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Basic and Clinical Subjects of Myofunctional … and Clinical Subjects of Myofunctional Therapy ......
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Basic and Clinical Subjects of Myofunctional TherapyUsing a New Oral Rehabilitation Apparatus
Part . 2 Evaluation of Chronological Changes of "Labial-Closure-Strength"from Youth to Adults
NORO Akio, HOSOKAWA Souhei*, TAKAHASHI Junichi**,AKIHIRO Yoshiaki***, NISHIMOTO Yukihito*, HOSOKAWA Ihei,
MAKIISHI Takemi and HIRAI Yoshito
The Third Department of Conservative Dentistry, Tokyo Dental College
(Chief: Prof HIRAI Yoshito)
1-2-2 Masago, Mihama-ku, Chiba 261-8502, Japan*Department of General Practice, Tokyo Dental College, Suidobashi Hospital
2-9-18, Misakicho, Chiyoda-ku, Tokyo 101-0061, Japan**Department of General Practice, Tokyo Dental College
1-2-2, Masago, Mihama-ku, Chiba 261-8502, Japan***Department of Dentistry, Tokyo Dental College, Suidobashi Hospital
2-9-18, Misakicho, Chiyoda-ku, Tokyo 101-0061, Japan(Received for Publication: July 26, 2002)
Reprinted fromThe Japanese Journal of Conservative Dentistry
Vol. 45, No. 5 (2002)
The Japanese Journal of Conservative DentistryThe general theme of this article had been reportedduring the 112rd to the 116th conferences of Japan
Dental Conservation Academy45 (5) : 817~828, 2002
1
Preface
There are some aged people who have growing difficulties to make use of artificial denture due to serious deterioration of oral myofunctional ability although they feel imminent necessity of artificial teeth because their force of mastication is becoming weaker and weaker by losing their permanent teeth mainly in aging process.In addition, weak strength of labial closure leads to inefficiency of closing mouth cavity so that a growing number of aged people suffer from deterioration of oral cavity environment due to perpetual evaporation of saliva. Some people may suffer, by the subsequent complications of cerebro- vascular disorder, from such sequelae as glossa-motor functional disorder / mastication, ingestion, swallowing disorders / articulation disorders / facial nerve palsy / drooping corner of the mouth / face deformation, sagging / watering and what is worse, some of them might even have got senile dementia concurrently. On the other hand, it is observed among youth that there are growing numbers of young people who do mouth breathing due to deteriorated labial-closure strength caused by changes in eating habits. Some of them have discomfort in pharynx or oral cavity and develop symptoms such as xerotomia, glossalgia, mouth ulcer, gingivitis, periodontis, ozostomia, adenoid growths, adenoiditis, and tonsillitis; others induce allergic diseases such as sinus, asthma, and atopy.
As for middle-aged and elderly people, this
weakening of labial-closure strength through overweight, insufficient exercise, drinking, and aging may outset sinking of tongue root during sleep, which eventually results in mouth breathing and snoring. It may well develop obstructive sleep apnea syndrome (OSAS) and it may also be a remote cause of lifestyle related serious diseases. From infant to aged people in large age bracket, diseases that may be developed by weakening labial-closure strength are as follows: 1 Lifestyle-related diseases, the infarction, hypertension, diabetes) 2 Adenoiditis, tonsillitis, inflammation of upper respiratory airway, synus, asthma, and tonsill focal infection syndrome such as atopic dermatitis and plantar pustulosis caused by mouth-breathing during sleep. factors of which are attributed to obstructive sleep apnea syndrome and snoring ( ischemic heart disease, cerebral 3 Nonconformity/unsustainability/difficulty of upholding artificial denture, which is caused by functional deterioration of oral cavity, muscles with paralysis or sequelae or growing old. 4 Sicca syndrome, glossalgia, mouth ulcer, gingivitis, periodontitis, multiple tooth caries, ozostomia by deterioration of oral cavity environment with evaporating saliva. Now that our society is rapidly aging, rehabilitation of motor functions of oral cavity muscle such as ingestion, swallowing and articulation is a prime task with a tandem study of disturbance of higher cerebral functions.
Through several conferences of Japanese conservative dentistry (from 112th to 116th), we
Research was carried out to measure the chron-logical changes of L-C-S (Labial-Closure Strength)with aging. Numbers of subjects were 3,172 youth(2 to 19 yrs old), 761 adults (20 to 59 yrs old), and170 eldery (60 to 89 yrs old), for total of 4,103subjects. L-C-S is fully developed at the age ofabout 18-20 yrs for both males and females. L-C-Swas 14-16 N for males and 10-12 N for females.These numbers showed little change until age 60,but there after the strength declined gradually withincreasing age. L-C-S at age 80 was 5 to 7 N, whichwas almost the same as at age 3, LCS of healthy
youth and adults, both males and females, in every age group, were 3 - 4 N higher compared with youth and adults who had diseases. Starting to train the oral cavity muscles with the use of the oral rehabili-tation apparatus LIP TRAINER "Patakara®", from around age 60 will increase the L-C-S, and is effective in terms of health maintenance. L-C-S appears to be a useful parameter that shows the status of the respiratory organs and immune related disease, indicating the health status of the oral cavity environment. (Request original article reprints to Dr. NORO)
Vol. 45, No. 5The Japanese Journal of Conservative Dentistry
rehabilitation apparatus such as LIP TRAINER [Patakara®] (manufactured by "DENTAL YUMI CORP", Figure1), labial closure strength indicator called [Lip DeCum/LDC-110] (made by Cosmo Instruments Co. Ltd. Figure 2) and a Lip-holder [DuClean] ( made by C Instruments Co. Ltd. Figure 3) , and at the same time, we have emphasized that the labial closure strength has its own characteristics from youth to aged people, and have highlighted its significance and evaluation.
