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NUTRITION IN COMPLETE DENTURE PATIENTS

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INDIAN DENTAL ACADEMY •

Leader in continuing dental education

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CONTENTS INTRODUCTION DEFINITIONS DIETARY COUNSELING OF PROSTHODONTIC PATIENT RISK FACTORS FOR MALNUTRITION IN DENTURE PATIENTS RDA FOR ELDERLY

EFFECT OF NUTRITIONAL DEFICIENCIES ON ORAL HEALTH IN ELDERLY ASSESSING NUTRITIONAL STATUS NUTRITION GUIDELINES FOR PROSTHODONTIC PATIENTS DIETARY SUGGESTIONS FOR DENTURE WEARERS. DIET AFTER DENTURE INSERTION www.indiandentalacademy.com SUMMARY


INTRODUCTION Enjoyment of food is regarded as an important determinant of an adult’s quality of life. Mobile teeth ,ill-fitting complete denture prosthesis or edentulism may preclude eating favorite foods, as well as limit the intake of essential nutrients .Decreased chewing ability ,fear of choking while eating ,and irritation of the oral mucosa when food particles get under the dentures may influence food choices of the denture wearers.Conversely,a complete denture prosthesis depends ultimately on the health & the integrity of the denture bearing www.indiandentalacademy.com

tissues for successful function and the comfort of the patient..


If the denture bearing tissues are nutritionally deficient ,the If the denture bearing tissues are nutritionally deficient ,the prosthesis will be uncomfortable with the complaints of the wearer prosthesis will be uncomfortable with the complaints of the wearer ,no matter how well constructed .Malnourished denture bearing ,no matter how well constructed .Malnourished denture bearing tissues probably accounts for as many denture failures ,as do the tissues probably for as many failures imperfect designsaccounts to resist the forces of denture occlusion. This is,as do the imperfect designs resist theyears forces especially true in thetolater middle ,andoftheocclusion. elderly, theThis majoris especially for truethe in complete the later middle ,and the elderly, the major recipients dentureyears prosthesis. recipients for all the types of the oral prosthesis. www.indiandentalacademy.com


DEFINITIONS

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Nutrition Nutrition can be defined as the sum of the processes by which an individual takes in and utilizes food. (FDI working group – Dr. M. Midda, Prof. K.G. Konig). Nutrition may be defined as the sum total of the process by which the living organism receives and utilizes the food materials necessary for growth, maintenance of life, enhancing metabolic process, repair and replacement of worn out tissues and energy supply. (Z.S.C Okoye) Nutritional status Nutritional status is defined by Christakis as the “health condition of an individual as influenced by his intake and utilization of nutrients determined from the correlation of information from www.indiandentalacademy.com

physical, biochemical, clinical and dietary studies (Nizel, Papas).


Food : Food can be defined as an edible substance made up of a variety of nutrients that nourish the body. (Nizel and Papas). Food may be defined as any liquid or solid substance which when ingested serves one or more of the following functions : 1. Provides energy, 2. Supplies materials for growth, maintenance of body functions and sustenance of life and metabolic processes, reproduction, or for repair and replacement of worn out tissues. 3. Supplies materials necessary for the regulation of energy production

or

the

processes

of

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reproduction, or repair. (Z.S.C Okoye)

growth

maintenance,


Diet Diet can be defined as the types and amounts of food eaten daily by an individual (FDI). The sum total of the foods or mixtures of foods which an individual consumes each day is referred to as his diet. (Z.S.C Okoye) Malnutrition Malnutrition is a generic term given to the pathophysiological consequences of ingestion of inadequate, excessive or

unbalanced

amounts

of

essential

nutrients

(Primary

malnutrition), as well as the impaired utilization of these nutrients brought

about

by

malnutrition). (FDI).

factors

such

as

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disease

(Secondary


Balanced diet A balanced diet is that which supplies all the essential nutrients in adequate amounts and in biologically available forms. (Z.S.C Okoye) Basal metabolism Basal metabolism is the minimum amount of energy needed to regulate and maintain the involuntary essential life processes, such as breathing, beating of the heart, circulation of the blood, cellular activity, keeping muscles in good tone and maintaining body temperature. (Nizel, Papas) BMR (Basal metabolic rate): BMR is defined as the number of kilocalories expended by the organism per square meter of body surface per hour. (K cal / m2/ hour). (Nizel, Papas) Nutrient: A Nutrient is the active principle or the ultimate nourishing www.indiandentalacademy.com chemical substance in food. (Z.S.C Okoye)


As stated by GPT – 7 • Geriatrics The branch of medicine that treats all problems peculiar to the aging patients, including the clinical problems of senescence and senility. • Dental geriatrics The branch of dental care involving problems peculiar to advanced age and aging or Dentistry for the aged patient. www.indiandentalacademy.com


Gerodontics The treatment of dental problem in aged or aging persons, also spelled Geriodontics. Gerodontology The study of the dentition and dental problems in aged or aging persons. Metabolism The sum of all the physical and chemical processes by which living organized substance is produced and maintained (anabolism) and also the transformation by which energy is www.indiandentalacademy.com

made available for the uses of the organism (catabolism).


