Journal Pone 0295078

PLOS ONE
RESEARCH ARTICLE
Association between oral condition and

subjective psychological well-being among
older adults attending a university hospital
dental clinic: A cross-sectional study
Noriko Takeuchi ID1*, Nanami Sawada1, Daisuke Ekuni2, Manabu Morita3
1 Department of Preventive Dentistry, Okayama University Hospital, Okayama, Okayama, Japan,

2 Department of Preventive Dentistry, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences,
a1111111111 Okayama University, Okayama, Okayama, Japan, 3 Department of Oral Health, Takarazuka University of
a1111111111 Medical and Health Care, Takarazuka, Hyogo, Japan
a1111111111
a1111111111 * [email protected]
a1111111111
Abstract
Positive psychological well-being has a favorable impact on survival rates in both healthy
OPEN ACCESS
and unhealthy populations. Oral health is also associated with psychological well-being, is
Citation: Takeuchi N, Sawada N, Ekuni D, Morita M
multidimensional in nature, and includes physical, psychological, emotional, and social
(2023) Association between oral condition and
subjective psychological well-being among older domains that are integral to overall health and well-being. This study aimed to identify the
adults attending a university hospital dental clinic: associations between individual and environmental characteristics, oral condition and nutri-
A cross-sectional study. PLoS ONE 18(11): tional status in relation to subjective well-being among older adults using the Wilson and
e0295078. https://doi.org/10.1371/journal.
Cleary conceptual model. The participants were older adults (age � 60 years) attending a
pone.0295078
university hospital. Subjective well-being was assessed using the World Health Organiza-
Editor: Boyen Huang, University of Minnesota
tion-5 Well-Being Index, oral condition was assessed based on the number of bacteria in the
School of Dentistry, UNITED STATES
tongue coating, oral wettability, tongue pressure, occlusal force, oral diadochokinesis, and
Received: May 31, 2023
masticatory ability, and subjective swallowing function was assessed using the Eating
Accepted: November 14, 2023 Assessment Tool, number of remaining teeth, and number of functional teeth. In addition,
Published: November 28, 2023 factors related to well-being, including social networks, life–space mobility, nutritional status,
Copyright: © 2023 Takeuchi et al. This is an open smoking history, drinking history, and medical history were assessed. In the analysis, struc-
access article distributed under the terms of the tural equation modeling was used to investigate the association between oral condition and
Creative Commons Attribution License, which subjective well-being. Confirmatory factor analysis revealed oral condition as a latent vari-
permits unrestricted use, distribution, and
able, including tongue pressure, oral diadochokinesis /pa/, /ta/, /ka/, occlusal force, mastica-
reproduction in any medium, provided the original
author and source are credited. tory ability, subjective swallowing function, and number of functional teeth. Structural
Equation Modeling revealed that oral condition was positively correlated with nutritional sta-
Data Availability Statement: All relevant data are
within the manuscript and its Supporting tus, and nutritional status was positively correlated with the World Health Organization-5
Information files. Well-Being Index. These findings suggest that oral condition may influence subjective well-
Funding: M.M and N.T was supported by the being via nutritional status or social environmental factors.
Japan Society for the Promotion of Science, JSPS
KAKENHI Grant Numbers JP17K12046 and
JP17H04421. The funders had no role in study
design, data collection and analysis, decision to
publish, or preparation of the manuscript. URL:
https://www.jsps.go.jp/j-grantsinaid/.
PLOS ONE | https://doi.org/10.1371/journal.pone.0295078 November 28, 2023 1 / 14

PLOS ONE Association between oral condition and subjective psychological well-being
Competing interests: The authors have declared Introduction

that no competing interests exist.
Well-being is a positive state experienced by individuals and societies. Similar to health, it is a
resource for daily life that is determined by social, economic, and environmental conditions
[1]. The Geneva Charter for Well-being was endorsed at the Global Conference on Health Pro-
motion in 2021, coordinated by the World Health Organization. It underlines the urgency of
creating sustainable “well-being societies”.
In Japan, the average life expectancy is estimated to increase to 84.95 years for men and
91.35 years for women by 2065 [2]. As the ultimate goal of geriatrics is to achieve well-being,
an important societal challenge is to identify factors related to subjective well-being to achieve
a “100-year life period” among older adults [2].
Subjective well-being is defined as “all of the various types of evaluations, both positive and
negative, that people make of their lives. It includes reflective cognitive evaluations, such as life
satisfaction and work satisfaction, interest and engagement, and affective reactions to life
events, such as joy and sadness” [3]. Positive psychological well-being is known to have a
favorable impact on survival rates in both healthy and unhealthy populations [4]. Subjective
well-being and health are closely associated with age [3, 4]. If older adults can maintain both
subjective well-being and health commensurate with their age, they can extend their healthy
life-span. On the other hand, poor subjective well-being has been reported to be associated
with depression, functional limitations, low levels of wealth, unpaid work, a perceived lack of
positive support from one’s spouse, children, and friends, a small social network [5, 6], smok-
ing, low levels of physical activity, alcohol intake [7], and systemic disease such as stroke,
chronic lung disease, rheumatoid arthritis, diabetes, and cancer [8].
Oral health is also known to be associated with psychological well-being. In a review by
Peres et al. [9], oral health was defined as being multidimensional in nature and to include
physical, psychological, emotional, and social domains, which are integral to overall health and
well-being. In their scoping review, Badewy et al. [10] reported that poor oral health has a sig-
nificant impact on the general health status of older adults. Appropriate interventions can also
improve oral function among older adults [11]. Satisfaction with diet in everyday life has been
shown to be associated with oral health-related quality of life (HRQoL) and subjective well-
being in older Japanese adults, even after adjusting for a loss of teeth [12]. Occlusal force has
been reported to be associated with psychological frailty in Japanese community-dwelling
older adults [13] considering the possibility that reduced nutritional intake and appetite may
mediate the relationship between occlusal force and psychological frailty. The complete loss of
teeth has been associated with deteriorations in psychological and subjective well-being in
older adults [14], based on the fact that tooth loss leads to a loss of facial aesthetics and person-
ality, which affects the individual’s social performance and ability to form social relationships,
resulting in low levels of well-being.
Wilson and Cleary [15] developed a model that clearly conceptualizes the relationship
between clinical factors and HRQoL. Their model describes the causal pathways of several
determinants in HRQoL, including biological and physiological factors such as cellular func-
tion and organs, symptom status (i.e., patients’ perceptions of cognitive, physical, and emo-
tional functioning), functional health (i.e., physical, psychological, social, and role
functioning), general health perceptions (i.e., subjective evaluation of the integrated concept of
all health aspects), and overall quality of life (i.e., subjective evaluation of the patients’ overall
well-being). In the dental field, this model has been used to link xerostomia, edentulism, and
the need for prosthodontic treatment to oral health-related QoL (OHRQoL) among older
adults [16–20]. These previous studies support part of the key direct pathways hypothesized by
Wilson and Cleary [15]. However, the findings were limited to edentulous older people with