In this article, we have carried out our research and have scrutinized how the labial closure strength [L-C-S] will develop or change from youth to aged people and we have investigated and analyzed how these chronological changes of L-C-S (Labial-Closure-Strength) are constructed in alignment with sex and age. Finally, we have, through its significance and evaluation, introduced the standard value of L-C-S, which could be a reference parameter that indicates the status of oral cavity environment.
Subjects and Methodology
1. Subjects and Research methods
Numbers of subjects were constructed of 3172 of youth group (3 to 19 yrs old), 761 of adult group (20 to 59 yrs old), and 170 of elderly group (60 to 89 yrs old), which has totaled to 4,103 subjects.
As for the subjects of youth group, which consists of kindergarten, primary school, middle school, high school students, and universities, we have measured L-C-S at a regular health check at their institutions, and have collected interview sheets from each subject. For adults and elderly, the subjects were outpatients of SuidoBashi Hospital of Tokyo University of Medical & Dental, from whom we have collected the data in the same manner as the other groups.
The data collected in this research are those done through diagnostic consultations direct from those patients (not healthy people) or self-declared information from their family members. The patients or former patients are either suffering or
2October 2002
have suffered from mouth-breathing, tonsillitis, adenoiditis, atopy, asthma, synus, sneezing and lifestyle-related diseases or have a history of them. Evaluation in accordance with degrees of seriousness of diseases and symptoms was not carried out in this research because of consideration of individual variation. For users of artificial denture, who are, strictly from the dental point of view, considered as dental patients, are identified as healthy people unless they have above diseases or symptoms as described above. As for the classification of Healthy group and Patient group, we have segregated them into the two groups according to whether or not they have previous illnesses as stated above with assistance of the data collected, so that we could analyze in meticulous details the L-C-S status in relationship with the factors of age and genders by applying statistical methods.
2. Method to measuring L-C-S values
After attaching the lip-holder[DuClean] to the sensor of L-C-S indicator [Lip DeCum] (Figure 3), we have measured L-C-S by asking subjects to hold it between two lips in upright sitting posture with FH-plane being parallel to the floor level and letting subjects to close upper-lip and lower lip with maximum strength without maxillomandibular teeth ever touched (Figure 4). This device has four sets of Strain Gauge in the sensor part and the main device will convert the measured values into loading value (N : Newton, 1N / 102g ) and indicate the peak value with digital display.
Results
1. Evaluation of L-C-S in regards with age brackets and gender
According to age brackets, changes in average values of L-C-S are as follows (figure 5 to 6): From 3 to 4 yrs old, 7.0+2.0N (n=82) for male, 7.2 +2.2N(n=100) for female. From 5 to 9 yrs old, 9.5+2.6N (n=247) for male, 9.2+2.4N ( n=240 ) for female. From 10 to 14 yrs old, 12.2+3.2N (n=428) for male, 10.0+3.7N (n=713) for female. From 15 to 19 yrs old, 13.3+3.2N (n=434) for male, 10.7+3.2N (n=928) for female. From 20 to 24 yrs old,
Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
3 Vol. 45, No. 5
(Figure 3) Upper Photo: Lip holder [DuClean®] Below Photo: The Lip holder mounted to the sensor of the L.C.S Indicator Holder Material: Polypropylene
(Figure 4) Sample photo of L.C.S data collection
To get ready for L.C.S Indicator [ Lip DeCum®] with a Lip holder [DuClean®] mounted to the sensor, and have the subject bite the holder between upper and below lips. Then, you measure the L.C.S while the subject, sitting upright (with FH plane being parallel to the floor plane), shall close it's upper and below lips by the utmost strength, always with the upper and below teeth never touched. In a similar
(Figure 2)Labial Closure Strength (L.C.S) Indicator [ Lip DeCum®/LDC-110] with a Lip holder [DuClean®] mounted to the sensor .
(Figure 1) Oral Cavity Rehabilitative Device LIP TRAINER [ Patakara®]Spring Force: Rehabilitation/Soft/Normal
Material of LIP TRAINER [Patakara®] : Highly elastic polymer plastic with rubber composite (Polyester elastomer)
Torsion Spring
LIP TRAINER[Patakara®]
Hourglass(3 Minutes)
Reference Value Of L.C.S
Rehabilitation Less than 7 N
Soft 7 N ~ 14 N
Normal More than 14 N 1 N / 102g
Strength Diagram of LIP TRAINER [Patakara®]
W/O Torsion Spring
With Torsion Spring
StrengthPurpose (Color)
Rehabilitation(Green)
Soft(Pink)
Normal(Blue)
100g
280g ~ 300g
500g
300g
500g ~ 550g
780g ~ 800g
The Japanese Journal of Conservative Dentistry
RecommendedLIP TRAINER
[Patakara®]
4October 2002
old, 13.6+3.8N (n=45) for male, 11.1+3.3N (n=140) for female. From 25 to 29 yrs old, 14.8+3.1N (n=89) for male, 10.9+2.9N (n=71) for female. From 30 to 34 yrs old, 15.6+2.9N (n=50) for male, 11.0+3.6 N (n=25) for female. From 35 to 39 yrs old, 16.2+4.4N (n=51) for male, 11.1+3.4N (n=30) for female. From 40 to 44 yrs old, 15.7+3.7N (n=44), 11.6+3.2N (n=26) for female. From 45 to 49 yrs old, 15.5+3.1N (n=39) for male, 12.1+3.5N (n=35) for female. From 50 to 54 yrs old, 16.1+4.7N (n=40) for male, 10.2+2.8N (n=30) for female. From 55 to 59 yrs old, 14.4+4.3N (n=34) for male, 9.8+2.1N (n=21) for female. From 60 to 64 yrs old, 11.7+4.7N (n=21) for male, 12.0+5.3N (n=16) for female. From 65 to 69 yrs old, 11.2+5.0N (n=25) for male, 9.4+2.9N (n=22) for female. From 70 to 74 yrs old, 9.6+4.7N (n=21) for male, 7.3+2.9N (n=17) for female. From 75 to 79 yrs old, 6.7+3.1N (n=9) for male, 7.1+3.0N (n=12) for female. From 80 to 84 yrs old, 7.1+3.0N (n=12) for male, 5.8+2.6N (n=7) for female. From 85 to 89 yrs old, 5.8+3.6N (n=5) for male, 5.6+2.3N (n=6) for female.
