Influence of the masticatory function on the swallowing in the healthy elderly

Data from 47 healthy elderly subjects (29 female and 18 male) were analyzed and evaluated by the application of the mastication clinical protocol and the functional clinical examination of the oropharyngeal swallowing. The mastication evaluation was recorded in video; the mastication type, the bolus formation, and the mastication time were analyzed. During the clinical evaluation of the swallowing, patients` performance was verified when food with different consistencies was tested. After this evaluation, subjects were classified according to the dysphagia level. Data was analyzed in a descriptive way using comparison and correlation statistical tests.

Results

The average mastication time was 32.45 seconds. Most subjects presented bilateral mastication (62%), adequate bolus formation (75%) and about half (47%) had moderate oropharyngeal dysphagia. According to the statistic analysis, there was no correlation among the level of swallowing dysfunction, the mastication type and the bolus formation. However, there was a statistically significant moderate positive correlation between the level of swallowing dysfunction and the mastication time.

Conclusion

It was verified that a relationship between the mastication time and the dysphagia level exists. However, no influence of mastication type and bolus formation on the swallowing of the elderly was found in this study.

Keywords
Deglutition; Mastication; Deglutition disorders; Aged; Aging

Mastication time n (%)				Bolus formation n (%)			Mastication time *
CU	PU	AB	SB	Inadequate	Partial	Adequate	Minimum - maximum	Mean+ SD
8 (17)	10 (21)	25 (53)	4 (9)	2 (4)	10 (21)	35 (75)	16 – 77	32.45+12.12

Level of swallowing dysfunction	n (%)
Normal swallowing	4 (9)
Functional swallowing	11 (23)
Mild dysphagia	10 (21)
Moderate dysphagia	22 (47)

Gender	Mastication and swallowing	p-value
Male x Female	Mastication type	0.69
	Bolus formation n	0.61
	Mastication time	0.39
	Degree of the swallowing dysfunction	0.10

n				Correlation coefficient	p-value
47	Age	X	Mastication type	-0.17	0.25
			Bolus formation	0.02	0.91
			Mastication time	-0.125	0.40
			Level of swallowing dysfunction	-0.07	0.65

			Correlation coefficient	p-value
Level of swallowing dysfunction	X	Mastication type	0.15	0.33
		Bolus formation	-0.21	0.16
		Mastication time	0.48	0.001*

Gender	n (%)
Men	18 (38.30)
Women	29 (61.70)
Age
Minimum	60
Maximum	82
Mean	68.08
SD	5.59
Denture type	n (%)
Partial denture prosthesis	17 (36.17%)
Removable complete denture prosthesis	18 (38.3%)
Complete fixed dental prosthesis	12 (25.53%)

Classification	Observed aspects
Normal swallowing (level 0A)	No alterations are observed in any of the aspects evaluated among the consistencies tested;
Functional swallowing (level 0B)	It represents the swallowing without risks of penetration and aspiration, but difficulties are expected, such as: excessive participation of the cervical and/or facial muscles, head movement, adequate oropharyngeal transit time and absence of other factors;
Oropharyngeal dysphagia Mild (level I)	Presence of the clinical signs mentioned in the level IA, it may also involve anterior mouth spillage, residue in oral cavity, increased time of oropharyngeal transit and absence of the other factors;
Oropharyngeal dysphagia Moderate (level II)	Presence of signs that suggest the presence of laryngeal penetration (cough, phlegm, altered cervical auscultation, vocal quality alteration, alteration in the laryngeal elevation and respiratory alteration). Signs of the level IB can be found, besides nasal reflux and multiple swallows;
Oropharyngeal dysphagia Severe (level III)	Presence of the aspects described in level II, with substantial residue in the oral cavity, reduction or difficulty in laryngeal elevation, inefficient or absent cough, plus signs that suggest presence of aspiration such as the cyanosis (change in facial color).

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E-mail: revista@audiologiabrasil.org.br

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[1] Correspondence address: Giédre Berretin-Felix. Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry, Universidade de São Paulo. Al. Dr. Octávio Pinheiro Brisola, 9/75, Vila Universitária, Bauru (SP), Brazil, CEP: 17012-901. E-mail: gfelix@usp.br