Fig 1. Hypothetical model using the Wilson and Cleary conceptual model. Path coefficients and p-values are shown
above. Rectangles indicate observed variables, and ovals show latent variables. Abbreviations: ODK, oral
diadochokinesis; EAT-10, the 10-item Eating Assessment Tool; MNA, Mini-Nutritional Assessment; LSNS, Lubben
Social Network Scale; LSA, Life Space Assessment; WHO-5, World Health Organization-5 Well- Being Index.
https://doi.org/10.1371/journal.pone.0295078.g001
dentures [17], xerostomia [18], or only a few diagnostic items for oral health status [16, 18, 19];
few reports have examined psychosocial factors [16, 19].
Therefore, we hypothesized that the oral condition may be associated with subjective well-
being among older adults even when considered alongside nutritional status and both individ-
ual and environmental characteristics.
Given this background, the present study aimed to identify the associations between individual
and environmental characteristics, oral condition, and nutritional status in relation to subjective
well-being among older adults using the Wilson and Cleary conceptual model (Fig 1). The specific
aim was to determine how nutritional status and environmental characteristics are associated
with the effects of various oral conditions on subjective well-being among older adults.
Materials and methods

Study participants
The participants in this cross-sectional study were older patients (age � 60 years) who had reg-
ularly visited the Preventive Dentistry Clinic at Okayama University Hospital from November
2017, when recruitment began, to January 2019. Those who could not respond to the question-
naire or walk independently were excluded. Written, informed consent to participate in this
study was obtained from all participants. We had no access to information that could identify
individual participants during or after data collection. This study followed the STROBE guide-
lines regarding cross-sectional studies.
Evaluation of subjective psychological well-being

In this study, the World Health Organization-5 Well-Being Index (WHO-5), which is com-
posed of five items that measure positive mood, vitality, and general interests [21, 22], was

used to assess subjective well-being. The Japanese version of the WHO-5 has been shown to be
reliable and valid in older adults [21]. In the WHO-5, the respondents are asked to rate their
subjective well-being in the previous 2 weeks on a 6-point Likert scale from 0 (not present) to
5 (constantly present). The total raw score is then multiplied by 4 to obtain the final score,
with higher scores indicating greater psychological well-being [23].
Assessment of oral condition

After calibration, three trained dentists assessed the participants’ oral condition based on the
number of remaining teeth [13], the number of functional teeth, and the following seven items
recommended by the Japanese Society of Gerontology [24] as diagnostic items for oral hypo-
function: number of bacteria in the tongue coating, oral wetness, tongue pressure, occlusal
force, oral diadochokinesis (ODK), masticatory ability, and swallowing function.
Number of bacteria in tongue coating. To collect samples for counting the number of
bacteria in the tongue coating, the central part of the tongue was swabbed three times with a
sterile cotton swab over a length of 1 cm [24–26]. A constant-pressure device was used to
reduce the variation in operator performance [27]. Next, a bacterial counter (Panasonic
Healthcare, Tokyo, Japan) was used to measure the number of bacteria in 1 mL of collected
sample. Samples were taken twice, and then the average of the two samples was calculated.
Oral wetness. To measure the degree of oral wetness, an oral moisture checker (Mucus1;
Life Co., Saitama, Japan) [24–26] was used on the center of the dorsum of the tongue at a dis-
tance of 1 cm from the tip of the tongue and the right and left buccal mucosa. After attaching a
special sensor cover, the sensor was pressed with a force of approximately 200 g to achieve uni-
form contact with the test surface. This was held for about 2 seconds until the device displayed
the measured value. Measurements were performed twice, and oral wetness was defined as the
average value for all measurements.
Tongue pressure. A tongue depressor (TPM-01; JMS, Hiroshima, Japan) [24–26, 28, 29]
was used to measure tongue pressure. In this study, we defined the maximum tongue pressure
as the pressure generated when the balloon of the tongue depressor probe was arbitrarily
crushed between the tongue and palate on the anterior surface of the palate and held for several
seconds at maximum force. Measurements were performed with dentures, if present, practiced
beforehand, and carried out twice with a rest in between. Finally, the average value from all
measurements was calculated.
Occlusal force. An occlusal diagnostic system consisting of a pressure-sensitive film
(Dental Prescale1 II; Fujifilm, Kuala Lumpur, Malaysia) and a pre-calibrated scanner
(GT-X830; Seiko Epson, Suwa, Japan) [24–26, 30, 31] was used to measure occlusal force. All
participants were asked to bite the pressure-sensitive film with maximum force for 3 seconds.
Denture wearers underwent the measurement with their dentures in place. Measurements
were performed only once.
Oral diadochokinesis (ODK). The speed and elaboration of tongue and lip movements
were assessed based on ODK [24–26, 32, 33]. In this study, we measured /pa/, /ta/, and /ka/
sounds, which can be used to evaluate lip, anterior tongue, and posterior tongue movements,
respectively. All participants were instructed to repeat each sound as quickly as possible for 5
seconds. The number of pronunciations was recorded using a digital counter (Kenko-kun1
Handy; Takei Scientific Instruments, Niigata, Japan), after which, the number of pronuncia-
tions per second was calculated. Each sound pronunciation was measured twice, and then the
average value was calculated.
Masticatory ability. To assess masticatory ability, the glucose concentration after chewing
gummy jelly (Glucolumn1; GC, Tokyo, Japan) for 20 seconds was measured [24–26]. After

