Clinical and laboratory predictors for plaque erosion in patients with acute coronary syndromes

Background-—Plaque erosion is responsible for 25% to 40% of patients with acute coronary syndromes (ACS). Recent studies suggest that anti-thrombotic therapy without stenting may be an option for this subset of patients. Currently, however, an invasive procedure is required to make a diagnosis of plaque erosion. The aim of this study was to identify clinical or laboratory predictors of plaque erosion in patients with ACS to enable a diagnosis of erosion without additional invasive procedures. Methods and Results-—Patients with ACS who underwent optical coherence tomography imaging were selected from 11 institutions in 6 countries. The patients were classified into plaque rupture, plaque erosion, or calcified plaque, and predictors were identified using multivariable logistic modeling. Among 1241 patients with ACS, 477 (38.4%) patients were found to have plaque erosion. Plaque erosion was more frequent in non–ST-segment elevation-ACS than in ST-segment–elevation myocardial infarction (47.9% versus 29.8%, P=0.0002). Multivariable logistic regression models showed 5 independent parameters associated with plaque erosion: age 15.0 g/dL, and normal renal function. When all 5 parameters are present in a patient with non–ST-segment elevation-ACS, the probability of plaque erosion increased to 73.1%. Conclusions-—Clinical and laboratory parameters associatedwith plaque erosion are explored in this retrospective registry study. These parametersmay be useful to identify the subset ofACS patients with plaque erosion and guide themto conservativemanagement without invasive procedures. The results of this exploratory analysis need to be confirmed in large scale prospective clinical studiesDr. Jang has received an educational grant from Abbott Vascular and Medicure. Dr. Adriaenssens has received grants and consulting fees from Abbott Vascula

Prediction of Health Care Costs by Dental Health Care Costs and Periodontal Status

Reducing heath care costs is an important issue in Japan. The aim of this study was to analyze the contribution of oral health to health care costs and to predict health care costs by statistical modeling. Data from 46 individuals (29 men and 17 women; mean age of 44.6 ± 1.7 years) on health care costs, dental health care costs, and the results of the salivary levels of lactate dehydrogenase (LD) over two years were provided by the association. Multilayer perceptron neural networks were applied to predict the health care costs from data from the previous year and included health care costs, dental health care costs, and salivary levels of LD. Nonlinear relationships were observed between medical health care costs, dental health care costs, and periodontal conditions. The health care costs from the previous year were the most important predictor of health care costs. The simulation results showed that health care costs decreased with the increase in dental health care costs from the previous year. Health care costs increased with increasing salivary levels of LD from the previous year. Improvements in periodontal conditions and dental health care may play some roles in reducing health care costs

Prioritization of the Skills to Be Mastered for the Daily Jobs of Japanese Dental Hygienists

Dental hygienists require proficiency in a wide variety of job skills. Dental hygienists should master their job skills step by step, and the prioritization of these steps is important. In this study, we investigated the frequency at which Japanese dental hygienists performed daily jobs and attempted to classify the jobs according to the proficiency levels. The aim of this study was to surmise the order in which skills should be mastered in terms of priority and to investigate the relationship between daily jobs and the motivation for completing jobs. The Japan Dental Hygienists’ Association conducts a survey on the employment status of dental hygienists in Japan every five years. The questionnaire is distributed to all members of the Japan Dental Hygienists’ Association. In this study, the responses of 3,807 dental hygienists who worked at dental clinics were analyzed. We analyzed 77 kinds of daily jobs and the items regarding the motivation to work. For the analysis, item response theory (IRT), structural equation modeling (SEM), and logistic regression analysis were applied. According to the item response curve, the jobs were classified into 11 clusters. The jobs classified into Cluster 1 were the jobs that most of the average-proficiency Japanese dental hygienists performed. Scaling and root planing were the representative jobs in Cluster 1. Performing the jobs classified into Cluster 5 clearly discriminated whether the dental hygienists were performing multiple jobs. Jobs concerning care for elderly or disabled patients were classified into Cluster 5. Jobs concerning gerodontology, implants, management of staff, and consultations were significantly associated with the motivation to perform jobs. Polishing and adjustment of orthodontic apparatuses was negatively associated with the motivation to perform jobs. Understanding the features of each daily job of dental hygienists is important for planning dental hygienists’ lifelong educational programs and evaluating their skill levels and proficiency levels. The results presented in this study may help to reveal the characteristics of dental hygienists’ daily jobs

