyroid cartilage were correlated negatively (p < .01) to perceived cohesiveness with high correlation coefficient (|r|> .9). Advantages of in vivo measurement over conventional shear rheology in assessing texture attributes perceived during swallowing were identified. PRACTICAL APPLICATIONS: This research provides food manufactures with knowledge on a novel objective method for texture measurement of fluid foods and beverages based on human physiology during swallowing. Variable from this method can work as a measure for texture design of food products to meet consumers' preference, particularly foods for dysphagia patients whose demand is increasing in this aged society although subjects of study should be expanded to these people in the future.

DOI： 10.1111/jtxs.12261

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：NATURE PUBLISHING GROUP  

Swallowing is a very important and complex physiological behaviour. The dynamic of swallowing has created great interest as any procedural abnormality will result in dysphagia and even lower quality of life. However, a non-invasive evaluation of biomechanical coordination during oropharyngeal swallowing, which includes the activities of the tongue, the hyoid and swallowing-related muscles, has not yet been achieved. In the present study, we recruited fifteen subjects, and a non-invasive sensing system composed of a pressure sensor, a bend sensor, surface electrodes and a microphone was created to simultaneously monitor tongue pressure, hyoid motion, and surface EMG of swallowing-related muscles, as well as take sound recordings, when the subjects swallowed 5 ml of water. In addition to obtaining the durations of certain motor events, the considerable time (beginning, peak and ending time) of tongue pressure production, suprahyoid and infrahyoid muscle activity and hyoid motion were successfully measured. Moreover, the significant correlations between swallowing-related muscles, tongue pressure, and the hyoid were confirmed. These findings suggest that the non-invasive sensing system has potential as a good candidate for monitoring and evaluating the oropharyngeal process of swallowing, which may be useful in clinical work involving dysphagia evaluation and rehabilitation.

DOI： 10.1038/s41598-017-15243-6

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Authorship：Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: The aim of the present study was to quantify the relation between physical fitness and oral function, including tongue and lip movements. BACKGROUND: Physical fitness and oral function influence quality of life and activities of daily living in older individuals. Occlusal contact and mastication performance are associated with physical fitness, but the association between tongue and lip movements and physical fitness is unclear. MATERIAL AND METHODS: Sixty-six independent community-dwelling older individuals (24 men, 42 women; mean age, 70.3 ± 5.9 years) participated in this study. Measures of physical fitness were the one-leg standing time with eyes open, the functional reach test, anteflexion, the timed up and go test, and grip strength. Measures of oral function were tongue pressure, lip pressure, tongue movement from side to side, the repetitive saliva-swallowing test (RSST), oral diadochokinesis and masticatory efficiency. Multiple regression analysis was used to quantify the relation between physical fitness and oral function. RESULTS: After adjustment for age, sex, BMI, exercise habits and number of remaining teeth, the tongue movement from side to side and/or oral diadochokinesis were chosen as significant factors in each physical fitness measurement. Furthermore, the lip pressure and masticatory efficiency were associated with handgrip strength. CONCLUSION: Oral function, including tongue and lip movements, was associated with physical fitness in older people in this study. Tongue dexterity as characterised by tongue movement from side to side and oral diadochokinesis particularly associated with physical fitness.

DOI： 10.1111/ger.12186

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Abnormalities of swallowing in patients with mandibular prognathism have not been evaluated quantitatively. The aim of this study was to compare tongue pressure production for bolus transfer between volunteers with normal occlusion and patients with mandibular prognathism. The control group had 10 female volunteers with normal occlusion, and the patient group had 10 women with mandibular prognathism. Tongue pressure was measured by a palatal sensor sheet at five sites on swallowing 4 mL of a tasteless and odourless jelly. Results: The tongue pressure waveform differed between the control and patient groups. The incidence of a double-peak tongue pressure waveform was more frequent in the patient group. In both groups, the exertion of tongue pressure began at the anterior point of the sensor sheet, followed by the peripheral parts. Although the order of expression of tongue pressure was the same for the two groups, maximum tongue pressure at all parts of the sensor sheet was lower in the patient group than in the control group. Furthermore, swallowing time was longer in the patient group than in the control group at the peripheral parts of the palate. These results clearly show the difference in tongue pressure production during swallowing between patients with mandibular prognathism and volunteers with normal occlusion. The current findings suggest that maxillofacial morphology may affect tongue movement during swallowing.

DOI： 10.1111/joor.12379

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1007/s00455-015-9641-2

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DOI： 10.5466/ijoms.15.85

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The prevalence of esophageal involvement and its impact on clinical manifestations in patients with multiple system atrophy (MSA) remains unknown. We recruited 16 consecutive patients with dysphagia associated with MSA (MSA group) and 16 consecutive patients with dysphagia associated with amyotrophic lateral sclerosis (ALS group). We assessed the presence or absence of food stagnation within the esophagus using videofluorography. Food stagnation within the esophagus was observed in 16 patients (100 %; 7 severe, 9 mild) in the MSA group and in 4 patients (25 %; 4 mild) in the ALS group (P &lt; 0.001). Follow-up videofluorography revealed that food stagnation in patients with MSA could exacerbate during the disease course. Patients with MSA and severe food stagnation showed a wide range of intraesophageal stasis by videofluorography. Among the 16 patients in the MSA group, 4 developed aspiration pneumonia and 1 died of suffocation associated with food regurgitation during continuous positive airway pressure therapy. In conclusion, food stagnation within the esophagus occurs more frequently in MSA patients with dysphagia than in ALS patients with dysphagia. Because food stagnation can cause serious complications such as aspiration pneumonia and suffocation, patients with MSA should be evaluated by videofluorography, especially those with stagnation in the esophageal phase.

DOI： 10.1007/s00455-015-9641-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

In swallowing, the tongue contacts against the hard palate to generate pressure for propelling a bolus from the oral cavity into the pharynx. Meanwhile, the hyoid and larynx move upward and forward to facilitate the bolus from the pharynx into the esophagus. It has been well known that sequential coordination between those actions is critical for safety accomplishment of swallowing. However, the absence of noninvasive assessment for it limits the detection to the physiological symptom of dysphagia. We applied a sensor sheet on the hard palate to measure tongue contact pressure and a bend sensor on the frontal neck to monitor the laryngeal movement, which was synchronized with hyoid motion for assessing the coordination between both actions in 14 healthy male subjects when swallowing 5 ml of water. The sequential order of tongue pressure and hyoid movement was successfully displayed. Tongue pressure was produced after slight movement of the hyoid and closely to the hyoid elevation, then reached a maximum when the hyoid stabilized in the most anterior superior position, and ceased concurrently with the onset of hyoid descent. Additionally, the synchronized data from both sensors showed positive correlations between identified time points on the laryngeal signal waveform and onset, peak and offset of tongue pressure. Our sensing system successfully showed the coordination between tongue pressure production and hyoid motion, and could be a simple and noninvasive method for clinicians to evaluate the oral and pharyngeal stages of swallowing. (C) 2015 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.physbeh.2015.05.004

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Relationship between throat sensations of beverages and some parameters from two types of in vivo measurements of swallowing was investigated. It was indicated using carbonated water that sparkling sensation can be assessed by the acoustic analysis of the swallowing sound, where both the intensity and the occurrence of the sound detected at a particular frequency of 4.0kHz during the bolus flow through the pharynx were increased by sparkling sensation. It was also indicated using beer that bodying sensation can be assessed by the kinetic analysis of the laryngeal movement, where both the duration and the activity of the larynx required for one swallowing cycle and detected on a bend sensor were increased by bodying sensation. Furthermore, it was demonstrated by these in vivo measurements that human swallowing behavior can be modified by the addition of flavor compounds, which was sometimes accompanied with enhanced perception in each sensation.
Practical ApplicationsConsumers' palatability is becoming more diverse not only in solid or semi-solid foods but also liquid foods such as beverages. In the development of beverage products, including soft drinks and beers, throat sensations perceived during drinking should be designed proficiently because they can greatly impact the consumers' preference. Although the design of throat sensation of beverage products can be the key for the commercial success, the industry is still looking for any suitable measurement to quantify these human perceptions in an objective, reproducible and easy manner. Evaluation protocol established in the present study meets these requirements and should contribute to the development of high-value added products. In this aged society, usage of the protocol can be expanded to the development of beverage products for dysphagia patients in terms of prevented misleading, for example.

DOI： 10.1111/jtxs.12111

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Blackwell Publishing  

Aim: Contact of the tongue against the hard palate plays an important role in swallowing. Therefore, age-related decline in tongue function has received much attention. The purpose of the present study was to investigate the effect of complete denture wearing on tongue motor biomechanics during swallowing in healthy edentulous older adults. Methods: A total of 19 edentulous patients (6 males and 13 females, mean age 76.2±7.2 years) without any history of neuromuscular disease or dysphagia were selected. All patients were wearing complete dentures in both the upper and lower jaws. Tongue pressure against the hard palate during swallowing saliva was recorded using an original T-shaped sensor sheet with five measuring points. Measurements were carried out both with and without the prostheses. For evaluating swallowing ability, the frequency of swallowing saliva in 30s was recorded (Repetitive Saliva Swallowing Test). Results: With the prostheses, the maximal magnitude and duration of tongue pressure was larger at Ch. 1 (anterior-median part of the hard palate) and Ch. 2 (mid-median part) right and left circumferential parts than without the prostheses. As for the integral of tongue pressure, that with prostheses was larger at all 5 channels than that without prostheses. There was significant improvement in the Repetitive Saliva Swallowing Test value while wearing prostheses. Conclusions: These results suggested that swallowing function deteriorated as a result of the decline in tongue-palate contact on removing complete dentures in edentulous older adults. Clinical relevance: The present study showed the effect of wearing prostheses on swallowing in edentulous older adults.

DOI： 10.1111/ggi.12315

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Language：Chinese   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To investigate the tongue pressure (TP) produced by tongue-hard palate contact in the process of normally swallowing liquid in healthy adults. METHODS: Thirteen adult male subjects were recruited to perform a single swallow of 5 ml water when sitting with upright position. The tongue pressure sensor sheet was used to monitor TP as a result of tongue-hard palate approximatation in the anteriomedian, midmedian, posteriomedian and circumferential parts, and the swallowing sound was recorded by microphone. The temporal sequence of TP at each measured part was obtained after setting the swallowing sound as the reference time. Also, the total duration, pre-peak duration, post-peak duration, maximum magnitude and integrated value of TP were recorded and compared among the measured parts. RESULTS: TP was produced from anterior to posterior along the midline of hard palate during normal swallowing of water [Ch1: (-0.40 ± 0.22) s, Ch2: (-0.36 ± 0.21) s, Ch3: (-0.24 ± 0.18) s], with the circumferential TP [Ch4: (-0.38 ± 0.23) s, Ch5: (-0.40 ± 0.23) s] occurring nearly to the anteriomedian one (P > 0.05). Before the swallowing sound (P < 0.05), TP at each part reached a peak synchronously [Ch1: (-0.12 ± 0.24) s, Ch2: (-0.16 ± 0.22) s, Ch3: (-0.13 ± 0.21) s, Ch4: (-0.16 ± 0.23) s, Ch5: (-0.17 ± 0.23) s] in a rapid manner (P > 0.05), then decreased gradually until disappeared simultaneously [Ch1: (0.32 ± 0.23) s, Ch2: (0.27 ± 0.21) s, Ch3: (0.23 ± 0.16) s, Ch4: (0.33 ± 0.31) s, Ch5: (0.33 ± 0.29) s] (P > 0.05) after the swallowing sound (P < 0.05). The TP related parameters (the total duration of TP:Ch1: (0.72 ± 0.20) s, Ch2: (0.63 ± 0.16) s, Ch3: (0.47 ± 0.17) s, Ch4: (0.70 ± 0.35) s, Ch5: (0.73 ± 0.29) s; the pre-peak duration of TP: Ch1: (0.28 ± 0.21) s, Ch2: (0.20 ± 0.16) s, Ch3: (0.12 ± 0.10) s, Ch4: (0.21 ± 0.22) s, Ch5: (0.23 ± 0.21) s; the post-peak duration of TP: Ch1: (0.44 ± 0.23) s, Ch2: (0.43 ± 0.18) s, Ch3: (0.36 ± 0.18) s, Ch4: (0.49 ± 0.25) s, Ch5: (0.50 ± 0.23) s; the maximum magnitude of TP: Ch1: (13.80 ± 7.73) kPa, Ch2: (12.40 ± 6.51) kPa, Ch3: (10.26 ± 7.15) kPa, Ch4: (12.16 ± 5.38) kPa, Ch5: (13.08 ± 5.05) kPa; the integrated value of TP: Ch1: (4.99 ± 3.69) kPa×s, Ch2: (4.25 ± 2.13) kPa×s, Ch3: (2.88 ± 1.87) kPa×s, Ch4: (4.32 ± 3.47) kPa×s, Ch5: (4.63 ± 2.49) kPa×s were significantly smaller in the posteriomedian part among all the five parts measured. No laterality was found in TP produced at the circumferential parts of the hard palate (P > 0.05). CONCLUSIONS: The TP at each part coordinates precisely during swallowing. The effective measurement of TP by tongue pressure sensor sheet will facilitate the evaluation of oral swallowing and the diagnosis of dysphagia simply and non-invasively.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Dysphagic patients are fed soft meals made of gels and process them by squeezing the food with the tongue, which reduces food size. Although the gels are designed based on rheological analyses, the impact of the initial gel texture on tongue kinetics is not known. This study investigated the effect of gel consistency on tongue pressure during squeezing and swallowing and compared results of the mechanical analyses. Fifteen healthy young subjects participated in this study. Tongue pressure during squeezing and swallowing was measured by a sensor sheet with five measuring points. Five ml of water and six gel samples prepared using two gelling agents at three concentrations each were used as test materials. Subjects were instructed not to chew the food but to squeeze it using their tongue. The shape of the tongue pressure waveform during the initial squeeze was similar to the stresse-time curve using a texture analyzer. However, the sequential order of tongue pressure during squeezing and swallowing was different. Tongue pressure during the initial squeeze was affected by gel consistency. The amplitude of tongue pressure during swallowing increased as gel consistency increased, but the duration of pressure was not affected. The slopes of tongue pressure generation were not affected by gel consistency, although the mechanical measurements showed increases in these slopes with increasing gel consistency. These results suggest that findings regarding characteristics of tongue movement during squeezing and textural properties of gels might be useful for food design and clarification of oral physiology. (C) 2014 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.foodhyd.2014.09.029