chewing, the participants were instructed to hold 10 mL of water in their mouths before drain-
ing it into a filtration mesh. A glucose sensor (Glucosensor1 GS-II; GC) was then used to
measure the glucose concentration in the filtrate. Each measurement was performed twice,
and then the average value was calculated.
Swallowing function. To assess swallowing function, we administered the Japanese ver-
sion of the Eating Assessment Tool (EAT-10) (Nestlé, Vevey, Switzerland) [24–26, 34, 35],
which is a self-administered questionnaire composed of 10 questions on swallowing. Each
question is scored from 0 to 4, with the total score ranging between 0 and 40, and a lower total
score indicating fewer swallowing problems.
Numbers of teeth present and number of functional teeth. The oral examinations
involved counting the number of remaining teeth and the number of functional teeth. The
number of functional teeth was defined as the sum of the number of natural teeth present and
prostheses (e.g., pontics, implants, dentures) replacing any missing teeth. Stump teeth and
those with severe decay were not considered [25, 26, 36].
Questionnaire survey
Social network. To assess each participant’s relationships with others and the community,
we administered the abbreviated version of the Lubben Social Network Scale (LSNS-6) [37].
The original LSNS is a social network scale for older adults developed by Lubben in 1988 [38].
The Japanese version of the LSNS-6 has been shown to be reliable and valid [39]. The LSNS-6
is composed of three questions that assess kinship relationships (“How many relatives do you
see or keep in touch with at least once a month?”, “How many relatives do you see or talk to at
least once a month?”, and “How many relatives do you feel free to talk to about your private
matters?”), and three similar questions that assess non-kinship relationships. The three kinship
items are repeated for connections with people other than relatives, except the word “relatives”
is replaced with “friends”. The score for the entire scale is an equally weighted version of the
six items, with the total score ranging from 0 to 30.
Life–space mobility (LSM). LSM, which is associated with nutritional status [40], social
networks [41], and tongue pressure [42], was measured using the life–space assessment (LSA).
This assessment quantifies movement during the last month into five life–space levels. Specific
questions on the LSA are: “During the past 4 weeks, have you been to: [Level 1] ‘other rooms
of your home besides the room where you sleep?’, [Level 2] ‘an area outside your home, such
as your porch, deck, patio, hallway (of an apartment building), garage, or in your own yard or
driveway?’, [Level 3] ‘places in your neighborhood other than your own yard or apartment
building?’, [Level 4] ‘places outside your neighborhood but within your own town?’, and
[Level 5] ‘places outside your town?’” For each level, participants are asked how often they
traveled to that area and whether they required equipment (e.g., a walker) or the assistance of
another person to access that space. The life–space score is the sum of the score for each of the
five levels. Individual level scores were obtained by multiplying the level number (1–5), a value
for the frequency (1 = less than once per week, 2 = 1–3 times/week, 3 = 4–6 times/week,
4 = daily), and a value for independence (2 = no assistance, 1.5 = use of equipment only,
1 = assistance from another person with or without equipment). The life–space score ranges
from 0 (never leaves one’s bedroom) to 120 (able to move around outside of town daily with-
out assistance). The LSA has been translated in to Japanese by the Physical Therapy Associa-
tion [43] and is used for older adults in Japan [44].
Nutritional status. Nutritional status was assessed using the Mini-Nutritional Assessment
(MNA; Nestlé) [45]. The MNA is a nutrition screening tool specifically designed for older
adults [46] and is widely used in Japan [26, 47, 48]. The MNA is a 30-point scale composed of

18 items that assess four aspects of nutritional status: an anthropometric assessment (body
mass index, weight loss, upper middle arm circumference, and calf circumference), a global
assessment (mobility, prescription medications, independent living, psychological stress or
acute disability, pressure ulcers or bedsores, and neuropsychological problems), a dietary
assessment (complete daily diet, decreased dietary intake, fluid intake, protein intake, fruit and
vegetable intake, and feeding methods), and self-assessment (nutritional status and health sta-
tus) [49]. The higher the total score, the better the nutritional status.
Smoking and alcohol history. Smoking and alcohol histories were confirmed by a ques-
tionnaire. Smoking history was categorized into two groups: never smokers and a combination
of current and former smokers [25]. For alcohol history, the respondents were asked to indi-
cate how much beer, sake, shochu, whiskey, or wine they each drank per day. The amount of
ethanol was calculated in grams as follows: 633 mL beer contains 23 g of ethanol, 180 mL sake
contains 23 g of ethanol, 180 mL shochu contains 36 g of ethanol, 30 mL whiskey contains 10 g
of ethanol, and 60 mL wine contains 9 g ethanol [50]. Heavy drinking was defined as ethanol
intake of 22 g/day or more [51].
Medical information. A questionnaire composed of items on the following conditions that
have been linked to well-being was used to record medical history: stroke, chronic lung diseases,
rheumatoid arthritis, diabetes, and cancer [8]. Responders who indicated that they were “cur-
rently receiving treatment” for any of the disease were classified as having that disease.
Statistical analysis
Intra- and inter-examiner reliability were investigated using intraclass correlation coefficients
(ICCs). ICC values > 0.75 were considered indicative for excellent stability, 0.40–0.75 for fair
to good stability, and < 0.40 for poor stability [52]. Descriptive statistics were conducted for
demographic status, subjective psychological well-being, oral conditions, social status, nutri-
tional status, and medical information. Fig 1 shows the hypothetical model with reference to
previous studies [13, 40–42] using the Wilson and Cleary conceptual model. Structural equa-
tion modeling (SEM) was applied to analyze the relationship between oral condition and sub-
jective psychological well-being. The first step was to examine the components of oral
condition using confirmatory factor analysis (CFA). Next, the hypothetical model was exam-
ined. Based on previous research, the affect from oral condition to environmental characteris-
tics was also examined. The association between oral condition and subjective psychological
well-being was then analyzed using Spearman’s correlation coefficient. Maximum likelihood
estimation considering missing data was performed in the SEM. The comparative fit index
(CFI), Tucker–Lewis index (TLI), and root mean square error of approximation (RMSEA)
were reported. The acceptable fit index criteria used in the SEM were as follows: CFI > 0.90,
TLI > 0.90, and RMSEA < 0.10. Stata Version 17.0 software (Stata Corp LLC, College Station,
TX) was used for all analyses with the significance level set at 0.05.
Ethical considerations
This study was conducted in accordance with the tenets of the Declaration of Helsinki, and all
procedures involving human participants were approved by the ethics committee of Okayama
University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences and Oka-
yama University Hospital (approval No.: 1803–038).
Results
In total, 218 participants were analyzed in this study (male: n = 66 [30.3%], female: n = 152
[69.7%]; mean age: 75.0 years). The ICCs for the intra- and inter-examiner reliability were

Table 1. The characteristics of the participants.