Opportunistic Bacteria in Tonsil and Dental Plaque are Indicator for Oral Care

Background of the study: Detection of the opportunistic microorganisms can be the indicator for the oral hygiene. However, there are many sampling sites in one subject.Context and purpose of study: The purpose of this study was to evaluate the suitable sampling site for opportunistic pathogens as an indicator of the oral hygiene.Results: In the 21 healthy females’ swab samples of tonsil, meticillin-sensitive Staphylococcus aureus, Pneumobacillus, Haemophilus influenzae, H. parainfluenzae, Lancefield group A streptococci, Lancefield group G streptococci, Haemophilus sp. were detected; detection rates were 33.3%, 4.8%, 19.0%, 4.8%, 4.8% and 14.3%, respectively. The detection rates of methicillin-sensitive Staphylococcus aureus and Haemophilus sp. were the highest when compared to the other sampling sites. For H. influenzae, the detection rates were relatively high; 14.3% for tongue, 38.1% for dental plaque and 52.4% for saliva.Main findings: Detections of the commensal and opportunistic pathogens from tonsil and saliva were independent. Microbial flora form nasal cavity was independent form pharynx.Conclusion: Tonsil and saliva are the suitable sampling site to detect the opportunistic pathogens for the indicator of the oral hygiene.Brief Summary: Opportunistic pathogens in tonsil or saliva can be the indicator of the oral hygiene.Potential implications of the study: For the prevention of pneumonia, oral care is useful. In this situation, MRSA, P. aeruginosa, β-hemolytic streptococci, S. marcescens, M. catarrhallis or H. influenza in tonsil or saliva can be the indicator of the oral care.</p

Supplied Food Consistency and Oral Functions of Institutionalized Elderly

Background. Maintaining good oral function is one of the goals of dental treatment. The Japanese national insurance system newly introduced the concept of management of oral function according to the life stage. For the application of management of oral functions of the elderly, seven kinds of examination is a must for the diagnosis: xerostomia, oral hygiene status, maximum occlusal pressure, tongue and labium function, tongue pressure, chewing ability, and swallowing function. We analyzed the relationship between oral functions and supplied food consistency. Methods. Oral functions and supplied food consistency of sixty-nine institutionalized elderly were investigated. There were 13 men and 56 women, and their mean age was 86.23 ± 7.02. Oral functions were measured and evaluated according to the Japanese insurance system. Data were analyzed by item response theory analysis, ROC analysis, and decision analysis. Results. By the item response theory analysis, tongue pressure and swallowing functions had high discrimination ability. The subjects who had malfunction of the tongue and labium all had processed food. The subjects with difficulty in swallowing, even without malfunction of the tongue and labium, all had processed food. Conclusion. Supplied food consistency may depend on the oral functions. However, as oral function has some dimension, a systematic evaluation system is necessary to decide the supplied food consistency

Oral Microbiome in Four Female Centenarians

The oral microbiome of healthy older adults has valuable information about a healthy microbiome. In this study, we collected and analyzed the oral microbiome of denture plaque and tongue coating samples from four female centenarians. After DNA extraction and purification, pyrosequencing of the V3&ndash;V4 hypervariable regions of the 16S rRNA was carried out. The bacterial taxonomy for each lead was assigned based on a search of the EzBioCloud 16S database. We obtained a total of 199,723 valid, quality-controlled reads for denture plaque and 210,750 reads for tongue coating. The reads were assigned 407 operational taxonomic units with a 97% identity cutoff. Twenty-nine species were detected in both denture plaque and tongue coatings from all subjects. Firmicutes was the most abundant phylum; the Streptococcus salivarius group was the most abundant species in both the denture plaque and tongue coatings; and the Fusobacterium nucleatum group was detected in all subjects. In the bacterial profile, species formed clusters composed of bacteria with a wide range of prevalence and abundance, not dependent on phyla; each cluster may have specific species that could be candidates for a core microbiome. Firmicutes and Veillonella were abundant phyla on both plaque and tongue coatings of centenarians

