Differences in oral hypofunction prevalence and category measures across age groups and sex in Japan: a pilot study

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This cross-sectional pilot study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function. Methods A total of 155 healthy adults (median age: 55 years, range: 22–89 years) participated in this study after providing informed consent. The cohort was age and sex matched. Seven oral function measures based on the concept of OHF were assessed: oral hygiene (Hygiene), oral dryness, maximum occlusal force (MOF), lip-tongue motor function (LTMF), maximum tongue pressure (MTP), masticatory function, and swallowing function. Hand grip strength (HGS) was also measured. The participants were divided into the young (20–39 years), middle (40–64 years), and old (≥ 65 years) age groups for linear regression analysis of differences in oral and physical function. Differences in OHF prevalence were tested by the chi-square test. Results The prevalence of OHF was significantly higher in the old group than in the young and middle groups. Such OHF measures as Hygiene, MTP, LTMF, and MOF were significantly worse in the old group as well. The measures of Hygiene and LTMF showed a moderate correlation with age in the multiple regression model (standardized partial regression coefficient, β = 0.24 and − 0.19, respectively). HGS was significantly associated with MTP (β = 0.58, p < 0.001) and LTMF (β = 0.38, p = 0.002) in both male and female participants. Conclusions Our findings suggest that OHF prevalence increases with age, especially after 65 years old. However, the pathological route may vary among OHF categories. oral hypofunction physical function aging Background Oral function significantly impacts nutrition as masticatory and swallowing functions are key elements in digestion[ 1 – 4 ]. A decline in oral function can cause deviations in nutritional intake, such as avoiding hard-textured foods and choosing a softer diet. This altered nutritional state can eventually lead to malnutrition, a primary cause of physical frailty[ 5 ]. Poor oral health also influences social activities, often impeding individuals from dining out with friends or family members, which can result in social frailty[ 6 , 7 ]. Thus, a decline in oral function is considered the starting point of general frailty[ 8 ]. Identifying and ameliorating oral frailty may help contribute to healthy longevity. Mastication involves comprehensive movements of the oral apparatuses[ 9 ]. Ingested food is reduced in size by biting with the jaw and teeth, aided by tongue movements and buccal contraction. The hyoid bone moves cyclically in association with jaw movements. The crushed food is mixed with the saliva to form a bolus, which is propelled in to the oropharynx by the tongue's squeeze-back motion, and accumulates in the valleculae until swallowing is initiated. The motion of these apparatuses is temporally linked during eating and speaking[ 10 ]. The deterioration of oral function can easily be overlooked since one function often compensates for others during eating. Quantitative assessment of the decline in specific oral functions is therefore crucial for monitoring oral condition and preserving oral health. The concept of "Oral Hypofunction" was proposed by the Japanese Society of Gerodontology to describe oral function deterioration and draw attention to oral function decline in older adults[ 11 ]. Oral hypofunction (OHF) comprises seven sub-symptoms and is diagnosed if at least three symptoms meet the cut-off criteria. The prevalence of OHF in older patients has recently been reported[ 12 ], which may help with its application in the clinical setting. By examining OHF quantitatively at a dental clinic, both the examiner and patient can understand the patient's current oral status, enabling prompt intervention in the early stages of oral function deterioration. It is widely recognized that physical strength, often represented by hand grip strength (HGS) and skeletal muscle mass, declines with age[ 13 , 14 ]. As those variables tend to decrease in the older population, they are routinely used as indicators for sarcopenia. Although normative data for physical strength and body composition are abundant[ 13 ], few reports have investigated oral function across the adult lifespan. Some oral functions, such as tongue pressure across lifespan, were evaluated in several countries[ 15 – 17 ], but not all of the OHF categories have been examined apart from in older populations. We have hypothesized that although oral function decreases with age, the pathological pathway may vary among OHF categories. To test this notion, the present cross-sectional study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function. Methods Participants This study’s protocol was approved by the Institutional Review Board of Tokyo Medical and Dental University (Approval ID: D2022-053-01). We recruited healthy asymptomatic adults in 10-year age segments from the 20’s to the 80’s for both male and female participants, respectively, from the community using advertising flyers distributed in public spaces. The inclusion criteria were healthy individuals over 20 years of age who could take part in the trial and had no pain or complaints regarding oral health at the time of participation. The exclusion criteria were neurological disorders and severe dysphagia. All participants provided written informed consent prior to enrollment in this investigation. Based on previous reports[ 15 , 16 ], we hypothesized a decline in OHF category measures in the elderly across age groups and sex. Assuming a mean difference of five among the groups and a standard deviation of 10, with α = 0.05 and β = 0.80, the required sample size was calculated to be 128. Therefore, we recruited a cohort of 140. Measures Oral function OHF was proposed by the Japanese Society of Gerodontology in 2016 as the integrated deterioration of several oral functions. The measurement details and OHF cut-off thresholds are described in a previous report[ 11 ] and summarized below and in Table 1 . OHF was diagnosed as meeting at least 3 of the 7 oral sub-symptom criteria. Table 1 Seven oral sub-symptoms of oral hypofunction and their cut-off criteria Oral sub-symptom Cut-off criterion Oral hygiene (Hygiene) Total number of bacteria > 10 6.5 CFU/mL Oral dryness (Dryness) Measured value with a moisture checker < 27.0 Maximum occlusal force (MOF) Occlusal force < 200 N Lip-tongue motor function (LTMF) Utterance count of /pa/, /ta/, or /ka/ <6/s Maximum tongue pressure (MTP) Maximum tongue pressure < 30 kPa Masticatory function (Mast-F) Glucose concentration in chewing test < 100 mg/dL Swallowing function (Swal-F) Total Eating Assessment Tool (EAT-10) score ≥ 3 (1) Oral hygiene (Hygiene): A sterilized swab was swiped 3 times in a 10 mm swath on the middle of the dorsal tongue surface and then placed in distilled water into a bacteria detection apparatus (Bacteria counter; Panasonic Healthcare, Tokyo, Japan).[ 18 , 19 ] Bacteria number was counted 3 times, and the calculated means were log transformed. (2) Oral dryness (Dryness): The wetness of the buccal mucosal surface was measured by an oral moisture checker (Mucus; Life Co., Ltd., Saitama, Japan).[ 20 , 21 ] The sensor of the instrument was attached to the right-side buccal surface of the participant for 2 seconds, and the degree of oral wetness was measured in triplicate at the same site for calculation of mean values. (3) Maximum occlusal force (MOF): Occlusal force was measured by 3 seconds of clenching using pressure-indicating film (Dental Prescale II; GC Corp., Tokyo, Japan).[ 22 ] The area of changed color on the sheet caused by clenching was measured by analysis software, calculated as occlusal force, and log transformed for analysis. (4) Lip-tongue motor function (LTMF): Participants were instructed to say the syllables /pa/, /ta/, or /ka/ as many times as possible within 5 seconds. The number of utterances was counted by a digital counter (Kenkokun Handy; Takei Scientific Instruments Co., Ltd., Niigata, Japan).