2. Evaluation of L-C-S for Healthy group and Patient group These subjects were divided into 2 groups. One is healthy group; the other is Patient group. Patient group is those people who have diseases or symptoms which are as follows; oral respiration, tonsillitis, adenoiditis, atopy, asthma, synus, snoring and life-related diseases.
L-C-S readings changed from 9.0±2.9N (from 3 to 9yrs old) to 16.8+3.9N (from 50 to 59 yrs old) for healthy male group, and those from 7.5±2.3N (from 3 to 9yrs old) to 14.1±4.8N (from 50 to 59yrs old) are for male patient group (Figure 7).
On the other hand, L-C-S reading changed from 9.3±2.8N (from 3 to 9 yrs old) to 12.4 ±2.1N (from 50 to 59yrs old) for healthy female group, and the readings from 7.7±2.5N (from 3 to 9yrs old) to 8.7±2.1N (from 50 to 59yrs old) are for sick female group (Figure 8). We have here clearly recognized that there are significant statistical differences of L-C-S ( p<0.05,
Mann-Whitney test) among age brackets groups both in male and female genders of the two categories.
3. Proportional comparison by age & sex of Healthy and Patient groups.
Proportions (Figure 9) of healthy people and sick people are as follows; As for male from 3 to 9 yrs old, 293 are healthy (89%) and 36 are sick (11%); 629 healthy people (73%) and 233 sick people (27%) for 10 to 19 yrs old;107 healthy people (86%) and 18 sick people (14%) for 20 to 29 yrs old; 88 healthy people (87%) and 13 sick people (13%) for 30 to 39 yrs old; 67 healthy people (81%) and 16 sick people (19%) for 40 to 49 yrs old;43 healthy people (58%) and 31 sick people (42%) for 50 to 59 yrs old. For female from 3 to 9 yrs old, 283 are healthy (83%) and 57 sick (17%);1,045 healthy people (64%) and 596 sick people (36%) for 10 to 19 yrs old; 113 healthy people (54%) and 98 sick people (46%) for 20 to 29 yrs old; 30 healthy people (55%) and 25 sick people (45%) for 30 to 39 yrs old; 36 healthy people (59%) and 25 sick people (41%) for 40 to 49 yrs old; 23 healthy people (45%) and 28 sick people (55%) for 50 to 59 yrs old.
Observation
1. Evaluation of L-C-S Values by age and sex
As for the transitional slope of average values of LCS (Figure 5) among both male and female youth, they have showed gradual increase (6 ~8N) from 3 to 6 years old. Afterward, male L-C-S keeps a position superior to female one, though, from 6 to 16 yrs old, both male and female L-C-S shows significant increase. As such, male and female L-C-S is most likely to develop up to age 18 to 20. We hereby presume that the value of L-C-S should reach very close to 14N and 12N for adult male and female respectively. We can also estimate that the L-C-S transition probably follow the pattern of human growth and development. The basis of this assumption that L-C-S is to reach its peak during a couple of years from 18 to 20 is we can substantially
Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
5 Vol. 45, No. 5
20
18
16
14
12
10
8
6
4
2
0
Labiel-C
losure-Strength.N
(Figure 5) Labia Closure Strength change for youth
Total Numbers
No. of Females
No. of Males
L-C-S for sick people
L-C-S for healthy people
Average of L-C-S
3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
6.8
6.9
6.9
31
32
63
7.2
7.5
7.4
51
68
119
8.2
8.2
8.2
54
43
103
7.4
7.1
7.3
45
47
92
9.6
9.1
9.4
60
54
114
11.1
10.5
10.8
50
51
101
11.3
10.9
11.1
38
39
77
11.7
10.2
11.0
66
46
112
11.6
10.5
11.1
47
43
90
12.3
9.2
10.8
111
155
266
12.4
10.2
11.3
114
287
401
13.2
9.7
11.5
90
182
272
12.6
10.2
11.4
119
279
398
14.1
11.8
13.0
60
290
350
13.3
9.2
11.3
115
242
357
13.5
10.8
12.2
74
51
125
13.4
11.3
12.4
66
66
132
13.6
11.6
12.6
21
66
87
Total Numbers
No. of Females
No. of Males
L-C-S (Female)
L-C-S (Male)
Average of L-C-S
3-4
7.0
7.2
7.1
82
100
182
5-9
9.5
9.2
9.3
247
240
487
10-14
12.2
10.0
11.1
428
713
1141
15-19
13.3
10.7
12.0
434
928
1362
20-24
13.6
11.1
12.4
45
140
185
25-29
14.8
10.9
12.8
80
71
151
30-34
15.6
11.0
13.3
50
25
75
35-39
16.2
11.1
13.7
51
30
81
40-44
15.7
11.6
13.6
44
26
70
45-49
15.5
12.1
13.8
39
35
74
50-54
16.1
10.2
13.1
40
30
70
55-59
14.4
9.8
12.1
34
21
55
60-64
11.7
12.0
11.8
21
16
37
65-69
11.2
7.3
8.4
25
22
47
70-74
6.9
7.3
8.4
21
17
38
75-79
6.7
7.1
6.9
9
12
21
80-84
7.1
5.8
6.5
9
7
16
85-89
5.8
5.6
5.7
5
6
11
Total
1664
2439
4103
(Figure 6) Labia Closure Strength according to age
20
18
16
14
12
10
8
6
4
2
0
Labiel-C
losure-Strength.N
The Japanese Journal of Conservative Dentistry
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(Figure 7) Changes of L-C-S in same age groups and differences between healthy people and sick people (male)
Total No. of MalesNo. of sick people
No. of healthy peopleL-C-S for sick peopleL-C-S for healthy people
20
18
16
14
12
10
8
6
4
2
03~99.07.529336329
10~1913.410.7629233862
20~2915.29.910718125
30~3916.313.68813101
40~4915.914.8671683
50~5916.814.1433174
The sick people have:
- oral respiration- adenoiditis- atopy- asthma- synus- snoring- lifestyle related
Labiel-C
losure-Strength.N
The sick people have:
- oral respiration- adenoiditis- atopy- asthma- synus- snoring- lifestyle related
Total No. of MalesNo. of sick people
No. of healthy peopleL-C-S for sick peopleL-C-S for healthy people
(Figure 8) Changes of L-C-S in same age groups and differences between healthy people and sick people (female)
20
18
16
14
12
10
8
6
4
2
0
Labiel-C
losure-Strength.N
3~99.37.728357340
10~1912.37.9
10455961641
20~2912.89.211398211
30~3913.78.5302555
40~4913.79.6362561
50~5912.48.7232851
Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
data to which we have made access by this research, because our research have comprised no less than 3000 young people while the number of adult and elderly is slightly less than 1000.
