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

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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© 2017 Japan Geriatrics Society Aim: To examine the longitudinal association between dentition status and incidence of frailty in older adults. Methods: The present prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Dental examinations, biochemical blood examinations, physical performance and anthropometric measurements, and structured questionnaires were carried out at baseline. The presence of ≥20 teeth with nine or more occluding pairs of teeth was defined as functional dentition. Annual follow-up examinations, including physical performance, anthropometric measurements and structured questionnaires, were carried out over a 5-year period to determine the incidence of frailty, defined as three or more of the following five components derived from the Cardiovascular Health Study: weight loss, weakness, slowness, poor energy and low physical activity level. Adjusted hazard ratios of frailty incidence according to dentition status were calculated from Cox proportional hazards regression analyses. Results: At baseline, 118 participants (36.6%) were defined as having functional dentition. During the follow up, 48 participants (14.9%) developed frailty. The adjusted hazard ratio for frailty in participants with functional dentition was 0.50 (95% confidence interval 0.25–0.98) compared with participants without functional dentition, after adjusting for sex, income, education, smoking status, body mass index, serum biomarkers and comorbidities. Conclusions: Functional dentition was significantly associated with a lower risk of frailty defined by the Cardiovascular Health Study frailty index in older Japanese adults. These results suggest that maintaining healthy and functional dentition into later life is important for frailty prevention. Geriatr Gerontol Int 2018; 18: 256–262.

DOI： 10.1111/ggi.13170

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© 2019 American Academy of Periodontology. BACKGROUND: People with chronic kidney disease (CKD) may have an increased risk of periodontal disease, but longitudinal evidence is sparse. METHODS: This 4-year cohort study assessed the association between CKD and changes in periodontal health status, defined by attachment loss (AL) progression, among older adults. Participants were 388 community-dwelling Japanese adults who were 70 years old at baseline with 7053 teeth. Estimated glomerular filtration rate (eGFR) was calculated by using baseline serum creatinine concentration. AL at six sites for every tooth was recorded at baseline and follow-up examinations. Multilevel logistic regression models estimated the tooth-specific risk of AL progression (≥1 site exhibiting a ≥3 mm increase in AL) with baseline CKD (eGFR < 60 mL/min/1.73 m2 ) as the principal exposure. RESULTS: At baseline, 27.8% of the study population (108/388 participants) had CKD. After 4 years, 21.8% of the studied teeth (1537/7053 teeth) exhibited AL progression. After applying inverse probability weighting and adjusting for potential confounders, including sex, use of devices for interdental cleaning, smoking, diabetes, tooth location, abutment for a removable denture, and highest AL, CKD was associated with significantly higher odds of AL progression (adjusted odds ratio: 1.73; 95% confidence interval: 1.15-2.60). CONCLUSIONS: The results suggest that CKD increases the risk of periodontal disease progression in older community-dwelling Japanese adults. Additional studies with more complete information, as well as in other geographic areas and age groups, are necessary to further generalize the findings.

DOI： 10.1002/JPER.18-0464

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© 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd Objective: To evaluate the association of salivary flow rate with all-cause mortality among older Japanese adults. We hypothesised that hyposalivation would be a marker for mortality. Background: Hyposalivation, which is an objectively measurable decrease in salivary flow, is highly prevalent among older adults. It is associated with malnutrition and poor general health. Methods: The study population comprised 600 community-dwelling Japanese adults (306 men and 294 women), who were 70 years old at baseline. They underwent stimulated salivary flow rate (SSFR) measurements and were followed up during a 10-year study period. After stratification by sex, the hazard ratios of all-cause mortality were estimated using Cox proportional hazards regression analysis comparing groups with and without hyposalivation (ie, SSFR < 0.7 mL/min). Results: The baseline prevalence of hyposalivation was 27.8% (85/306) among men and 47.3% (139/294) among women. During a mean (standard deviation) follow-up period of 104 (27) months, 80 deaths occurred: 60 (75.0%) deaths among men and 20 (25.0%) deaths among women. After adjusting for the number of remaining teeth, smoking status, exercise, hypoalbuminemia, diabetes and cardiovascular disease, hyposalivation at baseline was significantly associated with all-cause mortality among men (adjusted hazard ratio, 1.71; 95% confidence interval, 1.01-2.89). In contrast, no association between SSFR and all-cause mortality existed among women. Conclusion: Hyposalivation could be a marker for all-cause mortality among older community-dwelling Japanese men. Future studies investigating the association between SSFR and cause-specific mortality are warranted.