[ 23 ] The minimum number per second for /pa/, /ta/, and /ka/ utterances was calculated and used for analysis. (5) Maximum tongue pressure (MTP): A tongue pressure sensor balloon probe connected to a digital tongue pressure meter (JMS tongue pressure measuring instrument TPM-01; JMS Co. Ltd., Hiroshima, Japan) was placed on the dorsal tongue surface[ 15 ]. Participants were asked to press up against the probe with the tongue towards the hard palate at maximum strength for 3 seconds. After several practice movements, tongue pressure was assessed 3 times for calculation of mean values. (6) Masticatory function (Mast-F): Masticatory function was measured using a gummy jelly. Participants were instructed to chew 2 g of gummy jelly without swallowing the bolus or saliva for 20 seconds. They were then asked to hold 10 mL of distilled water in their mouth and spit out the jelly and water into a cup fitted with a funneled mesh. The amount of eluted glucose was measured with a masticatory ability testing system (Gluco Sensor GS-II; GC Corp. Tokyo, Japan).[ 24 ] (7) Swallowing function (Swal-F): Swallowing function was assessed by a self-administered questionnaire for swallowing (10-item Eating Assessment Tool; EAT-10) and expressed as a numerical score from 0 to 40.[ 25 ] Physical properties and activities (1) Body composition: Body mass index was calculated from measured height and weight for analysis. Body composition was measured by bioelectrical impedance analysis using an In Body 470 device (In Body Japan Inc., Tokyo, Japan). Participants stood on the apparatus during measurements. Appendicular muscle mass was divided by the square of the subject’s height and used for calculation of skeletal muscle mass index (SMI). Body fat percentage was determined as well. (2) HGS: Measurements were carried out in triplicate for each hand with a digital hand dynamometer (Grip-D; Takei Instruments, Niigata, Japan). The maximum HGS in the trials for both hands were used for analysis. Data analysis Associations between oral function and physical function To examine the association between oral function and physical function, simple correlation coefficients were calculated for bivariate analysis. Given the high collinearity between HGS and SMI, HGS was selected for multivariate analysis, for which multiple linear regression was employed. In the regression model, oral function was designated as the dependent variable, while age, sex, number of teeth, and HGS were set as independent variables. The age groups were established as the young group (20 to 39 years), middle group (40 to 64 years), and old group (65 years and older) for statistical analysis. Differences in oral function were scrutinized using one-way ANOVA segmented by age group and sex. If the main effect was significant, Tukey’s test was utilized for multiple comparisons. The proportions of participants who met the criteria for each OHF sub-symptom and overall OHF were calculated. Differences in the proportion of OHF among age groups and sex were evaluated using the chi-square test. The critical value for rejecting the null hypothesis was P < 0.05. Statistical analyses were performed using IBM SPSS Statistics 28.0 software (IBM, Armonk, NY, USA). Results A total of 155 participants (median age: 55 years, range: 22 to 89 years) completed the measurements (Table 2 ). In the multiple linear regression analysis (Table 3 ), all dependent variables were significantly associated with Hygiene and LTMF. For MTP, only HGS showed a strong correlation. Regarding MOF and Mast-F, the number of teeth was moderately correlated, with no significant correlations for the other factors. For Dryness and Swal-F, no significant contributors were identified by the regression model. Table 2 Distribution of participants in the age categories Age group (years) Male Female Total Young 20 11 10 21 30 12 10 22 40 11 10 21 Middle 50 11 14 25 60 10 14 24 Old 70 10 13 23 80 9 10 19 Total 74 81 155 Table 3. Multiple linear regression analysis of oral functions MTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; HGS, Hand grip strength; Bold indicates significant correlation ( P <0.05). In the analysis of differences among age groups with ANOVA, the categories of LTMF, MTP, and MOF were significantly lower in the old group than in the other two groups, and were also lower in women except for LTMF (Table 4 ). Hygiene also increased with age, with significant differences between the young and old groups. No significant differences were observed for the mean values of Dryness, Mast-F, or Swal-F among the three age groups or by sex. Table 4 Mean (standard deviation [SD]) values for oral function by age and sex Young Middle Old P value Mean SD Mean SD Mean SD Age_ctg Sex Age * Sex Hygiene 6.90 (0.54) 7.10 (0.48) 7.20 (0.34) 0.006 b 0.091 0.390 6.85 (0.49) 6.91 (0.51) 7.06 (0.60) Dryness 28.4 (5.7) 27.9 (2.3) 28.7 (2.2) 0.986 0.354 0.770 28.7 (3.0) 29.2 (2.0) 28.6 (3.2) MTP 41.8 (6.9) 39.4 (8.1) 33.2 (9.3) < 0.001 b,c < 0.001 0.911 34.5 (9.5) 35.9 (9.9) 26.5 (8.3) LTMF 32.2 (3.9) 29.7 (4.5) 28.0 (2.7) < 0.001 b,c 0.146 0.096 32.7 (3.3) 31.6 (2.7) 28.7 (3.7) MOF 2.99 (0.23) 2.85 (0.33) 2.68 (0.32) < 0.001 b,c 0.003 0.738 2.80 (0.22) 2.78 (0.24) 2.58 (0.28) Mast-F 196.7 (62.2) 176.7 (67.5) 170.9 (81.7) 0.182 0.482 0.340 188.3 (50.8) 183.9 (45.4) 160.1 (69.8) Swal-F 0.2 (0.7) 0.2 (0.6) 0.4 (0.8) 0.061 0.152 0.204 0.3 (1.1) 0.6 (1.8) 2.0 (5.8) HGS 42.4 (7.0) 37.6 (3.8) 31.6 (6.4) < 0.001 b,c < 0.001 0.083 25.8 (4.5) 24.7 (3.5) 20.7 (4.3) MTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; HGS, Hand grip strength Bold indicates significant differences ( P < 0.05). a: young vs. middle, b: young vs. old, c: middle vs. old The proportion of participants who met the criteria for each and overall OHF symptoms is shown in Table 5 . For MTP, LTMF, and MOF, the prevalence of test-positive was significantly higher in the older group for both male and female participants. For Hygiene, the prevalence of test-positive was remarkably high across all three groups. The prevalence of OHF was over 50% for both sexes in the old group, which was significantly higher than in the other groups. Table 5 Proportion of participants meeting the criteria for individual and overall OHF symptoms Young Middle Old Total P value N (%) N (%) N (%) N (%) Oral Hygiene Male 20 87.0% 23 85.2% 23 95.8% 66 89.2% 0.435 Female 12 60.0% 28 90.3% 26 86.7% 66 81.5% 0.016 Oral Dryness Male 5 21.7% 6 22.2% 6 25.0% 17 23.0% 0.959 Female 1 5.0% 7 22.6% 9 30.0% 17 21.0% 0.100 MTP Male 2 8.7% 2 7.4% 7 29.2% 11 14.9% 0.056 Female 6 30.0% 8 25.8% 17 56.7% 31 38.3% 0.032 LTMF Male 6 26.1% 8 29.6% 16 66.7% 30 40.5% 0.006 Female 6 30.0% 5 16.1% 15 50.0% 26 32.1% 0.018 MOF Male 2 8.7% 3 11.1% 7 29.2% 12 16.2% 0.109 Female 4 20.0% 2 6.5% 7 23.3% 13 16.0% 0.171 Mast-F Male 0 0.0% 3 11.1% 4 16.7% 7 9.5% 0.139 Female 2 10.0% 0 0.0% 5 16.7% 7 8.6% 0.066 Swal-F Male 1 4.3% 0 0.0% 0 0.0% 1 1.4% 0.139 Female 1 5.0% 0 0.0% 4 13.3% 5 6.2% 0.066 OHF Male 5 21.7% 5 18.5% 13 54.2% 23 31.1% 0.012 Female 4 20.0% 6 19.4% 18 60.0% 28 34.6% 0.001 MTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; OHF, Oral hypofunction Bold indicates significant differences ( P < 0.05). Discussion The current study examined the age-related differences in OHF and its category measures across age groups and sex in accordance with the criteria for OHF, in addition to their association with physical function. We observed that oral function was significantly influenced by both age and sex, although the effects varied among the measured factors. Our findings suggest that tongue strength and motor function are more closely associated with physical strength as represented by HGS, while the number of teeth may exert a greater influence on occlusal force and masticatory function. In terms of gender differences, tongue pressure and occlusal force were higher in men, while pronunciation performance was superior in women. Our results also indicate that the decline in oral function does not progress linearly with age; rather, it is generally preserved until middle age and then diminishes remarkably over the age of 65 years. This study corroborates earlier reports regarding tongue pressure in that MTP is lower in older groups and in women.[ 15 – 17 ] The findings from this investigation may have clinical implications for determining the optimal timing of OHF evaluation towards prompt intervention in the early stages of oral function decline. As limitations, the present study included a small cohort but spanned a wide age range, starting from 20 years old. Moreover, physical strength and body composition can vary significantly among different countries and ethnicities.[ 13 , 26 ] For instance, the diagnostic criteria for sarcopenia differ between Europe and Asia.