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A systematic and comprehensive review of the postgraduate (PG) level of gerodontology (GD) worldwide to gather information regarding 1) curriculum contents, 2) teaching methods, and 3) learning outcomes. Background: Providing geriatric education to dental personnel is crucial to cope with aged societies. There are scoping reviews regarding undergraduate curriculums, however, there is none for the post-graduate gerodontology (PG GD) programs. Objective: To systematically gather information about 1) topics, 2) teaching methods and 3) competencies/program learning outcomes from existing PG GD around the world to explore what and how Methods: This scoping review was conducted according to JBI Manual for Evidence Synthesis for a Scoping Review. MEDLINE via PubMed, Academic Search Ultimate (ASU) and Educational Resources Information Center (ERIC) were selected databases. Grey literature was explored via Google Scholar, Grey Matter, Grey Literature Report, and the university's sites web searching providing information on existing programs. In addition, we also directly contacted the directors of existing programs via email for pre-existing curriculum documents. Information was retrieved and collected by two members, and it analyzed by all four members by meeting Review questions: The purpose of this study is to gather data from existing programs worldwide, in order to address the review questions: 1) What are the content areas taught in a PG GD degree? 2) How are the topics in question one delivered to the students? 3) What competencies or learning outcomes are expected of students upon completion of their courses?

Background Oral hypofunction is defined as the reversible stage preceding oral dysfunction. However, its assessment and management need further examination and consideration. Objective The present study aimed to examine the current state of oral hypofunction among outpatients at the university hospital. Methods New outpatients underwent medical interviews and detailed assessment of oral hypofunction at their initial visit to our dental department. Oral hypofunction was diagnosed if results of three of the following seven assessment items were below cutoff values: poor oral hygiene, oral dryness, reduced occlusal force, decreased tongue-lip motor function, decreased tongue pressure, decreased masticatory function, and deterioration of swallowing function. The relationships between factors used to diagnose oral hypofunction as well as the distributions of assessment values were clarified. Results Seventy-five of 209 patients (35.9%) were finally diagnosed with oral hypofunction. Diagnosis of oral hypofunction was significantly related to patient age, Eichner index, a chief complaint of dental or periodontal disease or ill-fitting dentures, and a history of neurodegenerative disease. The lowest quintile values for poor oral hygiene, oral dryness, and decreased masticatory performance were all above current cutoff values. Reduced occlusal force contributed strongly to the diagnosis of oral hypofunction. Conclusion Oral hypofunction in dental outpatients at a university hospital was associated with patient age, medical history, and chief complaint at presentation. Diagnosis of oral hypofunction can be closely related to reduced occlusal force. The validity of cutoff values for assessments of oral hypofunction needs further consideration.

It has not yet been clarified how the type of the chewing task affects related muscle activity and how the suprahyoid muscles contribute to masticatory function in humans.This study aimed to investigate the difference in the suprahyoid muscle activity between the freely and unilaterally chewing tasks and between the working and non-working sides during chewing.Twenty healthy volunteers were instructed to chew peanuts and two different types of rice crackers in two ways: freely and unilaterally while surface electromyograms of the masseter and suprahyoid muscles were recorded. The chewing duration, number of chewing cycles and chewing rate were compared between the tasks. Furthermore, the masseter and suprahyoid muscle activities per chewing cycle were compared between the sides.The chewing duration was significantly longer, and the chewing rate was significantly higher during unilaterally chewing than freely chewing. The chewing duration differed significantly among the different foods; the harder the food, the longer the duration. Chewing rate and suprahyoid activity were significantly higher during soft rice cracker chewing. Masseter activity was higher on the chewing side than on the non-chewing side while there was no difference in suprahyoid activity between the sides.The current results demonstrate a difference in the masticatory efficacy between the chewing tasks and a functional role of the suprahyoid muscles during chewing, which does not differ between the chewing and non-chewing sides.

