Journal of the National Institute of Public Health 2016

Vol.65 No.2 p.175−182＜Original＞
Oral health conditions, behavior and swallowing
in patients with Parkinson’s disease
Yoshimi Nakayama 1 ，2 ），Mitsuru Mori 2 ）Hokkaido Kamikawa Public Health Center（Former Hokkaido Tomakomai Public Health Center）
Department of Public Health, Sapporo Medical University School of Medicine

1）2）

Abstract
Background: The symptoms of Parkinsonʼs disease (PD) can lead to problems in maintaining oral
health and an inability to swallow which can then negatively affect the patientʼs quality of life. The
purpose of the present study was to investigate oral health conditions, oral health behavior andswallowing among patients with PD in Japan.
Methods: We investigated 200 Parkinsonism patients in the east Iburi area of Hokkaido, Japan by mail.
From 108 respondents, we used 100 PD patients over 60 years of age as cases. Dental examinations for
Parkinsonism patients were not conducted. One thousand and thirty-four persons over 20 years of age
underwent dental examinations conducted by the municipalities in the Tokachi area of Hokkaido. We
selected 708 persons over 60 years of age as control. A structured questionnaire was employed for bothcases and controls. We compared oral health conditions and related factors between 100 PD patients and708 controls. The logistic regression model was used for adjusting for sex and age. We also conductedstratified analysis by sex while adjusting for age using this model.
Results: (1) Compared with the controls, PD patients had more complaints of chewing difficulties,
toothache, gingival bleeding, bad breath, sliminess of the mouth, annoying teeth alignment, food
impaction, swollen gums or mucosa and denture discomfort. (2) Fewer PD patients had their own teeth
regardless of sex. (3) More PD patients used a fluoride toothpaste than controls, regardless of sex. (4)PD patients performed daily tooth-brushing or denture cleaning more frequently than the controls. (5)Among PD patients, 55.6% had problems with swallowing.
Conclusion: We found that PD patients had more complaints about oral health and troubles withswallowing. It would be important for public health center to conduct dental checkups and professional
oral care through home visits for PD patients.

keywords: Oral health, Parkinson disease, Parkinsonism, Dysphagia(accepted for publication, 23th March 2016)

I.

Introduction

Parkinson’s disease (PD) is a progressive, disablingneurodegenerative disorder that is characterized bytremor, bradykinesia, muscle rigidity, postural instability
and gait disturbance [1]. In addition, there are no
established medical treatments to completely cure PD
because their etiologies remain largely unknown. These
symptoms can lead to problems in maintaining oral healthand an inability to swallow which can then negatively
affect the patient’s quality of life. In the elderly withdysphagia, dental disease and/or poor oral hygiene havebeen shown to have a high incidence of aspiration
pneumonia [2, 3], which often lead to death in patientswith PD [4, 5]. Therefore, it is important for patients withPD to maintain good oral hygiene.
However, their dental status is ultimately unknown.
Persson et al. [6] reported that in PD patients, there was

Corresponding author: Yoshimi NAKAYAMA
6-19-1-1 Nagayama Asahikawa-shi, Hokkaido 079-8610, Japan
Tel: 0166-46-5138
Fax: 0166-46-5262
E-mail: nakayama.yoshimi@pref.hokkaido.lg.jp

J. Natl. Inst. Public Health, 65（2）: 2016175

Yoshimi NAKYAMA，Mitsuru MORI

large number of remaining teeth, and the decayed toothcount was lower compared with controls. On the other
hand, several studies outside Japan reported that thedental status of the PD patients was poorer than that of
the controls [7-9]. As far as we know, there were threesurveys of the dental status of PD patients in Japan [3, 10,11]. Fukayo et al. [10] reported that the oral health of PD
outpatients with mild symptoms was better than thecontrols. Hanaoka et al. [11] reported patients with PD
had fewer remaining teeth, more caries and a higher
incidence of deep periodontal pockets. In our investigationof the oral health conditions of PD patients in the Okhotsk
area of Hokkaido Prefecture in 2000, patients with PD had
more complaints and fewer remaining teeth than thecontrols [3]. Accordingly, the findings in Japan were not
the same regarding the dental status of PD patients [3, 10,11].
We thought that the symptoms of PD patients made itdifficult for the patients to perform daily oral hygiene. PD
patients may be a higher-risk group for caries, periodontal
disease and swallowing dysfunction than the general
population. The purpose of the present study was toinvestigate the oral health conditions, oral healthbehaviors and swallowing abilities of patients with PD in
Japan.