Impact of the Serum Level of Albumin and Self-Assessed Chewing Ability on Mortality, QOL, and ADLs for Community-Dwelling Older Adults at the Age of 85: A 15 Year Follow up Study

Quality of life (QOL) and mortality are true endpoints of epidemiological or medical research, especially for community-dwelling older adults. Nutritional status and activities of daily living (ADLs) are associated with QOL and mortality. Good oral health status supports a good nutritional status. The aim of this study was to elucidate the complex structure of these important health-related factors. We surveyed 354 healthy older adults at the age of 85. Nutritional status was evaluated by the serum level of albumin. QOL, ADLs, self-assessed chewing ability, serum albumin level, and mortality during the 15 year follow up period were analyzed. Self-assessed chewing ability was associated with QOL and ADLs. Self-assessed chewing ability for slight-hard foods was associated with mortality in men. However, it was not associated with the serum albumin level. The serum albumin level was associated with mortality in women. These results indicate that maintaining good oral function is not enough. Nutritional instruction in accordance with oral function is indispensable for health promotion in older adults. When planning health promotion strategies for older adults, different strategies are needed for men and women

Structure and Validity of Questionnaire for Oral Frail Screening

Oral frailty is defined as the mild decline in oral function and located at the early and reversible stage of frailty. Therefore, early detection and early treatment of oral frailty is very useful. Simple and easy questionnaires, such as an oral frailty checklist, have been widely used for the screening and enlightenment of oral frailty of the Japanese people. We evaluate the structure and validity of the oral frailty checklist. The questionnaire of oral frailty was distributed for the citizens more than 50 years old from December 2018 to January 2019. The structural validity of the questionnaire is analyzed by structural equation modeling (SEM). The characteristics of the items are analyzed by Item Response Theory (IRT). The data of 725 subjects (360 men, 359 women, 6 no answer, mean age 71.3 &plusmn; 9.05) are analyzed. The questionnaire consisted of three latent variables. Items of &ldquo;Brushing teeth at least twice a day&rdquo;, &ldquo;Regular attendance of dental clinic&rdquo;, and &ldquo;Using denture&rdquo;, had low discrimination ability. The questionnaire used in this study is a useful tool for the screening of oral frailty. However, its scoring system needs to be improved

Nutritional Status and Oral Frailty: A Community Based Study

Compromised oral health can alter food choices. Poor masticatory function leads to imbalanced food intake and undesirable nutritional status. The associations among nutritional status, oral health behavior, and self-assessed oral functions status were investigated using a community-based survey. In total, 701 subjects more than 50 years old living Ebina city located southwest of the capital Tokyo were investigated. The number of remaining teeth was counted by dental hygienists. Oral health behavior and self-assessed oral functions were evaluated by oral frailty checklist. Nutritional status was evaluated by the brief-type self-administered diet history questionnaire using Dietary Reference Intakes for Japanese as reference. More than 80% of subjects&rsquo; intakes of vitamin B12, pantothenic acid, copper, and proteins were sufficient. In contrast, only 19% of subjects&rsquo; intake of vitamin A was sufficient and 35.5% for vitamin B1. More than 90% of subjects&rsquo; intakes of vitamin D and vitamin K were sufficient. Only 35.5% of subjects&rsquo; intakes of dietary fiber were sufficient. Overall, 88.9% of subjects had excess salt. The number of remaining teeth was not correlated with nutritional intakes. Oral health behavior significantly correlated with nutritional intakes. Oral functions are important for food choice; however, oral functions were not directly correlated with nutritional intakes. Comprehensive health instructions including nutrition and oral health education is necessary for health promotion