As for the transitional change of the average values of L-C-S (Figure 6) seen in grown up adults, L-C-S of male in their 30s to 40s brackets has nearly climbed up to 16N. It seems to us that this phenomenon may have been caused by their eating habit at growth and developing period specific to their age brackets. However, it needs more verification to know if it can be seen, by following the same logic, in the L-C-S transition line change in the male age brackets of their 20's to 30's. On the other hand, the female L-C-S does not seem to go up after their 30's. We, at this moment of time, presume that this is because female growth and development will come to a halt by their 20's. In addition, the decline, [or the increase, if any] of female L-C-S in their 40's and 50's could be explained by relatively smaller number of female adults subjects than that of the youth as well as relatively higher prevalent rate of sick female people among all subjects.
Last of all, we want to note that the growth and development of L-C-S will have completed most part of its activities around 18 to 20 yrs old for both males and females. In their 20's and after, the average L-C-S is observed as 14~16N for male, and 10~12N for female.
In aging process after, it changes by a certain ratio of its value unless they have serious diseases. We can now recognize that, before and after their 60's, there is a deteriorating tendency for L-C-S getting lower and lower due to aging. In 80's, people's L-C-S has decreased to 5~7N as low as that of kindergarten pupils. 2. Evaluation of L-C-S among healthy people and sick people
Healthy male adults have 14~17N of L-C-S while sick male adults have 10~14N of it.
On the other hand, healthy female adults have
have 12~14N of L-C-S value while sick female adults have 8~10N.
Sick people (unhealthy people) are the people who have oral respiration, tonsillitis, adenoiditis, atopy, asthma, synus, sneezing and lifestyle related diseases or have a history of them. There has been observed a difference of about 3~4N in L-C-S value between healthy group and sick group (Figure7~8) in each age bracket of both male and female, and sick groups have a lower value. We can say that there exits significant statistical differences of L-C-S (p<0.05, Mann-Whitney test) between the two groups regardless of age and gender.
The implications behind this data, we have deduced, would expose as follows: that the diversity of lactation conditions during infancy (less than 1 yrs old) has left increasing numbers of infants to grow up without promoting their L-C-S due to insufficient labial movement of sucking practices at their mother's breasts. This inadequacy coupled with changes of eating habits as they grow up may well cause harm to the L-C-S of kindergarten pupils and young people. As a result, this deficiency of L-C-S will accelerate to use mouth-breathing during sleep, develop chronic inflammation of pharyngeal lymphatic ring, get lower self-immune resistance, and develop diseases or allergic disorder of oral cavity and pharynx for a number of people. And as for middle-aged and elderly people, factors such as overweight, less exercise, drinking, aging, decline of their physical strength due to diseases will make their L-C-S get lower. The deterioration of L-C-S will not only promote tongue roots to sink further, which directly causes mouth-breathing and snoring, but sometimes it will cause obstructive sleep apnea syndrome. It even can prove to be, at the same time, a remote cause to develop serious lifestyle-related diseases.
