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 Table of Contents  
ORIGINAL HYPOTHESIS
Year : 2017  |  Volume : 8  |  Issue : 4  |  Page : 110-112

New evaluation for dental treatment using a body-composition analyzer


1 Department of Physiology, Tokyo Dental College, Chiyoda-ku, Tokyo, Japan
2 Sakaguchi Dental Clinic, Chuo-ku, Chiba, Japan
3 Clinical Business Department, The Lion Foundation for Dental Health, Sumida-ku, Tokyo, Japan

Date of Web Publication29-Nov-2017

Correspondence Address:
Mizuha Kojima
Department of Physiology, Tokyo Dental College, 2-9-18, Misaki-cho, Chiyoda-ku, Tokyo 101-0061
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/denthyp.denthyp_36_17

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  Abstract 

Introduction: Patients receiving home dental treatment typically have worse activities of daily living (ADL) scores than those of dental clinic outpatients. They cannot live independently, without somebody’s help, because of disabilities and motor dysfunction. In home-care, treatment for dysphagia is important for maintaining or improving ADL. New indicators that can be measured more simply and more quantitatively are required. The Hypothesis: We hypothesized that measurements obtained using a body composition analyzer may be applicable as a whole-body condition evaluation method for home-care patients. The advantage is its simple operation, lack of invasiveness, and short measurement time. Evaluation of the Hypothesis: If certain easy-to-use devices that can be used for home-based measurements can be developed in future, it may become possible to perform more effective check-ups in home-care cases. On the basis of the measurements obtained in this manner, patients can be provided rehabilitation plans and daily meal guidance.

Keywords: Activities of daily living, body composition, frail elderly, home care services, muscles


How to cite this article:
Kojima Y, Kojima M, Kokubun N, Inage M, Kasen T, Nohara K, Sakaguchi K, Sakaguchi Y. New evaluation for dental treatment using a body-composition analyzer. Dent Hypotheses 2017;8:110-2

How to cite this URL:
Kojima Y, Kojima M, Kokubun N, Inage M, Kasen T, Nohara K, Sakaguchi K, Sakaguchi Y. New evaluation for dental treatment using a body-composition analyzer. Dent Hypotheses [serial online] 2017 [cited 2019 Jun 19];8:110-2. Available from: http://www.dentalhypotheses.com/text.asp?2017/8/4/110/219449


  Introduction Top


Old age is characterized by a gradual decline in systemic physiological functions and reserve. If elderly individuals also suffer from an illness, the decline will be more significant.[1]

Patients receiving home-based dental treatment usually score worse on the activities of daily living (ADL) than do dental clinic outpatients. These individuals typically cannot live independently, without somebody’s help, because of disability. Dysphagia is present in 40−60% of patients receiving in-home dental care.[1] Loss of occlusal support or dysphagia have a negative impact on such patients.[2] This can lead to nutritional disorders and worsened ADL.[3],[4],[5] Therefore, in in-home dental care for elderly people, dentists are required not only to provide the usual care (primarily prosthetic therapy), but also to provide swallowing rehabilitation and instruction regarding diet, nutrition, and meal planning.

To measure the effects obtained by such interventions, it is important to evaluate the whole-body condition periodically and to plan treatment and rehabilitation based on these results. In recent years, health care workers have evaluated patients’ overall condition on the basis of questionnaires, weight change, and the blood albumin value. However, these methods have several disadvantages. In questionnaires related to malnutrition and ADL, it is difficult to measure detailed changes during treatment, and any increase or decrease in weight is not directly related to the patient’s ADL. Moreover, since blood tests are invasive, many patients do not agree to undergo frequent blood sampling. It has also been reported that some patients with high serum albumin values still have a poor nutritive status.[6],[7],[8],[9] It is, therefore, important to combine several methods to evaluate the effects obtained by the above-mentioned interventions. In the home-care setting, new indicators that allow simpler, minimally invasive, and more detailed quantitative evaluations are, therefore, required.

Moreover, the number of dementia patients has increased in areas where the elderly population has grown.[10] Globally, an estimated 47.5 million people are currently living with dementia, and the number of dementia cases is expected to double essentially every 20 years.[10] In many of these cases, communication is difficult, complicating the evaluation of the general condition of dementia patients. For such patients, quantitative, rather than subjective evaluations, are even more important.

In addition, it is desirable to be able to compare current records to past records. Because home-based rehabilitation is a long-term approach, such a comparison may help to maintain the motivation of such patients.

In recent years, due attention has been paid to the evaluation of whole-body condition, by measuring body composition, in various contexts. For instance, body composition is measured in renal patients before and after dialysis;[11] in dialysis outpatient clinics at general hospitals, there are medical facilities for the elderly, where the water content in the body can be measured before and after dialysis. Furthermore, body composition analyzers are also applied for the evaluation of patients with sarcopenia.[12],[13]


  The Hypothesis Top


We considered that measurements obtained via a body composition analyzer may be applicable as a whole-body condition evaluation method for home-based dental care. By combining information regarding height, age, and sex, as well as body weight and the electric resistance value of the whole body, such analyzers can assess body composition by means of a mechanism called “bioelectrical impedance analysis.” The approach can be used for any person who can grasp the hand grip on the machine. It has the advantage of simple operation, lack of invasiveness, and a short measurement time. Recently developed body composition analyzers can measure skeletal muscle mass at various sites,[13] such as the arm, leg, and trunk, and can also measure the body water content and fat mass in the body. This facilitates a review of the individual’s rehabilitation plan. Moreover, the apparatus can be used on any person who can adopt a standing position and who does not have a pacemaker.