Background :The occurrence of pneumonia is strongly associated with oral health in older people. The study aim was to clarify the effect of the suspension of visiting dental services on the occurrence of pneumoniaduring thecoronavirus disease 2019 (COVID-19) pandemic.Methods :A self-administered postal questionnaire survey was conducted in 215 nursing homes in Japan. The questionnaire assessed the provision of visiting dental services and the interruption of theseservices following COVID-19emergency restrictions. Pneumonia, hospitalization, and mortality rates were examinedfor January–June 2019 and January–June 2020. Results :Of facilities receiving visiting dental services, 37.7%had interruptions tothoseservices. Overall, pneumonia, hospitalization, and mortality rates were lower in 2020 compared with 2019.In those facilities with nointerruptions, rates were significantly lower in 2020 compared with 2019,whereasthere was no significant difference between 2019 and 2020 in facilities with interruptions.Conclusion :Continuous dental services in nursing homes during the COVID-19 pandemic led to lower rates of pneumonia, hospitalization, and mortality.

Examining the coordination of respiration and swallowing is important for elucidating the mechanisms underlying these functions and assessing how respiration is linked to swallowing impairment in dysphagic patients. In this study, we assessed the coordination of respiration and swallowing to clarify how voluntary swallowing is coordinated with respiration and how mastication modulates the coordination of respiration and swallowing in healthy humans. Twenty-one healthy volunteers participated in three experiments. The participants were asked to swallow 3 ml of water with or without a cue, to drink 100 ml of water using a cup without breathing between swallows, and to eat a 4-g portion of corned beef. The major coordination pattern of respiration and swallowing was expiration–swallow–expiration (EE type) while swallowing 3 ml of water either with or without a cue, swallowing 100 ml of water, and chewing. Although cueing did not affect swallowing movements, the expiratory time was lengthened with the cue. During 100-ml water swallowing, the respiratory cycle time and expiratory time immediately before swallowing were significantly shorter compared with during and after swallowing, whereas the inspiratory time did not differ throughout the recording period. During chewing, the respiratory cycle time was decreased in a time-dependent manner, probably because of metabolic demand. The coordination of the two functions is maintained not only in voluntary swallowing but also in involuntary swallowing during chewing. Understanding the mechanisms underlying respiration and swallowing is important for evaluating how coordination affects physiological swallowing in dysphagic patients.

Outcome prediction for dysphagia recovery is essential for rehabilitation treatment planning. Several studies have reported various predictors for resuming oral feeding after post-stroke dysphagia. However, evidence on oral health and function, a crucial part of feeding, has rarely been reported. Therefore, the goal of this study was to identify the oral status-related factors that could predict oral intake resumption in acute stroke patients.80 acute stroke patients with dysphagia were included. Clinical data, including the changes of general condition, oral and swallowing functions, were collected once a week until discharge. Patients were divided into two groups based on the outcome of the food intake level scale at discharge, and data were compared between the groups.60 patients had regained complete oral intake before discharge. Multiple logistic regression showed that posterior tongue pressure could significantly predict complete oral intake recovery. Tongue pressure and modified water swallowing test score also significantly influenced diet forms. In addition, Spearman correlation analysis showed that improvement of other oral status-related factors, such as oral moisture and dentition status, also indicated the improvement of diet forms and swallowing function during the hospital stay.Tongue pressure measurement could be a useful oral status-related indicator for predicting complete oral intake and adjusting diet forms for acute stroke patients during hospitalization. Acute stroke patients should receive proper oral status evaluation and implementation to enhance functional recovery.

There is wide variation in chewing behaviours, even among healthy humans. Further, the way in which humans determine swallowing initiation when chewing solid foods remains unclear. The current study sought to investigate how the bolus properties change over time during chewing, and to clarify which factors affect chewing and swallowing behaviours, including swallowing initiation, in healthy humans. Twenty-four healthy volunteers were instructed to chew 8 g of steamed rice and spit it out at 50%, 100% and 150% of their own chewing duration, defined as the time of chewing from onset of the first chewing cycle to onset of the first swallow. Chewing and swallowing behaviours were monitored and determined by visual inspection of video recordings. The physical properties such as hardness, cohesiveness and adhesiveness as well as water content of the bolus were measured. In each subject, maximum bite force, tongue pressure and stimulated salivary flow rate were also measured. Hardness gradually decreased, and the cohesiveness and water content of the bolus did not change up to 50% of chewing duration, followed by a slight but significant increase. The adhesiveness of the bolus rapidly decreased at the beginning of chewing. Chewing duration was significantly related to stimulated salivary flow rate; greater salivary flow rate was associated with shorter chewing duration. Variation of chewing duration and swallowing initiation was not dependent on bolus properties during the chewing of steamed rice, but mainly depended on the surface lubrication of the bolus.