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

The objectives of this study were to evaluate the state of tongue pressure production during supraglottic swallow (SS) and super-supraglottic swallow (SSS) performed by healthy adults, and to investigate the effects of these swallowing maneuvers on the oral stage of swallowing. The participants were 19 healthy individuals. Tongue pressure against the hard palate during swallowing was measured using a tongue pressure sensor sheet system with five pressure-sensitive points. The tasks comprised swallowing 5 mL of water by normal wet swallow, SS, and SSS, and the parameters for analysis were the duration, the maximal magnitude, and the integrated value of tongue pressure during swallowing. The duration of tongue pressure was significantly longer at the anterior-median part of the hard palate during both SS and SSS than with normal wet swallow. The maximal magnitude increased significantly only at the posterior part of the hard palate during SS, but at all points during SSS. The integrated value increased significantly only at the posterior-median part of the hard palate during SS, but at all points except the mid-median part of the hard palate during SSS. The maximal magnitude and integrated value were also significantly higher at the anterior-median and posterior circumferential parts during SSS than during SS. These results show that these two swallowing maneuvers, which are known primarily as techniques to protect the airway, also function to strengthen the tongue pressure produced by the contact between the tongue and the hard palate during swallowing and this effect is more pronounced during SSS.

DOI： 10.1007/s00455-014-9556-3

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

Instrumental compression test using artificial tongue was carried out to compare the fracture profile of gels with the first oral strategy for size reduction by humans (termed as the first size reduction). Gellan gel samples, whose size and shape were the same as those of artificial tongue, were prepared in a wide mechanical range and were compressed uniaxially on artificial tongue at crosshead speed of 10 mm/s. When apparent Young's modulus of artificial tongue was approximately 55 kPa, fracture probability of gels corresponded to the ratio of subjects who decided to use tongue-palate compression instead of mastication. This was applicable to the gels whose fracture strain was below 65% but not to the gels whose fracture strain was above 70% within the range of fracture stress tested; approximately 30-100 kPa. Fracture strain should be a critical initial mechanical parameter that relates to the decision of oral strategy.

DOI： 10.1111/jtxs.12080

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

Although dysphagia is a life-threatening problem in patients with Duchenne muscular dystrophy (DMD), the pathophysiology of oral stage dysphagia is yet to be understood. The present study investigated the tongue motor deficit during swallowing in patients with DMD and its relationship with disease-specific palatal morphology. Tongue pressure during swallowing water was recorded in 11 male patients with DMD and 11 age- and sex-matched healthy subjects using an intra-oral sensor with five measuring points, and the state of tongue pressure production was compared between the groups. Palatal morphology was assessed by a non-contact three-dimensional scanner on maxillary plaster models. In patients with DMD, the normal sequential order of tongue-palate contact was lost and the maximal magnitude and integrated value of tongue pressure on the mid-anterior part of palate were smaller than those in healthy subjects. The width of the palate in patients was greater than that in healthy subjects and the depth of the palate in patients had a negative correlation with tongue pressure magnitude on the median palate. Our results suggested that the deteriorated tongue motor kinetics prevented tongue movement during swallowing that was appropriate for the depth of the palate and affects the state of tongue pressure production during swallowing. (C) 2014 Elsevier B.V. All rights reserved.

DOI： 10.1016/j.nmd.2014.03.003

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Language：Chinese   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To evaluate the effects of the application of tongue pressure sensor sheet on the signal waveform of laryngeal movement produced by the bend sensor during deglutition. METHODS: Twelve adult male subjects were recruited to perform a single swallow of 5 ml water when sitting on the dental chair with upright position. The data recorded by bend sensor was obtained with attaching tongue pressure sensor sheet simultaneously or not. Then the measured parameters by bend sensor with or without concurrent application of tongue pressure sensor sheet were compared. RESULTS: There were no significant differences between the same time point on the signal waveform produced by bend sensor whether concurrently attaching tongue pressure sensor sheet or not (P > 0.05). Additionally, we found no statistical significances between matched phases on the signal waveform recorded by bend sensor with or without application of tongue pressure sensor sheet (P > 0.05). CONCLUSION: The findings in this study suggest us that the usage of tongue pressure sensor sheet exerted no influences on the waveform of the laryngeal movement produced by bend sensor during deglutition, facilitating us to further apply tongue pressure sensor sheet and bend sensor simultaneously to record tongue pressure production and hyoid activity during deglutition.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background: In the recent hyper-aged societies of developed countries, the market for soft diets for patients with dysphagia has been growing and numerous jelly-type foods have become available. However, interrelationships between the biomechanics of oral strategies and jelly texture remain unclear. The present study investigated the influence of the initial consistency of jelly on tongue motor kinetics in different oral strategies by measuring tongue pressure against the hard palate.
Methods: Jellies created as a mixture of deacylated gellan gum and psyllium seed gum with different initial consistencies (hard, medium or soft) were prepared as test foods. Tongue pressure production while ingesting 5 ml of jelly using different oral strategies (Squeezing or Mastication) was recorded in eight healthy volunteers using an ultra-thin sensor sheet system. Maximal magnitude, duration and total integrated values (tongue work) of tongue pressure for size reduction and swallowing in each strategy were compared among initial consistencies of jelly, and between Squeezing and Mastication.
Results: In Squeezing, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both the magnitude and duration of tongue pressure over a wide area of hard palate, but tongue work for swallowing increased at the posterior-median and circumferential parts by modulating only the magnitude of tongue pressure. Conversely, in Mastication, the tongue performed more work for size reduction with increasing initial consistency of jelly by modulating both magnitude and duration of tongue pressure mainly at the posterior part of the hard palate, but tongue work as well as other tongue pressure parameters for swallowing showed no differences by type of jelly.
Conclusions: These results reveal fine modulations in tongue-palate contact according to the initial consistency of jelly and oral strategies.

DOI： 10.1371/journal.pone.0091920

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This study aimed to investigate the influence of carbonated drinks with gas volumes (GV) of 0, 1.5, and 2.7 on linguapalatal swallowing pressure, intraoral carbonation perception, and maximum velocity of a bolus through the pharynx in healthy volunteers (N = 20, all female, age range
20-21 years). The volunteers swallowed a 12-mL drink in the natural state. Linguapalatal swallowing pressure was measured using a special sensor sheet, and maximum velocity of the bolus through the pharynx was measured using ultrasonic diagnostic imaging equipment. Peak magnitude, integrated value, and duration of linguapalatal swallowing pressure and maximum velocity of a liquid bolus through the pharynx increased with an increase in carbon dioxide content in the carbonated drink. The total integrated values of carbonated drinks with GV of 1.5 and 2.7 were larger than that of the drink without carbon dioxide. These results suggest that the carbon dioxide dissolved in carbonated drinks influences the activity of taste receptors in the mouth and results in neuromotor responses. © The Author 2013. Published by Oxford University Press. All rights reserved.

DOI： 10.1093/chemse/bjt062

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER  

Tongue-hold swallow (THS) has the potential to be a resistance exercise not only for the pharyngeal constrictor but for the tongue muscles. To elucidate the physiological mechanisms of THS, this study investigated intraoral pressure generation during THS in relation to different extents of tongue protrusion. Tongue pressure was measured by a 5-point pressure sensor sheet placed onto the hard palate of 18 healthy young subjects who performed three swallow tasks: normal dry swallow, THS with slight tongue protrusion, and THS with greater tongue protrusion. Subjects randomly repeated each task five times. Maximum range of tongue protrusion was also measured in each subject to estimate lingual flexibility. With an increase in the extent of tongue protrusion, pressure generation patterns became irregular and variable. Duration of pressure generation increased with statistical significance in the posterior circumferential parts of the hard palate (p &lt; 0.05). Maximal magnitude and integrated value of the pressure recorded at these locations increased in eight subjects as the extent of tongue protrusion increased, but it decreased in nine. The former group showed greater lingual flexibility, while the latter group exhibited less flexibility. THS may place different amounts of load on the tongue muscles by adjusting the degree of tongue protrusion.

DOI： 10.1007/s00455-013-9471-z

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer New York LLC  

The objectives of this study were to evaluate the state of tongue pressure production during supraglottic swallow (SS) and super-supraglottic swallow (SSS) performed by healthy adults, and to investigate the effects of these swallowing maneuvers on the oral stage of swallowing. The participants were 19 healthy individuals. Tongue pressure against the hard palate during swallowing was measured using a tongue pressure sensor sheet system with five pressure-sensitive points. The tasks comprised swallowing 5 mL of water by normal wet swallow, SS, and SSS, and the parameters for analysis were the duration, the maximal magnitude, and the integrated value of tongue pressure during swallowing. The duration of tongue pressure was significantly longer at the anterior-median part of the hard palate during both SS and SSS than with normal wet swallow. The maximal magnitude increased significantly only at the posterior part of the hard palate during SS, but at all points during SSS. The integrated value increased significantly only at the posterior-median part of the hard palate during SS, but at all points except the midmedian part of the hard palate during SSS. The maximal magnitude and integrated value were also significantly higher at the anterior-median and posterior circumferential parts during SSS than during SS. These results show that these two swallowing maneuvers, which are known primarily as techniques to protect the airway, also function to strengthen the tongue pressure produced by the contact between the tongue and the hard palate during swallowing and this effect is more pronounced during SSS.

DOI： 10.1007/s00455-014-9556-3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

ObjectivesBehavioural performance of tablet swallowing was evaluated with different tablet conditions in terms of size, number and surface coating.
MethodsFour different types of tablets were prepared: small or large, and with or without a surface coating. Fourteen normal male adults were instructed to swallow the prepared tablets with 15ml of water. The number of tablets in one trial was changed from one to three. To evaluate swallowing and tablet transport, electromyographic activity was recorded in the left suprahyoid muscles, and videofluorographic images were examined.
Key findingsAll tablet conditions (size, number and surface coating) affected the swallowing performance in terms of total number of swallows, electromyographic burst patterns and location of remaining tablets. Increases in the size and number of tablets increased the number of swallows and electromyographic burst area and duration. In addition, all of these parameters increased while swallowing tablets without a coating compared with tablets with a coating. Location of the remaining tablets was mainly within the mouth.
ConclusionsThis study only clarified the normal pattern of tablet swallowing under several conditions in healthy subjects, but the results may facilitate comprehensive evaluation and treatment planning in terms of administering medication to dysphagic patients.