[ 27 , 28 ] Tongue pressure measurements also vary between Japan, Europe and the United States[ 15 – 17 ], with lower values typically observed in Japan, despite the use of different measurement devices. Consequently, while our findings provide normative data on oral function across a broad age range, their applicability may be limited to Japan or East Asia. Further studies incorporating data from other countries are warranted to better understand global variation[ 13 ]. Another potential limitation of this study was that the participants were relatively healthy as they were recruited through flyers distributed in public spaces. This recruitment method may have attracted individuals with a particular interest in oral function and possessing a higher level of oral health literacy, which possibly influenced the study results. We witnessed that MTP was approximately 20% lower in the old group than in the young group. MTP also showed a strong correlation with HGS. Our results align with previous studies demonstrating a significant decline in MTP in individuals over the age of 65 years.[ 15 ] Given that the tongue is a mass of muscles representing oral muscle strength, lower tongue strength has been associated with diminished eating function and dietary level in older adults at nursing care facilities.[ 29 , 30 ] Tongue strength also influences swallowing, thereby implicating reduced tongue pressure as a risk factor for sarcopenic dysphagia.[ 31 ] Age-related declines in functional reserve, frailty, and sarcopenia have been linked to adverse health outcomes. We observed that oral muscle strength was somewhat correlated with physical strength across the different age categories; thus, preserving tongue strength may contribute to preventing oral frailty and promoting a healthy diet in the later stages of life. LTMF was significantly correlated with age, sex, number of teeth, and HGS in the multiple regression analysis. Articulation involves complex movements of the lips and/or tongue along with the jaw and phonation. Although speaking and eating utilize the same oral cavity, the control mechanisms for the tongue and jaw differ significantly between those activities, where tongue motion is more independent from jaw motion in speech.[ 10 ] LTMF showed a moderate correlation with HGS as well in our study. LTMF is indicative of general oral motor function and serves as a marker for oral frailty[ 8 ]. It should be noted that the relationship between LTMF and HGS does not represent a direct pathway. However, physical and oral muscle functions may exhibit similar patterns as influenced by age and sex. In contrast to MTP and LTMF, MOF and Mast-F scores were more closely associated with the number of teeth rather than age itself and were not significantly related to HGS. Past studies are consistent with our results on the slight effects of gender and age in relation to masticatory performance, while the number of teeth is highly associated with masticatory function and occlusal force[ 32 , 33 ]. Regardless of the age, occlusal force and masticatory function may be conserved if tooth number is properly maintained. Lastly, the prevalence of OHF and its sub-symptoms increased with age in this investigation. The cut-off values for each measure were initially established in a foundational report[ 11 ] that drew on data from earlier sources. Generally, the prevalence of OHF was lower in the young group and higher in the old group, reflecting an age-related decline in oral function. In the young group, approximately 20% met the criteria for OHF as compared with 60% in the old group, as similarly reported[ 34 ]. OHF measures such as MTP and LTMF, which represent oral muscle strength and motor function, respectively, displayed increased prevalence in the old population. The proportion of individuals meeting the OHF criteria for MOF was also higher in the old group, likely influenced by the lower number of teeth in this subgroup. Notably, most participants in this study met the OHF criteria for Hygiene. Although bacterial count tended to increase with age, it met the established cut-off even in the young group. It may therefore be necessary to reconsider the threshold for bacterial count to more accurately detect OHF. Conclusion Our study demonstrated an age-related increase in the prevalence of OHF along with age- and sex-related differences in multiple oral function categories that varied across parameters. Whereas tongue strength and motor function correlated significantly with age, occlusal force and masticatory function were more strongly influenced by the number of teeth than by age alone. Our findings may help determine the optimal timing for OHF evaluation and enable prompt intervention in the early OHF stages. Declarations Ethics approval and consent to participate. This study’s protocol was approved by the Institutional Review Board of Tokyo Medical and Dental University (Approval ID: D2022-053-01). Informed consent was obtained from all participants involved in the study. Consent for publication. Not applicable. Competing Interests A grant aid from GC Corporation Funding. A grant aid from GC Corporation and AMED Evidence review platform for prevention and health promotion services (Grant No. JP23rea522114). Author Contribution Study design and conceptualization: KM, MK, MS, Statistical analysis: MT, RH, KM, Interpretation of data: MT, RH, KM, Drafting and revision of manuscript: RH, KM, Review of manuscript: All authors approved the final version of the manuscript. Availability of data and materials. The data that support the findings of this study are available from the corresponding author (KM) upon reasonable request. References Tanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, Furuya H, Tsuji T, Akishita M, Iijima K. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol Biol Sci Med Sci 2017. Watanabe Y, Hirano H, Arai H, Morishita S, Ohara Y, Edahiro A, Murakami M, Shimada H, Kikutani T, Suzuki T. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc. 2017;65(1):66–76. Toniazzo MP, Amorim PS, Muniz F, Weidlich P. 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J Am Med Dir Assoc. 2020;21(3):300–e307302. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16–31. Nakagawa K, Matsuo K. Assessment of Oral Function and Proper Diet Level for Frail Elderly Individuals in Nursing Homes Using Chewing Training Food. J Nutr Health Aging. 2019;23(5):483–9. Tanaka Y, Nakano Y, Yokoo M, Takeda Y, Yamada K, Kayashita J. Examination about the Relation of Meal Form, Tongue Pressure, Grip and Walking State in Inpatient and Elderly Residents [Japanese]. Jpn J Dysphagia Rehabil. 2015;19(1):52–62. Ogawa N, Wakabayashi H, Mori T, Fujishima I, Oshima F, Itoda M, Kunieda K, Shigematsu T, Nishioka S, Tohara H, et al. Digastric muscle mass and intensity in older patients with sarcopenic dysphagia by ultrasonography. Geriatr Gerontol Int. 2021;21(1):14–9. Peyron MA, Woda A, Bourdiol P, Hennequin M. Age-related changes in mastication. J Oral Rehabil. 2017;44(4):299–312. Ikebe K, Matsuda K, Kagawa R, Enoki K, Yoshida M, Maeda Y, Nokubi T. Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol. 2011;56(10):991–6. Hatanaka Y, Furuya J, Sato Y, Uchida Y, Shichita T, Kitagawa N, Osawa T. Associations between Oral Hypofunction Tests, Age, and Sex. Int J Environ Res Public Health 2021, 18(19). Additional Declarations Competing interest reported. A grant aid from GC Corporation Cite Share Download PDF Status: Published Journal Publication published 06 Dec, 2024 Read the published version in BMC Oral Health → Version 1 posted Editorial decision: Revision requested 30 Oct, 2024 Reviews received at journal 24 Oct, 2024 Reviewers agreed at journal 19 Oct, 2024 Reviewers agreed at journal 15 Oct, 2024 Reviews received at journal 08 Sep, 2024 Reviewers agreed at journal 05 Sep, 2024 Reviewers agreed at journal 22 Aug, 2024 Reviewers invited by journal 22 Aug, 2024 Editor invited by journal 22 Aug, 2024 Editor assigned by journal 19 Aug, 2024 Submission checks completed at journal 19 Aug, 2024 First submitted to journal 16 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4923458","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":355417067,"identity":"7ff2c7d1-d3c1-40d1-a00e-1db37b9b66b2","order_by":0,"name":"Rena Hidaka","email":"","orcid":"","institution":"Tokyo Medical and Dental University","correspondingAuthor":false,"prefix":"","firstName":"Rena","middleName":"","lastName":"Hidaka","suffix":""},{"id":355417068,"identity":"6bffa0ee-78b9-4365-aa40-c44acbff6e4f","order_by":1,"name":"Koichiro Matsuo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYDADAwYGxgcMDMwwDj7ADNfCbHCAVC1sEjAteIFu+/nDn3kqGOTM2c+YVX/MsWbgbz/AUFyAR4vZmWQ2aZ4zDMaWPTlmNw5uS2eQOJPAYDwDn5YDyWzMvG0MiRtu8G4DajnMwHCDgcGYB5+W84+ZP8O0FIC0yBPUciOZQRqmhQGkxYCwlsdmknPOSBgbnMn/LHF2WzqP4ZnEBvx+OZ/4+MObChs5g+PHEj9UbrOWkzt++JgxvhCDAgk4C+gkxjZjwjrQAPNjkrWMglEwCkbBcAYApY1KUyrohrYAAAAASUVORK5CYII=","orcid":"","institution":"Tokyo