3. Prevalence rate among different age groups and gender
As for one of the young age brackets (3~19 yrs), we have carried out collection of data at schools by means of regular oral check-ups, so that there were many subjects (more than 3,000 subjects). On the other hand, the number of adult and elderly subjects
7 Vol. 45, No. 5The Japanese Journal of Conservative Dentistry
Proportion of healthy male and sick male (3~9yrs old)
Sick Male7.5 2.3Nn=36, 11%
+-
Healthy Male9.0 2.9Nn=293, 89%
+-
Proportion of healthy male and sick male (20~29yrs old)
Sick Male9.9 2.6Nn=18, 14%
+-
Healthy Male15.2 3.0Nn=107, 86%
+-
Proportion of healthy male and sick male (30~39yrs old)
Sick Male13.6 3.7Nn=13, 13%
+-
Healthy Male16.3 3.6Nn=88, 87%
+-
Proportion of healthy female and sick female
(3~9yrs old)Sick Female7.7 2.5Nn=57, 17%
+-
Healthy Female9.3 2.8Nn=283, 83%
Proportion of healthy male and sick male (40~49yrs old)
Sick Male14.8 3.3Nn=16, 19%
+-
Healthy Male15.9 3.6Nn=67, 81%
+-
Proportion of healthy male and sick male (10~19yrs old)
Sick Male10.7 2.6Nn=233, 27%
+-
Healthy Male13.4 3.2Nn=629, 73%
+-
Proportion of healthy male and sick male (50~59yrs old)
Sick Male14.1 4.8Nn=31, 42%
+-
Healthy Male16.8 3.9Nn=43, 58%
+-
Proportion of healthy female and sick female (40~49yrs old)
Sick Female9.6 2.9Nn=25, 41%
+-
Healthy Female13.7 2.7Nn=36, 59%
+-
Proportion of healthy female and sick female (10~19yrs old)
Sick Female7.9 2.4N
n=596, 36%+-
Healthy Female12.3 3.0N
n=1,045, 64%+-
Proportion of healthy female and sick female (30~39yrs old)
Sick Female8.5 2.1Nn=25, 45%
+-
Healthy Female13.7 2.9Nn=30, 55%
+-
Proportion of healthy female and sick female (20~29yrs old)
Sick Female9.2 2.9Nn=98, 46%
+-
Healthy Female12.8 2.3Nn=113, 54%
+-
Proportion of healthy female and sick female (50~59yrs old)
Healthy Female12.4 2.1Nn=23, 45%
+-Sick Female8.7 2.1Nn=28, 55%
+-
Total 329
Total 862 Total 101
Total 125 Total 83
Total 74
Total 61Total 211Total 340
Total 51Total 55Total 1,641
subjects (20~89yrs) was limited (no more than 1,000), because we could only collected the data of incoming patients to dental university hospitals. This may be one of the reasons of high proportion of sick people in adult and elderly age brackets. In terms of the ratio between healthy people and sick people, that of female sick people is always spotted much higher than that of male sick people in each age bracket. What is worthwhile noting here is that, regardless of male or female, 10 to 40% of sick people has always weaker L-C-S in all age brackets,
and as people get old, the proportion of sick people climbs up (Figure 9). In this research, we didn't carry out the individual assessment of L-C-S by diagnostic rating of diseases or symptoms, since it is varied by individuals. But in the near future we'd like to carry out these researches in more details by introducing certain correlation program which could bring forth to a decisive assertion in order to clarify its relationship to L-C-S.
(Figure 9) Relationship of Prevalent Rate and L-C-S by age and gender(Upper Graphs: Male, Below Graphs: Female)In the above graphs is clearly observed Statistical implications
(p<0.05, Mann-Whitney test) between Healthy Groups and Sick Groups.
8October 2002
+-
Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
1. Wetting and lubricating effect to mucosa tissue 2. Assistance of mastication, swallowing, articulation 3. Helping the digestion of food (digestive enzyme) 4. Solvent function for gustatory substances(Taste carrier to gustatory buds) 5. Protection of oral mucosa and pharyngeal mucosa 6. Disinfection, sterilization, and cleaning of mucosa 7. Excretion of bodily waste 8. Balancing the bodily fluid 9. Prevention of development of disorders in oral cavity (Tooth decay, periodontis, mouth ulcer)10. Improvement of stability of artificial denture
(Figure 10) Physiological functions of saliva
4. Countermeasures for weak L-C-S
It became clear through diagnostic consultations during this research that a lot of people classified in the weak L-C-S group of young age brackets had oral and pharyngeal region disorders (oral respiration, tonsillitis, adenoiditis) as well as sequential symptoms of allergic disorders (atopy, asthma, sinus) with high incidence.
It has been reported for long that oral respiration was one of the factors to develop periodontis. Oral respiration makes oral cavity dry and hinder sufficient work of physiological function of saliva, which, as a result, help dental plaque and dental calculi easily build up and finally induce periodontis and teeth caries. In order to discourage oral respiration which is a major risk factor for periodontis into nasal respiration, we should provide definitive therapy to eliminate the root factor. Though there has been so far introduced some treatments such as putting adhesive tape on nasal alar to enlarge nasal cavity and sleeping with adhesive plaster pasted over the mouth, they are only makeshift measures and not definitive therapy.
This newly developed oral rehabilitation tool LIP TRAINER [Patakara®] is designed to train oral muscle to increase L-C-S, we should say that it is a therapeutic apparatus that contribute to drastically reduce oral respiration during sleep. The author has reported several effects: that when the oral myofunctional training with LIP TRAINER [Patakara®] had been provided on people of all ages with lower L-C-S, then in a couple of months their L-C-S had increased; that loose mouth had tightened; that tongue sinking had disappeared; that habitual oral respiration during sleep had disappeared; that nasal respiration had stopped evaporation of saliva; that physiological function of saliva (Figure 10) had worked efficiently; that, therefore, various types of discomfort had been reduced.
Listed up in the Figures 11 to 13 are the effects and mechanism of the stretch work-out induced by this device, which are based on one year data of monitoring patients.