DOI： 10.1111/jphp.12155

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Objectives Behavioural performance of tablet swallowing was evaluated with different tablet conditions in terms of size, number and surface coating. Methods Four different types of tablets were prepared: small or large, and with or without a surface coating. Fourteen normal male adults were instructed to swallow the prepared tablets with 15 ml of water. The number of tablets in one trial was changed from one to three. To evaluate swallowing and tablet transport, electromyographic activity was recorded in the left suprahyoid muscles, and videofluorographic images were examined. Key findings All tablet conditions (size, number and surface coating) affected the swallowing performance in terms of total number of swallows, electromyographic burst patterns and location of remaining tablets. Increases in the size and number of tablets increased the number of swallows and electromyographic burst area and duration. In addition, all of these parameters increased while swallowing tablets without a coating compared with tablets with a coating. Location of the remaining tablets was mainly within the mouth. Conclusions This study only clarified the normal pattern of tablet swallowing under several conditions in healthy subjects, but the results may facilitate comprehensive evaluation and treatment planning in terms of administering medication to dysphagic patients. © 2013 Royal Pharmaceutical Society.

DOI： 10.1111/jphp.12155

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：HINDAWI PUBLISHING CORPORATION  

The aim of this study was to investigate oropharyngeal pressure flow dynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP. There was no significant difference between the offset of TP and PP. The onset of PP was temporally time-locked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.

DOI： 10.1155/2014/691352

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Language：English   Publishing type：Research paper (international conference proceedings)   Publisher：ROYAL SOC CHEMISTRY  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Elsevier Ltd  

Although dysphagia is a life-threatening problem in patients with Duchenne muscular dystrophy (DMD), the pathophysiology of oral stage dysphagia is yet to be understood. The present study investigated the tongue motor deficit during swallowing in patients with DMD and its relationship with disease-specific palatal morphology. Tongue pressure during swallowing water was recorded in 11 male patients with DMD and 11 age- and sex-matched healthy subjects using an intra-oral sensor with five measuring points, and the state of tongue pressure production was compared between the groups. Palatal morphology was assessed by a non-contact three-dimensional scanner on maxillary plaster models. In patients with DMD, the normal sequential order of tongue-palate contact was lost and the maximal magnitude and integrated value of tongue pressure on the mid-anterior part of palate were smaller than those in healthy subjects. The width of the palate in patients was greater than that in healthy subjects and the depth of the palate in patients had a negative correlation with tongue pressure magnitude on the median palate. Our results suggested that the deteriorated tongue motor kinetics prevented tongue movement during swallowing that was appropriate for the depth of the palate and affects the state of tongue pressure production during swallowing. © 2014 Elsevier B.V.

DOI： 10.1016/j.nmd.2014.03.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Hindawi Limited  

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Theaimof this study was to investigate oropharyngeal pressure flowdynamics during dry swallowing in ten healthy subjects. Tongue pressure (TP) was measured using a sensor sheet system with five measuring points on the hard palate, and pharyngeal pressure (PP) was measured using a manometric catheter with four measuring points. The order and correlations of sequential events, such as onset, peak, and offset times of pressure production, at each pressure measuring point were analyzed on the synchronized waveforms. Onset of TP was earlier than that of PP. The peak of TP did not show significant differences with the onset of PP, and it was earlier than that of PP.There was no significant difference between the offset of TP and PP.The onset of PP was temporally timelocked to the peak of TP, and there was an especially strong correlation between the onset of PP and TP at the posterior-median part on the hard palate. The offset of PP was temporally time-locked to that of TP. These results could be interpreted as providing an explanation for the generation of oropharyngeal pressure flow to ensure efficient bolus transport and safe swallowing.

DOI： 10.1155/2014/691352

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Although effortful swallow and the Mendelsohn maneuver are commonly used in dysphagia rehabilitation, little is known about their effects on tongue-palate pressure production. The purpose of this study was to investigate the effects of effortful swallow and the Mendelsohn maneuver on tongue pressure production. Fourteen healthy volunteers (10 men, 4 women
age range = 21-41 years) participated. Tongue pressures during dry swallow, water swallow, effortful swallow, and the Mendelsohn maneuver were measured using a sensor sheet system with five measurement points on the hard palate. Sequential order, duration, maximal magnitude, and the integrated value of tongue pressure at each measurement point were compared among the four tasks. Onset of tongue pressure at the posterior-circumferential parts occurred first in the Mendelsohn maneuver
that at the anterior-median part was earlier than at other parts in the effortful swallow. At all measurement points, tongue pressure duration was significantly longer in the Mendelsohn maneuver than in other tasks. Effortful swallow was most effective in increasing tongue pressure. The integrated value of tongue pressure at the posterior-circumferential parts in the Mendelsohn maneuver and at the median parts in the effortful swallow showed a tendency to increase. These results suggest that tongue pressure increases along a wide part of the hard palate in effortful swallow because the anchor of tongue movement is emphasized at the anterior part of the hard palate. The Mendelsohn maneuver provides prolonged and accentuated tongue-palate contact at the posterior-circumferential parts, which might be important for hyoid-laryngeal elevation during swallowing. © 2013 Springer Science+Business Media New York.

DOI： 10.1007/s00455-013-9464-y

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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The tongue is important for orofacial movements, including swallowing. Although numerous studies have focused on tongue pressure against the palate, its physiological role has not been fully evaluated. The tongue pressure generation may have the temporal coordination with the swallowing relational organs. The aim of this study was to clarify the physiological mechanisms of tongue pressure and to investigate the temporal relationship among tongue pressure, supra-hyoid muscle activity, and videofluorographic (VF) images during swallowing. Fifteen healthy young subjects participated. Tongue pressure measured using a sensor sheet with five channels, electromyographic EMG, and VF was recorded synchronously during 4-ml barium swallowing. Swallowing behavior in VF images with and without the sensor sheet was compared. Furthermore, the temporal relationship between events measured from tongue pressure, EMG, and VF was evaluated. Swallowing behavior on VF images was not affected by placement of the sensor sheet. Tongue pressure at the posterio-lateral point of the hard palate tended to have biphasic peaks. Tongue pressure production with a monophasic pattern appeared during the same period as the second peak in the biphasic pattern. The onset of tongue pressure was later than the start of hyoid movement and onset of EMG, and offset was observed between the hyoid at the up-forward position and reposition. Onset of tongue pressure at the anterior area was correlated with the start of slight hyoid elevation. Offset of tongue pressure at the posterio-lateral points was strongly time locked with the hyoid at the up-forward position. The present results suggested the temporal coordination of tongue pressure generation with the swallowing-related organs. That is, the tongue pressure was produced for bolus propulsion, and was closely related to hyoid movement temporally during swallowing. These results may contribute to clarify the clinical state with the disorder of tongue kinetics.

DOI： 10.1002/phy2.167

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PURPOSE: Although a closed hollow obturator is often applied to post maxillectomy patients, it has a few problems such as complexity of fabrication and water leakage to inside. A one step curing technique to fabricate a closed hollow obturator by constructing a small hollow bulb made by two thermoplastic resin sheets is described in the present report. METHODS: In the one step curing technique, after dewaxing the wax denture fabricated conventionally, one size smaller hollow body was fabricated with two thermoplastic resin sheets and set into the investment mold as a core. Then the circumferential part of obturator was cured by the pour type resin. This technique was used to fabricate an obturator prosthesis in a 60-year-old post-maxillectomy patient. The weight of this obturator was well controlled and the definitive prosthesis weighed 22 g. At a one year follow-up, the obturator fared well without any water leakage or breakage. CONCLUSIONS: This technique allows the fabricator to control the thickness and weight of the obturator by the amount of relief provided by the hollow bulb. It also rectifies the disadvantages of the closed hollow obturator such as water leakage and complex

DOI： 10.1016/j.jpor.2013.08.003

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nihon University School of Dentistry  

We evaluated the effects of gel consistency and bolus volume on ingestion in humans. Eight healthy men were asked to ingest liquids, and sample foods of different gel consistencies and volumes, as usual. Tongue pressure against the hard palate was recorded at five points, and bolus flow was recorded using videoendoscopic images. The number of squeezes increased as gel consistency and volume increased. The integrated magnitude of tongue pressure during squeezing increased with increasing gel consistency. Bolus propulsion into the pharynx was affected by bolus characteristics, and location of the bolus head at the onset of pharyngeal swallowing was not related to squeezing behavior. The trigger point at which pharyngeal swallowing began was subject-dependent. During swallowing, the magnitude of tongue pressure moderately increased with increasing gel consistency, as compared with squeezing. Tongue pressure was not related to bolus volume. The current results suggest that patterns of tongue pressure during squeezing and swallowing are differentially affected by bolus conditions. However, healthy subjects differed in the techniques used for squeezing and swallowing.

DOI： 10.2334/josnusd.55.191

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Other Link： http://search.jamas.or.jp/link/ui/2015016896

Language：English   Publishing type：Research paper (scientific journal)   Publisher：Nihon University School of Dentistry  

We evaluated the effects of gel consistency and bolus volume on ingestion in humans. Eight healthy men were asked to ingest liquids, and sample foods of different gel consistencies and volumes, as usual. Tongue pressure against the hard palate was recorded at five points, and bolus flow was recorded using videoendoscopic images. The number of squeezes increased as gel consistency and volume increased. The integrated magnitude of tongue pressure during squeezing increased with increasing gel consistency. Bolus propulsion into the pharynx was affected by bolus characteristics, and location of the bolus head at the onset of pharyngeal swallowing was not related to squeezing behavior. The trigger point at which pharyngeal swallowing began was subject-dependent. During swallowing, the magnitude of tongue pressure moderately increased with increasing gel consistency, as compared with squeezing. Tongue pressure was not related to bolus volume. The current results suggest that patterns of tongue pressure during squeezing and swallowing are differentially affected by bolus conditions. However, healthy subjects differed in the techniques used for squeezing and swallowing. (J Oral Sci 55, 191-198, 2013)

DOI： 10.2334/josnusd.55.191

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PUBLIC LIBRARY SCIENCE  

Background: Swallowing dysfunction (also known as dysphagia), which results in a deterioration of nutritional intake, slows rehabilitation and causes aspiration pneumonia, is very common following neurological impairments. Although videofluorographic (VF) examination is widely used for detecting aspiration, an objective and non-invasive method for assessing swallowing function has yet to be established because of a lack of adequate devices and protocols. In this paper, a bend sensor whose resistance is altered by bending was introduced to monitor swallowing-related laryngeal movement.
Methods: Six healthy male volunteers were recruited in the present study. Specific time points on the signal waveform produced by the bend sensor were defined to describe laryngeal movement by differential analysis. Additionally, the physiological significance of the obtained waveform was confirmed by analyzing the sequential correlations between the signal waveform from the bend sensor and hyoid bone kinetics simultaneously recorded by VF.
Results: Seven time points were successfully defined on the signal waveform to reference laryngeal movement. Each time point was well correlated with certain VF events, with evidence of no significant time lags, and there were positive correlations between waveform time points and matched VF events. Furthermore, obvious similarities were noticed between the duration of each phase on the signal waveform and the duration of the matched hyoid bone activity.
Conclusions: The present monitoring system using a bend sensor might be useful for observing the temporal aspects of laryngeal movement during swallowing, and it was well coordinated with hyoid bone movement.

DOI： 10.1371/journal.pone.0070850

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

An in vitro evaluation system of food texture was developed using artificial tongue and a conventional uniaxial compression apparatus to mimic the tongue-palate compression. Deformation behavior of agar gels on artificial tongues from silicone rubber with three levels of elastic modulus was observed during compression by a nondeformable plate. The results were compared with the oral strategy for size reduction from sensory evaluation by human subjects. Agar gels fractured upon compression when the strain of the gels was larger than that of artificial tongue, whereas they did not when the strain of the gels was equivalent to or smaller than that of the artificial tongue. When apparent elastic modulus of artificial tongue was approximately 5.5x104Pa, fracture profile of the gels corresponded well to human tests. Results suggest that the oral strategy for size reduction might be determined by sensing the relative strain of the gels to the tongue during compression to a somewhat small strain. Practical Applications In an aged society, there is an increasing demand for properly texturized foods for safe consumption by those who have mastication or chewing difficulty. Food of soft texture is often preferred by these people because of easy tongue-palate compression and no need of the teeth mastication. An in vitro evaluation system of food texture developed in the present study provides a simple method for food manufactures in assessing textural acceptability of products without using human subjects. This evaluation system can lead to the innovation of food product design for textural diversity and thus improved quality of life for these disadvantaged populations.

DOI： 10.1111/jtxs.12002

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The present study was designed to evaluate how typical Japanese staple foods - rice and rice cake - with different physical properties influence the patterns of muscle activity during chewing. Six normal adults were asked to eat rice and rice cake freely in a natural manner. Surface electromyographic recordings of the masseter and suprahyoid muscles were performed. There were large differences between the foods in terms of masticatory duration. The masseter activity per cycle was significantly greater for rice cake than for rice. The masseter activity gradually decreased as chewing progressed, although the suprahyoid activity did not change throughout the sequence of rice cake chewing. The results suggest that the process of bolus formation with rice cake is very different from that with rice in terms of jaw-closing and jaw-opening muscle activities. Practical Applications: This study aimed to examine how the masticatory sequence adapts to variations in the initial properties of foods. This research may enhance our understanding of the oral physiology of bolus formation and changes in the physical properties of foods during chewing. © 2012 Wiley Periodicals, Inc.