Medical and Dental University","correspondingAuthor":true,"prefix":"","firstName":"Koichiro","middleName":"","lastName":"Matsuo","suffix":""},{"id":355417069,"identity":"671f1b56-55a8-4901-8ec6-a80c204bb7a6","order_by":2,"name":"Misaki Tanaka","email":"","orcid":"","institution":"Tokyo Medical and Dental University","correspondingAuthor":false,"prefix":"","firstName":"Misaki","middleName":"","lastName":"Tanaka","suffix":""},{"id":355417070,"identity":"c57d0703-e76a-4c3f-b309-e19bf079873a","order_by":3,"name":"Murali Srinivasan","email":"","orcid":"","institution":"University of Zurich","correspondingAuthor":false,"prefix":"","firstName":"Murali","middleName":"","lastName":"Srinivasan","suffix":""},{"id":355417071,"identity":"de3dbda5-5505-4689-8c63-ccf1b8a9d2e6","order_by":4,"name":"Manabu Kanazawa","email":"","orcid":"","institution":"Tokyo Medical and Dental University","correspondingAuthor":false,"prefix":"","firstName":"Manabu","middleName":"","lastName":"Kanazawa","suffix":""}],"badges":[],"createdAt":"2024-08-16 08:06:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4923458/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4923458/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12903-024-05272-9","type":"published","date":"2024-12-06T15:58:02+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70964865,"identity":"3a9f7ccb-04ee-4af1-b389-5a38c540944a","added_by":"auto","created_at":"2024-12-09 16:16:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":820736,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4923458/v1/d0d855b5-2325-410c-a98c-11a78f37ef6d.pdf"}],"financialInterests":"Competing interest reported. A grant aid from GC Corporation","formattedTitle":"Differences in oral hypofunction prevalence and category measures across age groups and sex in Japan: a pilot study","fulltext":[{"header":"Background","content":"\u003cp\u003eOral function significantly impacts nutrition as masticatory and swallowing functions are key elements in digestion[\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. A decline in oral function can cause deviations in nutritional intake, such as avoiding hard-textured foods and choosing a softer diet. This altered nutritional state can eventually lead to malnutrition, a primary cause of physical frailty[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Poor oral health also influences social activities, often impeding individuals from dining out with friends or family members, which can result in social frailty[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Thus, a decline in oral function is considered the starting point of general frailty[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Identifying and ameliorating oral frailty may help contribute to healthy longevity.\u003c/p\u003e \u003cp\u003eMastication involves comprehensive movements of the oral apparatuses[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Ingested food is reduced in size by biting with the jaw and teeth, aided by tongue movements and buccal contraction. The hyoid bone moves cyclically in association with jaw movements. The crushed food is mixed with the saliva to form a bolus, which is propelled in to the oropharynx by the tongue's squeeze-back motion, and accumulates in the valleculae until swallowing is initiated. The motion of these apparatuses is temporally linked during eating and speaking[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e The deterioration of oral function can easily be overlooked since one function often compensates for others during eating. Quantitative assessment of the decline in specific oral functions is therefore crucial for monitoring oral condition and preserving oral health. The concept of \"Oral Hypofunction\" was proposed by the Japanese Society of Gerodontology to describe oral function deterioration and draw attention to oral function decline in older adults[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Oral hypofunction (OHF) comprises seven sub-symptoms and is diagnosed if at least three symptoms meet the cut-off criteria. The prevalence of OHF in older patients has recently been reported[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], which may help with its application in the clinical setting. By examining OHF quantitatively at a dental clinic, both the examiner and patient can understand the patient's current oral status, enabling prompt intervention in the early stages of oral function deterioration.\u003c/p\u003e \u003cp\u003eIt is widely recognized that physical strength, often represented by hand grip strength (HGS) and skeletal muscle mass, declines with age[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. As those variables tend to decrease in the older population, they are routinely used as indicators for sarcopenia. Although normative data for physical strength and body composition are abundant[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], few reports have investigated oral function across the adult lifespan. Some oral functions, such as tongue pressure across lifespan, were evaluated in several countries[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e–\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], but not all of the OHF categories have been examined apart from in older populations. We have hypothesized that although oral function decreases with age, the pathological pathway may vary among OHF categories. To test this notion, the present cross-sectional study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\n \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eParticipants\u003c/p\u003e\u003cp\u003e This study’s protocol was approved by the Institutional Review Board of Tokyo Medical and Dental University (Approval ID: D2022-053-01). We recruited healthy asymptomatic adults in 10-year age segments from the 20’s to the 80’s for both male and female participants, respectively, from the community using advertising flyers distributed in public spaces. The inclusion criteria were healthy individuals over 20 years of age who could take part in the trial and had no pain or complaints regarding oral health at the time of participation. The exclusion criteria were neurological disorders and severe dysphagia. All participants provided written informed consent prior to enrollment in this investigation.\u003c/p\u003e\u003cp\u003eBased on previous reports[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], we hypothesized a decline in OHF category measures in the elderly across age groups and sex. Assuming a mean difference of five among the groups and a standard deviation of 10, with α = 0.05 and β = 0.80, the required sample size was calculated to be 128. Therefore, we recruited a cohort of 140.\u003c/p\u003e\u003cp\u003eMeasures\u003c/p\u003e\u003ch2\u003eOral function\u003c/h2\u003e\u003cp\u003eOHF was proposed by the Japanese Society of Gerodontology in 2016 as the integrated deterioration of several oral functions. The measurement details and OHF cut-off thresholds are described in a previous report[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] and summarized below and in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. OHF was diagnosed as meeting at least 3 of the 7 oral sub-symptom criteria.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSeven oral sub-symptoms of oral hypofunction and their cut-off criteria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral sub-symptom\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCut-off criterion\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral hygiene (Hygiene)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of bacteria \u0026gt; 10\u003csup\u003e6.5\u003c/sup\u003e CFU/mL\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOral dryness (Dryness)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMeasured value with a moisture checker \u0026lt; 27.0\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum occlusal force (MOF)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOcclusal force \u0026lt; 200 N\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLip-tongue motor function (LTMF)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUtterance count of /pa/, /ta/, or /ka/ \u0026lt;6/s\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tongue pressure (MTP)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaximum tongue pressure \u0026lt; 30 kPa\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMasticatory function (Mast-F)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGlucose concentration in chewing test \u0026lt; 100 mg/dL\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwallowing function (Swal-F)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal Eating Assessment Tool (EAT-10) score ≥ 3\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e(1) Oral hygiene (Hygiene): A sterilized swab was swiped 3 times in a 10 mm swath on the middle of the dorsal tongue surface and then placed in distilled water into a bacteria detection apparatus (Bacteria counter; Panasonic Healthcare, Tokyo, Japan).