Nakagawa K, Matsuo K, Shibata S, Inamoto Y, Ito Y, Abe K, Ishibashi N, Fujii W, Saitoh E. Efficacy of a novel training food based on the process model of feeding for mastication and swallowing ― a preliminary study in elderly individuals living at a residential facility ―. Jpn J Compr Rehabil Sci 2014; 5: 72-78. Purpose: We examined the validity and safety of a newly developed chew-swallow managing food (CSM) as a training material for chewing and swallowing. Methods: Twenty-three elderly individuals (mean age: 82.8 ± 8.6 years) who followed a regular diet at a residential facility were enrolled in this study. The subjects ate 4 g each of CSM and puree 3 times while bolus transport and swallowing were recorded with a fiberoptic endoscope. For each trial, the number of chewing and swallowing movements was counted. We also identified the location of the leading edge of the food at swallow initiation, the amount of food residue in the oral cavity and pharynx, and the incidence of aspiration. The differences in measurements between CSM and puree trials were then compared statistically. Results: With the CSM, the number of chewing and swallowing movements was significantly higher than that with puree and the leading edge of the food was deeper in the pharynx at swallow initiation. There were no significant differences in food residue or aspiration between the 2 foods. Conclusion: Our findings suggest that CSM has an initial consistency that requires chewing but changes to a texture equivalent to puree at the time of swallowing. We are currently planning to verify the safety and efficacy of CSM in individuals with dysphagia.

Background: Oral care is important in preventing aspiration pneumonia in older adults. However, it is not clear what kind of oral care can reduce the number of bacteria in saliva. The purposes of this study are to clarify whether there is a relationship between plaque amounts and salivary bacterial counts, and how bacteria dispersed into the oral cavity by brushing can be reduced. Methods: First, saliva samples were collected from 10 healthy adult volunteers after 30 h of unbrushing and after thorough brushing, and the total bacterial count was determined by real-time PCR. Next, 40 older adults attending an outpatient dental clinic were randomly assigned into two groups: a wiping group (20 patients) and a mouthwashing group (20 patients). Saliva was collected before and after brushing, and after wiping in the wiping group and after mouthwashing in the mouthwashing group, and the total bacterial count was quantified by real-time PCR. Results: In a study of volunteers, there was no association between plaque amounts and salivary bacterial counts. In a study of older adult patients, salivary bacterial counts were significantly higher in patients with higher oral hygiene index and fewer remaining teeth. Brushing increased salivary bacterial counts. Wiping did not significantly reduce the number of bacteria, while mouthwash returned the increased number of bacteria after brushing to the pre-brushing level. Conclusions: There is no direct relationship between the amount of plaque and the number of bacteria in saliva. Brushing disperses bacteria into the oral cavity, resulting in a marked increase in the number of bacteria in saliva. Wiping does not collect the dispersed bacteria, and it seems essential to rinse the mouth after brushing. Trial registration: UMIN000045854.