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Background: Daily management of oral hygiene reduces mortality risk in older adults. This study aimed to investigate whether oral function(s) are related to the levels of oral bacteria in community-dwelling older adults.
Methods: A cross-sectional pilot study was conducted. Oral functions, including chewing ability, maximum labial closing force, and maximum tongue pressure, were evaluated. Oral bacterial level was assessed using a rapid quantification system based on a dielectrophoresis impedance measurement method. The correlation between oral bacterial level and each variable was evaluated using Pearson correlation coefficient and multiple regression analysis. Multiple comparisons of variables according to oral bacterial levels were performed by analysis of covariance to adjust for confounders.
Results: All participants were women. Among oral functions, only maximum tongue pressure was inversely correlated with oral bacterial level, according to Pearson correlation coefficient(r = −0.69, p = 0.005) and multiple regression (B ± SE = 0.081 ± 0.026, p = 0.014) analyses. The maximum tongue pressure in subjects with 106.5 to 107colony-forming units (CFU)/ml of oral bacteria (39.2 ± 3.9) was significantly higher than in those with 107 to 107.5CFU/ml (30.2 ± 5.1) (p = 0.004) and 107.5 to 108CFU/ml level (25.3 ± 2.3) (p = 0.001), adjusted for age.
Conclusion: Within the limitations of this pilot study, increasing tongue pressure was significantly associated with lower oral bacterial levels in community-dwelling older adults.
Keywords: Chewing ability, Labial closing force, Older adults, Oral bacteria, Tongue force
Aging is positively correlated with the presence of opportunistic infections, including methicillin-resistant Staphylococcus aureus, Haemophilus influenza,and Candida albicans,in the oral cavity . Recent increasing number of remaining teeth cause a detrimental effect on the prevalence of periodontitis in older adults in Japan. A high prevalence of periodontitis in older adults increases the risk for carotid intima media thickness, hypertension, and atherosclerotic plaque formation, leading to cardiovascular diseases [9-11]. A relationship between periodontitis and pneumonia and/or mortality risk from pneumonia in older adults has also been identified [12,13]. Poor oral hygiene and/or ineffective denture cleaning are possible risk factors for pneumonia [14,15]. Multiple lines of evidence have suggested that aging-related growth of oral pathogens increase the risk for systemic disease among older adults.
The purpose of this study, therefore, was to investigate whether deterioration of oral function(s) is correlated with the levels of oral bacteria in community-dwelling older adults. Our hypothesis was that oral frailty appearing in the lips, tongue, and chewing ability are impacted by levels of oral bacteria.
Study design and participants
Fifteen individuals who attended a seminar addressing food and health were surveyed in this cross-sectional study, which was performed in July 2017. Oral bacterial level and oral functions were assessed at 09:00-10:00 am. This study was conducted with the approval of the Medical Ethics Committee of Kyushu Dental University (No.17-1). Informed consent for participation was obtained from all subjects after written explanation of the study was provided.
Oral bacterial levels
Bacterial levels were measured using a rapid oral bacteria quantification system (Panasonic Healthcare Co. Ltd., Osaka, Japan),based on a dielectrophoresis and impedance measurement method [16,17]. The detection limit of this equipmentwas105colony-forming units (CFU)/ml. Definition of bacterial level conformed to manufacturer’s instructions as follows: level 1, <105CFU/ml; level 2, 105 to 106CFU/ml; level 3, 106 to 106.5CFU/ml; level 4, 106.5 to 107CFU/ml; level 5, 107 to 107.5CFU/ml; level 6, 107.5 to 108CFU/ml; and level 7, >108CFU/ml.
Chewing ability test
Labial closing force measurement
Labial closing force was evaluated using Lipplekun (Shofu Co., Kyoto). This newly developed medical device consists of a measuring apparatus and spindle connected to a disposable button-type intraoral piece by dental floss. Labial closing force is measured with a range from 0 N to 19.9 N. Measurement was performed with subjects in a relaxed sitting position, who were asked to grasp the button type piece with their lips as tightly as possible. The measurement was performed 3 times, and the maximum value was considered to represent the labial closing force.
Tongue pressure measurement
Tongue pressure was evaluated using a specified tongue pressure measurement device (JMS Co, TPM-01) . The TPM-01 is a newly developed, handheld manometry device consisting of a small balloon-type disposable oral probe. At zero calibration, the probe is inflated with air at a pressure of 19.6 kPa . Measurement was performed with subjects in a relaxed sitting position, who were asked to squash the balloon-formed probe interposed between the tongue and palate with as much force as possible. The measurement was performed 3 times, and the maximum value represented tongue pressure.
Experimental data are expressed as mean ± standard deviation (SD). Multiple regression analysis was used to analyze factors correlated with each variable. Analysis of covariance was performed for multiple comparisons adjusted for confounders. Comparison with each pair was analyzed by generalized linear model. Statistical analysis was performed using SPSS version 22 (SPSS Japan Inc., Tokyo Japan). Two-tailed p-values were calculated in all analyses; the alpha level for statistical significance was set at 0.05.
RESULTS AND DISCUSSION
The labial closing force plays an important role in holding the food bolus in the oral cavity, and maintaining negative pressure during swallowing. Previous studies have reported that labial closing force is positively correlated with hand grip force in older adults , suggesting a close relationship with frailty. Labial closing force is a critical factor for swallowing capacity in stroke patients with subclinical facial paresis; however, these two factors have no relationship in healthy subjects . That study also demonstrated that labial closing force had no correlation with age.31In the present study, all participants were healthy, which may explain why labial closing force was not correlated with other oral functions or bacterial levels. In addition, our results also indicated no relationship between labial closing force and age, which is consistent with previous studies.
This pilot study had several limitations, the first of which was the small number of subjects and its preliminary nature. Whereas neither chewing ability nor maximum labial closing force were correlated with bacterial levels, other outcome(s) may be revealed with a larger sample size. Second, we could not assess sex-based differences in oral bacterial levels and oral functions because all of our subjects were women. Previous studies have reported sex-based differences in the prevalence ratio of periodontitis  and the risk for frailty . Third, the effect of the number of teeth, occlusal support, or denture wearing on oral functions and/or oral bacterial levels was not assessed because oral examinations were not performed in this study. Fourth, not all potential confounding factors, such as education level, socioeconomic status, or health-related behavior, were collected. A previous study reported a significant relationship between socioeconomic status and oral hygiene habits, including tooth brushing frequency and periodical dental examination, in residential homes for older adults .
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