Journal List > J Korean Acad Oral Health > v.42(4) > 1122280

Shin, Chang, Cho, Song, and Choi: Association between masticatory ability, oral health-related quality of life and cognitive function in the elderly population using structural equation modeling



The aim of this study was to investigate the association between masticatory ability, oral health-related quality of life, and cognitive function in an elderly population using structural equation modeling.


A total of 308 subjects, aged 65 years and over, were recruited from the senior citizen center in Daegu, South Korea and provided consent for inclusion in the study. The Korean version of the Mini-Mental State Examination (K-MMSE) was used to assess the level of cognitive function. Masticatory ability was evaluated through chewing tests, patient-perceived masticatory function and, measurement of relative occlusal forces on molar teeth using the T-Scan III® system. All data were analyzed using χ2 tests, t-tests, and one-way ANOVA in SPSS version 23.0 for windows. Structural equation modeling was performed using SPSS AMOS version 22.0.


There was a significant association between cognitive function and molar teeth occlusal force. Ability of food chewing score and patient-perceived masticatory function could affect oral health-related quality of life (P<0.05). Higher occlusal forces on molar teeth, compared to anterior teeth, positively correlated with higher cognitive function.


These results suggest that an individual's oral health condition could affect molar teeth occlusal forces and may be related to a risk of developing dementia. Therefore, there is a need for implementing nation-wide policies to improve oral health, such as masticatory function, in the elderly population.

Figures and Tables

Fig. 1

Study model.

Fig. 2

Study model by structural equation model.

Table 1

Factor analysis and convergent validityfor oral health impactp rofile-14

Table 2

Factor analysis and convergent validity for geriatric oral health assessment index

Table 3

Characteristics of the study subjects

Table 4

Mastication level and occlusional status according to cognitive function


*one-way ANOVA or t-test.

**Chi-square test.

a,b,cSame letters means there is no significant difference between groups by tukey's multiple comparison.

Table 5

Mastication ability and cognitive fuction according to OHRQoL


*one-way ANOVA or t-test.

a,b,cSame letters means there is no significant difference between groups by tukey's multiple comparison.

