Impacts of wearing complete dentures on bolus transport during feeding in elderly edentulous

Abstract

Prosthetic treatment with dentures is often required for the elderly who have reduced swallowing function. Therefore, it is important to understand the relationship between denture-wearing and feeding function from the perspective of swallowing. To clarify changes in bolus transport during feeding in elderly edentulous patients with or without complete dentures. Subjects were 15 elderly edentulous volunteers who were treated with maxillary and mandibular complete dentures. The test food was 10 g of minced agar jelly containing barium sulphate with a particle diameter of 4·0-5·6 mm. Lateral videofluoroscopy was performed to assess the position of the leading edge of the bolus, the bolus volume in each area at swallow onset, bolus transit time and the mandibular position during pharyngeal swallowing. There were significant changes between the bolus transport with and without dentures. Without dentures, the leading edge of the bolus at swallow onset fell from the valleculae area to the hypopharynx, and the bolus volume in the hypopharynx increased. Bolus transit time increased in the oral cavity, valleculae and hypopharynx. The mandibular position shifted anterosuperior direction. The results arose owing to anatomical changes in the oral and pharyngeal structure and the following functional changes: poor food manipulation, poor bolus formation and delayed swallowing reflex. Removing dentures in elderly edentulous individuals influences bolus transport during feeding, resulting in the exacerbation of the reduced swallowing reserve capacity that accompanies ageing, and may increase the risk of dysphagia.

Locais de início da fase faríngea da deglutição: meta-análise

“…In the other studies, the consistencies and volumes varied among them, as there was no standardization and therefore difficult to perform analysis between the consistency and the location of the onset of the pharyngeal phase of swallowing. With regard to onset of the pharyngeal phase, 50% (six articles) reported discharge in the vallecula (2,(6)(7)(8)17,19) ; 25% (three articles) above, at or below the mandibular ramus (12,16,20) ; 16% (two articles) to dorsum of the tongue (2,6) ; 16% (two articles) to hypopharynx (8,21) ; 16% (two articles) to oropharynx (21,22) ; 8% (one article) to tongue (6) ; 8% (one article) to pyriform sinus (18) and 8% (one article) to oral cavity (7) . In some studies, the onset location of the pharyngeal phase was observed in more than one region for the same individuals (2,(6)(7)(8)21) .…”

“…With regard to onset of the pharyngeal phase, 50% (six articles) reported discharge in the vallecula (2,(6)(7)(8)17,19) ; 25% (three articles) above, at or below the mandibular ramus (12,16,20) ; 16% (two articles) to dorsum of the tongue (2,6) ; 16% (two articles) to hypopharynx (8,21) ; 16% (two articles) to oropharynx (21,22) ; 8% (one article) to tongue (6) ; 8% (one article) to pyriform sinus (18) and 8% (one article) to oral cavity (7) . In some studies, the onset location of the pharyngeal phase was observed in more than one region for the same individuals (2,(6)(7)(8)21) . More than one location was also observed for pharyngeal phase onset in eight studies (2,(6)(7)(8)12,16,20,21) , thus, some items were repeated in the calculation of the above percentages.…”

“…Above this age group, only 69 individuals were described in three different studies (8,18,19) . In two studies, both age groups were included and described only with the mean age of the participants (20,21) .…”

“…These individuals did not have any swallowing complaint or comorbidities that were known to influence swallowing dynamics. In five studies, the population was symptomatic for a total of 130 patients (43%) (8,18,19,21,22) . The underlying diseases or described clinical characteristics were: unilateral medullary infarction (21) , cricopharyngeal dysfunction (18) , post-removal of oral tumor (19) , absence of teeth (8) and bilateral lingual anesthesia of the inferior alveolar nerve with use of occlusal plate (22) .…”

“…The onset location of this phase of swallowing is regarded as an important fact, as the lack of onset or extended time for its occurrence can be a sign suggestive of dysphagia (6) . The location of this onset may be influenced by the volume and consistency of the bolus (2) , and according studies, by verbal commands and absence of dentition (7,8) .…”