II. Methods
1 ．Subjects
The design of this study is a case-control study
analyzing PD patients as cases and members of thegeneral population as control.
In Japan, patients with Parkinsonism can receive publicfinancial aid from the government if their disease stage
according to Hoehn and Yahr, is from III to V. The eligible
study cases that participated in this research were all
drawn from the 200 patients with Parkinsonism who hadreceived public financial aid in the east Iburi area in 2013.
East Iburi is located in the central part of Hokkaido, thenorthernmost island of Japan. One hundred and eight
Parkinsonism patients responded (response rate: 54%).
The case group of 108 patients of Parkinsonism iscomprised of 105 with Parkinson’s disease, one withcorticobasal degeneration and two with an undetermined

Table 1176

2 ．Method of survey
During the period spanning from June throughSeptember in 2013, we investigated the patients with
Parkinsonism by mail. A structured questionnaire was
employed for both patients and controls. Common
questions in the survey for patients and controls inquired
about dental status, oral complaints and oral healthbehavior. Question items for all cases and controls
included wearing dentures, bad breath, sliminess of themouth, chewing difficulties, swollen gums or mucosa,
pain of the jaw, having a dental examination regularly, thepresence of a family dentist, and smoking history.
Individuals who still had their own teeth were asked about
toothache, gingival bleeding, annoying teeth alignment,
food impaction, tooth movement, tooth brushing, andwhether they were using a fluoride toothpaste, aninterdental brush or dental floss. Those for individuals

Sex and age distribution of 100 Parkinsonʼs disease patients and 708 controls.
male
n(%)

age (year)
60-69
70-79
80+
total

diagnosis. We used 100 PD patients over 60 years of age
as cases. Forty-eight patients (48.0%) were in stage III(male: 17 patients, female: 31 patients), 24 patients (24.0%)
in stage IV (male: 12 patients, female: 12 patients), 27
patients (27.0%) in stage V (male: 6 patients, female: 21
patients) of the Hoehn & Yahr disability stages. The meanof the stages was 3.79 (standard deviation [SD] 0.84).
From June 2010 to March 2011, 1034 persons (457males, 577 females) over 20 years of age underwent dental
examinations conducted by the municipalities of Obihiro
city and Honbetsu town in the Tokachi area, located in theeastern part of Hokkaido. We selected 708 persons over
60 years of age as controls. The population and population
aging rate of the principal city (Tomakomai city: 23.2%) in
the east Iburi area are similar to that of Obihiro city
(24.3%), the principal city of the Tokachi area [12]. The
distribution of the age and sex in the 100 cases with PD
and 708 controls are shown in Table 1. The mean age ofthe100 cases was 74.5 (SD 8.0); there were 35 men (meanage75.8, SD 5.8 years) and 65 women (mean age73.8, SD
8.9). The mean age of the 708 controls was 71.0 (SD 6.9);
there were 310 men (mean age 71.7, SD 6.7) and 398
women (mean age 70.5, SD 7.0). Written informed
consent was obtained from all participants. This survey
was approved by the Ethical Committee of Sapporo
Medical University on May 24, 2013.

Parkinsonʼs diseasefemale
total
n(%)
n(%)

5 (14.3)
18 (51.4)
12 (34.3)
35 (100)

26 (40.0)
21 (32.3)
18 (27.7)
65 (100)

31 (31.0)
39 (39.0)30 (30.0)
100 (100)

male
n(%)

controlfemale
n(%)

total
n(%)

132 (42.6)
139 (44.8)
39 (12.6)
310 (100)

193 (48.5)
163 (41.0)
42 (10.6)
398 (100)325 (45.9)
302 (42.7)
81 (11.4)
708 (100)