DOI： 10.1111/j.1745-4603.2012.00364.x

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Background: Although palatal augmentation prostheses (PAPs) can improve dysphagia, their application is compromised in the absence of maxillary abutment teeth. Experimental lingual plates (ELPs) used for raising the tongue may be employed as alternative to PAPs. Methods. Influence of different ELP designs, plateau (P-type) and drop-shaped (D-type), on the intra-oral pressure during swallowing were tested. Eleven healthy dentate volunteers, with a mean age of 35.5±10.5 years, participated in this study. Tongue pressure on the hard palate was measured using an ultra-thin sensor sheet with five measuring points, whilst performing dry, 5-ml and 15-ml water swallows, with and without the ELPs in situ. Additional pressure sensors were installed in the lingual aspects of the ELPs, and on the vestibular aspect of the lower molars for measuring sublingual and oral vestibule pressures, respectively. Each measurement was recorded thrice. A repeated measures ANOVA was employed to verify differences in duration, maximal magnitude and integrated value for the different experimental situations. Tukey's post hoc test was performed for comparison testing. Statistical significance was set at p&lt
0.05. Results: The sequence of tongue-palate contact on the median line of the hard palate without ELPs was maintained, except for the 15 ml P-type swallow. Tongue pressure started earlier with the D-type but reached its peak nearly at the same time as without ELPs. The peak magnitude and cumulative tongue pressure against the hard palate decreased by wearing ELPs (p&lt
0.05), but was inconsistent between the two types of ELPs and for the different swallowing volumes. Both, maximum and cumulative vestibular pressures were mostly similar or larger with P-type than that with D-type. Conclusion: D-type and P-type ELPs seem to have the inverse effect of PAPs on the palatal tongue pressure during swallowing. These first counterintuitive findings do not yet justify rejecting the basic rationale of using ELPs for the treatment of dysphagia
hence a rather biologically designed piezographic lingual plate may be more appropriate. © 2013 Hori et al.
licensee BioMed Central Ltd.

DOI： 10.1186/1743-0003-10-64

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Palatal augmentation prostheses are commonly used in the treatment for dysphagia. By lowering the palatal contours, the tongue contact is increased and thus the bolus propulsion facilitated. However, the unfavourable weight of such appliances may be avoided when using lingual plates. Hence, the aim of this study is to investigate the effect of two different types of lingual plates on the vertical dimension in rest position. Eleven healthy dentate subjects with an average age of 35·5years (26-60years) volunteered in this pilot study. The vertical overbites were measured on plaster models. Two different designs of the experimental lingual plates were tested in this pilot study (P-type &amp
D-type). The inter-occlusal freeway space was measured using the electromagnetic K7 jaw-tracking system (Myotronics, USA), while the subjects were seated in an upright position. They were asked to close from rest position into maximum intercuspation for about 2s. Recordings were performed without the plates and subsequently with each of the two plate designs in situ. All recordings were performed three times and the second closing movement of each recording was used for the analysis. After averaging the repetitions without experimental lingual plates, with P-type and D-type plates, the differences were analysed using a Kruskall-Wallis test. The results showed no significantly increased freeway space while using both types of lingual plates. Hence, it can be concluded that any altered tongue pressure during swallowing with lingual plates is not related to an increase in vertical dimension. © 2012 Blackwell Publishing Ltd.

DOI： 10.1111/j.1365-2842.2012.02329.x

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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The present study tested whether electrical stimulation increases the number of voluntary repetitive swallows in humans. In addition, the potential of initiating both voluntary and involuntary swallows was compared using electrical stimulation. Fourteen normal male adults were instructed to perform repetitive voluntary swallowing as quickly as possible over 30. s, and the number of swallows was counted with and without repetitive electrical stimulation (80% of maximal tolerated intensity
0.1. ms in pulse duration
30. Hz) of the nasal cavity, nasopharynx, oropharynx, or laryngopharynx. Although the number of swallows was significantly increased during electrical stimulation of the laryngopharynx, oropharynx, and nasopharynx, there was a wide variation in the number among subjects. The number of reflexively evoked swallows (i.e., involuntary swallows) by pharyngeal stimulation also varied greatly, and there was a significant linear correlation in the number of swallows between voluntary and involuntary swallows. The present study demonstrated the facilitatory effects of pharyngeal electrical stimulation on voluntary swallowing in humans. Furthermore, the potentials of initiation of voluntary swallows are identical to those of involuntary swallows, which suggests that the swallowing central pattern generator is a common component of both neuronal networks and therefore is responsible for inter-individual variations. © 2012 Elsevier Inc.

DOI： 10.1016/j.physbeh.2012.02.007

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PERGAMON-ELSEVIER SCIENCE LTD  

The present study tested whether electrical stimulation increases the number of voluntary repetitive swallows in humans. In addition, the potential of initiating both voluntary and involuntary swallows was compared using electrical stimulation. Fourteen normal male adults were instructed to perform repetitive voluntary swallowing as quickly as possible over 30 s, and the number of swallows was counted with and without repetitive electrical stimulation (80% of maximal tolerated intensity; 0.1 ms in pulse duration; 30 Hz) of the nasal cavity, nasopharynx, oropharynx, or laryngopharynx. Although the number of swallows was significantly increased during electrical stimulation of the laryngopharynx, oropharynx, and nasopharynx, there was a wide variation in the number among subjects. The number of reflexively evoked swallows (i.e., involuntary swallows) by pharyngeal stimulation also varied greatly, and there was a significant linear correlation in the number of swallows between voluntary and involuntary swallows. The present study demonstrated the facilitatory effects of pharyngeal electrical stimulation on voluntary swallowing in humans. Furthermore, the potentials of initiation of voluntary swallows are identical to those of involuntary swallows, which suggests that the swallowing central pattern generator is a common component of both neuronal networks and therefore is responsible for inter-individual variations. (C) 2012 Elsevier Inc. All rights reserved.

DOI： 10.1016/j.physbeh.2012.02.007

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The purpose of this study was to compare the tongue pressure against the hard palate during the articulation of a monosyllable with that during swallowing. The participants were 20 healthy adults without swallowing or articulation disorder (10 men and 10 women, mean age +/- standard deviation: 22.5 +/- 0.9 years). Tongue pressure during articulation of [ki] (articulatory pressure) and during dry swallowing (swallowing pressure) was recorded by a 0.1-mm-thick sensor sheet with five measuring points attached to the hard palate. Biomechanical parameters such as maximal magnitude, duration, integrated value and slope gradient were compared between articulatory pressure and swallowing pressure at each measuring point. Although swallowing pressure was produced at each measuring point, articulatory pressure was found only in the posterior circumferential parts of the hard palate and was smaller in magnitude (14.916.7% of swallowing pressure) and integrated value, which meant the amount of work by tongue pressing (7.07.9%), shorter in duration (26.631.8%) and shallower in slope gradient, which meant the speed of tongue pressing (26.927.4%). Maximal magnitude was closely correlated with duration (R2 = 0.386) and slope gradient (R2 = 0.843) for articulatory pressure. These results first show the biomechanical differences between articulation and swallowing in terms of tongue contact with the hard palate. The findings suggest that tongue pressure measurement might be a useful investigation for patients with tongue motor disorder.

DOI： 10.1111/j.1365-2842.2011.02258.x

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Jaw clenching (clenching) is the result of an isometric contraction of jaw closing muscles. Because of the location of working muscles and afferent information during tooth contact, the effect of clenching on the cerebral and systemic circulation might differ from that of isometric limb exercise. This study aimed to investigate the characteristic changes in cerebral and systemic circulation during jaw clenching by comparing those during handgrip exercise. Subjects were 17 right-handed men. Bilateral middle cerebral arterial blood flow velocity (MCAV), electromyography (EMG) of contracting muscles, heart rate (HR) and blood pressure (BP) were measured during unilateral handgrip exercise and clenching tasks. Autonomic nerve activity was evaluated by analyzing fluctuations in HR and BP. MCAV was significantly increased during the task with significantly higher values on the non-working than working side irrespective of unilateral handgrip or unilateral jaw clenching. Changes in HR during jaw clenching were lower than those during handgrip exercise, and changes in vaso-motor sympathetic nerve activity during left jaw clenching were lower than those during left handgrip exercise. The present results indicate that, compared with handgrip exercise, unilateral jaw clenching promotes bilateral activation of MCAV with smaller effects on cardiac output and sympathetic nervous system activity. © 2011 Elsevier Inc.

DOI： 10.1016/j.physbeh.2011.07.028

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The purpose of this study was to investigate the influence of chin-down posture and bolus size on tongue pressure during swallowing. Eleven healthy volunteers (7 men, 4 women
age range = 26-59 years) participated in the experiments. Tongue pressure during dry and 5- and 15-ml water swallows in neutral and chin-down postures was measured using a sensor sheet system with five measuring points on the hard palate. Sequential order, maximal magnitude, duration, and integrated value of tongue pressure at each measuring point were compared between postures and bolus sizes. Onset of tongue pressure at posterior- circumferential parts occurred earlier in dry swallow than in 5- and 15-ml water swallows in each posture. Chindown posture was most effective for increasing tongue pressure in the 5-ml water swallow compared with dry swallow and the 15-ml water swallow, but it had almost no influence on tongue pressure with the 15-ml water swallow. These results suggest that chin-down posture increases the tongue driving force for small boluses in healthy subjects, which can be interpreted to mean that oropharyngeal swallowing in a chin-down posture requires more effort. © Springer Science+Business Media, LLC 2010.

DOI： 10.1007/s00455-010-9292-2

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：SPRINGER HEIDELBERG  

The aim of this study was to investigate the influence on cerebral hemodynamics of voluntary control of masticatory side and rhythm during gum chewing. Blood flow velocity in the middle cerebral artery was measured using transcranial Doppler ultrasonography to evaluate cerebral circulation in healthy volunteers. Heart rate and masseter muscle activity were recorded simultaneously. Volunteers performed three tasks: (1) free gum chewing, (2) gum chewing in which mastication was limited to the right side, and (3) gum chewing in which mastication was limited to the right side and rhythm was set at 1.0 Hz. Changes in cerebral circulation during pre-task, on-task, and post-task periods were analyzed using random effects model, and differences in cerebral circulation and muscle activity between tasks were analyzed using the Friedman test. In all tasks, on-task cerebral circulation was greater than pre-task. Muscle activity and masticatory rhythm varied between tasks, whereas the rate of increase in cerebral circulation did not differ significantly among tasks. These results suggest that cerebral circulation is activated during gum chewing, irrespective of voluntary control of masticatory side and rhythm.

DOI： 10.1007/s00784-009-0338-5

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Mastication as a mild but life-long exercise has been examined as a possibility for maintaining brain function in the elderly. Little is known, however, about the cerebral circulatory response during masticatory movement. The aim of this study was to develop a monitoring system for circulation dynamics during masticatory movement and to apply this system to the study of cerebral autoregulation. Cerebral blood flow, heart rate, and arterial blood pressure were simultaneously recorded, and changes in these circulatory systems were quantitatively evaluated in 38 young healthy volunteers. Transfer function analysis was also performed on blood pressure and cerebral blood flow for investigation of cerebral autoregulation during gum chewing. Although increases in cerebral blood flow, mean blood pressure, and heart rate suggested the activation of cerebral and systemic circulation during gum chewing, increased cerebral circulation was independent of systemic circulation. Our results suggest that cerebral autoregulation is well maintained during jaw movements.

DOI： 10.1177/0022034510383692

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The aim of this study was to investigate the influence on cerebral hemodynamics of voluntary control of masticatory side and rhythm during gum chewing. Blood flow velocity in the middle cerebral artery was measured using transcranial Doppler ultrasonography to evaluate cerebral circulation in healthy volunteers. Heart rate and masseter muscle activity were recorded simultaneously. Volunteers performed three tasks: (1) free gum chewing, (2) gum chewing in which mastication was limited to the right side, and (3) gum chewing in which mastication was limited to the right side and rhythm was set at 1.0 Hz. Changes in cerebral circulation during pre-task, on-task, and post-task periods were analyzed using random effects model, and differences in cerebral circulation and muscle activity between tasks were analyzed using the Friedman test. In all tasks, on-task cerebral circulation was greater than pre-task. Muscle activity and masticatory rhythm varied between tasks, whereas the rate of increase in cerebral circulation did not differ significantly among tasks. These results suggest that cerebral circulation is activated during gum chewing, irrespective of voluntary control of masticatory side and rhythm. © 2009 Springer-Verlag.

