Oral frailty can contribute to physical and mental health disorders. Previous research has shown an association between frailty and self-reported difficulty in chewing or swallowing. However, their combined assessment has obscured their specific impact on frailty-related outcomes. To investigate the independent associations between difficulty in chewing or swallowing and 1-year frailty outcomes, while also examining their interactions. This retrospective cohort study utilized the DeSC database to identify older adults aged ≥ 75 years who underwent health checkups between April 2014 and November 2022. Multivariate Cox regression analyses were conducted to assess the association between self-reported difficulty in chewing or swallowing and outcomes, including hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality within 1 year. Interactions between chewing and swallowing difficulties were also evaluated. Among 359,111 older adults, 39.0% reported oral function difficulties. Swallowing difficulty alone lacked significant outcome association. However, chewing difficulty alone was significantly associated with higher risks of hospitalization due to aspiration pneumonia (hazard ratio (HR), 1.35; 95% confidence interval (CI), 1.15-1.58; P < 0.001), all-cause hospitalization (HR, 1.08; 95% CI, 1.05-1.11; P < 0.001), and all-cause mortality (HR, 1.28; 95% CI, 1.14-1.44; P < 0.001) compared with no self-reported difficulty. A significant positive interaction between self-reported difficulty in chewing and swallowing was observed for all-cause mortality (P = 0.009). Self-reported difficulty in chewing was significantly associated with higher risks of hospitalization due to aspiration pneumonia, all-cause hospitalization, and all-cause mortality among older adults. Chewing and swallowing difficulties showed a synergistic effect, significantly increasing all-cause mortality risk.

This prospective clinical study aimed to assess self-reported orofacial esthetics, chewing function, and oral health-related quality of life (OHRQoL) over three years in the Kennedy Class I patients without posterior dentition who received free-end saddle removable partial dentures (RPDs) retained by two mini dental implants (MDIs) inserted in the canine/first premolar region. The study\'s robust findings reaffirm the viability of MDI-retained RPDs as a treatment modality in contemporary prosthodontics, instilling confidence in the dental community.
METHODS: 92 participants with posterior edentulism in the maxilla or mandible received 184 MDIs and 92 RPDs. After one year, three participants were excluded, and another seven were excluded after three years. The final sample was 82 participants. Self-perceived orofacial esthetics was assessed by the Orofacial Esthetic Scale (OES), chewing function by the Chewing Function Questionnaire (CFQ), and the OHRQoL by the OHIP-14. Statistical analysis utilized multivariate regression analysis, standardized effect size calculation, Wilcoxon Signed Rank test, and Friedman\'s test.
RESULTS: OHRQoL and chewing function significantly improved (p < 0.001) one month after MDI loading by the new RPDs and continued to improve over the observation period (p < 0.05). The OES also significantly improved (p < 0.001) and remained almost unchanged over the next three years (p = 0.440).
CONCLUSIONS: Despite the limitations of this study, the MDI-retained RPD appears to be a viable treatment modality in contemporary prosthodontics from the patients\' perspective.

BACKGROUND: The Test of Mastication and Swallowing Solids (TOMASS) is a reliable tool for assessing chewing and swallowing in healthy adults, using commercially available crackers. TOMASS-Children (TOMASS-C) is the paediatric version of TOMASS.
OBJECTIVE: The present study aimed to establish normative data for TOMASS-C using a validated regional commercial cracker among healthy individuals aged between 6-20 years of India.
METHODS: 327 healthy individuals between 6-20 years were recruited in a cross-sectional study design following a convenient sampling procedure. Participants consumed one validated regional cracker and the procedure was video recorded. Data were stratified according to age groups (6-7, 8-9, 10-13, 14-17 and 18-20 years) and sex (boys and girls). Two Speech Language Pathologists independently analysed the video recordings to derive discrete bites, masticatory cycles, swallows and total swallow time indices. Using them, time/swallow, masticatory cycles/bite, swallows/bite and time/bite were calculated.
RESULTS: All parameters of TOMASS-C had moderate to good (0.6-0.85) test-retest reliability and moderate to excellent (0.69-0.99) inter-rater reliability at p > .000. Younger participants took more bites, chewed more times and swallowed more frequently with longer chewing and swallowing time. Boys exhibited a lower number of swallows, shorter swallow time and reduced total masticatory time at p > .05. Additionally, girls demonstrated fewer bites and chewing cycles compared to boys at p > .05.
CONCLUSIONS: TOMASS-C using a validated regional cracker was feasible and reliable. Normative data established for healthy boys and girls between 6-20 years offers much-needed quantitative data to objectively delineate individuals with and without chewing and swallowing solid food difficulties.

