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| REVIEW ARTICLE |
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| Year : 2023 | Volume
: 15
| Issue : 4 | Page : 328-336 |
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Types and effects of oral exercise on oral function in the elderly: A scoping review of interventional studies
Novitasari Ratna Astuti1, Lisdrianto Hanindriyo2, Probosuseno3, Yayi Suryo Prabandari4
1 Doctoral Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; Faculty of Dentistry, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
2 Department of Preventive and Community Dentistry, Faculty of Dentistry, Universitas Gadjah Mada, Yogyakarta, Indonesia
3 Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
4 Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| Date of Submission | 26-Dec-2022 |
| Date of Decision | 12-Jul-2023 |
| Date of Acceptance | 12-Jul-2023 |
| Date of Web Publication | 31-Aug-2023 |
Correspondence Address:
Prof. Yayi Suryo Prabandari
Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta 55281
Indonesia
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jioh.jioh_267_22
Aim: Currently, there have been several literature reviews on oral exercise with elderly samples, but there have been no reviews on oral exercises based on the types and effects of oral exercise improving oral function. Therefore, it is necessary to map the possibilities of prominent oral exercises which most effectively affecting the oral functions from previous studies by scoping review. This scoping review aimed to map available evidence on the types and effects of oral exercise in improving oral function among the elderly population. Methods and Materials: The research on types and effects of oral exercise among the elderly was comprehensively searched through the Cochrane, Embase, PubMed, Scopus, and Web of Science databases. This scoping review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for scoping reviews. The inclusion criteria of this review were articles published in 2008–2021, with elderly subjects more than ≥60 years, articles describing types and effects of oral exercise, original articles, research articles or research papers, and articles with interventional studies, including randomized control trials and quasi-experimental study type. Results: The types of oral exercises were tongue exercise, masticatory muscle exercise, swallowing exercise, salivary gland massage, verbal, facial muscle exercise, lip stretching, cheek stretching, facial muscle exercise, and neck stretching. Meanwhile, the effects of oral exercise which improved oral functions were swallowing ability, masticatory ability, oral diadochokinesis, oral moisture degree, cheek expanding ability, lip–tongue motor function, increased salivary secretion, and decreased subjective oral dryness. Fifteen articles were obtained for this study, and 13 of them showed the effectiveness of tongue exercise in improving oral function. Conclusions: Oral exercises are effective to improve oral function, mostly as a way to increase the swallowing ability in the elderly. In addition, it was also revealed that the most effective type of exercise is tongue exercise. Keywords: Elderly, Oral Exercise, Oral Function, Swallowing Ability
How to cite this article:
Astuti NR, Hanindriyo L, Probosuseno, Prabandari YS. Types and effects of oral exercise on oral function in the elderly: A scoping review of interventional studies. J Int Oral Health 2023;15:328-36 |
How to cite this URL:
Astuti NR, Hanindriyo L, Probosuseno, Prabandari YS. Types and effects of oral exercise on oral function in the elderly: A scoping review of interventional studies. J Int Oral Health [serial online] 2023 [cited 2023 Dec 4];15:328-36. Available from: https://www.jioh.org/text.asp?2023/15/4/328/384659 |
| Introduction | |  |
Oral health not only refers to the existing number of teeth and the degree of oral hygiene but also covers functional abilities, including tongue and lip motor skills, salivary flow rate, and taste perception. Oral functional impairment decreases the effectiveness of chewing, affects nutritional deficits, prevents elderly people from enjoying meals and interacting with others, and may finally cause social isolation.[1]
Age-related tooth loss and an increased prevalence of oral disorders are expected to have a substantial effect on overall health. Age-related on oral function to chew and swallow decreases; these have been identified as significant issues in oral health.[2],[3] Oral hypofunction or impaired oral function is common in the elderly who live in the community and is strongly linked to frailty in older adults. Therefore, preventing frailty will increase the healthy life expectancy of the elderly.[4]
This is important for the elderly to maintain and enhance their oral health as an older demographic community is prone to several risk factors that endanger oral health. This happens because they are more vulnerable to a number of diseases due to changes brought on by aging in the body. People who are experiencing mouth discomfort can anticipate that by following any intervention, their oral function will return to normal.[5] The improvement of oral function has been shown to have a positive impact on overall health, protecting the respiratory system, enhancing the immune system, and improving nutritional status. It is thought to be more successful in putting in place programs of promoting oral health before health issues and functional disruptions arise from a prevention and health promotion perspective. Accordingly, it is imperative to offer these programs to the elderly population before they start experiencing oral health issues.[6] Oral exercise can improve oral function temporarily and enable continued improvement, which motivates patients to maintain oral health and hygiene.[1] It is necessary to map the possibilities of prominent oral exercises which most effectively affecting the oral functions from previous studies by scoping review. Oral exercise is a common technique used for dependent elderly. Muscles surrounding the oral cavity can theoretically be strengthened because the oral cavity contains several muscles that can be trained through oral exercise. Therefore, oral exercise was believed can preserve and enhance oral function.[1] Oral exercises have been developed specifically in the elderly to improve decreased oral function. This scoping review aimed to map available evidence on the types and effects of oral exercise in improving oral function among the elderly.