We'd like to report in this article that so far as young and middle-aged to elderly people are concerned, our device has succeeded in improving, though not perfect, oral respiration during sleep, snoring and obstructive sleep apnea syndrome and that it has ameliorated such diseases and symptoms related to oral cavity and pharynx that include xerostomia, glossalgia, mouth ulcer, ozostomia, periodontitis, adenoid, tonsillitis, adenoiditis and asthma. At the same time through this research, bit by bit, we came to know that this device could be an effective therapy for atopic dermatitis and carpopedal pustulosis which are considered as chronic diseases. In addition to the above effects, the device has not merely proved that it would eliminate the wrinkles and distortions of facial muscles as well as double chin by overweight and aging process which are frequently observed among middle-aged to elderly people, but also that it could restore young looking, firm and pure face (small face). Other effects have been partly proved that, so long as aged people are concerned, it could probably ameliorate eating habit / swallowing / articulation disorder / tongue movement failure/mastication disorder/stability & maintenance of artificial denture/aspiration pneumonia/oral cavity peripheral muscle palsy / drool / rehabilitation of oral cavity / facial nerve palsy/dementia. (Figure 14)
9 Vol. 45, No. 5The Japanese Journal of Conservative Dentistry
10October 2002Fa
cial
ner
ve p
alsy
; Fac
ial d
isto
rtio
nE
limin
ate
doub
le-c
hin;
fac
ial s
hape
( s
mal
l fac
e )
Los
s of
exp
ress
ion;
Pre
vent
ion
of d
rool
Sagg
ing
faci
al m
uscl
e; D
roop
ing
angl
e of
mou
thFu
nctio
nal i
mpr
ovem
ent o
f ar
tific
ial d
entu
re;
mai
ntai
ning
its
stab
ility
Im
prov
emen
t of
righ
t-le
ft b
alan
ce o
f fa
cial
mus
cles
Im
prov
emen
t of
artic
ulat
ion
diso
rder
s,
tong
ue m
ovem
ent,
and
mas
ticat
ion
Prev
entio
n of
asp
irat
ion
pneu
mon
ia
Dis
use
atro
phic
dem
entia
Cer
ebro
vasc
ular
dem
entia
Impr
ovem
ent o
f m
emor
y an
d se
nile
dec
ay
Prev
entio
n of
sud
den
deat
hA
llorh
ythm
ic p
ulse
and
day
time
drow
sine
ssM
orni
ng h
eada
che
and
bed-
wet
ting
Ang
ina
pect
oris
and
myo
card
ial i
nfar
ctio
nB
rain
hae
mor
rhag
e an
d br
ain
infa
rctio
nH
igh
bloo
d pr
essu
re a
nd d
iabe
tes
Impr
ovem
ent o
f co
ncen
trat
ion
Acc
eler
atio
n of
sal
iva
secr
etio
n G
ingi
vitis
and
per
iodo
ntis
Bad
bre
ath,
dry
mou
th a
nd m
outh
ulc
erX
eros
tom
ia a
nd g
loss
algi
aM
ultip
le c
arie
s
Enh
ance
men
t of
imm
une
syst
em in
thro
at
Ade
noid
hyp
ertr
ophy
Ade
noid
itis
and
peri
tons
illiti
s A
sthm
a an
d br
onch
itis
Alle
rgic
syn
usA
topi
c de
rmat
itis
Con
tact
der
mat
itis
Impr
ovem
ent o
f co
nditi
on o
f dr
y sk
inPl
ante
r pu
stul
osis
Eff
ects
Cha
nge
of e
atin
g ha
bits
at l
ower
ag
e; d
evel
opm
ent o
f ov
erw
eigh
t, ag
ing,
and
dis
ease
s
Dec
line
of L
-C-S
/ fun
ctio
nal
decl
ine
of o
ral m
uscl
e
Gro
win
g ne
cess
ity o
f or
al m
uscl
e tr
aini
ng
Eff
ects
of
stre
tchi
ng w
orko
ut
by u
sing
LIP
TR
AIN
ER
[P
ATA
KA
RA
®]
1.
Fun
ctio
nal I
mpr
ovem
ent
2.
Pre
vent
ion
of d
isea
ses
3.
Pre
vent
ion
of a
ging
Stim
ulus
to
the
surr
ound
-in
g ar
eas
of li
ps w
ith
stre
tch
wor
kout
Tra
inin
g of
m
imet
ic
mus
cles
(o
rbic
ular
m
uscl
e of
m
outh
&
chee
k m
uscl
e)
Stim
ulus
to
fac
ial
nerv
e
By
labi
al
clos
ure,
ap
ex o
f to
ngue
to
uche
s pa
late
be
hind
up
per
ante
rior
te
eth,
th
eref
ore
tong
ue
mov
es to
th
e an
tero
supe
rior
of
oral
ca
vity
Prev
entio
n of
sin
king
ro
ot o
f th
e to
ngue
du
ring
sl
eep
Kee
ping
ai
rway
an
d re
duci
ng
snor
e
Alle
viat
-io
n of
ob
stru
ct-
ive
slee
p ap
nea
synd
ro-
me
Prev
entio
n of
life
styl
e re
late
d di
seas
es
Prev
entio
n of
de
hydr
atio
n of
ora
l m
ucos
a
Faci
litat
e st
erili
zing
fu
nctio
n of
Sal
iva
Alle
viat
ion
of p
laqu
e
Prev
entio
n of
car
ies
&
peri
odon
tis
Reh
abili
tatio
n w
ith
surv
ivin
g ab
ility
Cha
nge
oral
re
spir
atio
n to
nas
al
resp
irat
ion
duri
ng
slee
p
Rel
ief
of
synu
s an
d th
roat
in
flam
ma
-tio
n
Act
ivat
ing
imm
une
syst
em o
f sy
nus
and
phar
ynge
s
Red
ucin
g fo
cal
infe
ctio
n of
to
nsil
and
alle
rgic
di
sord
ers
(Fig
ure
11)
Eff
ects
exp
ecte
d of
the
reha
bilit
ativ
e de
vice
LIP
TR
AIN
ER
[Pa
taka
ra®
] (U
nder
clin
ical
ver
ific
atio
n)
Stre
ngth
en
of L
-C-S
Act
ivat
ion
of
mim
ic m
uscl
e,
mas
sete
r an
d lin
gual
mus
cle
Tra
ctio
n of
pa
lsie
d m
uscl
e by
hea
lthy
mus
cle
Rec
over
y of
m
otor
fun
ctio
n an
d pr
even
tion
of a
ging
Enh
ance
men
t of
cere
bral
blo
od
flow
to r
ight
fr
onta
l cor
tex
Prev
entio
n of
m
uscl
e ag
ing,
re
habi
litat
ive
effe
ct o
f br
ain
Prev
entio
n of
de
men
tia a
nd it
s tr
eatm
ent
Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
Listed above are reasons why strengthened L-C-S will alter oral respiration into nasal-alar respiration during sleep, and then reduce discomfort in oral cavity and pharynx, which will subsequently help improve overall body conditions and symptom of diseases.