J. Natl. Inst. Public Health, 65（2）: 2016

Oral health conditions, behavior and swallowing in patients with Parkinsonʼs disease

with dentures involved denture discomfort, cleaning
dentures, and storing their dentures correctly before
sleeping. In addition, the presence of their own teeth andtroubles with swallowing (spilling one’s food from themouth, choking on food or beverage, coughing during
eating or drinking, always making a noise with the throat,taking a long time to swallow) were surveyed among theParkinsonism patients. Dentists from the dental clinics in
Obihiro city and Honbetu town examined the teeth of the1034 controls. The dental examinations were conductedby a trained dentist at a local dental clinic under sufficientartificial light, with dental mirrors, and explorers. The
contents of the dental examination were the diagnoses ofdental caries (sound teeth, filled teeth, decayed teeth andmissing teeth). For the survey of 1034 controls, publichealth nurses in Honbetsu town or dental hygienists froma dental clinic in Obihiro city interviewed the subjects
with a structured questionnaire on the day of the dental
examination. Dental examinations were not conducted for
the Parkinsonism patients.

and age to assess the difference between the case groupand the control group by oral complaints, oral healthbehaviors and dental status. The adjusted odds ratio (OR)and its 95% confidence interval (CI) for oral health in PD
patients were estimated. We also conducted stratified
analysis by sex using this model. Tests of statisticalsignificance were based on a two-sided p-value, and thea-error was set at 5 %. The SAS system (ver.9.4; SAS
Institute, Cary, NC, USA) was employed for the analysis.

III. Results
1 ．Results from a case-control study
Table 2 shows the results from the logistic regression
analyses of oral health in PD patients, adjusted for sex andage, in males and females after adjusting for age.
i ) Dental status
As shown in Table 2, individuals without their own teeth
were more commonly found among the PD patients thanin the control group(OR 4.56; 95%CI, 2.16-9.65). PD
patients more commonly lacked their own teeth than thecontrols in both males and females (male: OR 9.92; 95%CI,
2.43-40.39; female: OR 3.64; 95%CI, 1.49-8.90).

3 ．Analyses
We used the logistic regression model adjusted for sex

Table 2

Results of logistic regression analysis of oral health conditions in 100 Parkinsonʼs disease patients and 708 controls
cases controls

cases
n(%)

adjusted for sex, age
controls
odds ration(%)

by sex adjusted for age
male(95%CI)

cases
n(%)

femalenncontrolsn(%)

odds ratio(95%CI)

cases
n(%)

controlsn(%)

odds ratio(95%CI)No own teeth
Wearing dentures

100
100

708
700§

16(16.0) 19(2.7)
57(57.0) 452(64.6)

4.56(2.16-9.65)*
0.55(0.35-0.87)*

5 (14.3)
4 (1.3)21(60.0) 193(63.1)

9.92(2.43-40.39)＊
0.63(0.29-1.35)

11(16.9) 15(3.8)
36(55.4) 259(65.7)

3.64(1.49-8.90)*
0.51(0.29-0.89)*

Oral complaints
Toothache
Gingival bleeding

84†
84†

689†
689†

22(26.2)
19(22.6)72(10.5)35(5.1)

3.23(1.86-5.61)*
6.04(3.22-11.36)*

7 (23.3)
6 (20.0)38(12.4)12(3.9)2.43(0.95-6.21)
6.88(2.28-20.78)*

15(27.8)
13(24.1)

34(8.9)23(6.0)3.96(1.98-7.91)*
5.49(2.54-11.86)*

Bad breath
Sliminess of the mouth

99§
99§

708
708

26(26.3)
40(40.4)38(5.4)40(5.7)9.21(5.03-16.85)*
12.50(7.29-21.43)*

11(32.4)
16(47.1)

19(6.1)16(5.2)9.36(3.74-23.39)*
21.24(8.46-53.30)*

15(23.1)
24(36.9)19(4.8)24(6.0)9.03(4.02-20.27)*
9.46(4.84-18.51)*

Chewing difficulties
Annoying teeth alignment
Food impaction

99§
84†
84†

708
689†
689†

23(23.2) 55(7.8)
19(22.6) 37(5.4)
53(63.1) 143(20.8)