[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Bacteria number was counted 3 times, and the calculated means were log transformed.\u003c/p\u003e\u003cp\u003e (2) Oral dryness (Dryness): The wetness of the buccal mucosal surface was measured by an oral moisture checker (Mucus; Life Co., Ltd., Saitama, Japan).[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] The sensor of the instrument was attached to the right-side buccal surface of the participant for 2 seconds, and the degree of oral wetness was measured in triplicate at the same site for calculation of mean values.\u003c/p\u003e\u003cp\u003e(3) Maximum occlusal force (MOF): Occlusal force was measured by 3 seconds of clenching using pressure-indicating film (Dental Prescale II; GC Corp., Tokyo, Japan).[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] The area of changed color on the sheet caused by clenching was measured by analysis software, calculated as occlusal force, and log transformed for analysis.\u003c/p\u003e\u003cp\u003e (4) Lip-tongue motor function (LTMF): Participants were instructed to say the syllables /pa/, /ta/, or /ka/ as many times as possible within 5 seconds. The number of utterances was counted by a digital counter (Kenkokun Handy; Takei Scientific Instruments Co., Ltd., Niigata, Japan).[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] The minimum number per second for /pa/, /ta/, and /ka/ utterances was calculated and used for analysis.\u003c/p\u003e\u003cp\u003e(5) Maximum tongue pressure (MTP): A tongue pressure sensor balloon probe connected to a digital tongue pressure meter (JMS tongue pressure measuring instrument TPM-01; JMS Co. Ltd., Hiroshima, Japan) was placed on the dorsal tongue surface[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Participants were asked to press up against the probe with the tongue towards the hard palate at maximum strength for 3 seconds. After several practice movements, tongue pressure was assessed 3 times for calculation of mean values.\u003c/p\u003e\u003cp\u003e(6) Masticatory function (Mast-F): Masticatory function was measured using a gummy jelly. Participants were instructed to chew 2 g of gummy jelly without swallowing the bolus or saliva for 20 seconds. They were then asked to hold 10 mL of distilled water in their mouth and spit out the jelly and water into a cup fitted with a funneled mesh. The amount of eluted glucose was measured with a masticatory ability testing system (Gluco Sensor GS-II; GC Corp. Tokyo, Japan).[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e(7) Swallowing function (Swal-F): Swallowing function was assessed by a self-administered questionnaire for swallowing (10-item Eating Assessment Tool; EAT-10) and expressed as a numerical score from 0 to 40.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e\u003ch3\u003ePhysical properties and activities\u003c/h3\u003e\u003cp\u003e(1) Body composition: Body mass index was calculated from measured height and weight for analysis. Body composition was measured by bioelectrical impedance analysis using an In Body 470 device (In Body Japan Inc., Tokyo, Japan). Participants stood on the apparatus during measurements. Appendicular muscle mass was divided by the square of the subject’s height and used for calculation of skeletal muscle mass index (SMI). Body fat percentage was determined as well.\u003c/p\u003e\u003cp\u003e(2) HGS: Measurements were carried out in triplicate for each hand with a digital hand dynamometer (Grip-D; Takei Instruments, Niigata, Japan). The maximum HGS in the trials for both hands were used for analysis.\u003c/p\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003ch2\u003eAssociations between oral function and physical function\u003c/h2\u003e\u003cp\u003e To examine the association between oral function and physical function, simple correlation coefficients were calculated for bivariate analysis. Given the high collinearity between HGS and SMI, HGS was selected for multivariate analysis, for which multiple linear regression was employed. In the regression model, oral function was designated as the dependent variable, while age, sex, number of teeth, and HGS were set as independent variables. The age groups were established as the young group (20 to 39 years), middle group (40 to 64 years), and old group (65 years and older) for statistical analysis. Differences in oral function were scrutinized using one-way ANOVA segmented by age group and sex. If the main effect was significant, Tukey’s test was utilized for multiple comparisons. The proportions of participants who met the criteria for each OHF sub-symptom and overall OHF were calculated. Differences in the proportion of OHF among age groups and sex were evaluated using the chi-square test.\u003c/p\u003e\u003cp\u003eThe critical value for rejecting the null hypothesis was P \u0026lt; 0.05. Statistical analyses were performed using IBM SPSS Statistics 28.0 software (IBM, Armonk, NY, USA).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 155 participants (median age: 55 years, range: 22 to 89 years) completed the measurements (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In the multiple linear regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), all dependent variables were significantly associated with Hygiene and LTMF. For MTP, only HGS showed a strong correlation. Regarding MOF and Mast-F, the number of teeth was moderately correlated, with no significant correlations for the other factors. For Dryness and Swal-F, no significant contributors were identified by the regression model.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of participants in the age categories\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge \u003c/p\u003e \u003cp\u003egroup (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eYoung\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOld\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable 3. Multiple linear regression analysis of oral functions\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/127393_c7e80a1c9bb65875/127393_custom_files/img1726819482.png\"\u003e\u003c/p\u003e\n\u003cp\u003eMTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; HGS, Hand grip strength; Bold indicates significant correlation (\u003cem\u003eP\u003c/em\u003e \u0026lt;0.05).\u003c/p\u003e\n\u003cp\u003eIn the analysis of differences among age groups with ANOVA, the categories of LTMF, MTP, and MOF were significantly lower in the old group than in the other two groups, and were also lower in women except for LTMF (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Hygiene also increased with age, with significant differences between the young and old groups. No significant differences were observed for the mean values of Dryness, Mast-F, or Swal-F among the three age groups or by sex.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMean (standard deviation [SD]) values for oral function by age and sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYoung\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eOld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eAge_ctg\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAge * Sex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHygiene\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(0.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003csup\u003e\u003cb\u003eb\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.390\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(0.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDryness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.986\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.770\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMTP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(6.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e33.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(9.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.911\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(9.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLTMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.096\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e28.