(Figure 12)
Lip-closure
Apex of the tongue touches palate behind upper anterior teeth
Body of the tongue moves anterosuperior
Strengthen depressor muscle of septum
Broaden out nasal cavity downward, making flow
of air stream smooth
As for overweight people who can keep
certain tension of tongue muscle during sleep, their respiration won't be disturbed by
Smooth air flow can be maintained from
nostril to upper airway at one's sleep.
(Making sure of nasal alar breathing)
Cold and dry air doesn't directly
reach to pharyngeal area when breathing.
Eliminating conditions of
inflammation in pharyngeal area
sleep.
Stopping snoringand OSAS
Preventing pharynx swelling,
adenoiditis, bronchial asthma
Reducing sensitization in Waldeyer Pharynx
Lymph Ring (Reducing tonsillolith at pharyngeal crypt)
Improving bad-breath
Reducing chances to develop focal infection
of tonsil
Effective to atopic dermatitis, plantar pustulosis; improving
so-called "other immunity-related disorders"
11 Vol. 45, No. 5The Japanese Journal of Conservative Dentistry
1. H
elpi
ng to
get
hig
her
L-C
-S, i
mpr
ove
loos
e-lip
con
ditio
n, a
nd
e
limin
ate
the
habi
t of
oral
res
pira
tion.
2. I
nduc
e or
al r
espi
ratio
n to
nas
al-a
lar
brea
thin
g, w
hich
res
ults
in
r
ecov
erin
g in
flam
mat
ion
of th
roat
and
in p
rom
otin
g so
und
r
espi
rato
r sy
stem
.
3. P
reve
ntio
n of
dry
ness
in o
ral c
avity
, whi
ch le
ads
to im
prov
emen
t of
p
erio
dont
itis,
ozo
stom
ia, m
outh
ulc
er, g
loss
algi
a, x
eros
tom
ia.
4. P
rom
otin
g se
cret
ion
of s
aliv
a as
wel
l as
deve
lopi
ng
f
avor
able
env
iron
men
t for
sal
iva
to f
unct
ion,
and
mai
ntai
ning
ora
l cav
ity c
omfo
rtab
le.
5. T
rain
ing
oral
mus
cles
, whi
ch r
esul
ts in
bet
ter
left
-rig
ht m
uscl
e
bal
ance
, and
then
am
elio
ratin
g th
e su
stai
nabi
lity,
sta
bilit
y,
f
unct
iona
bilit
y an
d m
astic
atio
n of
art
ific
ial d
entu
re
6. P
reve
ntio
n of
sin
king
tong
ue r
esul
ts in
red
ucin
g sn
ore
and
o
bstr
uctiv
e sl
eep
apne
a sy
ndro
me(
Pre
vent
ion
of li
fe-s
tyle
rel
ated
dis
ease
s )
7. I
mpr
ovin
g ob
scur
atio
n of
pro
nunc
iatio
n af
ter
cere
bro-
vasc
ular
dis
orde
r, tw
itchi
ng f
ace,
mou
th c
orne
r dr
oopi
ng, a
nd r
ecov
ery
of
m
otor
fun
ctio
ns s
uch
as w
ater
ing,
eat
ing
and
swal
low
ing.
8. P
rom
otin
g ex
pres
sive
cou
nten
ance
, im
prov
ing
sagg
ing
face
,
hel
ping
reg
ain
adol
esce
nt s
mile
. ( r
evita
lizat
ion
of m
imic
mus
cles
)
9. M
akin
g m
outh
and
fac
e lin
e fi
rm a
nd p
ure,
rem
ovin
g do
uble
-chi
n
whi
ch is
lead
ing
to s
limm
ing
dow
n th
e fa
ce(
smal
l fac
e )
(Fig
ure1
3) D
isea
ses
and
sym
ptom
s w
hich
is d
evel
oped
by
low
er L
-C-S
Lif
esty
le-r
elat
ed
dise
ases
Dry
ski
n, c
onta
ct
derm
atiti
sat
opic
der
mat
itis,
pl
anta
r pu
stul
osis
asth
ma
and
bron
chiti
s
Infl
amm
atio
n of
to
nsils
;Ton
silll
ar
hype
rtro
phy,
ade
noid
s/
chro
nic
foca
l in
fect
ion
of to
nsil
Den
tal p
laqu
e, d
enta
l ca
lcul
us, c
oate
d to
ngue
, ba
d-br
eath
, dry
-mou
th
and
xero
stom
ia
Obs
truc
tive
slee
p ap
nea
synd
rom
e
Det
erio
ratio
n of
ora
l-ca
vity
en
viro
nmen
t
Eva
pora
tion
of s
aliv
a
Usi
ng o
ral r
espi
ratio
n du
ring
sle
ep
men
tal a
ctiv
ity d
eter
iora
tes
L-C
-S is
get
ting
wea
ker
cere
bral
blo
od f
low
is
get
ting
dow
n
Ape
x of
tong
ue d
oesn
't re
ach
pala
te b
ehin
d up
per
ante
rior
teet
h
Infl
amm
atio
n of
up
per-
airw
ay
Snor
ing
Infl
amm
atio
n of
tons
ils
chro
nic
foca
l in
fect
ion
of to
nsil
Tons
illla
r hy
pert
roph
y,
aden
oids
(Fig
ure
14)
Eff
ects
of
labi
al s
tret
ch w
orko
ut b
y th
e re
habi
litat
ive
oral
dev
ice
LIP
TR
AIN
ER
[Pa
taka
ra®
]
12October 2002 Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age
13 Vol. 45, No. 5The Japanese Journal of Conservative Dentistry
(Fig
ure
15)
The
coo
rdin
ated
mov
emen
t of
Lab
ial c
losu
re a
nd to
ngue
ape
x br
ough
t by
enha
ncin
g L
-C-S
The
ape
x po
sitio
n of
tong
ue
of u
nhea
lthy
peop
le w
ith
wea
k L
-C-S
It to
uche
s be
hind
low
er
ante
rior
teet
h
Lip
s ar
e op
en a
nd
the
root
of
tong
ue
is li
kely
to s
ink
Ora
l re
spir
atio
n an
d sn
orin
g[U
nhea
lthy
body
]
The
ape
x po
sitio
n of
tong
ue
of h
ealth
y pe
ople
with
st
rong
L-C
-S
It to
uche
s pa
late
be
hind
upp
er
ante
rior
teet
h
Lip
s ar
e cl
osed
and
th
e ro
ot o
f to
ngue
is
rai
sed
upN
asal
res
pira
tion
[Hea
lthy
body
]
By
labi
al c
losu
re,
the
apex
of
tong
ue r
each
es t
o pa
late
beh
ind
uppe
r-an
teri
or te
eth
and
the
body
of
tong
ue m
ove
ante
rosu
peri
or.