Table 6

Model fit for study model

Table 7

Path coefficient for study model

Table 8

Path coefficient for study model



1. Kimura M, Watanabe M, Tanimoto Y, Kusabiraki T, Komiyama M, Hayashida I, et al. Occlusal support including that from artificial teeth as an indicator for health promotion among community-dwelling elderly in Japan. Geriatr Gerontol Int. 2013; 13:539–546.
2. Min KJ, Hwang JS. A study on the effect of the daily activities on the quality of life for the aged. J Welf Aged. 2007; 36:221–246.
3. Kato T, Usami T, Noda Y, Hasegawa M, Ueda M, Nabeshima T. The effect of the loss of molar teeth on spatial memory and acetylcholine release from the parietal cortex in aged rats. Behav Brain Res. 1997; 83:239–242.
4. Kim CS, Choi YK. Survey of adults' perceptions of the association between chronic diseases and oral health. J Dent Hyg Sci. 2017; 17:12–19.
5. Linden GJ, Lyons A, Scannapieco FA. Periodontal systemic associations: review of the evidence. J Clin Periodontol. 2013; 40:Suppl 14. S8–S19.
6. Shin HE, Kim HJ, Cho MJ, Choi YH, Song KB. Relationship between cancer and oral health in Korean adults determined using data from the 6th (2013–2014) Korea National Health and Nutritional Examination Survey. J Korean Acad Oral Health. 2017; 41:16–21.
7. Hur IG, Lee TY, Dong JK, Hong SH. The effects of dental prostheses to the quality of life among the elderly. J Korean Acad Prosthodont. 2010; 48:101–110.
8. Lee DC, Lee HL, Suh I, Kim DK. Factors affecting on the compliance of health screening program: A study for the insured in a district medical insurance association. J Korean Acad Fam Med. 1997; 18:739–751.
9. Petersen PE. The world oral health report 2003: continuous improvement of oral health in the 21st century-the approach of the WHO global oral health programme. Community Dent Oral Epidemiol. 2003; 31:Suppl 1. 3–23.
10. Lee HK, Song KB, Lee SK, Park JH, Choi YH. Association between tooth loss and cardiovascular risk indicators in the Korean elderly. J Korean Acad Dent Health. 2008; 32:495–503.
11. Cho MJ, Shim JS, Kim HC, Song KB, Choi YH. Relationship between metabolic syndrome components and periodontal health determined using a self-reported questionnaire. J Korean Acad Oral Health. 2016; 40:231–237.
12. Park JH, Jeong SH, Lee GR, Song KB. The impact of tooth loss on oral health related quality of life among the elderly in Seongju, Korea. J Korean Acad Dent Health. 2008; 32:63–74.
13. González-Gross M, Marcos A, Pietrzik K. Nutrition and cognitive impairment in the elderly. Br J Nutr. 2001; 86:313–321.
14. Locker D, Matear D, Stephens M, Lawrence H, Payne B. Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly. Community Dent Oral Epidemiol. 2001; 29:373–381.
15. Atchison KA, Dolan TA. Development of the geriatric oral health assessment index. J Dent Educ. 1990; 54:680–687.
16. Bollen KA, Long JS. Testing structural equation models. Introduction. Sociol Methods Res. 1992; 3:123–131.
17. Browne MW, Cudeck R. Alternative ways of assessing model fit. Sociol Methods Res. 1992; 21(2):230–258.
18. U.S. Preventive Services Task Force. Screening for dementia: recommendations and rationale. Am J Nurs. 2003; 103:87. 89. 91. 93. 95.
19. Kwon YC, Park JH. Korean version of Mini-Mental State Examination (MMSE-K). Part I: development of the test for the elderly. J Korean Neuropsychiatr Assoc. 1989; 28:125–135.
20. Lee HS, Lee DH, Kim CM. The effects of oral health on activity of daily living, depression and quality of life in elderly women. Korean J Health Promot. 2014; 14:50–58.
21. Park JU, Park MH. Ability for chewing a social activity and connection with the life function of a senior citizen. J Korean Acad Dent Technol. 2007; 29:87–103.
22. Kim YH, Lee JH. A study on the OHIP-14 of some local women impact on the EQ-5D for review. J Korean Acad Oral Health. 2015; 39:180–185.
23. Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. Lancet Neurol. 2008; 7:812–826.
24. Cho MJ, Jung EK, Lee SS, Choi YH, Song KB. The relationship between the number of remaining teeth and senile dementia: a pilot study. J Korean Acad Oral Health. 2015; 39:214–219.
25. Jeon MJ, Kim DK, Lee BJ. Oral health status of elderly long-term hospitalized patients with and without dementia in Jeollanam-do, South Korea. J Korean Acad Dent Health. 2008; 32:299–308.
26. Paganini-Hill A, White SC, Atchison KA. Dentition, dental health habits, and dementia: the leisure world cohort study. J Am Geriatr Soc. 2012; 60:1556–1563.
27. Shibuya N. Influence of dentures in partial denture wearers on brain function. Ann Jpn Prosthodont Soc. 2009; 1:148–156.
28. Myung JY. Comparison of dental status and masticatory function between mild cognitive impairment patients and Alzheimers disease patients [dissertation]. Seoul: Ewha Womans University;2015. [Korean].
29. Miura H, Yamasaki K, Kariyasu M, Miura K, Sumi Y. Relationship between cognitive function and mastication in elderly females. J Oral Rehabil. 2003; 30:808–811.
30. Takeshita H, Ikebe K, Kagawa R, Okada T, Gondo Y, Nakagawa T, et al. Association of personality traits with oral health-related quality of life independently of objective oral health status: a study of community-dwelling elderly Japanese. J Dent. 2015; 43:342–349.
31. Lee MS. Health-related factors influencing the quality of life of rural elderly subjects- activities of daily living, cognitive functions, prevalence of chronic diseases. Korean J Community Nutr. 2012; 17:772–781.
32. Go HB, Kim MG, Kim JY, Kim HS, Park YS, Seo SH, et , al . The relationship between dementia and oral health in some elderly in Daejeon. J Dent Hyg Sci. 2016; 16:481–487.
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