DOI： 10.1007/s00784-009-0338-5

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background and Purpose-Dysphagia is important for prognosis in patients with stroke because this condition can cause aspiration pneumonia or nutritional deficits. The present study investigated the relationship between tongue motor deficits and dysphagia in patients with acute stroke.
Methods-Maximal tongue pressure on the hard palate when swallowing 5 mL of water was measured using a T-shaped sensor sheet with 5 measuring points in 33 dysphagic and 31 nondysphagic patients with acute stroke. Maximum tongue pressures at each measuring point were compared between dysphagic and nondysphagic groups and between paralyzed and nonparalyzed sides.
Results-Tongue pressure at each measuring point was significantly smaller in dysphagic patients than in nondysphagic patients with the largest significant difference on the paralyzed side. The magnitude of tongue pressure to predict dysphagia was calculated as 4.6 kPa on the paralyzed side, offering 71.4% sensitivity and 72.3% specificity.
Conclusions-Reduced tongue pressure on the paralyzed side may predict dysphagia in patients with acute stroke. (Stroke. 2010;41:2982-2984.)

DOI： 10.1161/STROKEAHA.110.594960

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BACKGROUND AND PURPOSE: Dysphagia is important for prognosis in patients with stroke because this condition can cause aspiration pneumonia or nutritional deficits. The present study investigated the relationship between tongue motor deficits and dysphagia in patients with acute stroke. METHODS: Maximal tongue pressure on the hard palate when swallowing 5 mL of water was measured using a T-shaped sensor sheet with 5 measuring points in 33 dysphagic and 31 nondysphagic patients with acute stroke. Maximum tongue pressures at each measuring point were compared between dysphagic and nondysphagic groups and between paralyzed and nonparalyzed sides. RESULTS: Tongue pressure at each measuring point was significantly smaller in dysphagic patients than in nondysphagic patients with the largest significant difference on the paralyzed side. The magnitude of tongue pressure to predict dysphagia was calculated as 4.6 kPa on the paralyzed side, offering 71.4% sensitivity and 72.3% specificity. CONCLUSIONS: Reduced tongue pressure on the paralyzed side may predict dysphagia in patients with acute stroke.

DOI： 10.1161/STROKEAHA.110.594960

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Although swallowing movement is known to change with aging, age-related differences in the tongue pressure for propelling a bolus from the oral cavity into the pharynx have yet to be investigated in a physiological condition. We hypothesized that tongue pressure during swallowing changed with aging and, using a 0.1-mm-thick sensor sheet with 5 measuring points, measured it while a 15-mL quantity of water was swallowed by young and elderly dentate individuals. Both groups showed a similar order of tongue pressure production at each point. However, the elderly group showed longer duration at each point, lower maximal magnitude in the anterio-median part of the hard palate, and higher magnitude in the circumferential parts of the hard palate than the young group. These results provide the first quantitative evidence of the age-related changes in tongue movement during natural swallowing, which could be attributed to muscle weakening and morphological changes in the oropharynx. © 2010 International &amp
American Associations for Dental Research.

DOI： 10.1177/0022034510370801

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MOLECULAR DIVERSITY PRESERVATION INTERNATIONAL-MDPI  

Dysphagia (difficulty in swallowing) is an important issue in the elderly because it causes aspiration pneumonia, which is the second largest cause of death in this group. It also causes decline in activities of daily living and quality of life. The oral phase of swallowing has been neglected, despite its importance in the evaluation of dysphagia, because adequate protocols and measuring devices are unavailable. However, recent advances in sensor technology have enabled straightforward, non-invasive measurement of the movement of important swallowing-related organs such as the lips and tongue, as well as the larynx. In this article, we report the present state and possibility of clinical application of such systems developed in Japan.

DOI： 10.3390/s100100176

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BACKGROUND: Although poststroke dysphagia is an important issue for determining prognosis, the pathophysiology of oral-phase dysphagia has yet to be clarified due to a lack of adequate devices and protocols. The present study investigated the relationships between swallowing pressure production by the tongue and dysphagia in stroke patients using a newly developed method of tongue pressure measurement with a sensor sheet system. METHODS: Subjects were 64 stroke patients, including 30 patients with dysphagia. A T-shaped sensor sheet with 5 measuring points was attached to the hard palate to record tongue pressure while swallowing 5 ml of water. The average maximal magnitude and incidence of abnormalities such as asynchronous and/or polyphasic patterns in tongue pressure waves in 5 locations were compared between patients with and without dysphagia. RESULTS: The average maximal tongue pressure was significantly smaller in patients with dysphagia than in those without dysphagia. Asynchronous and polyphasic patterns showed a sensitivity of 63 and 87%, and a specificity of 91 and 71%, respectively, for identifying patients with dysphagia. CONCLUSION: Tongue pressure production during

DOI： 10.1159/000315140

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Authorship：Lead author   Language：Japanese   Publisher：Japan Prosthodontic Society  

<B>Patient:</B> A 27-year-old female had undergone partial mandibulectomy under the diagnosis of mucoepidermoid carcinoma. The temporary denture was placed after 17days postoperatively. After the forearm flap became stable, the final denture with hand-made artificial porcelain teeth fabricated and frozen muddy porcelain method (P-C•P•F) was inserted. The patient was followed for 8 years with no complications.<br><B>Discussion:</B> Both pre-surgical impression and P-C•P•F method contributed to the recovery of appearance and function in the early post-operative stage. This method allows the preoperative state of dentition to be precisely reproduced.<br><B>Conclusion:</B> This report suggests usefulness of P-C•P•F method applied in the maxillofacial prosthetic patients who lost a lot of teeth by tumor resection.

DOI： 10.2186/ajps.1.412

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Other Link： http://search.jamas.or.jp/link/ui/2010031512

Language：English   Publishing type：Research paper (scientific journal)  

In today's aging society, dentists are more likely to treat patients with dysphagia and are required to select an optimal treatment option based on a complete understanding of the swallowing function. Although the tongue plays an important role in mastication and swallowing as described in human oral feeding models developed in 1990s, physiological significances of tongue function has been poorly understood due to the difficulty in monitoring and analyzing it. This review summarizes recent approaches used to evaluate tongue function during swallowing quantitatively mainly focusing on modern sensing methods such as manofluorography, sensing probes, pressure sensors installed in the palatal plates and ultrasound imaging of tongue movement. Basic understanding on the kinematics and biomechanics of tongue movement during swallowing in normal subjects was provided by the series of studies. There have been few studies, however, on the pathological change of tongue function in dysphagic patients. Therefore further improvement in measurement devices and technologies and additional multidisciplinary studies are needed to establish therapeutic evidence regarding tongue movement, as well as the best prosthodontic approach for dysphagia rehabilitation. © 2009 Japanese Association for Dental Science.

DOI： 10.1016/j.jdsr.2009.03.005

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Purpose: The prosthodontic treatment of dysphagic patients may preclude favorable treatment outcomes due to uncoordinated or discordant oral and pharyngeal functions. Since optimal treatment requires a full understanding of the mechanism of oropharyngeal swallowing, this study seeks to describe the normal temporal pattern of tongue-, jaw-, and swallowing-related muscle coordination during voluntarily triggered swallows in healthy patients. Materials and Methods: Tongue pressure against the hard palate at seven measuring points, swallowing sounds, and surface electromyography (EMG) activity of the masseter, anterior digastric, and infrahyoid muscles during voluntarily triggered swallowing were recorded in seven healthy male volunteers. The order of onset and offset of these parameters was analyzed by repeated-measures two-way analysis of variance. Results: The onset of anterior digastric muscle activity occurred first and was significantly earlier than the onset of the masseter or infrahyoid muscles and tongue pressure. The onset of masseter muscle activity was also significantly earlier than that of the infrahyoid muscle and tongue pressure. Offset of masseter activity was almost simultaneous with the swallowing sound and was significantly earlier than the offset of the anterior digastric and infrahyoid muscles as well as tongue pressure. The EMG burst of the anterior digastric muscle continued until the offset of tongue pressure, and was followed by the offset of infrahyoid muscle activity. Conclusions: The temporal coordination patterns of the tongue, jaw, and oropharyngeal muscles during voluntarily triggered swallowing appear to agree with known safe management of a bolus and offer criteria for evaluating the function of oropharyngeal swallowing. Int J Prosthodont 2009; 22: 493-498.

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Hasegawa Y, Sakagami J, Ono T, Hori K, Zhang M, Maeda Y. Circulatory response and autonomic nervous activity during gum chewing. Eur J Oral Sci 2009
117: 470-473. © 2009 The Authors. Journal compilation © 2009 Eur J Oral Sci Mastication has been proven to enhance the systemic circulation, with circulatory responses seeming to be largely regulated by autonomic nervous activity via a more complex regulatory system than those of other activities. However, few studies have examined the relationships between changes in autonomic nervous activity and the systemic circulation that are induced by masticatory movement. We investigated changes in the systemic circulation and autonomic nervous activity during gum chewing to clarify the influence of mastication. Electrocardiograms, arterial blood pressure, and masseter electromyograms were taken while chewing gum continuously as indicators of systemic circulation in 10 healthy subjects with normal dentition. Cardiac sympathetic activity and vagus nervous activity, as well as vasomotor sympathetic nervous activity, were evaluated by fluctuation analysis of heart rate and blood pressure. Repeated analysis of variance and multiple comparisons were performed to determine chronological changes in each indicator during gum chewing. Gum chewing increased the heart rate and the mean arterial pressure. Although cardiac sympathetic activity and vagus nervous activity showed significant changes, vasomotor sympathetic nervous activity did not. These results suggest that changes in the autonomic nervous activity of the heart are mainly involved in the enhancement of systemic circulation with gum chewing. This explains some characteristics of autonomic nervous regulation in masticatory movement. © 2009 The Authors. Journal compilation © 2009 Eur J Oral Sci.

DOI： 10.1111/j.1600-0722.2009.00637.x

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER IRELAND LTD  

PURPOSE: The aim of this study was to develop a sensor sheet for measuring tongue pressure during swallowing and to clarify its usefulness by comparing it with a conventional pressure sensor installed in the palatal plate. METHODS: A tactile sensor system was used for the construction of the measuring system. Based on our preceding study, a T-shaped sensor sheet with 0.1mm thickness, five measuring points (three points on the median line, two points on the posterior-lateral part) and three sizes based on the morphological analysis of 60 maxillary casts was designed for application on the hard palate. To elucidate the sensing characteristics of the sensor sheet, the output level of the sensor sheet was compared with that of a conventional pressure sensor under the same load. The maximal magnitude of tongue pressure (MP) during the swallowing of 15 ml water was recorded by a sensor sheet attached to the palatal mucosa and was compared with that recorded by pressure sensors installed in the palatal plate. RESULTS: The output level of the sensor sheet was smaller than that of the pressure sensor. There was a high correlation between the output levels of the two sensors (R=0.952, P&lt;0.00

DOI： 10.1016/j.jpor.2008.08.008

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Vertical alveolar augmentation by distraction osteogenesis has become a standard pretreatment of dental implants due to the main benefit of lack of donor site complications, and many reports have shown its benefit with various types of alveolar distractors. However, autogenous bone transplantation and/or guided bone regeneration techniques are still the standard treatment for correcting a narrow alveolar ridge because of few commercially available distractors for alveolar widening. In this article, we treated a case by a mesh-plate type of alveolar widening distractor for a narrow posterior mandibular alveolar ridge after extirpation of a large jaw cyst.

DOI： 10.1016/j.tripleo.2008.07.006

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Language：English   Publisher：Japan Prosthodontic Society  

Tongue plays an important role by making contact with palate in swallowing. This study was aimed for investigating the utility of originally developed measuring system of tongue pressure in the rehabilitation of dysphagic patients with prosthesis. Subject was a 68 years old male post-surgical laryngeal cancer patient who underwent percutaneus endoscopic gastrostomy because of dysphagia. Tongue pressure during dry swallow was recorded by using our original sensor sheet system (Nitta, Japan) with five measuring points (Chs.1-5) attached on the palatal surface of maxillary denture (RPD). Tongue impression was taken by his maxillary denture and the palatal contour was changed into palatal augmentation prosthesis (PAP), then tongue pressure with PAP was recorded and compared with that with RPD. Magnitude of tongue pressure on median line (CHs.1-3) of palatal surface of RPD was nearly 0 and that on the circumferential part (Chs.4 and 5) had laterality. In PAP, however, magnitude of tongue pressure on the median line increased and showed normal pattern (Ch.1>Ch.2>Ch.3) and that on the circumferential part showed no laterality. Improvement of the tongue pressure production described by our system might contribute to the bolus transport in oral phase of swallowing.