Edentulism can generate negative impacts on self-esteem, interpersonal relationships, and oral functions. Removable prostheses are commonly used for tooth replacement, but they may cause discomfort due to micromovements during mastication. Objective and quantifiable methods are needed to evaluate these micromovements. A pilot study was conducted to determine the micromovements in removable prostheses during mastication using a 3D electromagnetic articulography (EMA-3D) system. One elderly participant wearing lower removable prostheses and an upper total well-fitting removable prosthesis was studied. The EMA-3D system was used to record movements in three spatial planes. Peanuts were given as test food, and the participant was instructed to chew normally while recordings were carried out until feeling the need to swallow. Analyses of the upper total prosthesis show micromovements ranging from 0.63 ± 0.11 to 1.02 ± 0.13 mm. During simultaneous analyses of the upper prosthesis and lower partial prosthesis, interference was not observed. This pilot study demonstrated the feasibility of using the EMA-3D system to evaluate micromovements in removable prostheses during mastication. Further research is needed to evaluate a larger sample and assess the clinical implications of these micromovements.

OBJECTIVE: To examine the association between rheumatoid arthritis (RA) and oral hypofunction (OHF) using propensity score matching (PSM) to adjust for differences between older adults with RA and the general older adult population.
METHODS: We conducted a cross-sectional survey among 189 older adults with RA in 2019 (mean age, 71.9 ± 3.6) and 47 178 independent older adult residents in 2016 (mean age, 71.6 ± 4.0), respectively. The questionnaire covered information on socio-demographic characteristics and OHF for both groups. Age, sex, educational level and smoking history were used to determine PSM. Prevalence ratios (PRs) and 95% confidence intervals (CIs) of self-reported OHF (fewer remaining teeth, decreased masticatory function, deterioration of swallowing function and oral dryness) were estimated using Poisson regressions.
RESULTS: OHF was observed in 44.4% of patients with RA and 27.5% of residents. Before PSM, the prevalence of OHF among patients with RA was higher than that of residents (PR, 1.75; 95% CI, 1.50-2.05). After PSM, there were 189 patients with RA and residents, and the prevalence of OHF among patients with RA was still higher (PR, 1.61; 95% CI, 1.22-2.13). Poisson regression showed that the prevalence of 19 or fewer teeth (PR, 1.06; 95% CI, 0.82-1.36), difficulties eating tough foods (PR, 1.18; 95% CI, 0.90-1.55), difficulties swallowing tea or soup (PR, 1.77; 95% CI, 1.19-2.63), and dry mouth (PR, 2.79; 95% CI, 1.90-4.07) was higher among patients with RA than residents.
CONCLUSIONS: Compared with the general older adult population, patients with RA have a higher prevalence of self-reported OHF.

OBJECTIVE: This study aimed to investigate the effect of periodontitis and current occlusal relationship on the progression rate of Alzheimer\'s disease (AD).
METHODS: Ninety Alzheimer\'s patients, who were divided into three groups as Stage I (n=42), Stage II (n=29), and Stage III (n=19), based on the Clinical Dementia Rating Scale, were included in the study. Cognitive status of the patients was evaluated with Standardized Mini-Mental Test (SMMT) at baseline and repeated 6 months later. Clinical periodontal examinations were recorded and occlusal relationship status was classified according to the Eichner Index.
RESULTS: Of 90 Alzheimer\'s patients, 65 were toothed individuals with periodontitis and 25 were edentulous individuals without active periodontal disease. Stage II and Stage III toothed Alzheimer\'s patients had higher percentage of bleeding on probing (BOP%) and clinical attachment level (CAL) values than Stage I patients (p<0.05). Stage III Alzheimer\'s patients had significantly higher probing pocket depth (PPD) values than Stage I individuals (p<0.05). ΔSMMT values showed positive correlation with BOP% (r=0.308, p=0.013) and PPD (r=0.275, p=0.027). Among the evaluated parameters, being in the AD Stage II-Stage III, having periodontitis and age variable had significant effects on ΔSMMT levels (p<0.05).
CONCLUSIONS: Within the limits of our study, it can be concluded that periodontitis may increase the severity and also accelerate the progression rate of AD.
CONCLUSIONS: These results are precious to show the necessity of proper oral hygiene activities and regular dental visits in patients with toothed AD.
BACKGROUND: This study was registered and approved by clinical trials (NCT05807100).

BACKGROUND: The impact of treatments on completely edentulous individuals on masticatory performance (MP), oral health-related quality of life (OHRQoL), nutritional status (NS) and socio-economic profile (SP) is unclear in the literature.
OBJECTIVE: To compare the MP, OHRQoL, NS and SP of totally edentulous elderly users of bimaxillary complete dentures (CD) and users of lower implant-supported fixed complete dentures (IFCD).
METHODS: Forty participants were allocated into groups according to rehabilitation treatment (n = 20): bimaxillary CD (G1) and lower IFCD, and upper CD (G2). The evaluation of MP used almonds by the method of sieves. Four questionnaires (Geriatric Oral Health Assessment Index-GOHAI and Oral Health Impact Profile Edent-OHIP-Edent, Brazilian Economic Classification Criteria-ABEP and Mini Nutritional Assessment-MNA) were applied to assess the OHRQoL, SP and NS of the elderly, respectively. After evaluating the statistical assumptions, the Mann-Whitney (α = .05) test was applied to compare the groups regarding MP, OHRQoL, NS and SP. Spearman\'s correlation (α = .05) was performed to verify the correlation between the MP, the OHRQoL and the NS of the participants.
RESULTS: G2 showed better MP (p < .05) in all masticatory cycles, OHRQoL (p < .05) and NS than the G1. However, the participants\' self-perception of oral health did not differ between groups (p < .05). A moderate negative correlation was found between MP and OHRQoL for 40 masticatory cycles (r2  = -0.513; p = .001).
CONCLUSIONS: Individuals rehabilitated with IFCD had a higher average monthly family income and achieved superior behaviour in MP and OHRQoL, in addition to lower risks of malnutrition when compared to individuals using bimaxillary CD.

