Original article

The effect of tooth loss on gait stability of communitydwelling older adults Christina Brand1, Stephanie A. Bridenbaugh2, Mateja Perkovac1, Fabienne Glenz1, Christian E. Besimo1, Pedram Sendi1, Reto W. Kressig2 and Carlo P. Marinello1 1

Clinic for Reconstructive Dentistry and Temporomandibular Disorders, Dental School, University of Basel, Basel, Switzerland; 2University Center for Medicine of Aging Basel, Felix Platter-Hospital, Basel, Switzerland

Gerodontology 2014; doi: 10.1111/ger.12136 The effect of tooth loss on gait stability of community-dwelling older adults Objective: To investigate the effects of tooth loss on gait stability in a healthy elderly population. Methods: A case–control study was conducted among healthy and prosthetically well-restored seniors over the age of 65 years. The test group comprised 24 edentulous participants who were restored with complete dentures in the upper jaw and an overdenture fixed on two implants in the lower jaw. The control group comprised 25 dentate participants who either still had their natural teeth or were restored with conventional fixed partial dentures. Gait stability was evaluated by measuring the parameters ‘gait velocity’ and ‘cycle-time variability’ during self-selected normal walking speed and under dual-task performance conditions. Measurements were conducted using the GAITRiteâ electronic walkway system. Results: Dentated and fixed restored participants (the control group) had a significantly higher gait velocity compared with denture wearers (the test group) under both normal walking (p = 0.03) and dual-task performance conditions (p = 0.01). In each test condition, among edentulous participants, gait velocity did not significantly differ according to whether the participant wore their dentures. Conclusion: The present results suggest that tooth loss in healthy seniors is associated with lower gait velocity and therefore may have a negative impact on gait stability. Keywords: gait stability, gait analysis, tooth loss, restorative dentistry, gerodontology, geriatrics, seniors

Introduction Fall-related injuries among older adults are a major public health concern1–3. Each year, up to onethird of seniors over the age of 65 fall, of which half fall multiple times4,5. Around 10–20% of these falls cause serious injuries, such as hip fractures or head trauma,6,7 and 30% of patients in this age group die within the first year after a hip fracture. Individuals who survive these injuries commonly face a significantly decreased quality of life, especially loss of independence8. Furthermore, these fall-related injuries impose a socioeconomic burden on the society9–11. These severe impacts make it essential to prevent seniors from falling. Several studies have shown that gait and body balance instability are major risk factors for Preliminary Data were presented at the 83rd meeting of the American Prosthodontic Society, Chicago, IL, USA, February 24, 2011.

falls12,13. Pijnappels et al.12 demonstrated that improvements in lower limb strength led to better balance of older people, and they suggested lower limb training as a strategy to prevent seniors from falling. Several recent reports have indicated that tooth loss also has a negative impact on body balance. Gangloff and Perrin14 demonstrated that proprioception of the mandibular system affects postural control. Yoshida et al.15,16 reported a relationship between dental malocclusion and falls among elderly patients with dementia and speculated that the proprioceptive sensation from the periodontal ligament receptor may play a role in body balance control. Okubo et al.17 reported that complete dentures improved the body balance and gait stability of edentulous patients. These findings suggest that tooth loss may affect body balance. However, to date, little is known about the influence of dental occlusion on gait stability among community-dwelling older adults with respect to their numbers of remaining teeth.

© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd

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Therefore, the aim of this study was to compare gait stability among edentulous and dentate healthy seniors.

or inflammatory diseases. The number of medications taken daily was self-reported. Gait analysis

Materials and Methods Ethics The study protocol was approved by the Ethics Committee of Basle (EKBB). All participants signed informed consent. Participants All participants (n = 49) were former patients of the author’s department and volunteered to participate in the study. Each was at least 65-yearsold, living independently and able to walk at least 10 m without assistance. Their teeth were prosthetically restored in the author’s department, and their dental restorations were judged as clinically optimal at the time the study was conducted. The test group comprised 24 edentulous participants (16 female) who were each restored with complete dentures in the upper jaw and an overdenture supported and retained by two implants in the lower jaw. The control group comprised 25 dentate participants (14 female) who each either had their natural teeth or were restored with conventional fixed partial dentures to a minimum of up to the second premolars. Clinical assessment The study protocol included two different appointments. The first appointment focused on participant’s general health status. Cognitive health was assessed with the Mini-Mental State Examination (MMSE), and only those with a score of ≥24 points (maximum 30 points, with higher scores associated with better cognition) were enrolled in the study18. The MMSE was administered by one of the authors (MP), who was trained by a neuropsychologist for correct administration and scoring of the test18. Muscle strength was tested using the hand grip test with a Dynamometer friction grip meter (Takei Scientific Instruments, Niigata City, Japan)19. The measurement was collected twice using the dominant hand, and the better value was used for analysis. A brief medical history was recorded, and a physical examination was performed that included height, weight and length of the legs. No participant had a history of serious lower extremity trauma or severe muscular, neurological, orthopaedic, cardio-vascular, metabolic

At the second appointment, gait analyses was performed according to the European guidelines for clinical applications of spatio-temporal gait analysis in older adults using the GAITRiteâ Platinum System (CIR Systems, PA, USA)20. This system consists of a 972-cm-long electronic walkway (Fig. 1a) with integrated pressure sensors placed every 1.27 cm over an active electronic surface area of 792 9 610 cm, giving a total of 29 952 sensors. The scanning frequency was 60 Hz. Data from the mechanically activated sensors were transferred via cable and serial port to a computer and analysed with the GAITRiteâ software version 3.9. The walkway was flanked at the beginning and end by 1.25-m-long optically identical yet electronically inactive walkway sections to capture acceleration and deceleration phases of gait. Participants wore their normal shoes during gait analysis. Before testing, the test administrator (SAB) gave standardised verbal instructions and a visual demonstration regarding the test procedure. No practice walks were performed before testing. Subtle gait changes cannot be observed or measured during the single task of normal walking, but can be measured under dual-task performance conditions. For this reason, each participant performed two walks in this study. The first was the single task of walking forward at a normal self-selected pace (Fig. 1b). The second walk was a motor dual task consisting of normal walking while simultaneously carrying a tray with a half-filled glass of water (Fig. 1c). The participants were given no instructions regarding task prioritisation. Dentate participants performed each walk once, whereas the edentulous participants performed each walk twice – once with and once without dentures. Gait velocity (cm/s) and cycletime variability (%) were analysed as outcome parameters. Cycle-time variability is defined as the change in stride time between each stride, calculated according to the following formula: coefficient of variation ¼ðstandard deviation/meanÞ  100: Statistics As a convenience sample was used for analysis, no ex ante sample size calculation was performed. A paired t-test was used to assess differences

© 2014 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd

Tooth loss may cause gait instability of the aged (a)

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Figure 1 (a) Gait analyses was performed on the electronic GAITRiteâ- Walkway System (CIR Systems Havertown, PA). (b) Normal Walking- Walking at a self-determined normal speed. (c) Dual Task Condition - Carrying a tray with a cup of water while walking at a self-selected normal speed.

within the test group with and without dentures, while a two-sample t-test with equal variances was used to compare differences in outcomes between the test and control groups. A p value of

The effect of tooth loss on gait stability of community-dwelling older adults.

To investigate the effects of tooth loss on gait stability in a healthy elderly population...
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