Total Male Female
(n = 218) (n = 66) (n = 152)
Age (years) 75.0 ± 6.8a 75.5 ± 6.8 74.8 ± 6.8
WHO-5 68.3 ± 18.6 89.5 ± 18.5 68.1 ± 18.7
Number of bacteria in tongue coating (CFU × 106/mL) 18.8 ± 17.6 21.0 ± 19.4 17.9 ± 16.7
Oral wetness 29.0 ± 2.0 28.8 ± 2.2 29.1 ± 2.0
Tongue pressure (kPa) 31.3 ± 8.4 31.1 ± 8.8 31.4 ± 8.2
Occlusal force (N) 528.9 ± 384.2 652.8 ± 446.1 485.1 ± 351.1
ODK (times/s)
/pa/ sound 5.9 ± 0.9 5.8 ± 0.9 5.9 ± 0.8
/ta/ sound 5.9 ± 0.8 5.9 ± 0.9 5.9 ± 0.8
/ka/ sound 5.6 ± 0.8 5.4 ± 1.0 5.7 ± 0.8
Masticatory ability (mg/dL) 172.1 ± 67.7 178.8 ± 69.5 169.5 ± 67.0
EAT-10 0.9 ± 2.6 1.0 ± 3.4 0.9 ± 2.2
Number of remaining teeth 20.2 ± 7.0 20.1 ± 7.6 20.3 ± 6.7
Number of functional teeth 26.3 ± 3.4 26.2 ± 3.3 26.4 ± 3.5
LSNS-6 15.3 ± 5.8 16.2 ± 6.7 14.9 ± 5.4
LSA 92.1 ± 24.2 93.5 ± 24.7 91.4 ± 24.0
MNA 25.1 ± 2.6 25.5 ± 2.5 24.9 ± 2.7
Smoking experience 7 (3.2)b 4 (6.1) 3 (2.0)
Heavy drinking 37 (30.0) 4 (36.9) 13 (8.6)
Stroke 5 (2.3) 3 (4.5) 2 (1.3)
Chronic lung diseases 7 (3.2) 1 (1.5) 6 (3.9)
Rheumatoid arthritis 5 (2.3) 0 (0.0) 5 (3.3)
Diabetes 25 (11.4) 7 (10.6) 18 (11.8)
Cancer 3 (1.4) 1 (1.5) 2 (1.3)
a
average ± standard deviation
b
n (%)
Abbreviations: WHO-5, the World Health Organization-5 Well-Being Index; ODK, Oral diadochokinesis; EAT-10, the Eating Assessment Tool; LSNS-6, the Lubben
Social Network Scale, LSA, life–space assessment; MNA, the Mini-Nutritional Assessment
https://doi.org/10.1371/journal.pone.0295078.t001
0.984 (95% Confidence Interval [CI]: 0.934–0.996) and 0.985 (95% CI: 0.940–0.998), respec-
tively. The characteristics of the participants are shown in Table 1. Descriptive statistics of the
univariate associations between oral condition and well-being are presented in Table 2.
The multicollinearity of each index of oral condition was confirmed. the Variance Inflation
Factor ranged from 1.03 to 3.36, so all indexes were used in the analysis. The results using all
diagnostic items of the hypothetical model (Fig 1) were accepted by STATA, and no notification
messages were obtained about analyzed parameters. CFA was conducted on oral condition and
individual characteristics. Even after excluding the number of bacteria in the tongue coating,
oral wetness, and the number of remaining teeth, which showed p > 0.05 for the latent variable
oral condition, the model fit was poor (RMSEA = 0.096, CFI = 0.903, TLI = 0.864). Specification
of residual correlations between masticatory ability and occlusal force (modification index [MI]
= 18.783, standardized expected parameter change [EPC] = 0.310), masticatory ability and
number of functional teeth (MI = 12.556, standardized EPC = 0.243), and ODK /ka/ sound, and
number of functional teeth (MI = 6.778, standardized EPC = 0.200) improved the model fit.
SEM in the hypothetical model was performed using the modified oral condition and indi-
vidual characteristics. After removing paths with p > 0.05, all path coefficients were

Table 2. Descriptive statistics for the univariable association between oral condition and the WHO-5.
Coefficient P-valuea
Number of bacteria in tongue coating (CFU × 106/mL) 0.060 0.382
Oral wetness 0.026 0.697
Tongue pressure (kPa) 0.021 0.760
Occlusal force (N) 0.026 0.719
ODK (times/s)
/pa/ sound 0.060 0.375
/ta/ sound 0.038 0.579
/ka/ sound 0.026 0.700
Masticatory ability (mg/dL) 0.055 0.417
EAT-10 -0.178 0.008
Number of remaining teeth 0.023 0.736
Number of functional teeth -0.060 0.379
a
Spearman’s correlation coefficient
Abbreviations: ODK, Oral diadochokinesis; EAT-10, the Eating Assessment Tool
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statistically significant and showed a good fit (RMSEA = 0.042, CFI = 0.963, TLI = 0.949) (Fig
2). SEM revealed that oral condition was significantly associated with MNA score (standard-
ized path coefficient = 0.160, p = 0.036). The MNA score was significantly associated with the
WHO-5 score (standardized path coefficient = 0.190, p = 0.018). Environmental characteristics
were significantly associated with oral condition (standardized path coefficient = 0.223,
p = 0.027), MNA score (standardized path coefficient = 0.351, p = 0.001), and WHO-5 score
(standardized path coefficient = 0.361, p <0.001). When the path way from oral condition to
environmental characteristics was examined (Fig 2), each path was significant (p < 0.05) and
the goodness of fit was adequate (RMSEA = 0.042, CFI = 0.963, TLI = 0.949).
Fig 2. Structural equation modeling of the relationship between oral condition and subjective well-being (final
model). Path coefficients and p-values are shown above. Rectangles indicate observed variables, and ovals show latent
variables. Values of single-headed arrows indicate standardized coefficients. The levels of significance considered were
*p < 0.05, **p < 0.01, and ***p < 0.001. Abbreviations: ODK, oral diadochokinesis; EAT-10, the 10-item Eating
Assessment Tool; MNA, Mini-Nutritional Assessment; LSNS, Lubben Social Network Scale; LSA, Life–Space
Assessment; WHO-5, World Health Organization-5 Well- Being Index.
https://doi.org/10.1371/journal.pone.0295078.g002