3.61(2.06-6.31)*
5.01(2.71-9.29)*
6.72(4.13-10.92)*

7 (20.6)
8 (26.7)21(70.0)28(9.0)11(3.6)64(20.9)

2.42(0.93-6.29)
9.84(3.46-28.01)*
8.20(3.56-18.92)*

16(24.6)
11(20.4)
32(59.3)27(6.8)26(6.8)79(20.6)

4.51(2.24-9.09)*
3.51(1.62-7.62)*
5.86(3.20-10.72)*

Swollen gums or mucosa
Tooth movement

99§
84†

708
689†

21(21.2)
11(13.1)

78(11.0)54(7.8)2.57(1.47-4.47)*
1.81(0.90-3.63)

6 (17.7)
4 (13.3)45(14.5)25(8.2)

1.29(0.50-3.34)
1.73(0.55-5.46)

15(23.1)
7 (13.0)33(8.3)29(7.6)4.00(1.98-8.11)*
1.84(0.76-4.43)

Denture discomfort
Pain of the jaw

57‡
99§

452‡
708

24(42.1)
2 (2.0)67(14.8)
11(1.6)

3.92(2.15-7.16)*
1.08(0.23-5.13)

6 (28.6)0(0)30(15.5)5 (1.6)2.09(0.74-6.00)－

18(50.0)
2 (3.1)37(14.3)
6 (1.5)5.63(2.64-11.99)*
1.67(0.32-8.70)

Dental status

Oral health behavior
Brushing teeth less than once a day

84†

658♭

17(20.2) 205(31.2)

0.56(0.32-0.99)＊

6 (20.0) 128(43.1)

0.31(0.12-0.78)＊

11(20.4)

77(21.3)

0.89(0.44-1.83)

Cleaning denture less than once a
day

57‡

434¶

14(24.6) 172(39.6)

0.49(0.26-0.95)＊

5 (23.8) 104(53.3)

0.27(0.10-0.79)＊

9 (25.0)68(28.5)

0.76(0.33-1.73)

Not removing dentures and putting
them in a cup of water when sleeping
Using a fluoride toothpaste

57‡

433¶

14(24.6) 119(27.5)

0.83(0.43-1.61)

8 (38.1)

62(32.3)

1.18(0.46-3.07)

6 (16.7)

57(23.7)

0.61(0.24-1.56)

84

♭

674

57(67.9) 272(40.4)＊

2.99(1.84-4.86)

20(66.7) 108(35.9)＊

3.25(1.46-7.26)

37(68.5) 164(44.0)

2.77(1.51-5.10)*

Not using a interdental brush
Not using use a dental floss

84†
84†

674♭
674♭

54(64.3) 459(68.1)
77(91.7) 618(91.7)

0.85(0.52-1.38)
1.00(0.44-2.29)

20(66.7) 239(79.4)
29(96.7) 284(94.4)

0.51(0.22-1.16)
1.70(0.22-13.44)

34(63.0) 220(59.0)
48(88.9) 334(89.5)

1.13(0.62-2.06)
0.90(0.36-2.25)

Not having a dental examination
regularly

100

657§

44(44.0) 313(47.6)

0.85(0.55-1.30)

11(31.4) 136(46.9)

0.60(0.28-1.29)

33(50.8) 177(48.2)

1.04(0.61-1.78)

Not having own family dentists
100
708
19(19.0) 108(15.3)
Having a hystory of smoking
100
708
17(17.0) 192(27.1)
CI: confidence interval－: not calculated＊: p<0.05†: Having own teeth‡: Using dentures§: Excluding missing value♭: Excuding those without own teeth and misssing value¶: Excuding those not using dentures and missing value

1.32(0.76-2.29)
0.64(0.37-1.13)

4 (11.4) 51(16.5)
14(40.0) 120(38.7)

0.80(0.27-2.42)
1.25(0.60-2.60)