BACKGROUND: Despite the use of dual antiemetic agents, postoperative nausea and vomiting (PONV) occurs in an unacceptably large number of patients post-tonsillectomy. There has been increased interest in alternative and non-pharmacological treatments for PONV e.g., chewing gum. We investigated if chewing a large confectionary jelly snake had prophylactic antiemetic effects postoperatively in young children.
METHODS: Prospective, open-label randomised controlled trial of 240 patients, 2-16 years. Patients administered a confectionary jelly snake to chew postoperatively were compared with a control group. The primary outcome was the number of episodes of vomiting within 6 h of the operation on an intention-to-treat basis.
RESULTS: incidence of nausea, vomiting at 6 and 24 h, rescue antiemetic use, acceptability, delayed discharge.
RESULTS: 233 patients were randomised to receive the confectionary snake (snake group, 118) or standard care (control group, 115). The number of vomiting episodes in 6 h was similar between groups on an intention-to-treat basis, with 39 episodes across 22 (19%) patients in the control group and 31 across 19 (16%) patients in the snake group (p = 0.666). From post anaesthetic care unit until 24 h there was no difference in doses of antiemetics or delayed discharge due to PONV. A secondary as per protocol analysis did not change this result.
CONCLUSIONS: Chewing of confectionery jelly snakes within one hour of waking following adenotonsillectomy with vapour-maintained anaesthesia and two prophylactic antiemetics did not further reduce the incidence of early vomiting.
BACKGROUND: prospective registration at the Australia and New Zealand Clinical Trials Registry (ACTRN12618000637246).

OBJECTIVE: The aim of this study was to examine effects of the observation of video-recorded chewing in a daily setting on mixing ability, cognition, activities of daily living, depressive symptoms and quality of life of older adults with dementia.
METHODS: A clustered randomised controlled trial was carried out with residents from 14 residential care facilities. n = 56 participants\' data were analysed. An experimental group watched videos of people chewing, displayed on tablet-PCs during lunch, while a control group watched videos of nature and buildings. This was scheduled to take place 5 days a week for 12 weeks. A two-colour chewing gum test was used to measure mixing ability, neuropsychological tests for cognition and questionnaires for the other outcomes. Effects were examined via hierarchical linear mixed model analyses for T1-T3 (i.e. pre-, halfway and post-intervention). When a significant interaction effect was found, T4 (follow-up) was also included.
RESULTS: The experimental (n = 27) and control (n = 28) groups differed on a few variables at baseline. A significant Time*Group interaction effect was found for the Mini-Mental State Examination only (b = 1.18, t(48.35) = 2.53, p = .015), in favour of the experimental group. A significant effect was also found, albeit smaller, when T4 was included.
CONCLUSIONS: One potential reason for the intervention effect on cognition is activation of specific brain areas. Some challenges associated with conducting this intervention in a daily setting are presented. Further research is required before a well-considered decision can be made regarding any potential implementation.
BACKGROUND: Number: NTR5124. Date of registration: 30 March 2015, retrospectively registered (during participant inclusion).

Human mastication is a complex and rhythmic biomechanical process regulated by the central nervous system (CNS). Muscle synergies are a group of motor primitives that the CNS may combine to simplify motor control in human movement. This study aimed to apply the non-negative matrix factorization approach to examine the coordination of the masticatory muscles on both sides during chewing. Ten healthy individuals were asked to chew gum at different speeds while their muscle activity was measured using surface electromyography of the right and left masseter and temporalis muscles. Regardless of the chewing speed, two main muscle synergies explained most of the muscle activity variation, accounting for over 98% of the changes in muscle patterns (variance accounted for >98%). The first synergy contained the chewing side masseter muscle information, and the second synergy provided information on bilateral temporalis muscles during the jaw closing. Furthermore, there was robust consistency and high degrees of similarity among the sets of muscle synergy information across different rate conditions and participants. These novel findings in healthy participants supported the hypothesis that all participants in various chewing speed conditions apply the same motor control strategies for chewing. Furthermore, these outcomes can be utilized to design rehabilitation approaches such as biofeedback therapy for mastication disorders.