Background: To date, there have been few guidelines proposed for adjustment of the food consistency, particularly to match the oral function of older adults, which will guide clinicians and caregivers in appropriately modifying food. Objective: We investigated how oral, swallowing, and cognitive conditions of older adults who required daily nursing care in a nursing home were associated with different dietary food consistencies. Methods: Clinical examinations to record dentition status, swallowing, and cognitive functions were performed, and the feeding status, including the food consistencies and need for assistance at lunchtime, was evaluated in 37 older residents in nursing homes. The swallowing function was assessed by performing a modified water-swallowing test, and food swallowing was tested using pudding and rice crackers. The χ2 test was used to determine the relationships among the parameters. Results: No participants were able to take cooked rice, nor regular and soft side dishes. There was no significant relationship between dentition status and feeding status. Of the participants, 95% ate pudding without any problems and 49% ate rice crackers without any signs of swallowing difficulty such as coughing or stopping chewing. There was a significant relationship between the food test score using a rice cracker and the level of food consistencies, and between the same test score and the level of mealtime assistance, whereby the better the score of the food test using a rice cracker, the better was the level of food consistencies including use of a thickening agent and the better was the level of mealtime assistance. Conclusion: The results strongly suggest that the food test using a rice cracker was associated with the level of food consistency and mealtime assistance for older adults in nursing homes.

We investigated how the physical properties of food affect chewing kinematics, and examined the effects of aging on behavior. Twenty young and 21 older volunteers were asked to freely chew rice crackers and spit the food out at their average chewing duration. We compared chewing characteristics among the conditions (age × rice cracker), and examined the area of rectified masseter and suprahyoid electromyographic bursts per chewing cycle. We also evaluated temporal changes in those values. In addition, the bolus properties at the end of chewing were compared. The harder/larger the rice cracker, the longer the chewing duration and the greater the number of chewing cycles. These values also increased with age. Chewing cycle time was not affected by age and rice cracker properties, except in one condition: for the rice cracker with the lowest hardness and density, the chewing cycle time was longer than for the other rice crackers. Chewing cycle time decreased at the middle stage of chewing, followed by an increase, with increasing suprahyoid electromyographic activity at the late stage. The physical properties of the bolus at the end of chewing did not differ between age groups, and depended on the initial properties. The water absorption rate of the bolus was significantly greater for the rice cracker with the lowest hardness and density compared with other rice crackers. The results demonstrated that not only hardness, but also other factors, such as density, significantly affected chewing behaviors.

We investigated how swallowing behaviors are affected by the temperature and carbonation of water in healthy humans. Twenty-nine healthy volunteers were instructed to drink as much natural water, carbonated water, or cider as they wanted, and we recorded the volume of solution swallowed and electromyographic (EMG) activity of the masseter and suprahyoid muscles. Sensory tests regarding the ease of holding the solution in the mouth and ease of swallowing were also performed. The volume of carbonated water swallowed was significantly lower than that of natural water and cider. The ease of holding and swallowing the solution significantly differed between solution types such that natural water was the easiest solution to hold and swallow, followed by cider and then carbonated water in both tests. EMG activity was also affected by the solution type. Masseter EMG activity was significantly lower when swallowing natural water compared with carbonated water. Suprahyoid EMG activity was significantly lower when swallowing natural water compared with carbonated water and cider. The volume of solution swallowed was significantly correlated with the ease of holding and swallowing the solution, but not with masseter or suprahyoid EMG activities. The ease of holding and swallowing the solution significantly affected masseter and suprahyoid EMG activities. The results suggested that when participants experienced difficulty holding and swallowing the solution, masseter and suprahyoid EMG activity increased. Considering our findings that mechanical stimulation with bubbles decreased the volume of solution swallowed and increased EMG activities, carbonated water swallowing may be useful in treating deglutition disorders.