  Evaluation of the Hypothesis Top


Skeletal muscle mass gradually decreases after the age of 45 years.[14] Additionally, elderly people require a higher protein intake than do young people, and skeletal muscle mass reduces in the absence of protein.[15],[16] Those with poor dietary habits, involving intake of low amounts of protein, have a poor nutritional status. Protein malnutrition leads to not only decreased ADL, but also inflammation and heart failure.[17] If eating disorders are improved, with increase in protein intake, a patient’s skeletal muscle mass increases. Furthermore, treating dysphagia is important for improving nutritional status and involves modification of the amount and content of the meal. In cases where rehabilitation of tongue motor function is needed, the texture of the food also needs to be changed;[18] for instance, if the pressure that can be exerted by a patient’s tongue is inadequate, they can only eat soft food.

If devices that allow body composition measurements at home can be invented and developed, it may become possible to perform more effective and quantitative home-based checkups in dental treatment. This can be applied to guide oral rehabilitation plans and daily meals for individual patients. Such body composition analyzers may allow measurements of dental treatment results and thus, improvement of patient’s ADL.


  Conclusion Top


In home-based care, investigations that are minimally invasive, simple, and objective are required to gain a quantitative assessment of the patient’s status. We hypothesize that measurements obtained by using a body composition analyzer may be applicable as a whole-body condition evaluation method in a home-care setting.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Shanley C, O’Loughlin G. Dysphagia among nursing home residents: An assessment and management protocol. J Gerontol Nurs 2000;26:35-48.  Back to cited text no. 1
    
2.
Genkai S, Kikutani T, Suzuki R, Tamura F, Yamashita Y, Yoshida M. Loss of occlusal support affects the decline in activities of daily living in elderly people receiving home care. J Prosthodont Res 2015;59:243-8.  Back to cited text no. 2
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3.
Budtz-Jørgensen EJ, Chung J-P, Mojon P. Successful aging—The case for prosthetic therapy. J Pub Health Dent 2000;60:308-12.  Back to cited text no. 3
    
4.
Yamada M, Nishiguchi S, Fukutani N, Tanigawa T, Yukutake T, Kayama H et al. Prevalence of sarcopenia in community-dwelling Japanese older adults. J Am Med Dir Assoc 2013;14:911-5.  Back to cited text no. 4
    
5.
Yamanouchi A, Yoshimura Y, Matsumoto Y, Jeong S. Severely decreased muscle mass among older patients hospitalized in a long-term care ward in Japan. J Nutr Sci Vitaminol 2016;62:229-34.  Back to cited text no. 5
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6.
Reuben DB, Greendale GA, Harrison GG. Nutrition screening in older persons. J Am Geriatr Soc 1995;43:415-25.  Back to cited text no. 6
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7.
Hedlund JU, Hansson L-O., Örtqvist ÅB. Hypoalbuminemia in hospitalized patients with community-acquired pneumonia. Arch Intern Med 1995;155:1438-42.  Back to cited text no. 7
    
8.
Omran ML, Morley JE. Assessment of protein energy malnutrition in older persons, Part II: Laboratory evaluation. Nutrition 2000;16:131-40.  Back to cited text no. 8
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9.
Covinsky KE, Covinsky MH, Palmer RM, Sehgal AR. Serum albumin concentration and clinical assessments of nutritional status in hospitalized older people: Different sides of different coins? J Am Geriatr Soc 2002;50:631-7.  Back to cited text no. 9
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10.
Global-Action-against-dementia-pdf.pdf [Internet]. Available from: http://www.alzheimers.org.nz/getattachment/News-Info/Dementia-worldwide/Global-Action-against-dementia-pdf.pdf/. [Last accessed on2017 Jun 29].  Back to cited text no. 10
    
11.
Cohn SH, Brennan BL, Yasumura S, Vartsky D, Vaswani AN, Ellis KJ. Evaluation of body composition and nitrogen content of renal patients on chronic dialysis as determined by total body neutron activation. Am J Clin Nutr 1983;38:52-8.  Back to cited text no. 11
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12.
Zoico E, Di Francesco V, Guralnik JM, Mazzali G, Bortolani A, Guariento S et al. Physical disability and muscular strength in relation to obesity and different body composition indexes in a sample of healthy elderly women. Int J Obes Relat Metab Disord 2004;28:234-41.  Back to cited text no. 12
    
13.
Chien M-Y., Huang T-Y., Wu Y-T. Prevalence of sarcopenia estimated using a bioelectrical impedance analysis prediction equation in community-dwelling elderly people in Taiwan. J Am Geriatr Soc 2008;56:1710-5.  Back to cited text no. 13
    
14.
Walrand S, Guillet C, Salles J, Cano N, Boirie Y. Physiopathological mechanism of sarcopenia. Clin Geriatr Med 2011;27:365-85.  Back to cited text no. 14
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15.
Morley JE. Decreased food intake with aging. J Gerontol A Biol Sci Med Sci 2001;56:81-8.  Back to cited text no. 15
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16.
Breen L, Phillips SM. Skeletal muscle protein metabolism in the elderly: Interventions to counteract the ‘anabolic resistance’ of ageing. Nutr Metab (Lond) 2011;8:68.  Back to cited text no. 16
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17.
Cederholm T, Jägrén C, Hellström K. Outcome of protein-energy malnutrition in elderly medical patients. Am J Med 1995;98:67-74.  Back to cited text no. 17
    
18.
Hayashi R, Tsuga K, Hosokawa R, Yoshida M, Sato Y, Akagawa Y. A novel handy probe for tongue pressure measurement. Int J Prosthodont 2002;15:385-8.  Back to cited text no. 18
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Introduction
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