Nutrient: A Nutrient is the active principle or the ultimate nourishing According to Heartwell chemical substance in food. (Z.S.C Okoye) Gerontology As stated by GPT – 7 Geriatrics Is the scientific study of the process and phenomenon of The branch of medicine that treats all problems peculiar to aging. the aging patients, including the clinical problems of senescence Gerontology and senility. DentalAs geriatrics defined by the Gerontological society in 1959 is the The branch of dental care involving problems peculiar to branch of age knowledge, is concerned withpatient. situations and advanced and agingwhich or dentistry for the aged Gerodontics changes inherent in increments of time, with particular reference The treatment of dental problem in aged or aging persons, to post-maturational stages. also spelled Geriodontics. Gerodontology Senility The study of the www.indiandentalacademy.com dentition and dental problems in aged or Is old age accompanied by infirmity. aging persons.


Since most edentulous adults are of advanced age, a large number of patients with dentures can be expected to have nutritional deficits. The nutritional status of the complete denture wearer also is influenced by economic hardship, social isolation, degenerative diseases, medication regimens, and dietary supplementation practices. Nearly half of the older individuals have clinically identifiable nutrition problems. Undernutrition increases with advancing age. In elderly persons the oral health problems may contribute to involuntary weight loss and a lower body mass index. www.indiandentalacademy.com


An understanding of the nutritional requirements, symptoms of malnutrition, and environmental factors that influence food choices will assist the prosthodontist in identifying the denture wearing patients at risk of malnutrition .Dietary guidance and nutritional support will improve the tolerance of the oral mucosa to new dentures and prevent the rejection of dentures. Since denture fabrication requires a series of appointments, dietary analysis and counseling can be easily incorporated into an edentulous patient’s treatment plan. www.indiandentalacademy.com


Factors contributing to nutritional problems in the elderly . www.indiandentalacademy.com


The factors that contribute to the nutritional problems in the elderly are as follows:

i. Physiologic changes associated with aging. i. Psychosocial aspects ii.Drugs iii.Economic factors iv.Changes in oral conditions www.indiandentalacademy.com


1. Physiologic changes associated with aging The elderly are often at high risk for developing a nutritional deficiency due to the physiologic changes accompanying aging. Knowledge of the effects of the aging processes on nutritional status, nutrient requirements of the elderly, and the factors affecting dietary intake will help the prosthodontist provide meaningful guidance to the elderly patient in achieving improved oral health. www.indiandentalacademy.com


There is gradual loss of function associated with aging in most organs and tissues of the body. These changes occur slowly and are influenced by genetics, socioeconomic status, illness, life events, accessibility of health care, and the environment.

There

is a general loss of cells and lower energy levels of the remaining cells during aging. This is associated with a diminished reserve capacity.

That is, in the absence of disease, the organ will

function appropriately, but its ability to respond to stress will decrease with time.

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Body composition Advancing age, with or without illness, results in significant changes in body composition. As age advances, there is a steady decrease in lean body mass (muscle mass) of about 6.3 per cent for each decade of life.

This loss in lean tissue, however, is

accompanied by an increase in body fat and decrease in total body water.

The rate of decline varies with the specific tissue or

organ being measured. www.indiandentalacademy.com


Korenchevsky has reported that by age 70 the kidneys and lungs show a weight loss of approximately 10% when compared with the values of young adults, while the liver diminishes by 18% and skeletal muscles by 40%. Between the ages of 20 and 90, BMR declines by 20%.

If this is not

accompanied by a reduction in caloric intake or increase in activity levels, slow weight gain will occur. www.indiandentalacademy.com


Bone density also declines with age. During growth and development, bone formation exceeds resorption. After peak bone age is achieved, usually between 30 and 40 years of age, bone loss begins to occur, as bone resorption exceeds bone formation. Progressive bone loss begins in women at about 35 – 45 years of age and in men at about 40 – 45 years of age. Women tend to have less bone density than do men.

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Metabolic alterations Varying but progressive decrements occur in indices of physiologic function such as cellular enzymes, nerve conduction & velocity, resting cardiac output, renal blood flow, maximum work rate, and maximum oxygen uptake.

Nutrient uptake by cells

appears to decline with age, suggesting that older organisms may require higher plasma levels of nutrients in order to maintain optimal tissue concentrations. www.indiandentalacademy.com


Along with decline in tissue and cellular function, metabolic activity is also progressively altered with aging.

