岡本 美英子

Objectives: Malnutrition can influence perioperative complications and long-term survival in patients with gastrointestinal (GI) cancers. Oral functional decline is associated with decreased food intake, and a reduced number of remaining teeth contributes to malnutrition. However, the impact of preoperative oral conditions on perioperative nutritional status remains unclear. This study investigated the relationship between the number of remaining teeth and the prognostic nutritional index (PNI) in patients undergoing surgery for gastrointestinal malignancies. Methods: In total, 178 patients who underwent gastrointestinal surgery with perioperative oral management at our hospital between January and December 2022 were retrospectively analyzed. Data, including age, sex, tumor site, number of remaining teeth, blood test results, skeletal muscle index, and body mass index (BMI), were extracted from electronic medical records. The PNI and CRP-albumin ratio (CAR) were calculated. Correlations between the number of remaining teeth and nutritional indicators were examined. Results: The number of remaining teeth showed a significant correlation with the PNI in the upper gastrointestinal group (r = 0.336, p = 0.015) and with BMI in the hepatobiliary-pancreatic group (r = -0.519, p = 0.001), after adjusting for age using partial correlation analysis. No significant correlations were observed in the lower GI group. Conclusions: Among patients with upper GI cancer, a lower number of remaining teeth was associated with a lower PNI, influencing postoperative outcomes. Impaired oral function may affect the prognosis of patients with upper GI tumors, emphasizing the need for careful, comprehensive nutritional and oral management as part of perioperative support.

BACKGROUND: Postoperative pneumonia is a serious lung cancer surgery complication. Perioperative oral management can help prevent its development. OBJECTIVES: This study aimed to determine the characteristics of patients who developed postoperative pneumonia despite perioperative oral management. METHODS: This study included 396 consecutive patients who underwent lung cancer surgery under general anesthesia at Fujita Health University Okazaki Medical Center from April 2020, the opening of the hospital, to the end of December 2023. Patient data, including age, gender, body mass index, underlying disease, smoking index, spirogram, operative time, amount of blood loss during operation, and operative procedure, were obtained from medical records. Oral examinations were conducted to determine the number of remaining teeth and whether dental caries are present and to examine tooth mobility and probing pocket depths > 4 mm. Furthermore, the patients were asked whether they had regular dental checkups. The patients were divided into the pneumonia and no-pneumonia groups following lung surgery, and the factors involved in postoperative pneumonia were investigated. RESULTS: A total of 390 patients were analyzed (six were excluded), of whom 33 developed postoperative pneumonia. Among them, 17 were excluded from the analysis due to preoperative interstitial pneumonia. Consequently, the incidence of postoperative pneumonia was 16 of 373 patients (4.3%). Significant differences were observed between the groups in terms of age, sex, chronic obstructive pulmonary disease, smoking index, operative time, number of remaining teeth, and regular dental checkups. Logistic regression analysis using these significant items revealed that fewer than 20 remaining teeth were significantly associated with the development of postoperative pneumonia (p = 0.043). CONCLUSIONS: The results of this study indicated that the incidence of postoperative pneumonia following perioperative oral function management was maintained as low as that reported previously. The importance of dental intervention in the perioperative period was also elucidated. A high number of patients who developed postoperative pneumonia despite these interventions had fewer than 20 remaining teeth, suggesting that more attention should be paid to perioperative oral management, including the prevention of aspiration pneumonia.

ABSTRACT Objective We aimed to examine the effects of oral care in patients with terminal cancer approaching death. Background Patients with terminal‐stage cancer often experience symptoms like oral dryness and candidiasis. Previous studies showed that without professional dental care, oral hygiene significantly worsens within 3 weeks before death. Therefore, oral management is essential for patients with terminal cancer. However, the specific effects of oral hygiene in these patients remain unclear. Material and Methods Twenty patients were admitted to two palliative care units at our institution between June 2022 and May 2023 and received oral care multiple times before death. Oral hygiene was assessed using the Oral Health Assessment Tool (OHAT), and oral dryness was evaluated with an oral moisture checker. The Face Rating Scale (FRS) was assessed before and after professional oral care. Results During the week of death, the number of people who were able to speak and follow instructions decreased, while the number who used sedatives and oxygen increased. There was no significant difference in the degree of oral dryness before oral care between the time of hospitalisation and the week of death. However, oral dryness improved significantly after oral care at admission (before: 21.0 ± 8.3, after: 26.7 ± 3.2) and the week of death (before: 16.8 ± 8.4, after: 25.8 ± 3.7). There was no difference in the time taken for oral care or FRS scores at admission and the week of death. Conclusion Continuous oral care in patients with terminal cancer can prevent worsening oral hygiene and maintain moisture.

ABSTRACT Background There is growing interest in the relationship between oral function and lifestyle‐related diseases. Objectives This study aimed to investigate the associations between the results of oral function tests and those of blood tests for lipid abnormalities, glucose metabolism and kidney function. Methods A total of 118 individuals aged ≥ 50 years (80 men and 38 women) who had undergone health check‐ups at our hospital in 2021 and 2023 were examined. Based on the fasting blood glucose (GLU), HbA1c, high‐density lipoproteins (HDL), low‐density lipoproteins (LDL), urea nitrogen (BUN) and estimated glomerular filtration rate (eGFR) values obtained from the health check‐up results; the subjects were divided into two groups: those with test values outside the reference range in 2021 and/or 2023 and those with test values within the reference range. The results of seven oral function tests were compared between the groups using the Mann–Whitney U test. p < 0.05 was considered significant. Results The group with GLU and HbA1c values outside the reference ranges had significantly lower numbers of remaining teeth (RTN) and oral diadochokinesis (OD) values compared to the group within the reference range. The groups with HDL and LDL values outside the standard ranges had a significantly higher tongue coat index (TCI) and significantly lower OD. Significant differences in TCI and OD/ta/ /ka/ were observed between BUN groups within and outside the reference range. Likewise, significant differences in TCI, RTN and OD/ta/ /ka/ were observed between eGFR groups within and outside the reference range. Conclusions Subjects with blood test values outside the reference range exhibited a decline in oral function, indicating that a decline in oral function might increase the risk of lifestyle‐related diseases and facilitate the progression of frailty.

Introduction Oral hypofunction comprises seven aspects of oral condition, including oral hygiene, oral dryness, bite strength, tongue‐lip motor function, tongue pressure, masticatory function, and swallowing function. Each of these seven has a single diagnostic criterion; however, the use of a single indicator without consideration of sex, age, or other factors is controversial. The purpose of this study was to evaluate the association between the oral hypofunction test and sex, age, and number of remaining teeth. Methods The study was conducted at 12 facilities by the members of the Japanese Society of Geriatric Dentistry during April to December 2019. The participants comprised 181 healthy older adults aged 65 years and over (56.9% female; age range 65–95 years) who regularly visited these facilities. All tests of oral function and oral status available in Japan were performed on the participants, and the association between these tests and sex, age, and number of remaining teeth was examined. Results Sex differences were observed in masticatory function, bite force, lip closure force, jaw‐opening force, oral diadochokinesis “ka,” and tongue coating index (p < .05). In men, age was weakly (r = 0.20–0.40) associated with masticatory function, jaw‐opening force, maximum tongue pressure, oral diadochokinesis, and swallowing function. In women, the number of remaining teeth, masticatory function, jaw‐opening force, and oral diadochokinesis “ta” and “ka” was also weakly associated with age. Conclusions Performance on the oral hypofunction test differs by sex, age, and number of remaining teeth. This means that the current single criterion for evaluation requires caution in its interpretation.