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(3.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(0.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.738\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(0.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMast-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e196.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(62.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e176.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(67.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e170.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(81.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e188.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(50.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e183.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(45.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e160.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(69.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwal-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(0.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(0.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.204\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHGS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb,c\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(3.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e(4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eMTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; HGS, Hand grip strength\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eBold indicates significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003ea: young vs. middle, b: young vs. old, c: middle vs. old\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe proportion of participants who met the criteria for each and overall OHF symptoms is shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. For MTP, LTMF, and MOF, the prevalence of test-positive was significantly higher in the older group for both male and female participants. For Hygiene, the prevalence of test-positive was remarkably high across all three groups. The prevalence of OHF was over 50% for both sexes in the old group, which was significantly higher than in the other groups.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eProportion of participants meeting the criteria for individual and overall OHF symptoms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eYoung\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eMiddle\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eOld\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOral\u003c/p\u003e \u003cp\u003eHygiene\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e85.2%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95.8%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e89.2%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.435\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e90.3%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e86.7%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e81.5%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.016\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eOral\u003c/p\u003e \u003cp\u003eDryness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.7%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.2%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e25.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e23.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22.6%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21.0%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMTP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e7.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e14.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e25.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e56.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e38.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.032\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLTMF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e29.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e66.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e40.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e32.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMOF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e29.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e16.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.109\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e23.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e16.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMast-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e11.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e9.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e16.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e8.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSwal-F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e1.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.139\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e13.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e6.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOHF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e18.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e54.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e31.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e60.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e34.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eMTP, Maximum tongue pressure; LTMF, Lip-tongue motor function; MOF, Maximum occlusal force; Mast-F, Masticatory function; Swal-F, Swallowing function; OHF, Oral hypofunction\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eBold indicates significant differences (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study examined the age-related differences in OHF and its category measures across age groups and sex in accordance with the criteria for OHF, in addition to their association with physical function. We observed that oral function was significantly influenced by both age and sex, although the effects varied among the measured factors. Our findings suggest that tongue strength and motor function are more closely associated with physical strength as represented by HGS, while the number of teeth may exert a greater influence on occlusal force and masticatory function. In terms of gender differences, tongue pressure and occlusal force were higher in men, while pronunciation performance was superior in women. Our results also indicate that the decline in oral function does not progress linearly with age; rather, it is generally preserved until middle age and then diminishes remarkably over the age of 65 years. This study corroborates earlier reports regarding tongue pressure in that MTP is lower in older groups and in women.[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The findings from this investigation may have clinical implications for determining the optimal timing of OHF evaluation towards prompt intervention in the early stages of oral function decline.\u003c/p\u003e \u003cp\u003eAs limitations, the present study included a small cohort but spanned a wide age range, starting from 20 years old. Moreover, physical strength and body composition can vary significantly among different countries and ethnicities.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] For instance, the diagnostic criteria for sarcopenia differ between Europe and Asia.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] Tongue pressure measurements also vary between Japan, Europe and the United States[\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], with lower values typically observed in Japan, despite the use of different measurement devices. Consequently, while our findings provide normative data on oral function across a broad age range, their applicability may be limited to Japan or East Asia. Further studies incorporating data from other countries are warranted to better understand global variation[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Another potential limitation of this study was that the participants were relatively healthy as they were recruited through flyers distributed in public spaces. This recruitment method may have attracted individuals with a particular interest in oral function and possessing a higher level of oral health literacy, which possibly influenced the study results.