15(23.1)
3 (4.6)1.70(0.88-3.27)
0.23(0.07-0.74)*†

J. Natl. Inst. Public Health, 65（2）: 201657(14.3)
72(18.1)

177

Yoshimi NAKYAMA，Mitsuru MORI

Individual wearing dentures were less commonly seenamong PD patients than the controls (OR 0.55; 95%CI,
0.35-0.87). Fewer female PD patients wore dentures thanfemale controls (OR 0.51; 95%CI, 0.29-0.89).
ii ) Oral complaints
More PD patients complained of toothache (OR 3.23;
95%CI, 1.86-5.61), chewing difficulties (OR 3.61; 95%CI,
2.06-6.31), swollen gums or mucosa (OR 2.57; 95%CI, 1.474.47) and denture discomfort (OR 3.92; 95%CI, 2.15-7.16)
than controls, and more female PD patients complained ofthem than female controls.
More PD patients complained of gingival bleeding (OR6.04; 95%CI, 3.22-11.36), bad breath (OR 9.21; 95%CI, 5.0316.85), sliminess of the mouth (OR 12.50; 95%CI, 7.2921.43), annoying teeth alignment (OR 5.01; 95%CI, 2.719.29) and food impaction (OR 6.72; 95%CI, 4.13-10.92) thancontrols, and more PD patients complained of them thanboth male and female controls.
iii) Oral health behavior
Fewer PD patients brushed their teeth (OR 0.56; 95%CI,
0.32-0.99) or cleaned their dentures (OR 0.49; 95%CI, 0.260.95) less than once a day than controls, and fewer male
PD patients brushed their teeth and cleaned theirdentures less than once a day than male controls.
More PD patients used a fluoride toothpaste thancontrols (OR 2.99; 95%CI, 1.84-4.86), and more PD patientsused a fluoride toothpaste than both male and female
controls (male: OR 3.25; 95%CI, 1.46-7.26, female: OR 2.77;
95%CI, 1.51-5.10).
Fewer female PD patients had a history of smoking
than female controls (OR 0.23; 95%CI, 0.07-0.74).
2.

Complaints of swallowing among PD patients
Table 3 shows the complaints of swallowing among

Table 3the 100 PD patients. As for swallowing, 55 (55.6%) PD
patients answered that they had some problems. By
multiple answer, over 25% of PD patients complained of
the following: spilling one’s food from the mouth (25.3%),
choking on food (28.3%), choking on beverage (27.3%).

IV. Discussion
1.

The oral health conditions of 100 PD patients
In the present study, PD patients had more oral
complaints compared to the controls. We found that many
PD patients had symptoms such as caries and periodontal
disease. Some previous studies [8, 9, 11, 13] reported PD
patients had more caries or instances of periodontal
disease compared to the controls. This may be explainedby the following reasons. First, PD patients may besuffering from xerostomia [1, 4, 14, 15] or nausea [15,16]
caused by the administration of antiparkinsonian
medications such as anticholinergics and levodopa. Saliva
acts to neutralize and dilute acids formed by dental plaquefrom ingested carbohydrates. Patients with xerostomia
are more likely to develop caries and periodontal disease
and nausea causes a decrease in oral hygiene. Second,
Kennedy et al. [17] reported that S. mutans as cariogenic
bacteria, does show a significantly higher percentage in
the PD group compared to the control group. Thirdly, PD
patients have demonstrated diminished manual dexterity,
which limits their ability to carry out the effective removalof plaque [4].
In this study, those who complained of chewing
difficulties and denture discomfort were more commonly
among the PD patients than the controls, female patientsin particular. This showed a similar finding to ourinvestigation [3] in the Okhotsk area of Hokkaido in 2000.

Troubles of swallowing among 100 Parkinsonʼs disease patients.
n(%)＊

No problem
Swallowing ploblems
Details of swalllowing problems(multiple answer);
Spilling one's food from the mouth
Choking on food
Choking on beverage
Coughing during eating or drinking
Always making a noise with the throat
Taking a long time to swallow

178n(%)＊＊
43(43.4%)
55(55.6%)

25(25.3%)
28(28.3%)
27(27.3%)
19(19.2%)
5 (5.1%)20(20.2%)

Gastrostoma

1 (1.0%)Total##: Excluding missing value＊: n(%) for details of swallowing problem (multiple answers)＊＊: n(%) for no problem, swallowing problems and gastrostoma

99(100%)J. Natl. Inst. Public Health, 65（2）: 2016

Oral health conditions, behavior and swallowing in patients with Parkinsonʼs disease