DOI： 10.2186/prp.7.240

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Other Link： http://search.jamas.or.jp/link/ui/2009105294

Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：DR DIETRICH STEINKOPFF VERLAG  

In elderly persons, it is thought that maintenance of masticatory function may have a beneficial effect on maintenance of cerebral function. However, few studies on cerebral circulation during mastication exist. This study aimed to verify a possible increase in cerebral circulation and the presence of cerebral hemispheric dominance during gum chewing. Twelve healthy, young right-handed subjects with normal dentition were enrolled. Bilateral middle cerebral arterial blood flow velocities (MCAV), heart rate, and arterial carbon dioxide levels were measured during a handgrip exercise and gum chewing. During gum chewing, electromyography of the bilateral masseter muscle was recorded.MCAV and heart rate significantly increased during exercise compared to values at rest.During gum chewing, there were no differences in the rate of increase in MCAV between the working and non-working sides, but during the handgrip exercise, the rate of increase in MCAV was significantly greater for the non-working side than for the working side.During gum chewing,muscle activity on the working side was significantly greater than that on the non-working side. These results suggest that during gum chewing, cerebral circulation increases bilaterally and does not show contralateral dominance, as it does during the handgrip exercise.

DOI： 10.1007/s00415-007-0570-3

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：BLACKWELL PUBLISHING  

Objective: To investigate the influence of maximal bite force, maximal tongue pressure, number of mastications and swallowing on the oro-pharyngeal residue in the elderly.
Background: Oro-pharyngeal residue in the elderly is an indication of clysphagia. Pharyngeal residue is especially critical as it may cause aspiration pneumonia, which is one of the major causes of death in elderly.
Materials and methods: Videofluorographic recordings were performed on 14 elderly volunteers (six males, eight females, age range 65-93 years) without any history or symptoms of dysphagia. The subjects were instructed to consume 9 g of barium containing bread in two manners; free mastication and swallow (FMS: masticate and swallow freely), and limited mastication and swallow (LMS: swallow once after 30 chewing actions). The amount of oral and pharyngeal residue was evaluated using a 4-point rating scale. Maximal occlusal force was measured by a pressure sensitive sheet, and maximal tongue pressure using a handy probe. Multiple regression analysis was performed to examine the influence of these items on the amount of oral and pharyngeal residue in FMS and LMS.
Results: In FMS, age was found to be a factor which increased oral residue (p = 0.053), and the number of swallowing (p = 0.017) and the state of the prosthesis (p = 0.030) reduced the pharyngeal residue. In LMS, tongue pressure was a factor which reduced oral residue (p = 0.015) and increased pharyngeal residue (p = 0.008).
Conclusion: It is suggested that in the elderly tongue pressure contributed to propulsion of the food bolus from oral cavity into the pharynx, and multiple swallowing contributed to the reduction in the amount of pharyngeal residue.

DOI： 10.1111/j.1741-2358.2007.00172.x

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Purpose: Oral cancer develops frequently in older populations. In Japan, the incidence of oral and pharyngeal cancer is 9,201 per year, with such tumors accounting for 1.74% of all cancers. Although obturator prostheses play an important role in the rehabilitation of postmaxillectomy patients, clinicians sometimes experience difficulty in placing obturator prostheses in edentulous maxillae, and criteria for the objective evaluation of treatment outcome have yet to be established. The present study aimed to investigate postsurgical factors influencing the masticatory performance of postmaxillectomy patients with edentulous maxillae fitted with obturator prostheses. Materials and Methods: The extent of the hard palate defect, status of the mandibular dentition, mouth-opening distance, and maximum occlusal force were investigated, and masticatory performance was measured using a testing gummy jelly in 27 postmaxillectomy patients with edentulous maxillae fitted with obturator prostheses. The influence of these items was evaluated quantitatively, and theoretical masticatory performance for each subject was calculated using multiple-regression analysis (quantification method type 1). Results: Although average masticatory performance was almost equivalent to that of healthy, independent older patients with occlusal support classified as Eichner C, considerable individual variation was noted among subjects. The order of strength of influence on masticatory performance was identified by category weight: extent of hard palate defect &gt; status of posterior mandibular teeth &gt; maximum occlusal force &gt; mouth-opening distance. A relatively high correlation (R-2 = 0.78, P &lt;.01, Pearson correlation coefficient) was evident between theoretical and actual values. Conclusion: Masticatory performance could be predicted by evaluating postsurgical factors in patients with edentulous maxillae fitted with obturator prostheses.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT AMER ASSOC DENTAL RESEARCHI A D R/A A D R  

Temporal changes in cerebral blood flow induced by jaw movement have yet to be investigated. To assess the influence of pattern and intensity of muscle contraction during jaw movement on task-induced change in cerebral blood flow, we performed bilateral transcranial Doppler ultrasound examination during clenching, gum chewing, and tooth tapping in healthy volunteers. A random-effects model analysis revealed a significant increase in middle cerebral artery blood flow velocity during clenching (high muscle activity) and gum chewing (moderate muscle activity), compared with the preceding rest period; however, such an increase was not detected during tooth tapping (low muscle activity). Cerebral blood flow was greater on the working side during the intensive isometric contraction of the masseter muscle in clenching. These results suggest that task-induced change in cerebral blood flow during jaw movement is influenced by the change in peripheral circulation evoked by muscle contraction.

DOI： 10.1177/154405910708600110

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Japan Prosthodontic Society  

<B>Purpose:</B> Little objective investigation has been published regarding factors influencing masticatory performance of post-maxillectomy patients with obturator prosthesis. This study aimed to assess the relationship between masticatory performance and sociological and post-surgical factors, and to develop a theoretical equation predicting masticatory performance using significant factors.<BR><B>Methods:</B> In 37 post-maxillectomy patients with obturator prosthesis, their age, gender, resection of hard and soft palate, number of posterior maxillary teeth, occlusal support, and mouth-opening distance on masticatory performance were investigated, and masticatory performance was measured using a gummy jelly. The influence of these items was evaluated quantitatively using multiple regression analysis (Quantification Method type I). The strength of influence of each explanatory factor on the masticatory performance, identified by the category weight and theoretical value of masticatory performance of each subject, was calculated by totaling the category weights and the constant. Pearson correlation coefficient was used to analyze the correlation between actual values and theoretical values of masticatory performance.<BR><B>Results:</B> The order of strength of influence on masticatory performance was identified by the category weights: extent of hard palate resection (1229.9) > occlusal support (1113.0) > mouth-opening distance (280.8) > age (209.0) > resection of soft palate (194.2) > number of posterior maxillary teeth (186.4). There was a high correlation (<I>R</I>²=0.863, <I>P</I><0.01) between the theoretical values calculated by the predictive equation and the actual values.<BR><B>Conclusion:</B> Masticatory performance of post-maxillectomy patients could be predicted with high accuracy in patients with soft palate defect limited to the anterior part.

DOI： 10.2186/prp.6.181

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Other Link： http://search.jamas.or.jp/link/ui/2008113040

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)   Publisher：INT AMER ASSOC DENTAL RESEARCHI A D R/A A D R  

The tongue plays an important role in mastication and swallowing by its contact with the hard palate. Using an experimental palatal plate with 7 pressure sensors, and recording jaw movement using mandibular kinesiography, we assessed, in healthy subjects, the coordination of tongue and jaw movements during the entire masticatory sequence of solids, by measuring tongue pressure against the hard palate. Tongue pressure appeared during the occlusal phase, reached a peak near the start of opening, and disappeared during opening. Specific patterns in order, duration, and magnitude of tongue pressure were seen at the 7 pressure sensors in each chewing stroke. Magnitude and duration were significantly larger in the late stage of chewing (8 strokes before initial swallowing) than in the early stage (until 8 strokes after starting mastication). The normal pattern of tongue contact against the hard palate, control of tongue activity, and coordination with jaw movement during mastication is described.

DOI： 10.1177/154405910608500214

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OBJECTIVES: The tongue plays an important role in swallowing by contacting the palate. The aim of the present study was to investigate the characteristics of tongue pressure production during swallowing in post-stroke patients using a newly developed sensor sheet. MATERIALS AND METHODS: Ten post-stroke inpatients with hemiplegia and five healthy volunteers participated in this study. Magnitude of tongue pressure during a dry swallow was measured using a newly developed sensor sheet comprising five sensors applied directly to the palate or to the palatal surface of a maxillary denture using denture adhesive. Swallowing ability was evaluated by measuring the time taken to swallow 30 ml of water. The magnitude of tongue pressure was compared between the post-stroke patients and healthy subjects as well as between each measuring point in both groups. The relationship between tongue pressure and swallowing ability and that between tongue pressure and state of occlusal support were also examined. RESULTS: The magnitude of tongue pressure in the post-stroke patients was smaller than that of the healthy subjects at the measuring points along the median line (Welch test, p &lt; 0.05), larger i

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Contact of the tongue against the hard palate plays an important role in swallowing. This study aimed to clarify the pattern of contact between the tongue and hard palate by analyzing tongue pressure produced in swallowing 15 ml of water by healthy subjects wearing an experimental palatal plate with seven pressure sensors. Tongue pressure was generated initially by close contact with the anteriomedian part of the hard palate, then with the circumferential part, and finally softly with the posteriomedian part. Tongue pressure reached a peak quickly, then decreased gradually before disappearing almost simultaneously at each measured part of the hard palate. Magnitude and duration were significantly larger in the anteriomedian part compared to the other six parts measured, and was significantly smaller in the posteriomedian part. No laterality was found in tongue pressure produced at the circumferential parts of the hard palate. Our findings indicate that the order of tongue contact against each part of the hard palate as well as duration and magnitude of tongue pressure are coordinated precisely during swallowing. These findings could aid assessment of the tongue movement of dysphagic patients during rehabilitation.

DOI： 10.1007/s00455-004-0010-9

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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 (&lt; 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 abi

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Language：Japanese   Publisher：(一社)日本口腔ケア学会  

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近年、高齢者のフレイル予防と健康長寿における咀嚼の重要性が注目されている。咀嚼は運動としては軽微であるが、豊富な感覚情報や情動変化を伴うため、脳循環や体循環を賦活化する効果を有している。また、客観的な咀嚼能力検査によって、咀嚼能力の低下がメタボリックシンドローム罹患のリスクとなることが示唆された。さらに、肥満予防を目的とした咀嚼行動変容を促すための、ウエアラブルデバイスの開発が行われている。このように、運動、能力、行動の様々な面からアプローチすることによって、咀嚼を利用した高齢者のヘルスプロモーションの可能性が広がるものと期待される。(著者抄録)

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近年、高齢者のフレイル予防と健康長寿における咀嚼の重要性が注目されている。咀嚼は運動としては軽微であるが、豊富な感覚情報や情動変化を伴うため、脳循環や体循環を賦活化する効果を有している。また、客観的な咀嚼能力検査によって、咀嚼能力の低下がメタボリックシンドローム罹患のリスクとなることが示唆された。さらに、肥満予防を目的とした咀嚼行動変容を促すための、ウエアラブルデバイスの開発が行われている。このように、運動、能力、行動の様々な面からアプローチすることによって、咀嚼を利用した高齢者のヘルスプロモーションの可能性が広がるものと期待される。(著者抄録)

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＜文献概要＞簡易な機器で舌挙上に負荷を加えることを目的とし,ばねばかりを用いた簡易な舌-口蓋接触トレーニングを考案した.本研究では,ばねばかりにより調節した牽引負荷が舌圧に与える影響を検討した.対象は最大押し付け舌圧が各年代の平均値未満であった嚥下障害を呈する患者20名とした.方法は,はかりに固定したガーゼを舌-口蓋接触の力のみで10秒間保持するように指示し,評価者がはかりを牽引した.負荷量は50g,100g,200g,300gの4条件を設定した.牽引時の舌圧最大値,舌圧積分値を舌圧センサシートで記録,解析し,負荷量の増加に伴う舌圧の増加傾向の有無の検定,各条件間での比較を行った.口蓋の正中前方部,左右後方周縁部では,牽引力の増加に伴い,舌圧最大値,舌圧積分値は有意な増加傾向を認めた.また正中前方部の舌圧最大値,舌圧積分値は各条件間で有意差を認め,牽引力の増加に伴って舌圧が増加した.ばねばかりを用いた簡易な舌-口蓋接触トレーニングは舌前方部へ負荷を加えるトレーニングとして利用できる可能性が示唆された.