Discussion
The results of this study revealed that oral condition was not directly associated with well-
being, but was associated with nutritional status, and that nutritional status was associated
with well-being.
The association observed between oral condition and nutrition is supported by previous
studies [53, 54]. In a systematic review and meta-analysis, Toniazzo et al. [53] reported that
subjects with good nutritional status had a significantly higher number of tooth pairs/(func-
tional teeth units) than did those at risk for malnutrition and those with poor nutrition. In
another review, Iwasaki et al. [54] reported a study that supported a possible relationship
between poor oral function and inadequate, poor-quality diets and malnutrition. They found
that older adults with poor oral function were more likely to have low dietary intake and poor
nutritional status, and that malnourished older adults were more likely to have poor oral
function.
Previous studies have also shown that nutrition affects well-being. A systematic review of
randomized controlled trials [55] reported that the protein and amino acids found in beef may
positively influence well-being through improved physical function in healthy adults
aged � 50 years. Piqueras et al. [56] examined the relationship between subjective well-being
and healthy lifestyle in young adults and found that eating lunch, fruits, and vegetables every
day was associated with good well-being. Obesity has been reported to be associated with
depression. Therefore, they considered that the daily intake of lunch, fruits, and vegetables
contributes to well-being because it limits fat intake and prevents obesity [57]. In the present
study, nutritional status may have been related to well-being through physical function
improvement and obesity prevention.
This study showed pathways from environmental characteristics to oral health and from oral
health to environmental characteristics. Previous studies [58–60] have suggested that poor social
support and poor social networks adversely affect dental caries, gingivitis, and tooth loss. Those
studies further indicated that social capital is commonly associated with psychological distress,
which may increase the risk of periodontal disease and lead to increased smoking and con-
sumption of sweets, which in turn, may increase the risk of dental caries and periodontal dis-
ease. Moreover, individuals who have poor chewing skills or difficulty with verbal and
emotional communication due to poor oral health may experience a decrease in self-confidence,
which predisposes them to loneliness [5]. The findings of this study also suggest that there may
be a bidirectional association between oral condition and environmental characteristics.
In this study, environmental characteristics were associated with nutritional status. Ingham
et al. [61] reported that the low support for social environment profile had the poorest nutri-
tional status. Mills et al. [62] reported that individuals with restricted social networks had
lower nutrition risk scores. They discussed that close relationships may increase opportunities
to share meals and resources for food-related activities such as grocery shopping and meal
preparation, and that eating with others has been shown to improve food intake and reduce
nutritional risks.
In the present study, an association was observed between social networks and well-being.
Becker et al. [63] reported that parenthood, marital status, and social networks are related to
the well-being and mental health of older people. Buckley et al. [64] investigated the associa-
tion between the LSNS-6 and subjective health in older adults in Puerto Rico and found that
connections with friends affect subjective health through a psychological sense of community.
These previous results support the findings of the present study.
The neuromuscular units of the face and oral cavity are involved in speech, chewing and
swallowing. Decremental changes occur in these motor units and their coordinated functions

during the aging process. To measure events per unit time, ODK tests the ability to make artic-
ulatory speech and antagonistic movements in quick succession, alternating opposing muscle
groups [33]. This ability is typically evaluated by measuring how fast an individual can repeat
the monosyllabic sounds /pa/, /ta/, and /ka/, which in turn, allows for an assessment of the
motor ability of the lips, as well as of the anterior and posterior sections of the tongue. While
the concept of ODK has been predominantly reported in Japan, additional studies have been
conducted in other regions [32, 33, 65]. Previous studies have shown that ODK has high test–
retest reliability [66, 67]. The validity of ODK as an index for assessing oral function in older
adults has also been reported by various studies [36, 68].
Limitations
This study did have some limitations. First, as this was a cross-sectional study, it was not possi-
ble to establish a causal relationship between each factor. Therefore, further longitudinal stud-
ies are needed. Second, we did not examine some of the environmental characteristics that
have previously been reported to be related to well-being (e.g., low wealth, unpaid work).
Third, the study participants were relatively healthy older patients who regularly visited the
university hospital. It is possible that direct associations were not shown as being statistically
significant. Therefore, the generalizability of the findings is limited. Further studies with a
larger patient population are warranted.
Conclusions
The results of the present study suggest associations between oral condition and nutritional
status and between nutritional status and subjective well-being among older adults attending a
university hospital dental clinic, as influenced by environmental characteristics. Oral condition
may influence subjective well-being through nutritional status.
Supporting information
S1 Dataset.
(XLSX)
Acknowledgments
The authors specially thank all the study participants.
Author Contributions
Conceptualization: Noriko Takeuchi, Nanami Sawada, Daisuke Ekuni, Manabu Morita.
Formal analysis: Noriko Takeuchi, Nanami Sawada.
Funding acquisition: Noriko Takeuchi, Manabu Morita.
Investigation: Nanami Sawada, Daisuke Ekuni, Manabu Morita.
Project administration: Manabu Morita.
Validation: Daisuke Ekuni.
Writing – original draft: Noriko Takeuchi.