DOI： 10.1111/ger.12319

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© 2017 John Wiley & Sons Ltd To determine whether maximum bite force (MBF), an objective measure of oral function, is associated with development of frailty in community-dwelling older adults. This prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Baseline MBF was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up examinations, including physical fitness and anthropometric evaluation and structured questionnaires, were administered annually over a 5-year period to determine the incidence of frailty, which was defined by the presence of 3 or more of the following 5 components derived from the Cardiovascular Health Study: low level of mobility, low physical activity level, weakness, shrinking and poor endurance and energy. Adjusted hazard ratios (HRs) of incidence of frailty according to sex-stratified tertiles of baseline MBF were calculated using Cox proportional hazards regression models. During the follow-up, 49 participants (15.2%) developed frailty. Participants in the lower tertile of MBF exhibited a significantly greater risk of frailty than those in the upper tertile. After adjustment for sex, depression, diabetes and Eichner index, the adjusted HRs for frailty in the upper through lower tertiles of MBF were 1.00 (reference), 1.27 (95% confidence interval [CI]: 0.50-3.20) and 2.78 (95% CI: 1.15-6.72), respectively (P for trend =.01). Poor oral function, as indicated by low MBF, increases the risk of development of frailty among elderly men and women.

DOI： 10.1111/joor.12578

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© 2018 John Wiley & Sons A/S. Aim: To evaluate the longitudinal association of combined healthy lifestyle factors with incidence or progression of periodontitis and tooth loss in older adults. Materials and methods: This 6-year study included 374 Japanese 70-year olds with 7,157 teeth, from a source eligible baseline population of 554 individuals. Four lifestyle factors—cigarette smoking, physical activity, relative weight, and dietary quality— were scored as healthy (1 point) or unhealthy (0 point). Adding the individual scores generated the “healthy lifestyle score” (0–4 points). Multilevel mixed-effects logistic regression models were applied to evaluate tooth-specific associations between the baseline healthy lifestyle score and the incidence or progression of periodontitis (increase in clinical attachment loss ≥3 mm) and tooth loss. Results: After 6 years, 19.0% of the teeth exhibited periodontitis incidence or progression and 8.2% were lost. Compared with a healthy lifestyle score of 0–1 (least healthy), the highest score (4 points) was associated with a significantly lower tooth-specific risk of periodontitis (adjusted odds ratio = 0.32; 95% confidence interval: 0.16–0.62) and tooth loss (adjusted odds ratio = 0.42; 95% confidence interval: 0.23–0.77). Conclusions: Simultaneous adherence to multiple healthy lifestyle factors significantly lowers the risk of incidence or progression of periodontitis and tooth loss in older adults.

DOI： 10.1111/jcpe.12920

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© 2014 John Wiley & Sons AS and The Gerodontology Association. Published by John Wiley & Sons Ltd. Background and Objective Potentially significant associations between metabolic syndrome (MetS) and periodontal disease have been reported in recent studies; however, there is a dearth of literature regarding the relationship of MetS with serum antibody levels to periodontal pathogens. The aim of this cross-sectional study was to investigate the association between MetS and serum antibody to the periodontal pathogen Porphyromonas gingivalis (P. gingivalis) in 216 Japanese individuals aged 79 years. Materials and Methods Serum antibody levels to P. gingivalis were measured by enzyme-linked immunosorbent assay. An elevated serum antibody response was defined as the upper quartile and was considered as the outcome variable. A multivariable logistic regression model was used to evaluate the association of MetS defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria with an elevated antibody status. Adjustments for gender, income, education, smoking status, dental-care utilisation patterns and brushing frequency were considered. Results The prevalence of MetS was 22.2% (n = 48). Study participants with MetS were 2.9 times more likely to have an elevated serum antibody to P. gingivalis (adjusted odds ratio = 2.91, 95% confidence interval = 1.24-6.85) after simultaneous adjustment for other covariates. Conclusion Our findings suggest an independent relationship between MetS and serum antibody levels to P. gingivalis in the Japanese elderly. Additional longitudinal epidemiologic studies with larger, more diversified samples and more complete information are needed to substantiate our findings.