Bakke et al. [18] reported that mastication and orofacial
functions are impaired in moderate and advanced PD(Hoehn & Yahr stages II-IV). This may be explained by
the following reasons. First, PD patients may be sufferingfrom mastication disorders with oral dyskinegia orxerostomia as a side-effect from using levodopa [1, 3, 19,20]. The tongue may dislodge the mandibular denture,and facial muscles that are rigid or uncontrollable may
prevent a maxillary denture from maintaining a retentive
seal [4]. Saliva plays the role of adhesive for wearing
dentures. Xerostomia cause dentures to drop off themucosa or become unstable. Second, tremors and rigidityof the orofacial musculature may create difficulties incontrolling and retaining dentures [1, 14], or difficulties inchewing. Thirdly, PD patients have a slowness in theirchewing due to bradykinesia [1].
Many females, but not so many males, PD patientscomplained of denture discomfort and chewing
difficulties. Female PD patients might suffer from denture
discomfort or chewing difficulties caused by involuntary
movements of the facial muscles, tongue and lips, as oral
dyskinesia is more commonly seen in elderly women thanin elderly men [2].
The present study showed that many PD patients did
not have their own teeth, regardless of sex. This showed asimilar finding to our investigation [3] in the Okhotsk areaof Hokkaido in 2000. Einarsdóttir et al. [7] reported that
subjects with PD had significantly more missing teeth
than the comparison group. Cicciú et al. [8] reported thatthe frequency of missing teeth in PD patients was
significantly higher than in the control group. However,
Persson et al. [6] reported that PD patients had moreremaining teeth than controls. Many PD patients in thepresent study may be more likely to be suffering fromdental caries and periodontal disease according to theircomplaints. Aida et al. [21] reported that most of thepermanent teeth were extracted due to caries andperiodontal disease in Japan. In addition, gait disturbancesand postural instability accentuated by the symptoms of
PD may have increased the difficulty experienced bypatients when going to a dental clinic during the earlystage of caries.
In this study, we found that more PD patients sufferfrom swollen gums or mucosa than controls after
adjusting for sex and age. Xerostomia caused by the useof antiparkinsonian medications is a possible cause. Saliva
involves mucin, which functions as a lubricating action
and also protects the mucosal epithelia of oral the cavity.
Kennedy et al. [17] reported that PD patients showed asignificant increase in mucositis compared with thecontrol groups.
2 ．Swallowing conditions
Fifty-five (male: 24 patients, female: 31 patients) of the99 (55.6%) PD patients had self-perceived swallowing
problem. This showed a similar finding to ourinvestigation [3] in the Okhotsk area of Hokkaido in 2000.
Clifford et al. [22] reported that 48% of PD patients had
dysphagia. Melo et al. [23] reported that a recent
systematic review showed that PD patients are threetimes more likely than normal controls to develop
oropharyngeal dysphagia. However, we may haveunderestimated the proportion of PD patients withdysphagia in the present study because of the following
reasons. First, swallowing dysfunction occurs from theonset of the earliest stages of Parkinson’s disease, even inasymptomatic cases [24, 25]. Second, Nilsson et al. [24]found dysphagia in more than 90% of PD patients who
were in the same stages as our study subjects (Hoehn andYahr stages III and IV). The reasons for why many PD
patients have dysphagia may be xerostomia [1, 4, 14, 15,
26] caused by the administration of antiparkinsonian
medications such as anticholinergics and levodopa, thedementia most PD patients display[1, 27],various motor
disorders such as hypokinesia, akinesia and so on [28], aside effect of using levodopa [1, 4, 14, 29] or poor denturecontrol [22].
3 ．Oral health behavior of PD patients
In this study, more PD patients brushed their teeth orcleaned their own dentures more than twice a day thanthe controls. Fukayo et al. [10] reported that thefrequency of tooth-brushing was higher among PD
patients. On the other hand, in our 2000 investigation [3]in the Okhotsk area of Hokkaido, fewer PD patientsbrushed their teeth or cleaned their own dentures every
day than those in the control group. Müller et al. [9]reported that PD patients had lower frequencies of daily
tooth-brushing than the controls. As PD patients of thisstudy had more oral complaints than the controls, PD
patients would consciously brush their teeth or clean theirdentures to reduce their symptoms.
In this study, more PD patients used a fluoride
toothpaste than the controls. As more PD patients had
symptoms, such as caries, than the controls, PD patientswould consciously use a fluoride toothpaste to prevent
caries.
There are some limitations to our study. First, we did
not check the duration of the disorder. There is thepossibility of a survival bias, because we used not only
incident cases, but also prevalent cases. Cereda et al. [27]reported that swallowing disturbances were significantly
associated with a longer disease duration. Second, thecontrols were not randomly selected from the general
population. The participants in this study were those who
were interested a dental examinations conducted by themunicipality, possibly causing a response bias. Thirdly, inthis study, the area the PD subjects were living in was