References
1. Nutbeam D, Muscat DM. Health Promotion Glossary 2021. Health Promot Int. 2021; 36: 1578–1598.
https://doi.org/10.1093/heapro/daaa157 PMID: 33822939
2. Cabinet Office. Annual Report on the Ageing Society FY 2022. [cited 26 Jan 2023]. Available: https://
www8.cao.go.jp/kourei/whitepaper/w-2022/html/zenbun/index.html
3. Diener E, Chan MY. Happy People Live Longer: Subjective Well-Being Contributes to Health and Lon-
gevity. Appl Psychol-Health Well Being. 2011; 3: 1–43. https://doi.org/10.1111/j.1758-0854.2010.
01045.x
4. Chida Y, Steptoe A. Positive psychological well-being and mortality: a quantitative review of prospective
observational studies. Psychosom Med. 2008; 70: 741–756. https://doi.org/10.1097/PSY.
0b013e31818105ba PMID: 18725425
5. Rouxel P, Heilmann A, Demakakos P, Aida J, Tsakos G, Watt RG. Oral health-related quality of life and
loneliness among older adults. Eur J Ageing. 2017; 14: 101–109. https://doi.org/10.1007/s10433-016-
0392-1 PMID: 28579932
6. Hassel AJ, Danner D, Schmitt M, Nitschke I, Rammelsberg P, Wahl H-W. Oral health-related quality of
life is linked with subjective well-being and depression in early old age. Clin Oral Investig. 2011; 15:
691–697. https://doi.org/10.1007/s00784-010-0437-3 PMID: 20582443
7. Steptoe A, Deaton A, Stone AA. Subjective wellbeing, health, and ageing. Lancet. 2015; 385: 640–648.
https://doi.org/10.1016/S0140-6736(13)61489-0 PMID: 25468152
8. Wikman A, Wardle J, Steptoe A. Quality of life and affective well-being in middle-aged and older people
with chronic medical illnesses: a cross-sectional population based study. PLoS One. 2011; 6: e18952.
https://doi.org/10.1371/journal.pone.0018952 PMID: 21559485
9. Peres MA, Macpherson LMD, Weyant RJ, Daly B, Venturelli R, Mathur MR, et al. Oral diseases: a
global public health challenge. Lancet. 2019; 394: 249–260. https://doi.org/10.1016/S0140-6736(19)
31146-8 PMID: 31327369
10. Badewy R, Singh H, Quiñonez C, Singhal S. Impact of Poor Oral Health on Community-Dwelling
Seniors: A Scoping Review. Health Serv Insights. 2021; 14: 1178632921989734. https://doi.org/10.
1177/1178632921989734 PMID: 33597810
11. Shirobe M, Watanabe Y, Tanaka T, Hirano H, Kikutani T, Nakajo K, et al. Effect of an Oral Frailty Mea-
sures Program on Community-Dwelling Elderly People: A Cluster-Randomized Controlled Trial. Geron-
tology. 2022; 68: 377–386. https://doi.org/10.1159/000516968 PMID: 34247160
12. Iinuma T, Arai Y, Takayama M, Takayama M, Abe Y, Osawa Y, et al. Satisfaction with dietary life affects
oral health-related quality of life and subjective well-being in very elderly people. Journal of Oral Sci-
ence. 2017; 59: 207–213. https://doi.org/10.2334/josnusd.16-0414 PMID: 28637980
13. Akema S, Mameno T, Nakagawa T, Inagaki H, Fukutake M, Hatta K, et al. Relationship between occlu-
sal force and psychological frailty in Japanese community-dwelling older adults: The Septuagenarians,
Octogenarians, Nonagenarians Investigation with Centenarians study. Journal of the American Geriat-
rics Society. n/a. https://doi.org/10.1111/jgs.18239 PMID: 36691687
14. Muhammad T, Srivastava S. Tooth loss and associated self-rated health and psychological and subjec-
tive wellbeing among community-dwelling older adults: A cross-sectional study in India. BMC Public
Health. 2022; 22: 7. https://doi.org/10.1186/s12889-021-12457-2 PMID: 34983470
15. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of
patient outcomes. JAMA. 1995; 273: 59–65. PMID: 7996652
16. Rebelo MAB, Cardoso EM, Robinson PG, Vettore MV. Demographics, social position, dental status
and oral health-related quality of life in community-dwelling older adults. Qual Life Res. 2016; 25: 1735–
1742. https://doi.org/10.1007/s11136-015-1209-y PMID: 26708574
17. Baker SR, Pearson NK, Robinson PG. Testing the applicability of a conceptual model of oral health in
housebound edentulous older people. Community Dentistry and Oral Epidemiology. 2008; 36: 237–
248. https://doi.org/10.1111/j.1600-0528.2007.00394.x PMID: 18474056
18. Baker SR, Pankhurst CL, Robinson PG. Testing relationships between clinical and non-clinical vari-
ables in xerostomia: A structural equation model of oral health-related quality of life. Qual Life Res.
2007; 16: 297–308. https://doi.org/10.1007/s11136-006-9108-x PMID: 17033902
19. Salih MA, Ali RW, Nasir EF. Linking the demographic, socio-economic and oral health status to oral
health-related quality of life of the sudanese older adults: a cross sectional study. BMC Oral Health.
2023; 23: 371. https://doi.org/10.1186/s12903-023-03089-6 PMID: 37291534
20. Vettore MV, Ahmad SFH, Machuca C, Fontanini H. Socio-economic status, social support, social net-
work, dental status, and oral health reported outcomes in adolescents. Eur J Oral Sci. 2019; 127: 139–
146. https://doi.org/10.1111/eos.12605 PMID: 30648760