\u003c/p\u003e \u003cp\u003eWe witnessed that MTP was approximately 20% lower in the old group than in the young group. MTP also showed a strong correlation with HGS. Our results align with previous studies demonstrating a significant decline in MTP in individuals over the age of 65 years.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] Given that the tongue is a mass of muscles representing oral muscle strength, lower tongue strength has been associated with diminished eating function and dietary level in older adults at nursing care facilities.[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] Tongue strength also influences swallowing, thereby implicating reduced tongue pressure as a risk factor for sarcopenic dysphagia.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] Age-related declines in functional reserve, frailty, and sarcopenia have been linked to adverse health outcomes. We observed that oral muscle strength was somewhat correlated with physical strength across the different age categories; thus, preserving tongue strength may contribute to preventing oral frailty and promoting a healthy diet in the later stages of life.\u003c/p\u003e \u003cp\u003eLTMF was significantly correlated with age, sex, number of teeth, and HGS in the multiple regression analysis. Articulation involves complex movements of the lips and/or tongue along with the jaw and phonation. Although speaking and eating utilize the same oral cavity, the control mechanisms for the tongue and jaw differ significantly between those activities, where tongue motion is more independent from jaw motion in speech.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] LTMF showed a moderate correlation with HGS as well in our study. LTMF is indicative of general oral motor function and serves as a marker for oral frailty[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It should be noted that the relationship between LTMF and HGS does not represent a direct pathway. However, physical and oral muscle functions may exhibit similar patterns as influenced by age and sex.\u003c/p\u003e \u003cp\u003eIn contrast to MTP and LTMF, MOF and Mast-F scores were more closely associated with the number of teeth rather than age itself and were not significantly related to HGS. Past studies are consistent with our results on the slight effects of gender and age in relation to masticatory performance, while the number of teeth is highly associated with masticatory function and occlusal force[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Regardless of the age, occlusal force and masticatory function may be conserved if tooth number is properly maintained.\u003c/p\u003e \u003cp\u003eLastly, the prevalence of OHF and its sub-symptoms increased with age in this investigation. The cut-off values for each measure were initially established in a foundational report[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] that drew on data from earlier sources. Generally, the prevalence of OHF was lower in the young group and higher in the old group, reflecting an age-related decline in oral function. In the young group, approximately 20% met the criteria for OHF as compared with 60% in the old group, as similarly reported[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. OHF measures such as MTP and LTMF, which represent oral muscle strength and motor function, respectively, displayed increased prevalence in the old population. The proportion of individuals meeting the OHF criteria for MOF was also higher in the old group, likely influenced by the lower number of teeth in this subgroup. Notably, most participants in this study met the OHF criteria for Hygiene. Although bacterial count tended to increase with age, it met the established cut-off even in the young group. It may therefore be necessary to reconsider the threshold for bacterial count to more accurately detect OHF.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Our study demonstrated an age-related increase in the prevalence of OHF along with age- and sex-related differences in multiple oral function categories that varied across parameters. Whereas tongue strength and motor function correlated significantly with age, occlusal force and masticatory function were more strongly influenced by the number of teeth than by age alone. Our findings may help determine the optimal timing for OHF evaluation and enable prompt intervention in the early OHF stages.\u003c/p\u003e"},{"header":"Declarations","content":" \u003ch2\u003eEthics approval and consent to participate.\u003c/strong\u003e \u003cp\u003eThis study\u0026rsquo;s protocol was approved by the Institutional Review Board of Tokyo Medical and Dental University (Approval ID: D2022-053-01). Informed consent was obtained from all participants involved in the study.\u003c/p\u003e \u003ch2\u003eConsent for publication.\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eA grant aid from GC Corporation\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding.\u003c/h2\u003e \u003cp\u003eA grant aid from GC Corporation and AMED Evidence review platform for prevention and health promotion services (Grant No. JP23rea522114).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eStudy design and conceptualization: KM, MK, MS, Statistical analysis: MT, RH, KM, Interpretation of data: MT, RH, KM, Drafting and revision of manuscript: RH, KM, Review of manuscript: All authors approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eAvailability of data and materials.\u003c/h2\u003e \u003cp\u003eThe data that support the findings of this study are available from the corresponding author (KM) upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eTanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, Furuya H, Tsuji T, Akishita M, Iijima K. Oral frailty as a risk factor for physical frailty and mortality in community-dwelling elderly. J Gerontol Biol Sci Med Sci 2017.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWatanabe Y, Hirano H, Arai H, Morishita S, Ohara Y, Edahiro A, Murakami M, Shimada H, Kikutani T, Suzuki T. Relationship between frailty and oral function in community-dwelling elderly adults. J Am Geriatr Soc. 2017;65(1):66\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eToniazzo MP, Amorim PS, Muniz F, Weidlich P. Relationship of nutritional status and oral health in elderly: Systematic review with meta-analysis. Clin Nutr. 2018;37(3):824\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwasaki M, Motokawa K, Watanabe Y, Shirobe M, Ohara Y, Edahiro A, Kawai H, Fujiwara Y, Kim H, Ihara K, et al. Oral hypofunction and malnutrition among community\u0026mdash;dwelling older adults: Evidence from the Otassha study. Gerodontology. 2022;39(1):17\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHakeem FF, Bernabe E, Sabbah W. Association between oral health and frailty: A systematic review of longitudinal studies. Gerodontology. 2019;36(3):205\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoyama S, Aida J, Kondo K, Yamamoto T, Saito M, Ohtsuka R, Nakade M, Osaka K. Does poor dental health predict becoming homebound among older Japanese? BMC Oral Health. 2016;16(1):51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIwasaki M, Shirobe M, Motokawa K, Tanaka T, Ikebe K, Ueda T, Minakuchi S, Akishita M, Arai H, Iijima K, et al. Prevalence of oral frailty and its association with dietary variety, social engagement, and physical frailty: Results from the Oral Frailty 5-Item Checklist. Geriatrics \u0026amp; gerontology international; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaka T, Hirano H, Ikebe K, Ueda T, Iwasaki M, Shirobe M, Minakuchi S, Akishita M, Arai H, Iijima K. Oral frailty five-item checklist to predict adverse health outcomes in community-dwelling older adults: A Kashiwa cohort study. Geriatr Gerontol Int. 2023;23(9):651\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuo K, Palmer JB. Anatomy and physiology of feeding and swallowing: normal and abnormal. Clin Integr Care. 2023;16:100139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatsuo K, Palmer JB. Kinematic linkage of the tongue, jaw, and hyoid during eating and speech. Arch Oral Biol. 2010;55(4):325\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinakuchi S, Tsuga K, Ikebe K, Ueda T, Tamura F, Nagao K, Furuya J, Matsuo K, Yamamoto K, Kanazawa M, et al. 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Standard values of maximum tongue pressure taken using newly developed disposable tongue pressure measurement device. Dysphagia. 2008;23(3):286\u0026ndash;90.