Basal metabolic rate

(BMR) an estimate of the body’s energy requirements under basal conditions, declines by approximately 20% between 30 and 90 years of age. In addition capacity of the elderly to metabolize glucose is impaired.

There is a reduced ability to synthesize,

degrade and excrete lipids, with a subsequent accumulation of lipids in the blood and tissues. www.indiandentalacademy.com


With respect to hepatic albumin synthesis it has been observed that aged individuals are less responsive than younger individuals to increase in dietary protein intake. This suggests that in the elderly the benefits derived from improved nutrition may be limited by the capacity of the individual to respond.

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Depending on the body metabolism ,the individual may need more or less of the nutrients proposed in the R.D.A.{a quantitative estimate of the nutrient intakes}.

R.D.A.

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The best means of reducing the caloric intake is by replacing the foods high in fats and sugar with complex carbohydrates & these should be the mainstay for the person’s diet. Since to the physiological

stresses

are

associated

with

age

related

degenerative diseases, protein needs of the older adults are thought to be slightly higher than those of the younger persons. It is recommended that 10%-35% of the total calories or 1 g/kg of the body wt. comes from protein. Dietary regulations

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Gastrointestinal functioning The physiologic changes in the gastrointestinal tract that occur with aging include decreased peristalsis, decreased hydrochloric acid secretion, and altered oesophageal motility. It is suggested that the degree of malabsorption differs for various nutrients with age. For example, the ability to absorb calcium declines with age. Loss of muscle tone in the stomach results in reduced gastric motility causing delayed emptying of stomach as well as a reduction in hunger contractions. This loss of muscle tone throughout the digestive tract can contribute to constipation. In fact, constipation has been shown to occur five to six times more frequently in thewww.indiandentalacademy.com elderly than in young adults.Overall,


Sensory changes It is assumed that olfaction and taste generally decrease with age.

In addition to smell and possibly taste, visual and

hearing acuity declines with age. These changes can indirectly affect nutrient intake through altered food purchasing and preparation behaviors.

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Inability to read labels, recipes, prices or light the gas stove can lead to an inadequate dietary intake. Loss of hearing can result in a self-imposed restriction on social activities such as eating out or asking questions in grocery stores.

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Psychosocial factors Exton Smith has categorized malnutrition in the elderly according to various primary and secondary causes. I] Primary causes Ignorance of balanced diet. Inadequate income Social isolation Physical disability Mental disorders II] Secondary causes Alcoholism Increased use of drugs Edentulism

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Because eating is very much a social activity, loneliness can contribute to malnutrition. Loss of a spouse or friend can result in the loss of an eating companion for the elderly individual who might be eating alone or preparing his own meals for the first time in his life

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Mental disorders in the older patient can result in confusion, forgetfulness, irritability, acute depression, or in extreme situations true dementia. These persons can forget to eat even if food is available and are particularly at risk for protein or caloric malnutrition.

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Alcoholism undermines the nutritional status by providing “empty� calories derived from alcohol and interferes with nutrient absorption.

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Drugs Older people are the chief users of drugs. Although the elderly account for 11% of the population, they are taking 25% of the prescribed and over the counter drugs. Many of these drugs interfere with digestion, absorption, utilization or excretion of essential nutrients.

Additionally, some drugs profoundly affect

appetite, decrease salivary flow and affect taste and smell acuity.

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Economic factors Economic factors are a major force in determining the variety and nutritional adequacy of the diet. Surveys suggest a relationship between income and nutritional adequacy. Vitamin C, in particular, is a nutrient that has been shown to be influenced by income.

Additionally, other factors that can affect nutritional

intake are also influenced by income, such as transportation, housing and facilities for food storage and preparation. www.indiandentalacademy.com


Changes in oral status of the elderly 1. Alteration in gustation and olfaction Gustation (taste perception) is mediated through the papillae, taste buds and free nerve endings that are found primarily in the tongue but also over the hard and soft palates and in the pharynx.

In general, the number of these structures

appears to decrease with age. The tongue perceives four modalities of taste – salt, sweet, sour, and bitter. The tongue is more sensitive to salt and sweet, where as the palate is more sensitive to sour and bitter. www.indiandentalacademy.com


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Olfaction is the act of perceiving odors. In contrast with gustation, olfaction

can

be

stimulated

by

extremely

low

chemical

concentrations. Denture wearers, do exhibit a significant decrease in their ability to decipher differences in sweetness of certain foods, along with hardness and texture. This decrease in the sensory aspect of the food can result in a decrease in food consumption because tasteless, odorless food most likely will not be eaten. www.indiandentalacademy.com


Salivary function Xerostomia is a condition of dry mouth as a result of diminished salivary flow commonly found in the elderly. It is not a direct consequence of the aging process but may result from one or more factors affecting salivary secretion. Emotions (especially fear or anxiety), neuroses, organic brain disorders, and drug therapy all can cause xerostomia.