21. Awata S, Bech P, Koizumi Y, Seki T, Kuriyama S, Hozawa A, et al. Validity and utility of the Japanese
version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly commu-
nity residents. Int Psychogeriatr. 2007; 19: 77–88. https://doi.org/10.1017/S1041610206004212 PMID:
16970832
22. World Health Organization. Regional Office for Europe. Wellbeing measures in primary health care/the
DepCare Project: report on a WHO meeting: Stockholm, Sweden, 12–13 February 1998. World Health
Organization. Regional Office for Europe; 1998. Report No.: WHO/EURO:1998-4234-43993-62027.
Available: https://apps.who.int/iris/handle/10665/349766
23. Topp CW, Østergaard SD, Søndergaard S, Bech P. The WHO-5 Well-Being Index: A Systematic
Review of the Literature. PPS. 2015; 84: 167–176. https://doi.org/10.1159/000376585 PMID: 25831962
24. Minakuchi S, Kazuhiro T, Kazunori I, Takayuki U, Fumiyo T, Kan N, et al. Deterioration of Oral Function
in the Elderly-The Position Paperof Japanese Society of Gerodontology in 2016- (in Japanese). J J Ger-
odont. 2016; 31: 81–99. https://doi.org/10.11259/jsg.31.81
25. Takeuchi N, Sawada N, Ekuni D, Morita M. Oral Factors as Predictors of Frailty in Community-Dwelling
Older People: A Prospective Cohort Study. Int J Environ Res Public Health. 2022; 19: 1145. https://doi.
org/10.3390/ijerph19031145 PMID: 35162167
26. Sawada N, Takeuchi N, Ekuni D, Morita M. Oral function, nutritional status and physical status in Japa-
nese independent older adults. Gerodontology. 2021. https://doi.org/10.1111/ger.12593 PMID:
34599786
27. Hisano A, Kikutani T, Tashiro H, Tamaru F, Hamada R. The Effect of Sampling Pressure Applied to the
Tongue on Bacterial Counts. J J Gerodont. 2009; 24: 354–359. https://doi.org/10.11259/jsg.24.354
28. Wang T, Tai J, Hu R, Fan S, Li H, Zhu Y, et al. Effect of Tongue-Pressure Resistance Training in Post-
stroke Dysphagia Patients With Oral Motor Dysfunction: A Randomized Controlled Trial. Am J Phys
Med Rehabil. 2022; 101: 1134–1138. https://doi.org/10.1097/PHM.0000000000001998 PMID:
35320813
29. Steele CM, Peladeau-Pigeon M, Barbon CAE, Guida BT, Tapson MS, Valenzano TJ, et al. Modulation
of Tongue Pressure According to Liquid Flow Properties in Healthy Swallowing. J Speech Lang Hear
Res. 2019; 62: 22–33. https://doi.org/10.1044/2018_JSLHR-S-18-0229 PMID: 30950761
30. Yoon W, Hwang S, Chung C, Kim K-H. Changes in occlusal function after extraction of premolars: 2-
year follow-up. Angle Orthod. 2017; 87: 703–708. https://doi.org/10.2319/112116-836.1 PMID:
28485615
31. Cruz-Moreira K, Alvarez-Cordova L, González-Palacios Torres C, Chedraui P, Jouvin J, Jiménez-
Moleón JJ, et al. Prevalence of frailty and its association with oral hypofunction in older adults: a gender
perspective. BMC Oral Health. 2023; 23: 140. https://doi.org/10.1186/s12903-023-02824-3 PMID:
36899360
32. Liu X, Zhang X, Feng Q. Dynamic change in the thickness of the masseter muscle between contraction
and relaxation is associated with the masticatory function in older adults: a cross-sectional study.
Annals of Palliative Medicine. 2022; 11: 3755763–3753763. https://doi.org/10.21037/apm-22-1344
PMID: 36636000
33. dos Santos Nogueira DM, de Matos Vieira AIC, de Azevedo Reis E. Oral-motor function in older people:
Exploring new dimensions of frailty. Journal of Oral Rehabilitation. 2023; 50: 802–811. https://doi.org/
10.1111/joor.13492 PMID: 37162292
34. Nishida T, Yamabe K, Ide Y, Honda S. Utility of the Eating Assessment Tool-10 (EAT-10) in Evaluating
Self-Reported Dysphagia Associated with Oral Frailty in Japanese Community-Dwelling Older People.
J Nutr Health Aging. 2020; 24: 3–8. https://doi.org/10.1007/s12603-019-1256-0 PMID: 31886801
35. Belafsky PC, Mouadeb DA, Rees CJ, Pryor JC, Postma GN, Allen J, et al. Validity and reliability of the
Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008; 117: 919–924. https://doi.org/10.
1177/000348940811701210 PMID: 19140539
36. Watanabe Y, Hirano H, Arai H, Morishita S, Ohara Y, Edahiro A, et al. Relationship Between Frailty and
Oral Function in Community-Dwelling Elderly Adults. J Am Geriatr Soc. 2017; 65: 66–76. https://doi.org/
10.1111/jgs.14355 PMID: 27655106
37. Lubben J, Blozik E, Gillmann G, Iliffe S, von Renteln Kruse W, Beck JC, et al. Performance of an abbre-
viated version of the Lubben Social Network Scale among three European community-dwelling older
adult populations. Gerontologist. 2006; 46: 503–513. https://doi.org/10.1093/geront/46.4.503 PMID:
16921004
38. Lubben JE. Assessing social networks among elderly populations. Family & Community Health: The
Journal of Health Promotion & Maintenance. 1988; 11: 42–52. https://doi.org/10.1097/00003727-
198811000-00008

39. Kurimoto A, Awata S, Ohkubo T, Tsubota-Utsugi M, Asayama K, Takahashi K, et al. [Reliability and
validity of the Japanese version of the abbreviated Lubben Social Network Scale]. Nihon Ronen Igakkai
Zasshi. 2011; 48: 149–157. https://doi.org/10.3143/geriatrics.48.149 PMID: 21778631
40. Jadczak AD, Edwards S, Visvanathan R. Life-Space Mobility in Aged Care Residents: Frailty In Resi-
dential Sector over Time (FIRST) Study Findings. J Am Med Dir Assoc. 2022; 23: 1869.e1–1869.e6.
https://doi.org/10.1016/j.jamda.2022.04.013 PMID: 35613663
41. Miyashita T, Tadaka E, Arimoto A. Cross-sectional study of individual and environmental factors associ-
ated with life-space mobility among community-dwelling independent older people. Environ Health Prev
Med. 2021; 26: 9. https://doi.org/10.1186/s12199-021-00936-2 PMID: 33461488
42. Morishita M, Ikeda T, Saito N, Sanou M, Yasuda M, Takao S. Relationship between oral function and
life-space mobility or social networks in community-dwelling older people: A cross-sectional study. Clin
Exp Dent Res. 2021; 7: 552–560. https://doi.org/10.1002/cre2.381 PMID: 33325146
43. Harada K, Shimada H, Sawyer P, Asakawa Y, Nihei K, Kaneya S, et al. [Life-space of community-dwell-
ing older adults using preventive health care services in Japan and the validity of composite scoring
methods for assessment]. Nihon Koshu Eisei Zasshi. 2010; 57: 526–537. PMID: 20845714
44. Tran Y, Hashimoto N, Ando T, Sato T, Konishi N, Takeda Y, et al. Associations between motorized
transport access, out-of-home activities, and life-space mobility in older adults in Japan. BMC Public
Health. 2022; 22: 676. https://doi.org/10.1186/s12889-022-13033-y PMID: 35392850
45. Vellas B, Villars H, Abellan G, Soto ME, Rolland Y, Guigoz Y, et al. Overview of the MNA—Its history
and challenges. J Nutr Health Aging. 2006; 10: 456–463; discussion 463–465. PMID: 17183418
46. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature—What does it tell us? J Nutr
Health Aging. 2006; 10: 466–485; discussion 485–487. PMID: 17183419
47. Hiraike T, Momoki C, Habu D. Comparison of the adequacy of geriatric nutritional risk index with that of
the mini nutritional assessment-short form and global leadership initiative on malnutrition criteria in
assessing nutritional status to predict the 1-year prognosis of hospitalized Japanese older adults: a sin-
gle-institutional cohort study. BMC Geriatr. 2023; 23: 35. https://doi.org/10.1186/s12877-023-03740-5
PMID: 36670357
48. Mochizuki T, Yano K, Ikari K, Okazaki K. Factors Associated with Nutrition of Japanese Patients with
Rheumatoid Arthritis Who Underwent the Mini Nutritional Assessment (MNA), Health Assessment
Questionnaire Disability Index, and Body Composition Assessment by Bioelectrical Impedance Analy-
sis. J Nutr Sci Vitaminol (Tokyo). 2020; 66: 219–223. https://doi.org/10.3177/jnsv.66.219 PMID:
32612083
49. Caçador C, Teixeira-Lemos E, Oliveira J, Pinheiro J, Mascarenhas-Melo F, Ramos F. The Relationship
between Nutritional Status and Functional Capacity: A Contribution Study in Institutionalised Portu-
guese Older Adults. Int J Environ Res Public Health. 2021; 18: 3789. https://doi.org/10.3390/
ijerph18073789 PMID: 33916422
50. Murakami K, Hashimoto H. Associations of education and income with heavy drinking and problem
drinking among men: evidence from a population-based study in Japan. BMC Public Health. 2019; 19:
420. https://doi.org/10.1186/s12889-019-6790-5 PMID: 31014312
51. Wakabayashi I. Cross-sectional relationship between alcohol consumption and prevalence of metabolic
syndrome in Japanese men and women. J Atheroscler Thromb. 2010; 17: 695–704. https://doi.org/10.
5551/jat.3517 PMID: 20534949
52. Fleiss JL. Design and Analysis of Clinical Experiments. John Wiley & Sons; 2011.
53. Toniazzo MP, Amorim P de S, Muniz FWMG, Weidlich P. Relationship of nutritional status and oral
health in elderly: Systematic review with meta-analysis. Clin Nutr. 2018; 37: 824–830. https://doi.org/10.
1016/j.clnu.2017.03.014 PMID: 28392164
54. Iwasaki M, Motokawa K, Watanabe Y, Shirobe M, Inagaki H, Edahiro A, et al. Association between Oral
Frailty and Nutritional Status among Community-Dwelling Older Adults: the Takashimadaira Study. J
Nutr Health Aging. 2020; 24: 1003–1010. https://doi.org/10.1007/s12603-020-1433-1 PMID: 33155629
55. Hawley AL, Liang X, Børsheim E, Wolfe RR, Salisbury L, Hendy E, et al. The potential role of beef and
nutrients found in beef on outcomes of wellbeing in healthy adults 50 years of age and older: A system-
atic review of randomized controlled trials. Meat Sci. 2022; 189: 108830. https://doi.org/10.1016/j.
meatsci.2022.108830 PMID: 35483315
56. Piqueras JA, Kuhne W, Vera-Villarroel P, van Straten A, Cuijpers P. Happiness and health behaviours
in Chilean college students: a cross-sectional survey. BMC Public Health. 2011; 11: 443. https://doi.org/
10.1186/1471-2458-11-443 PMID: 21649907
57. de Wit LM, van Straten A, van Herten M, Penninx BWJH, Cuijpers P. Depression and body mass index,
a u-shaped association. BMC Public Health. 2009; 9: 14. https://doi.org/10.1186/1471-2458-9-14
PMID: 19144098

