Furuya Junichi, Tamada Yasushi, Sato Tomohide, Hara Atsushi, Nomura Taro, Kobayashi Takuya, Sakai Maiko, Kondo Hisatomo
Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University, Morioka, Iwate, Japan.
Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, MA, USA.
Gerodontology. 2016 Dec;33(4):513-521. doi: 10.1111/ger.12197. Epub 2015 May 4.
To investigate the effects of wearing complete dentures on pharyngeal shape for swallowing in edentulous older people.
In the absence of complete dentures, edentulous older people often lose the occlusal support necessary to position the mandible, which leads to an anterosuperior shift of the mandible during swallowing. This may result in pharyngeal shape changes effecting swallowing function in older people. However, the details of this phenomenon are currently unclear.
Participants were 17 older edentulous volunteers. Cone-beam computed tomography imaging was performed with the participant in the seated position and wearing (i) both maxillary and mandibular dentures, (ii) maxillary dentures only and (iii) no dentures. During imaging, participants were instructed to keep their mouth closed to the mandibular position determined in advance during swallowing for each denture-wearing condition. The volume, height and average cross-sectional area of the velopharynx and oropharynx were measured, and the positions of the epiglottis and mandible were recorded.
While the vertical height of the oral cavity and pharynx significantly decreased, the volume and average cross-sectional area of the oropharynx significantly increased when dentures were not worn (p < 0.01). The absence of dentures caused an anterosuperior shift of the mandible when swallowing and drew the epiglottis forward, resulting in expansion of the oropharynx where the tongue base forms the anterior wall.
The absence of dentures results in anatomical changes in oropharyngeal shape that may exacerbate the pharyngeal expansion caused by ageing and reduce the swallowing reserve.
探讨佩戴全口义齿对无牙颌老年人吞咽时咽腔形态的影响。
在未佩戴全口义齿的情况下,无牙颌老年人常失去定位下颌骨所需的咬合支持,这会导致吞咽时下颌骨向前上方移位。这可能会导致咽腔形态改变,影响老年人的吞咽功能。然而,这一现象的具体细节目前尚不清楚。
研究对象为17名老年无牙颌志愿者。让参与者坐在座位上,分别佩戴(i)上下颌义齿、(ii)仅上颌义齿和(iii)不佩戴义齿的情况下进行锥形束计算机断层扫描成像。在成像过程中,指导参与者在每种佩戴义齿情况下吞咽时将嘴巴闭合至预先确定的下颌位置。测量软腭咽和口咽的容积、高度及平均横截面积,并记录会厌和下颌骨的位置。
不佩戴义齿时,口腔和咽腔的垂直高度显著降低,口咽的容积和平均横截面积显著增加(p<0.01)。不佩戴义齿会导致吞咽时下颌骨向前上方移位,并使会厌向前牵拉,导致以舌根为前壁的口咽扩张。
不佩戴义齿会导致口咽形态发生解剖学改变,这可能会加剧衰老引起的咽腔扩张,并减少吞咽储备。