DOI： 10.1111/ger.12135

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© 2016 Japan Geriatrics Society. Aim: Saliva is important for maintaining oral function and regulating oral health. Reduced saliva flow rate, which is common among older adults, has been reported to be associated with perceived chewing and swallowing difficulties; however, its relationship to actual nutrient intake is unclear. The aim of the present cross-sectional study was to evaluate the relationship between hyposalivation and nutrient intake among older Japanese adults. Methods: The participants were 352 community-based Japanese aged 80 years. A stimulated salivary flow rate <0.5mL/min was defined as hyposalivation. Multivariable analysis of differences in nutrient and food intake outcome variables, which were collected through a validated food frequency questionnaire, between groups with/without hyposalivation was carried out using general linear models. Models included adjustment for number of teeth, denture use, sex, income, education, body mass index, smoking status, alcohol use, diabetes, medication, activities of daily living, depression and total calorie intake. Results: The hyposalivation group had significantly lower intake of n-3 polyunsaturated fatty acid, potassium, vitamin D, vitamin E, vitamin B6 and folate than the group without hyposalivation (P<0.05) after adjusting for confounders. Vegetable, fish and shellfish consumption was significantly lower in the hyposalivation group (P<0.05). Conclusions: Dietary intake was poorer in those with hyposalivation than among those without. A decrease in stimulated salivary flow rate could have negative effects on geriatric nutrition.

DOI： 10.1111/ggi.12500

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© 2014, The Society of The Nippon Dental University. The present study aims to investigate the correlation between SNP genotype patterns and periodontitis severity in Japanese type II diabetic patients. A cross-sectional study in 43 Japanese diabetic patients with periodontitis was performed. Blood samples were drawn for single nucleotide polymorphism (SNP) analyses and periodontal index (probing pocket depth and clinical attachment level) was subsequently recorded. Twelve functional genes with SNPs that had been shown to be associated with diabetes and/or inflammation were genotyped using a nuclease-mediated SNP-specific ligation method. Subjects with two or more sites with clinical attachment level ≥6 mm and who additionally had one or more sites with pocket depth ≥5 mm were classified as having severe periodontitis. Proportions of risk genotypes/non-risk genotypes between severe and non-severe periodontitis were subsequently compared. A high frequency (21/43 participants, 49 %) of adiponectin gene polymorphism (ADIPOQ 45T > G) homozygous risk genotype (TT genotype) was observed in the participants. The frequency of TGF-β1 SNP (29C > T) risk genotype (TT genotype) in severe periodontitis (34 %, n = 11) was significantly higher than in non-severe periodontitis (0 %, n = 0) (p = 0.04). Our study suggests that TGF-β1 SNPs (29C > T) may be used as one of the risk indicators for severe periodontitis in Japanese diabetic patients.

DOI： 10.1007/s10266-014-0171-4

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Background: There has been little evaluation in longitudinal epidemiologic studies of the effect of metabolic syndrome (MetS) on periodontal status. The specific aim of this longitudinal study is to investigate whether MetS in the Japanese population could be a risk factor for periodontal disease. Methods: A total of 125 older adults from Japan for whom data were available for the years 2003 to 2006 were selected for the current study. Full-mouth periodontal status, measured as clinical attachment level (CAL), was recorded at baseline and in follow-up examinations. Development of periodontal disease was considered to be ≥2 teeth demonstrating a longitudinal loss of proximal attachment of ≥3 mm at the follow-up dental examination. A multivariable Poisson regression model with robust error variance was used to evaluate the association of MetS defined by the modified National Cholesterol Education Program Adult Treatment Panel III criteria with development of periodontal disease. Adjustments for sex, income, education, smoking status, number of teeth at baseline, mean CAL at baseline, pattern of visits to a dentist, and brushing frequency were considered. Results: The prevalence of MetS was 21.6% (27/125). Study participants with MetS were approximately 2.6 times more likely to develop periodontal disease (adjusted relative risk 2.58, 95% confidence interval 1.17 to 5.67) after simultaneous adjustment for other covariates. Conclusions: These findings support the hypothesis that MetS may be a risk factor for periodontal disease in older Japanese individuals. Additional studies with larger, more diverse populations and more complete information are needed to substantiate the findings.