58. Vettore MV, Faerstein E, Baker SR. Social position, social ties and adult’s oral health: 13 year cohort
study. Journal of Dentistry. 2016; 44: 50–56. https://doi.org/10.1016/j.jdent.2015.12.004 PMID:
26673750
59. Kim E-K, Jung Y-S, Kim K-H, Kim K-R, Kwon G-H, Choi Y-H, et al. Social capital and oral health: The
association of social capital with edentulism and chewing ability in the rural elderly. Arch Gerontol Ger-
iatr. 2018; 74: 100–105. https://doi.org/10.1016/j.archger.2017.10.002 PMID: 29065366
60. Aida J, Kuriyama S, Ohmori-Matsuda K, Hozawa A, Osaka K, Tsuji I. The association between neigh-
borhood social capital and self-reported dentate status in elderly Japanese–The Ohsaki Cohort 2006
Study. Community Dentistry and Oral Epidemiology. 2011; 39: 239–249. https://doi.org/10.1111/j.1600-
0528.2010.00590.x PMID: 21091754
61. Ingham N, Labonté K, Dube L, Paquet C, Nielsen DE. A More Supportive Social Environment May Pro-
tect Against Nutritional Risk: A Cross-Sectional Analysis Using Data From the Canadian Longitudinal
Study on Aging. The Journal of Nutrition. 2023; 153: 1793–1802. https://doi.org/10.1016/j.tjnut.2023.01.
020 PMID: 37277163
62. Mills CM, Keller HH, DePaul VG, Donnelly C. Social Network Factors Affect Nutrition Risk in Middle-
Aged and Older Adults: Results from the Canadian Longitudinal Study on Aging. J Nutr Health Aging.
2023; 27: 46–58. https://doi.org/10.1007/s12603-022-1877-6 PMID: 36651486
63. Becker C, Kirchmaier I, Trautmann ST. Marriage, parenthood and social network: Subjective well-being
and mental health in old age. PLoS One. 2019; 14: e0218704. https://doi.org/10.1371/journal.pone.
0218704 PMID: 31339896
64. Buckley TD, Becker TD, Burnette D. Validation of the abbreviated Lubben Social Network Scale
(LSNS-6) and its association with self-rated health amongst older adults in Puerto Rico. Health & Social
Care in the Community. 2022; 30: e5527–e5538. https://doi.org/10.1111/hsc.13977 PMID: 36039906
65. Schimmel M, Domioni T, Bukvic H, Arakawa I, Seifert E, Abou-Ayash S. Oral diadochokinesis and asso-
ciated oro-facial function in young and old German mother-tongue speakers: A cross-sectional study.
Gerodontology. 2022; 39: 33–40. https://doi.org/10.1111/ger.12602 PMID: 34741348
66. Nishio M, Niimi S. Comparison of speaking rate, articulation rate and alternating motion rate in dysarth-
ric speakers. Folia Phoniatr Logop. 2006; 58: 114–131. https://doi.org/10.1159/000089612 PMID:
16479133
67. Blumberger J, Sullivan SJ, Clément N. Diadochokinetic rate in persons with traumatic brain injury. Brain
Inj. 1995; 9: 797–804. https://doi.org/10.3109/02699059509008235 PMID: 8605512
68. Tanaka T, Takahashi K, Hirano H, Kikutani T, Watanabe Y, Ohara Y, et al. Oral Frailty as a Risk Factor
for Physical Frailty and Mortality in Community-Dwelling Elderly. J Gerontol A Biol Sci Med Sci. 2018;
73: 1661–1667. https://doi.org/10.1093/gerona/glx225 PMID: 29161342

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PLOS ONE

Association between oral condition and

1 Department of Preventive Dentistry, Okayama University Hospital, Okayama, Okayama, Japan,

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Competing interests: The authors have declared Introduction

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Materials and methods

Evaluation of subjective psychological well-being

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Assessment of oral condition

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Table 1. The characteristics of the participants.

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