Rep
eatin
g th
is c
oord
inat
ed m
ovem
ent
mak
es t
he h
ealth
y ha
lf o
f to
ngue
exe
rt i
ts e
xtra
ctiv
e fo
rce,
and
it
pulls
the
oth
er p
aral
yzed
si
de.
Thi
s im
prov
es t
ongu
e m
ovem
ent,
swal
low
ing
mov
emen
t in
or
al c
avity
and
art
icul
atio
n di
sord
er.
The
air
way
will
be
mad
e su
ffic
ient
ly a
vaila
ble,
by
whi
ch,
in t
urn,
or
al r
espi
ratio
n w
ill c
hang
e to
nas
al r
espi
ratio
n. S
nori
ng w
ill b
e im
prov
ed a
s w
ell.
Lip
-clo
sure
Air
way
E
soph
agus
Kee
ping
ai
rway
av
aila
ble
2
1
1 2
Conclusion
1. It is observed that L-C-S shows positive development similarly for both male and female in their age bracket of 3~6 yrs old, however, the male subsequently develop higher L-C-S value than that of the female. The development of L-C-S continues, but halts by the time people reach at 18~20 yrs old regardless of gender. The values are close to 14N for male and 12N for female.
2. There have been observed 2 different peak values of the male L-C-S: 14N for the male in their 20's and 16N in their 30's~40's.
3. L-C-S starts to deteriorate around age 60 regardless of sex. It finally reaches 5~7N in their 80's, which is as low as the value for 3 yrs infant. 4. The average L-C-S value for healthy male adults is about 14~17N while that of the sick male adults is nearly 10~14N. As for the female adults, L-C-S for the healthy is about 12~14N while that of the sick is nearly 8~10N.
5. Each sick group in every age bracket between 3~59 yrs old, who has diseases or symptoms such as oral respiration, tonsillitis, adenoiditis, atopy, asthma, sinus, snoring and lifestyle-related diseases, indicates lower L-C-S value by 3~4N than that of the each healthy group respectively regardless of sex. We have here clearly recognized that there are significant statistical differences of L-C-S account for 10~40% of every age bracket, male and female irrespectively, and the prevalent rate goes up in accordance of age.
7. People who are suffering from severe illness show significantly lower L-C-S than the healthy others in the same age bracket.
8. L-C-S is an effective value indicator for the purpose of watching the conditions and risks of respiratory system and immune system. It has high potential to be one of the parameters to make assessment of the health of the oral environment.
For the first time, our research has not merely identified the standard values of L-C-S in every age
8. L-C-S is an effective value indicator for the purpose of watching the conditions and risks of respiratory system and immune system. It has high potential to be one of the parameters to make assessment of the health of the oral environment.
For the first time, our research has not merely identified the standard values of L-C-S in every age bracket of both genders but has also disclosed that the groups with lower values of L-C-S have contained, among themselves, a proportionally large number of people suffering from disorders in oral cavity and pharynx (oral respiration, tonsillitis and adenoiditis) as well as allergic disorders (atopy, asthma and synus). We are quite confident that Oral Rehabilitative Device LIP TRAINER [Patakara®] has high potential to prove it to be therapeutically an effective medical treatment (Figure 15) for those people who are suffering from many health problems which have mainly been induced by lower L-C-S.
The oral myofunctional rehabilitation by applying LIP TRAINER [Patakara®] will be an essential therapy which strengthens L-C-S. We hope that this device is going to be an indispensable tool for everyone that wishes to live a long and healthy life. The average Japanese life span is now above 80 yrs and the society in Japan will be a hyper aged society in 21st century. Making a better life such as enjoying food and talking to all friends with smile is everybody's aspiration. The role which the medical dentistry should play in clinical fields will be so increasingly crucial in view of maintaining healthy oral functions such as smooth saliva circulation, appreciation of food taste, smooth mastication and swallowing.
Last of all, we appreciate it very much from the bottom of our hearts if many researchers and clinicians may further scrutinize and evaluate the significance of L-C-S in the near future.
14October 2002 Functional Therapy of Oral Cavity Muscles in Accordance with Growth of C-L-S & Age