| Materials and Methods | | |
Reporting guideline
This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) guidelines for scoping reviews.
Search strategy
The search was conducted on February 92022, through five databases: (1) Cochrane, (2) Embase, (3) PubMed, (4) Scopus, and (4) Web of Science (WoS). Keywords used for searches were: (elderly OR aged) AND (oral exercise) AND (oral function). A combination of search terms was used, including the Boolean terms (And/Or) and Medical Subject Heading (MeSH) operators. The full detailed search strategy is presented in [Table 1].
Inclusion criteria
This study has inclusion criteria: (1) articles published between 2008 and 2021; (2) subjects were the elderly ≥60 years; (3) articles describing types of oral exercise and the effect of oral exercise; (4) articles were original or paper research or articles research; and (5) articles with interventional studies (randomized control trials [RCTs], and quasi-experimental).
Exclusion criteria
Articles with irrelevant topics were excluded: such as articles unrelated to oral exercise and oral function, non-research articles (letters to the editor, book chapters, and guidelines), and irrelevant study design (noninterventional studies).
Data extraction and analysis
Data were extracted from 15 articles that had been obtained in the previous stage. Data were grouped based on the following information (1) author(s), (2) year of publication, (3) study design, (4) participants, (5) participant characteristics (sample size and age), (6) purpose, (7) types of exercise/characteristics of oral exercises, (8) experimental intervention, (9) procedures, (10) intervention group, (11) control group, (12) outcome, and (13) conclusions.
| Results | | |
Search outcome
A total of 323 studies were identified in Cochrane, 166 from Embase, 676 from PubMed, 472 from Scopus, and 24 from Web of Science, for a total of 1661 studies. Using the Reference managing Software (Endnote), 177 duplicate articles were excluded, leaving a total of 1484 [Figure 1]. According to the inclusion and exclusion criteria, screening was conducted based on reviews of the titles and abstracts of the paper and resulted in the exclusion of 1467 records. The remaining 17 full-text papers were eligible, but two articles of non-English versions were excluded. Finally, a total of 15 papers were evaluated for analysis. The papers included ten RCTs and five quasi-experimental studies.
Descriptive characteristics of the studies
After following the article screening guidelines, 15 articles were included in this review. The majority of studies were conducted in East Asia (13 studies), Europe (two studies), and North America (one study). In addition, 10 of the 15 selected articles used RCTs research design, and five articles used a quasi-experimental design, which is shown in [Table 2]. Furthermore, [Table 2] also presents the summary of every selected study, in which there were ten articles with community-dwelling participants and five articles with institutionalized elderly participants. Participants were all ≥65 years. In general, this review included all of the studies that aimed to determine the effects of oral exercises on oral function in an elderly population [Table 2].
Types of oral exercises
From the synthesis of the selected 15 articles, it was clear that all studies reported the most common type of oral exercise, namely tongue exercise (15 articles) [Table 3]. By comparing the assessment results between the two groups before and after the intervention, it was obvious that in the intervention group, there were significant improvements in oral function with tongue exercises and weekly interventions implemented for two until three minutes at a time[1],[7] and 25–90 min of oral exercises during the implementation program[4],[5],[6],[8],[9],[10],[11] [Table 3].
Effects of oral exercise
There were 15 selected studies that stated that oral exercises were effective in improving oral function [Table 3]. The synthesis indicated that oral exercises were the most effective way to improve oral function, particularly for swallowing ability (nine articles). There were nine articles that showed significant improvement in swallowing ability in the intervention group, but there were no improvements in oral functions in the control group. In the intervention groups, the changes in swallowing ability significantly improved in less than three months[1],[8],[10],[11],[12] and within three months,[4] 6 months[7],[13] and after an eight months program[14] [Table 3].