DOI： 10.1902/jop.2015.140398

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The association between adipokines and inflammatory periodontal diseases has been studied over the last two decades. This review was intended to explore the observation that periodontal therapy may lead to an improvement of adipokines in diabetic patients. In summary, substantial evidence suggests that diabetes is associated with increased prevalence, extent and severity of periodontitis. Numerous mechanisms have been elucidated to explain the impact of diabetes on the periodontium. However, current knowledge concerning the role of major adipokines indicates only some of their associations with the pathogenesis of periodontitis in type 2 diabetes. Conversely, treatment of periodontal disease and reduction of oral inflammation may have positive effects on the diabetic condition, although evidence for this remains somewhat equivocal.

DOI： 10.4239/wjd.v5.i6.924

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Language：Japanese   Publisher：Japanese Society for Oral Health  

<p> This study aimed to examine trends in the number of teeth (NofT) by age, identify potential NofT trajectory patterns, and explore whether these trajectory patterns were associated with all-cause mortality among community-dwelling older adults. The study population consisted of 299 adults (baseline age, 70 years; 154 men and 145 women) who had 20 or more teeth. NofT data collected annually from 70 to 80 years of age were used to assign study members to trajectories applying group-based trajectory modeling. Three distinct NofT trajectories were identified: "retaining 28 teeth"; "mid-NofT, decreasing"; and "low-NofT, decreasing". Survival analysis using Cox-proportional hazard modeling with a maximum follow-up of 15 years (from 70 to 85 years of age) showed that the "retaining 28 teeth" trajectory was associated with lower all-cause mortality (adjusted hazard ratio = 0.50, 95% confidence interval = 0.28‒0.89) compared with the "low-NofT, decreasing" trajectory. These study results indicate that there is heterogeneity in the trend of NofT by age among community-dwelling adults with 20 or more teeth in their 70s, and that retention of a larger number of teeth, ideally 28 teeth, during later life is associated with greater longevity.</p>

DOI： 10.5834/jdh.69.3_131

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：Japanese Society for Oral Health  

<p> With advanced aging, there are growing demands for the management of sick persons and medical liaison systems. In such a situation, clinics are expected to play roles as primary medical institutions, such as dealing with diverse patients and promoting community-based multi-professional collaboration. To clarify the association between the statuses of different types of professionals working in dental clinics and their service contents, a questionnaire survey was conducted, involving all dental clinics in Niigata Prefecture (1,186 as of August 1, 2012), along with examination of their service provision in July of the same year. Among these clinics, 950 that responded to the questionnaire without missing values were analyzed. With the number of dentists or dental hygienists working in the study clinics as an explanatory variable and those of dental assistants and clerks as covariances, logistic regression analysis was performed to analyze the contents of home dental care services. Ordered logistic regression analysis was also used to examine the management of patients with disabilities and the provision of feeding/swallowing guidance.</p><p> The items only associated with the number of dental hygienists were home dental care services, visits to care facilities, dental hygiene guidance for care facilities, and the management of patients with disabilities (adjusted odds ratio [95% confidence interval]=1.12 [1.03-1.23], 1.11 [1.03-1.23], 1.31 [1.16-1.47], and 1.27 [1.16-1.40], respectively). The provision of feeding/swallowing guidance was only associated with the number of dentists (1.24 [1.04-1.48]).</p><p> In order to promote the management of diverse patients in dental clinics and their liaison with hospitals, it may be necessary to enhance dentists' awareness as a premise and basis for ensuring sufficient numbers of dentists and dental hygienists working in such clinics.</p>

DOI： 10.5834/jdh.69.1_10

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：Japanese Society for Oral Health  