J. Natl. Inst. Public Health, 65（2）: 2016179

Yoshimi NAKYAMA，Mitsuru MORI

different from that of the controls. However, thepopulation and population aging rate of the principal city
(Tomakomai city) of the east Iburi area are similar to
those of Obihiro city as principal city of the Tokachi area.
Fourth, because public financial aid included every patientwith Parkinsonism, we recruited all of them for thesurvey. However, we confined the analysis to PD patientsin order to refine the research hypothesis.
In conclusion, we found that PD patients had more
complaints about oral health (e.g., toothache, gingival
bleeding, chewing difficulties, denture discomfort). In
addition, 55.6% of PD patients had problems withswallowing. Moving forward, it would be important thatpublic health center continuously conducts dental
checkups and professional oral care through home visits
for PD patients. More than ever, it is necessary thatclinical dentists understand the oral health conditions andswallowing problems of PD patients.

Acknowledgements
Conflicts of interest: None declared

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Yoshimi NAKYAMA，Mitsuru MORI

パーキンソン病患者の口腔内状況，口腔保健行動及び嚥下の状況
中山佳美 ₁ ，2 ），森満 2 ）北海道上川保健所（前 北海道苫小牧保健所）
札幌医科大学医学部公衆衛生学教室

₁）
2）

抄録
背景：パーキンソン病の諸症状は，口腔内状態をより良く保つことを困難にさせたり，嚥下に問題を起こさせたりする．これは，パーキンソン病患者のquality of lifeに影響を与える，今回の研究の目的は，日本のパーキンソン病患者の口腔内状況，口腔保健行動及び嚥下の状況を調査することである．
方法：この研究デザインは，ケースコントロール研究である．調査対象者は，平成2₅年に，北海道東胆振地域に在住し，特定疾患医療受給者証を所持しているパーキンソン病関連疾患患者2₀₀人である．
このうち，₁₀₈人が調査に回答し，₆₀歳以上の₁₀₀人のパーキンソン病患者をケースとした．コント
ロールは，平成22年度に北海道十勝地域の市町村で実施した成人歯科健診受診者₁₀₃₄人のうち，₆₀歳以上の₇₀₈人とした．統計解析は，ロジスティック回帰分析を用い，性・年齢を調整し，オッズ比と₉₅％信頼区間を求め，口腔保健状況をケースとコントロール間で比較した．
結果：（₁︶健常者に比べて，パーキンソン病患者は，うまく咬めない，歯痛，歯肉出血，口臭，歯並びの悪さ，食片圧入，粘膜腫脹，義歯の不適合等を訴えている者が多かった．（2︶パーキンソン病患者は，健常者に比べて歯のない者が多かった．（₃︶パーキンソン病患者は，健常者に比べて，フッ化物配合歯磨剤を使用する者が多かった．
（₄︶パーキンソン病患者は，健常者に比べて，歯磨き及び義歯の清掃習慣が良かった．（₅︶パーキンソン病患者の₅₅.₆％が，嚥下に問題を抱えていた，
結論：パーキンソン病患者は，口腔内に多くの問題を抱え，嚥下も困難な者が多いことがわかった．
保健所は，パーキンソン病患者への訪問を通して，歯科健診及び専門的な口腔ケアを継続していくことが重要である．
キーワード：口腔保健，パーキンソン病，パーキンソン病関連疾患，嚥下障害

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J. Natl. Inst. Public Health, 65（2）: 2016