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これまで、様々なセンシング技術を使って解析した咀嚼・嚥下機能に関わる生体情報を、治療、リハビリテーション、食品開発の3つの方向へ展開してきた。これらの研究を、以下の項目に分けて述べた。1)プロセスモデルによる咀嚼・嚥下の包括的理解、2)咀嚼・嚥下時の舌圧の計測、3)嚥下における口腔と咽頭の協調性、4)舌圧測定による嚥下障害の診断、5)補綴装置による舌圧と嚥下障害の改善、6)リハビリテーション手技の効果検証、7)嚥下困難者用食品の開発、として述べた。

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

摂食嚥下リハビリテーションにおける歯科医師に期待される役割の一つに、補綴的なアプローチが挙げられる。このアプローチの中では、有床義歯の製作・調整だけではなく舌接触補助床(PAP)をはじめとするさまざまな装置が用いられる。舌接触補助床とは、舌機能の低下した患者に対して舌機能の代償を図るために装着される、上顎の床タイプの補綴装置のことである。こういった装置の製作・調整においては、時として専門的な補綴に関する知識や経験・技術を必要とする。また、その適応を適切に判断することも重要となる。補綴装置はうまく使用していただかないと効果を発揮しないだけでなく、不適合な装置はかえって機能を阻害する可能性がある。一方、摂食嚥下リハビリテーションはチーム医療が基本であり、多職種によるさまざまなアプローチを組み合わせて行われることが多い。PAPを用いた補綴的なアプローチだけではなく、各職種と連携して筋可動域訓練や筋負荷訓練といった間接訓練や、嚥下姿勢や食事の調整といった直接訓練なども検討してリハビリテーションプログラムに組み入れられる必要がある。保険医療におけるPAPの適用が摂食機能療法との併用を前提としているのも、こうした機能訓練や栄養管理、リスク管理がなければPAPの効果を十分に上げられないからである。本稿では、PAPを用いた摂食嚥下リハビリテーションの実際について、装置の製作方法やその際の注意点について解説するとともに、あわせて行われるリハビリテーションなどについても言及し、より効果的な嚥下機能回復を図るための方策を考えたい。また、その効果や新たな取り組みについて、検討する。(著者抄録)

DOI： 10.2186/ajps.9.334

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

極薄型の舌圧センサシートを口腔内に貼付することにより、自然な嚥下時の舌圧を多点で測定することができる。舌圧の持続時間、最大値、順序性、左右バランスなどのパラメータの変化は、脳卒中、神経筋疾患、口腔中咽頭がんなど各疾患特有の舌のmotor controlの異常と関連しており、不顕性の嚥下機能低下を捉えるうえで有用である。また、嚥下時舌圧データは、嚥下手技の舌に対する効果検証や、患者個々の舌機能に応じた食品性状の設定に応用することによって、摂食嚥下リハビリテーションにおけるさまざまなアプローチの合理化や効率化に貢献する可能性をもつと考えられる。(著者抄録)

DOI： 10.2490/jjrmc.54.666

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

口腔腫瘍患者では、腫瘍切除術により口腔内の環境が大きく変化し咀嚼・嚥下などの機能が低下する。そこで、顎顔面補綴治療や摂食嚥下機能療法が行われ、その形態や機能の回復が図られる。効果的な機能回復のために、顎顔面補綴専門医は術前から口腔外科担当医と綿密な連携をとり、腫瘍に対する治療計画を考慮するとともに術後の状況を予想しながら補綴治療を計画し介入を開始している。この顎顔面補綴治療における一連の過程では、計画的に歯科治療や口腔衛生管理・リハビリテーションが行われるべきである。また、術前からの口腔衛生管理や歯科治療は頭頸部腫瘍患者だけではなく、その他の部位の腫瘍においても、手術後の誤嚥性肺炎や感染症の予防、放射線療法や化学療法時の口腔粘膜炎や口腔内感染症などの対策に有効であると報告されていることから、平成26年度より周術期口腔機能管理が保険収載された。これらの周術期口腔機能管理や摂食嚥下機能療法においては、各職種との連携が重要であり、適切に文書を用いて情報提供を行うことが必要とされる。また、術前からの介入は、確実な感染管理・効果的なリハビリテーションと機能回復を図ることができ、早期退院・社会復帰のサポートへとつながる。本稿では、術前から計画的に行う周術期管理や摂食嚥下機能療法の実際や、他職種や他施設との連携のポイントなどについて概説する。また、こういった周術期口腔機能管理や口腔機能改善のための効率的なアプローチや、一般補綴歯科への応用などについて検討する。(著者抄録)

DOI： 10.2186/ajps.9.175

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

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Language：Japanese   Publisher：(NPO)日本顎変形症学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

DOI： 10.7144/sgf.23.138

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J02994&link_issn=&doc_id=20170814470014&doc_link_id=10.7144%2Fsgf.23.138&url=https%3A%2F%2Fdoi.org%2F10.7144%2Fsgf.23.138&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(公社)日本歯科医師会  

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Language：Japanese   Publisher：(公社)日本歯科医師会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

介護保険施設において、口腔ケアおよび摂食指導を必要としている要介護高齢者は少なくない。今後、研修歯科医が食事の場面に立ち会い、摂食指導をすることが重要であるが、その機会はまだ少ないと考えられる。新潟大学では、特別養護老人ホームを週に1回訪問し、口腔ケアや摂食指導を行っているが、その際に研修歯科医が2〜3名ずつ同行して、実際の口腔ケアや摂食指導を研修している。今後、よりよい研修プログラムを提供するため、研修歯科医の介護保険施設における口腔ケアおよび摂食指導の経験の有無や、本プログラムを研修した感想等に関するアンケート調査を実施した。対象は、2009〜2013年度に、口腔ケアおよび摂食指導の研修を行った本学研修歯科医144名とし、口腔ケアおよび摂食指導に対する知識・経験の有無について調査した。その結果、80.4%が口腔ケアの知識があると回答していたが、実際に口腔ケアあるいは摂食指導を経験したことがある者は少なかった(口腔ケア56.6%、摂食指導18.2%)。また、大半が、口腔ケアおよび摂食指導が勉強になったと回答していた。口腔ケアあるいは摂食指導に対する歯科専門スタッフの介入価値があると思うと回答した者は、口腔ケアでは82.5%、摂食指導では78.3%と高い割合を示した。要介護高齢者の数は増加の一途をたどっており、今後、口腔ケアおよび摂食指導において歯科医師が果たす役割は、ますます大きくなっていくと思われる。患者家族やコメディカルに摂食指導をする立場にある歯科医師の臨床研修に、介護保険施設等における口腔ケアおよび摂食指導を導入することは重要であるといえる。(著者抄録)

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

DOI： 10.2186/ajps.8.126

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Language：Japanese   Publisher：医歯薬出版(株)  

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

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Language：Japanese   Publisher：(公社)日本リハビリテーション医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

DOI： 10.11259/jsg.31.3

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(NPO)日本顎変形症学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Web of Science

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Language：Japanese   Publisher：(公社)日本歯科医師会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

DOI： 10.7144/sgf.22.148

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

舌は、咀嚼から嚥下にかけての過程において、巧緻な運動を行って食塊の形成と搬送に中心的な役割を果たしている。その運動性を評価する上で、舌と口蓋が接触することによって生じる舌圧は、有効な指標となる。健常者において一定のパターンを示す嚥下時の舌圧発現様相の崩れは、嚥下障害の出現と関連している。また、咀嚼の進行に伴う嚥下前の口腔から中咽頭への食塊の輸送には、咀嚼サイクル毎の舌圧発現の増加が関与している。舌圧や咀嚼能率を用いることによって、咀嚼・嚥下障害の程度を客観的に把握し、治療やリハビリテーションの合理化・能率化をはかることは、超高齢社会における歯科補綴治療のイノベーションに寄与すると思われる。(著者抄録)

DOI： 10.2186/ajps.8.46

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Language：Japanese   Publisher：The Japan Society of Cookery Science  

DOI： 10.11402/ajscs.28.0_43

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Language：Japanese   Publisher：新潟歯学会  

小脳橋角部髄膜腫摘出術後に嚥下障害を認めた一例を報告する。症例は57歳女性。2015年1月9日、疼痛の制御困難につき、当院脳神経外科入院下にて摘出術施行された。同月13日(術後4日目)、嚥下機能評価目的に当科初診。口腔衛生状態は不良で、残根歯多数認め、臼歯部の咬合支持はほぼ無い状態。安静時より湿性嗄声を認め、自己喀痰は困難。左側三叉・顔面・舌咽・迷走・舌下神経領域の運動・感覚不全麻痺あり。反復唾液嚥下テストは0回、唾液誤嚥の疑いを認めたために0.5mlの水飲みテストを行ったところむせを認めた。以上より、準備期から嚥下咽頭期にわたる機能的嚥下障害と診断して、まずは口腔ケア、間接訓練より介入開始。術後18日目、嚥下内視鏡検査を実施。検査食の咽頭部残留を認めるも明らかな誤嚥を認めなかったことから、翌日より直接訓練を開始。術後27日目、嚥下造影検査実施。右側臥位・左側頸部回旋位では、中間位に比して嚥下後の咽頭部残留が減少したことから、姿勢調整により経口摂取可能と判断して同日より食事開始。経過に応じ食上げを行い、並行して新義歯作製および咀嚼訓練実施。最終的に中間位にて米飯・軟々菜食まで摂取可能となり、術後86日目に自宅退院に至った。(著者抄録)

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Language：Japanese   Publisher：(公社)日本矯正歯科学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本顎口腔機能学会  

DOI： 10.7144/sgf.22.38

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：(NPO)日本バイオレオロジー学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

本文は、増加する認知症患者の背景と現状を鑑み、認知症患者に対する歯科口腔保健・歯科医療のあり方に関して整理を行い、現時点での日本老年歯科医学会の立場を表すものである。日本老年歯科医学会は、高齢化が進むわが国で、高齢者歯科医療のあり方について積極的に取り組んできた。しかし、認知症患者に対する歯科口腔保健・歯科医療に対する取り組みは十分とはいえない。近年、地域包括ケアがわが国の施策の中で重要なミッションの一つになっており、その中で&quot;QOLの維持・向上&quot;に対して歯科が大きな役割を果たす必要がある。そのためには、原因疾患や神経心理学的症状を理解し、病態の進行を的確に予測した継続的な支援計画と歯科治療計画を検討し、柔軟な対応を行うことが必要である。本文で指摘した認知症発症と口腔との関係、認知症初期段階での早期発見への関わりの整備、歯科医療の意思決定プロセスの整備、歯科治療・口腔機能の管理などの指針の作成を科学的根拠のもとに進め、他の医療、介護・福祉関係者だけでなく、国民に十分な理解を得て、認知症患者の歯科的対応と歯科治療を充実させ、認知症患者のQOLの維持と尊厳保持を進めていくことが日本老年歯科医学会の使命と考える。そのために、日本老年歯科医学会は、日本老年学会、歯科関連学会と協働し、学際的および多職種と連携して認知症の諸問題の解決に取り組み、正しく必要な情報を社会に発信していく決意をここに示す。(著者抄録)

DOI： 10.11259/jsg.30.3

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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Language：Japanese   Publisher：日本顎口腔機能学会  

DOI： 10.7144/sgf.21.122

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Language：Japanese   Publisher：日本顎口腔機能学会  

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J-GLOBAL

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Language：Japanese   Publisher：The Japan Society of Cookery Science  

DOI： 10.11402/ajscs.27.0_5

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本老年歯科医学会  

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Language：Japanese   Publisher：日本歯科医学教育学会  

超高齢社会の到来に伴い、訪問歯科診療の需要も増加しているが、供給は十分になされていないのが現状である。その理由として、在宅の訪問歯科診療実施が不安だという報告もある。今後、増加する訪問歯科診療の需要に応えるには、歯学部学生に対して、訪問歯科診療見学実習を実施し、実習後に評価を行って実習内容の改善に努めることが必要であると考える。新潟大学歯学部歯学科では、1998年から6年次生に対して訪問歯科診療見学実習を行っている。今回、訪問歯科診療に対する意識および現在行われている訪問歯科診療見学実習の評価に関する情報収集を目的として、質問紙法による調査を実施した。2013年に、6年次生を対象とした訪問歯科診療見学実習前後に無記名の質問紙調査を行い、比較検討した。解析対象となった33名全員が、実習を有意義であると回答していた。有意差は認められなかったものの、訪問歯科診療を「大変」と思う者および訪問歯科診療に対する不安は実習後に減少しており、訪問歯科診療を実際に見学することによって訪問歯科診療の実状を知ることができたためだと考えられる。その一方、見学後の総括で、訪問歯科診療で行うことが可能な診療や診療姿勢についての指導が必要であることも明らかになった。今後、見学内容をさらに改善し、継続していきたいと考えている。(著者抄録)