<p> Self-rated health is a simple way of assessing the health status. It is also used for oral health research in general population surveys. However, limited information is available on younger populations aged under 65 years.</p><p> Accordingly, the aim of this cross-sectional study was to investigate the association between the self-rated tooth and gingival health and self-rated general health based on a survey conducted by the 8020 Promotion Foundation in 2015.</p><p> For this survey, questionnaires were mailed to 5,000 people, aged 20 to 79, who were selected by stratified two-stage random sampling from Japanese municipalities, and 2,465 people responded (response rate=49.3%). </p><p> Data without missing responses from 1,972 participants were used for analysis.</p><p> The subjects were divided into three groups according to age: young participants (aged 20-39 years), middle-aged participants (aged 40-59 years), and elderly participants (aged 60-79 years).</p><p> An ordinal logistic regression model was created to evaluate the association between self-rated tooth and gingival health and self-rated general health for each group.</p><p> Multivariable models were adjusted for the number of teeth, sex, employment status, subjective economic status, education, comorbidity, presence of an adviser, and body mass index.</p><p> Based on the ordinal logistic regression analysis, participants with good self-rated tooth and gingival health had significantly better self-rated general health. The adjusted odds ratio (95% confidence interval) was 12.41 (7.22-21.34) for the young participants, 11.77 (7.50-18.48) for the middle-aged participants, and </p><p>10.07 (6.55-15.50) for the elderly participants.</p><p> The present study suggests that the self-rated tooth and gingival health is significantly correlated with self-rated general health among general Japanese subjects in all age groups.</p>

DOI： 10.5834/jdh.68.4_198

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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<p> The aim of this cross-sectional study was to evaluate the associations of tooth loss, denture use, and self-perceived denture fit with frailty in community-dwelling older Japanese adults. The subjects were 344 Japanese adults (177 men and 167 women) aged 79 years in Niigata City (Japan), who participated in an oral and general health examination and a questionnaire survey in 2007. Frailty was defined as the presence of ≥ 2 of the following 3 factors derived and modified from the Study of Osteoporotic Fracture Criteria for Frailty: 1) weight loss ≥ 5% over 2 years, 2) inability to do chair stands, and 3) answer of "no" to the question "Do you feel full of energy?". Associations between frailty and tooth loss, denture use, and self-perceived denture fit were evaluated using logistic regression analysis. The multivariable models were adjusted for sex, body mass index, and mental health. The frequency of frailty in this study was 8.4%. Multivariable logistic regression indicated that tooth loss (per each additional tooth present, adjusted odds ratio [OR]=0.94; 95% confidence interval [CI]=0.90–0.99), the presence of 20 teeth or more (compared with the presence of less than 20 teeth, adjusted OR=0.39, 95% CI=0.15–0.97), denture non-use (compared with denture use, adjusted OR=17.89, 95% CI=5.00–64.32), and self-perceived ill-fitting denture (compared with well-fitting denture, adjusted OR=3.38, 95% CI=1.01–11.27) were significantly correlated with frailty. Our results suggest that tooth loss, denture non-use, and self-perceived ill-fitting denture were associated with frailty in community-dwelling older Japanese adults.</p>

DOI： 10.5834/jdh.68.2_68

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

認知症に影響する口腔関連の要因には、歯周組織の慢性炎症状態、口腔への刺激および咀嚼運動による脳への刺激、口腔機能の低下による低栄養、長期間にわたるバランスの良い食事スタイル、生活習慣病および社会交流が挙げられる。これらのエビデンスとして国内外での多くの縦断または介入研究において、認知機能の低下・認知症の発症と口腔健康状態との間で有意な関連が報告されている。したがって、口腔保健は認知症予防に寄与する蓋然性が高いと考えられ、口腔保健に従事する関係者は、このことを念頭に置いて一次〜三次予防(口腔疾患の予防、早期発見・早期治療による歯の喪失の予防、喪失部位に対する補綴治療)を系統的に今後進めていく必要がある。また、口腔保健からのアプローチは他職種との連携を通して行われる必要がある。加えて、政策面においては高齢者における介護予防プログラムへの歯科保健の導入を一層促進すべきであり、研究面においては認知機能の低下・認知症の発症に及ぼす口腔保健の効果についてエビデンスをさらに積み重ね、認知症予防に向けた認知症施策の推進と評価に資する根拠と実践を図ることが必要である(図)。(著者抄録)

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Language：Japanese   Publisher：(一社)日本有病者歯科医療学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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Language：Japanese   Publisher：有限責任中間法人日本口腔衛生学会  

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Language：Japanese   Publisher：新潟歯学会  

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Language：Japanese   Publisher：(一社)日本口腔衛生学会  

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