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVanderwegen J, Guns C, Van Nuffelen G, Elen R, De Bodt M. The influence of age, sex, bulb position, visual feedback, and the order of testing on maximum anterior and posterior tongue strength and endurance in healthy belgian adults. Dysphagia. 2013;28(2):159\u0026ndash;66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYoumans SR, Youmans GL, Stierwalt JA. Differences in tongue strength across age and gender: is there a diminished strength reserve? Dysphagia. 2009;24(1):57\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamada R, Suehiro J, Nakano M, Kikutani T, Konishi K. Development of rapid oral bacteria detection apparatus based on dielectrophoretic impedance measurement method. IET Nanobiotechnol / IET. 2011;5(2):25\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkeda M, Miki T, Atsumi M, Inagaki A, Mizuguchi E, Meguro M, Kanamori D, Nakagawa K, Watanabe R, Mano K, et al. Effective elimination of contaminants after oral care in elderly institutionalized individuals. Geriatr Nurs. 2014;35(4):295\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIshimoto S, Tsunoda K, Akiya K, Fujimaki Y, Okada K, Kinoshita M, Yoshida T. Objective assessment of dry mouth using a non-invasive device. Acta Otolaryngol. 2009;129(12):1527\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFukushima Y, Yoda T, Kokabu S, Araki R, Murata T, Kitagawa Y, Omura K, Toya S, Ito K, Funayama S. Evaluation of an oral moisture-checking device for screening dry mouth. Open J Stomatol. 2013;3(08):440.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki T, Kumagai H, Watanabe T, Uchida T, Nagao M. 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Ann Otol Rhinol Laryngol. 2008;117(12):919\u0026ndash;24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGallagher D, Visser M, De Meersman RE, Sep\u0026uacute;lveda D, Baumgartner RN, Pierson RN, Harris T, Heymsfield SB. Appendicular skeletal muscle mass: effects of age, gender, and ethnicity. J Appl Physiol (1985). 1997;83(1):229\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen LK, Woo J, Assantachai P, Auyeung TW, Chou MY, Iijima K, Jang HC, Kang L, Kim M, Kim S, et al. Asian Working Group for Sarcopenia: 2019 Consensus Update on Sarcopenia Diagnosis and Treatment. J Am Med Dir Assoc. 2020;21(3):300\u0026ndash;e307302.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruy\u0026egrave;re O, Cederholm T, Cooper C, Landi F, Rolland Y, Sayer AA, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakagawa K, Matsuo K. Assessment of Oral Function and Proper Diet Level for Frail Elderly Individuals in Nursing Homes Using Chewing Training Food. J Nutr Health Aging. 2019;23(5):483\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTanaka Y, Nakano Y, Yokoo M, Takeda Y, Yamada K, Kayashita J. Examination about the Relation of Meal Form, Tongue Pressure, Grip and Walking State in Inpatient and Elderly Residents [Japanese]. Jpn J Dysphagia Rehabil. 2015;19(1):52\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOgawa N, Wakabayashi H, Mori T, Fujishima I, Oshima F, Itoda M, Kunieda K, Shigematsu T, Nishioka S, Tohara H, et al. Digastric muscle mass and intensity in older patients with sarcopenic dysphagia by ultrasonography. Geriatr Gerontol Int. 2021;21(1):14\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeyron MA, Woda A, Bourdiol P, Hennequin M. Age-related changes in mastication. J Oral Rehabil. 2017;44(4):299\u0026ndash;312.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIkebe K, Matsuda K, Kagawa R, Enoki K, Yoshida M, Maeda Y, Nokubi T. Association of masticatory performance with age, gender, number of teeth, occlusal force and salivary flow in Japanese older adults: is ageing a risk factor for masticatory dysfunction? Arch Oral Biol. 2011;56(10):991\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHatanaka Y, Furuya J, Sato Y, Uchida Y, Shichita T, Kitagawa N, Osawa T. Associations between Oral Hypofunction Tests, Age, and Sex. Int J Environ Res Public Health 2021, 18(19).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"oral hypofunction, physical function, aging","lastPublishedDoi":"10.21203/rs.3.rs-4923458/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4923458/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003e The deterioration of oral function to a state of oral hypofunction (OHF) has been associated with malnutrition and frailty. This cross-sectional pilot study investigated for differences in OHF prevalence and its category measures across age groups and sex, as well as their associations with physical function.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 155 healthy adults (median age: 55 years, range: 22\u0026ndash;89 years) participated in this study after providing informed consent. The cohort was age and sex matched. Seven oral function measures based on the concept of OHF were assessed: oral hygiene (Hygiene), oral dryness, maximum occlusal force (MOF), lip-tongue motor function (LTMF), maximum tongue pressure (MTP), masticatory function, and swallowing function. Hand grip strength (HGS) was also measured. The participants were divided into the young (20\u0026ndash;39 years), middle (40\u0026ndash;64 years), and old (\u0026ge;\u0026thinsp;65 years) age groups for linear regression analysis of differences in oral and physical function. Differences in OHF prevalence were tested by the chi-square test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of OHF was significantly higher in the old group than in the young and middle groups. Such OHF measures as Hygiene, MTP, LTMF, and MOF were significantly worse in the old group as well. The measures of Hygiene and LTMF showed a moderate correlation with age in the multiple regression model (standardized partial regression coefficient, β\u0026thinsp;=\u0026thinsp;0.24 and \u0026minus;\u0026thinsp;0.19, respectively). HGS was significantly associated with MTP (β\u0026thinsp;=\u0026thinsp;0.58, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and LTMF (β\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;=\u0026thinsp;0.002) in both male and female participants.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOur findings suggest that OHF prevalence increases with age, especially after 65 years old. However, the pathological route may vary among OHF categories.\u003c/p\u003e","manuscriptTitle":"Differences in oral hypofunction prevalence and category measures across age groups and sex in Japan: a pilot study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-20 08:07:40","doi":"10.21203/rs.3.rs-4923458/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-30T17:14:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-25T03:09:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86103682403576416997718919516774270063","date":"2024-10-20T02:40:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"1884936579168501559257337928926711912","date":"2024-10-15T11:39:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-09T03:33:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261955584154780226462572852205753741862","date":"2024-09-05T13:01:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113174058215914506492982379047201396515","date":"2024-08-22T09:02:10+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-22T08:56:16+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-22T06:18:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-20T02:40:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-20T02:39:47+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Oral Health","date":"2024-08-16T08:03:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-oral-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ohea","sideBox":"Learn more about [BMC Oral Health](http://bmcoralhealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/ohea/default.aspx","title":"BMC Oral Health","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"454f1bdf-da8d-409a-bf07-3de06ad112fd","owner":[],"postedDate":"September 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T16:05:55+00:00","versionOfRecord":{"articleIdentity":"rs-4923458","link":"https://doi.org/10.1186/s12903-024-05272-9","journal":{"identity":"bmc-oral-health","isVorOnly":false,"title":"BMC Oral Health"},"publishedOn":"2024-12-06 15:58:02","publishedOnDateReadable":"December 6th, 2024"},"versionCreatedAt":"2024-09-20 08:07:40","video":"","vorDoi":"10.1186/s12903-024-05272-9","vorDoiUrl":"https://doi.org/10.1186/s12903-024-05272-9","workflowStages":[]},"version":"v1","identity":"rs-4923458","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4923458","identity":"rs-4923458","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}