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Language：Japanese   Publisher：日本顎口腔機能学会  

舌圧・喉頭運動計測システムによるパーキンソン病(PD)患者の嚥下動態について検討した。治癒中のPD患者10例を対象とした。健常成人男性と比較してPD患者群の方が低い舌圧最大値を示した。嚥下時に舌圧発現を認めないChがみられた。さらに、通常は前方よりCh1-3の順に知多圧舌圧発現が見られる口蓋正中部において、発現順序の乱れがみられた。経口摂取している比較的軽度のPD患者においても、嚥下時舌運動の円滑な遂行が障害されていることが示唆された。PD患者においても喉頭運動波形は明瞭に記録され、解析点の抽出が可能であった。また、嚥下における喉頭運動の主たる部分T2(舌骨の急速挙上開始)-T6(舌骨の下降終了)は健常者に比べて延長する傾向にあり、しばしば再嚥下がみられた。PD患者の嚥下障害を非侵襲的に評価できる可能性が示唆された。

DOI： 10.7144/sgf.20.134

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Language：Japanese   Publisher：日本顎口腔機能学会  

味覚刺激が嚥下運動にどのような変化を与えるかについて調べることを目的として、異なる濃度の塩味またはうま味溶液を口腔内に微量注入した時の随意性嚥下運動を記録した。健常成人29名を対象として、出来るだけ早く繰り返し嚥下するよう指示し、その際に咽頭または口腔への溶液刺激(0.2mL/min)を与えた。咽頭への溶液刺激は蒸留水または0.3 M NaCl溶液とし、口腔への溶液刺激は蒸留水または3種類のNaイオン濃度(6mM、40mM、240mM)のうま味溶液(モル濃度比2対1のグルタミン酸ナトリウムとイノシン酸ナトリウム混合溶液)、うま味溶液と同濃度のNaイオンを含むNaCl溶液とした。測定開始後4から9回目までの各嚥下間の平均時間を嚥下間隔時間として各条件間で比較した。NaCl溶液、蒸留水いずれの咽頭刺激においても嚥下間隔時間の顕著な個人差が認められた。NaCl溶液刺激時の嚥下間隔時間は蒸留水よりも有意に長く、咽頭の水受容器による嚥下反射誘発促進効果、NaCl溶液による水受容器応答の抑制が確認された。さらにNaCl溶液刺激時の嚥下間隔時間が長い被験者ほど蒸留水刺激による随意性嚥下の促進効果が高かった。一方、口腔への溶液刺激では、うま味溶液刺激時のみ蒸留水に対して有意な短縮を認めた。随意性嚥下能力の高い順から上位群、中位群、下位群ごとに嚥下間隔時間の変化を調べたところ、上位群、下位群では各溶液の濃度の違いによる有意な差は認められなかったのに対して、中位群のみ溶液濃度が高くなるに従って嚥下間隔時間の短縮を認めた。以上の結果は、中位群におけるうま味成分がもつ随意性嚥下への促進効果を示唆するものである。随意性嚥下誘発能力の個人差をもとに、末梢入力に対する嚥下運動誘発の時間間隔を比較したところ、咽頭刺激時とは異なっていたことから、口腔への味覚刺激がもつ嚥下中枢への効果は単なる加重効果として捉えられず、その効果の作用機序の理解に向けてはさらなる議論が必要である。(著者抄録)

DOI： 10.7144/sgf.20.106

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Language：Japanese   Publisher：日本顎口腔機能学会  

摂食に関連した咽頭と食道機能の加齢変化とその関係について検討した。健常若年男性10例、健常高齢男性12例を対象とした。全ての被験食で若年者と比較して高齢者で食道内残留スコアが高値を示した。とろみ液体、粥で若年者と比較して高齢者で咽頭内残留スコアが高値を示した。嚥下反射惹起ポイントは全ての被験食で若年者と比較して高齢者で高値を示した。若年者群では食道、咽頭、口腔の各パラメータ間で有意な相関を認めなかったが、高齢者群では食道内残留と咽頭、口腔のいくつのパラメータ間で相関を認めた。とろみ液体と粥では咽頭内残留スコアが高い被験者は食道内残留スコアも有意に高値を示した。とろみ液体と粥では、嚥下反射惹起ポイントが高い被験者は食道内残留スコアが有意に高値を示した。とろみ液体と粥では、Eichner's分類B群およびC群がA群と比較して食道内残留スコアが有意に高かった。

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Language：Japanese   Publisher：日本嚥下医学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：新潟歯学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

本研究は、嚥下障害のある患者と健常者の舌骨運動時間と距離、舌骨位、および食塊移送のタイミングを比較することにより、嚥下障害における病態の一つと考えられる舌骨位の下垂が嚥下機能にどのように影響しているかを検証することを目的とした。対象は、嚥下障害を主訴として来院され嚥下造影検査を行った65名の患者(以下患者群)、対照として健常被験者10名(以下健常群)とした。得られたデータから、舌尖の運動開始を基準に舌骨運動・食塊移送の時間経過を計測し、また、第四頸椎前下縁を基準として舌骨位を計測し、患者群と健常群で比較を行った。患者群では食塊移送時間が口腔、咽頭ともに延長しており、更に食塊の咽頭流入は嚥下反射惹起を示す急速な舌骨挙上と比べ有意に先行していた。第四頸椎を基準とした場合、患者群と健常群に明らかな舌骨位の違いは認めなかった。疾患別の検索を行うと、嚥下反射以降は各疾患とも類似した舌骨の動きが認められたが、嚥下反射前は複雑な軌跡を示した。いくつかの疾患では、嚥下反射惹起前の舌骨の移動距離と移動時間に正の相関関係が認められたため、舌骨位が嚥下反射惹起遅延に影響を与えている可能性が考えられた。(著者抄録)

DOI： 10.7144/sgf.20.22

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Language：Japanese   Publisher：(一社)日本言語聴覚士協会  

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Language：Japanese   Publishing type：Meeting report   Publisher：日本歯科衛生学会  

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Language：Japanese   Publisher：医歯薬出版(株)  

2006〜2010年に当院を摂食・嚥下評価目的で受診した神経難病患者のうち、嚥下造影検査時に液体3mlの誤嚥を認めなかった筋萎縮性側索硬化症(ALS)患者35例と多系統萎縮症(MSA)患者43例および進行性核上性麻痺(PSP)患者5例の3疾患群と、健常者11例を加えた4群間で嚥下時の食塊移送状態を比較し、各疾患の特徴について検討した。結果、ALS患者の特徴として、嚥下反射惹起前に食塊が中咽頭から下咽頭にかけて流入し、嚥下後の咽頭内食塊残留が顕著であった。MSA患者では咽頭内食塊残留が他疾患に比べて少なかったものの、食塊の咽頭内早期流入が顕著であった。PSP患者は3疾患うち最も重度な嚥下機能障害を示した。すなわち、食塊が早期に下咽頭まで流入し、また咽頭内残留率が高かった。

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

増加する摂食・嚥下障害患者に対する有望な歯科的アプローチとして、口腔における食塊の形成と咽頭への送り込みに大きく寄与している舌機能の客観的評価と、その低下に対する代償的治療法である舌接触補助床(Palatal Augmentation Prosthesis、PAP)について取り上げる。舌機能はこれまで嚥下造影検査や嚥下内視鏡検査によって評価されてきたが、舌と口蓋との接触によって生じる舌圧を極薄型の舌圧センサシートを用いて測定することにより、咀嚼・嚥下における舌運動の正常と異常を定量的にとらえることができる。この舌圧測定は、PAPの適用診断、設計、効果判定において有効であり、今後代償嚥下手技の生理学的裏付けや咀嚼・嚥下困難者用食品の開発においても有用な情報を提供し得ると期待される。(著者抄録)

DOI： 10.2186/ajps.5.247

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

症例は43歳女性で、12年前に重症筋無力症と診断され、神経内科での治療と軟口蓋挙上型鼻咽喉補綴装置(PLP)を使用した摂食・嚥下リハビリテーションを行い、経過観察となっていた。再診時にPLP装着時に食事できないとの訴えがあり、診察所見および各種試験の結果、軟口蓋挙上不良による鼻咽腔閉鎖不全および舌萎縮と可動性低下が問題と考え、舌接触補助機能を付与したPLPの製作を行うこととした。維持力は4ヶ所のワイヤークラスプに求め、軟口蓋全体で支持を得る設計とした。製作したPLPと旧PLPを比較したところ、軟口蓋の挙上量はほぼ同じであったが、口蓋部分のボリュームが異なっており、舌との接触がしやすい形態で、反復唾液嚥下テストなどの機能評価により装着時の改善を確認した。装着後は唾液の嚥下がしやすくなり、構音機能の改善、努力性発声が少なくなって装着時間が延長した。装着後2年11ヵ月で良好に経過している。

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Language：Japanese   Publisher：(公社)日本歯科医師会  

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Language：Japanese   Publisher：(公社)日本補綴歯科学会  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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Language：Japanese   Publisher：神戸常盤大学・神戸常盤大学短期大学部  

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Language：Japanese   Publisher：日本歯科医学会  

本研究は歯科医師がチェアサイドで舌機能を簡便かつ定量的に評価しうる検査法を確立することを目的として、(1)摂食・嚥下リハビリテーションの診断支援に有用な舌機能検査法を確立し、実用化するための基礎となるガイドラインの作成、(2)最新の舌機能検査機器の効果の検証、(3)それらを用いた多施設研究を行うことが企画された。まず、エビデンスレベルに基づいた「摂食・嚥下リハビリテーションにおける診断支援としての舌機能検査法ガイドライン(案)」を作成し、エビデンスレベルは低いものの、各舌機能検査法の臨床的有用性が認められた。また、最大舌圧測定法は要介護高齢者の嚥下能力をよく反映すること、咀嚼・嚥下時舌圧測定法において記録された舌圧は、ビデオ嚥下造影法検査ならびに嚥下内視鏡検査で観察される嚥下機能とよく相関していることなどが明らかとなった。以上の結果から、今後の摂食・嚥下リハビリテーションの臨床において、新しく開発された舌機能検査機器を含む各種検査法の積極的な展開の必要性が示唆された。(著者抄録)

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Language：Japanese   Publisher：日本顎口腔機能学会  

DOI： 10.7144/sgf.19.162

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese   Publisher：日本顎口腔機能学会  

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Language：Japanese  

J-GLOBAL

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Language：Japanese  

J-GLOBAL

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J-GLOBAL

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Language：Japanese   Publisher：(一社)日本顎顔面補綴学会  

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Language：Japanese   Publisher：新潟歯学会  

【目的】居宅療養管理指導では、口腔内の衛生管理と口腔機能の評価が義務付けられている。今回、居宅療養管理指導の実施が対象者にもたらした効果について検討した。【対象と方法】S市在住で訪問診療の希望があった20名(82.2±8.0歳)を対象とした。訪問歯科診療および居宅療養管理指導を継続し、初診時と3ヵ月後の要介護度、摂食機能評価(栄養摂取状況、経口摂取状態、洗口能力、舌運動、頬運動、口輪筋運動、咀嚼運動、嚥下運動、義歯使用状況)、口腔清掃状況の各項目を比較し、それぞれ4段階で評価した。また、改善度について3段階で評価した。【結果】往診依頼内容は歯科治療8例、義歯治療7例、口腔ケア・摂食機能療法5例で、義歯治療依頼における要介護度が有意に低かった。摂食機能に関わる各項目を介入前後で比較したところ、いずれの項目についても統計学的に有意な変化は認められなかった。一方、改善度に関する解析では、いずれの項目も「変化なし」が有意に多かった。【考察】居宅療養管理指導を行うことで口腔衛生面、摂食に関わる機能の維持は可能だった。しかし、食事形態や経口摂取状況が低下したケースが認められたのは、予防的措置あるいは摂食機能以外の要因によると考えられる。本研究の結果、要介護高齢者であっても適切な歯科治療および療養管理指導を行うことで、要介護度の悪化防止と摂食機能の維持が可能なことが示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2012&ichushi_jid=J00999&link_issn=&doc_id=20130111530002&doc_link_id=%2Fdj2ngtdt%2F2012%2F004202%2F002%2F0089-0096%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdj2ngtdt%2F2012%2F004202%2F002%2F0089-0096%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：(一社)日本摂食嚥下リハビリテーション学会  

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Language：Japanese   Publisher：日本顎口腔機能学会