Six articles showed significant improvement in the salivary flow rate in the intervention group. In contrast, no improvements were seen in the control group. Changes in the salivary flow rate in the intervention group significantly increased in less than 3 months[1],[5],[11],[12] and within three months,[4] and after a 6 months program[13] [Table 3].
| Discussion | | |
Fifteen articles correlating various oral exercises with oral functions were obtained for this study. Four of these articles showed the effectiveness of tongue exercise in increasing salivary secretion, while 13 articles showed that tongue exercise was effective to improve swallowing ability (two articles showed that both of these oral functions were improved by tongue exercise). It is revealed that tongue exercises could be the most effective type of oral exercise to improve the swallowing ability in the elderly.
This scoping review revealed that the major participants were community-dwelling. It was found that more than 60% of the elderly living in communities had hypofunction of oral, which is closely related to frailty in the elderly population.[8] The tongue plays a significant part in swallowing as it is the main source of the propulsive forces that move food boluses.[15] Its strength is an important factor to decide in maintaining swallowing function in the elderly[16] and important for eating, swallowing decreasing tongue pressure is strongly related to dysphagia.[17] Elderly people frequently have swallowing problems that have affected their life quality and increased the risk of dehydration, aspiration pneumonia, and malnutrition.[18]. Oral exercise as an intervention and efficient self-management was initially intended to be straightforward and improve oral function in the elderly.[19] In this case, tongue exercise is one part of oral exercise.
The intervention of tongue exercise can improve the swallowing function in the oral and pharyngeal phases,[16] which can increase tongue strength effortful in swallowing pressure. It is seen effectively in increasing tongue pressure in wide tongue-palate contact areas during effortful swallow.[20] Tongue exercises that can raise tongue pressure are important in preventing sarcopenia and swallowing rehabilitation in the elderly.[21] Three studies reported the relation between tongue strength and the improvement of swallowing abilities.[22] The duration of tongue exercises is in the range of 4–12 weeks.[15] The current research showed some significant improvements in tongue strength-related measures and swallowing function after an 8-week tongue exercise program based on exercise protocol.[23] The physiology of swallowing is enhanced by tongue exercise, and it may have also strengthened the lingual muscle that is still needed to move food through the mouth and pharynx.[24] Tongue exercises give benefit in tongue strengthening in healthy subjects and the greatest improvement in the elderly.[25] An oral function intervention program for the elderly is effective to improve oral function.[26]
Oral exercise is crucial for enhancing swallowing performance and lowering the likelihood of swallowing problems in the elderly.[27] This review found an effective way in improving oral functions in the elderly through oral exercise and mostly to increase the swallowing ability. The review by Raj et al.[28], which revealed that oral exercise could successfully enhance elderly people’s oral functioning and be used as an intervention in self-regulating in promoting oral health. The review has several limitations. First, on the review level, we did not assess the credibility of the studies and outcome level as we aimed to map available evidence rather than to synthesize the effectiveness. Second, on the review level, we only retrieved studies that were published in English.
A valid review of articles should consider the credibility of the reviewed studies, such as bias controlling method, details in the methodology as well as the inclusion of several language reports (not only English) to show the variability and representativeness of the research result for the general population. Moreover, further research should also concern with the social, cultural, and eating habit patterns of the elderly.
| Conclusions | | |
The review aimed to map available evidence on the types and effects of oral exercise and concluded the type of oral exercise that gives the most effect in improving oral function among the elderly was tongue exercise. Oral function improved through oral exercise, mostly in increasing the swallowing ability of the elderly.
Acknowledgments
The authors wish to thank Universitas Gadjah Mada dan Universitas Muhammadiyah Yogyakarta for the unlimited access to their e-library to support the establishment of this review.
Financial support and sponsorship
The author(s) declared no financial support for this scoping review.
Conflicts of interest
The authors confirmed that there were no conflicts of interest arose from this review.
Author contribution
This scoping review was conceived and designed by NRA, and the search strategy was developed by YSP and LH. Article screening was contributed by all authors (NRA, YSP, PS, LH). NRA completed the data extraction and undertook the preliminary analysis of the findings. Final decisions about article verification, analysis, and synthesis of the key findings were reviewed by all authors. Editorial support was provided by LH and PS. This final manuscript prior to being approved for submission by all authors.
Ethical policy and institutional review board statement
Not applicable.
Patient declaration of consent
Not applicable.
Data availability statement
Not applicable.
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| 21. | Yano J, Yamamoto-Shimizu S, Yokoyama T, Kumakura I, Hanayama K, Tsubahara A Effects of anterior tongue strengthening exercises on posterior tongue strength in healthy young adults. Arch Oral Biol 2019;98:238-42. |
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[Figure 1]
[Table 1], [Table 2], [Table 3]
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