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In addition salivary gland function may be diminished by obstruction of the duct with a salivary stone, therapeutic radiation for head and neck cancer, infection such as mumps, sjogrens syndrome, lupus erythematosus, biliary cirrhosis, polymyositis, or dermatomyositis or sarcoid and autoimmune hemolytic anemia.

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Some of the commonly prescribed groups of drugs that produce xerostomia

are

antihypertensives,

anticonvulsants,

antidepressants, tranquilizers and anti Parkinson drugs.

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Since saliva lubricates the oral mucosa, the lack of saliva creates a dry and often painful mucosa. Without significant salivary flow, food debris will remain in the mouth, where it is fermented by dental plaque bacteria to organic acids that initiate the dental caries process. A major function of saliva, which contains calcium phosphates, is to buffer the acids and to re-mineralize the eroded enamel surface.

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In addition, lack of saliva can affect the nutritional status in a number of ways; 1. It hinders the chewing of food because it prevents the formation of a bolus. 2. It makes the mouth sore and chewing painful. 3. It makes swallowing difficult due to the loss of saliva’s lubricating effect. 4. It can cause changes in taste perception that decreases adequate food intake. www.indiandentalacademy.com


Oral mucosal changes The mucous membranes of the lips, the buccal and palatal tissues and the floor of the mouth change with age. The patient’s chief complaints are a burning sensation, pain and dryness of the mouth, as well as cracks in the lips. Chewing and swallowing become difficult, and taste is altered. The epithelial membrane is thin and friable and easily injured.

It heals slowly because of

impaired circulation. If the salivary deficiency is pronounced, the oral mucosa may be dry, atrophic, and sometimes inflamed, but more often it is pale and translucent. www.indiandentalacademy.com


Recommended Dietary Allowances for the Elderly Men Women Age

51+

51+

Weight (kg)

70

55

154

120

178

163

70

64

56

44

Protein (g)

1000

800

Vitamin A (Âľ g RE)+

5

5

10

8

60

60

1.2

1.0

1.4

1.2

16

13

(lb) Height (cm) (in)

Vitamin D (Âľ.g )+ Vitamin E (mg a-TE) Vitamin C (mg) Thiamine (mg)

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Riboflavin (mg)

2.2

2.0

Niacin (mg NE)

400

400

Vitamin B6 (mg)

3.0

3.0

800

800

Folic acid (µg) Vitamin B12 (µg) Calcium (mg) Phosphorus (mg) Magnesium

800 350 10 15 150

300 10 15 150

Iron (mg) Zinc (mg) Iodine (µ.g) www.indiandentalacademy.com BACK

800


Balanced diets (Indian) for old people over 60 years MEN FOOD STUFF

WOMEN

VEG

NON VEG

VEG

Cereals

320

320

220

Pulses

70

50

70

Green leafy vegetables

100

100

125

75

75

75

75

75

50

150

150

150

800

600

300

Fats and oils

30

30

30

Cheese

50

-

50

Meat and fish

-

100

-

Eggs

-

40

-

30

30

Other vegetables Roots and tubers Fruits Milk

Sugar and jaggery

30

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NON VEG 220 50 125 75 50 150 600 30 100 40 30


THE FIVE FOOD GROUPS All the nutrients necessary for optimal health in the desirable amounts can be obtained by eating a variety of foods in adequate amounts from the five food groups.

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These are 1. Vegetable Fruit Group : Four servings of vegetables and fruits, subdivided into three categories • Two servings of good sources of vitamin C, such as citrus fruits, salad greens, and raw cabbage • One serving of a good source of provitamin A, such as deep green and yellow vegetables or fruits

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•One serving of potatoes and other vegetables and fruits

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2]Bread – Cereal Group Four servings of enriched bread, cereals, and flour products

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3.] Milk - Cheese group Two servings of milk and milk based foods, such as cheese (but not butter)

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4.] Meat, Poultry, Fish and Beans Group Two servings of meats, fish poultry, eggs, dried beans and peas, and nuts

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5.] Fats, Sugar and Alcohol Group Additional miscellaneous foods, including fats and oils, sugar and alcohol; the only serving recommendation is for about 2 to 4 tablespoons of polyunsaturated fats, which supply essential fatty acids.

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In 1992, the U.S. Department of Agriculture developed the Food Guide Pyramid. This replaces the former basic four model of milk, fruits and vegetables, and grains.

The pyramid now

contains six categories: 1. Bread, cereal, rice, and pasta. 2. Vegetables. 3. Fruits. 4. Milk, yogurt, cheese. 5. Meat, poultry, fish, dry beans, eggs, and nuts. 6. Fats, oils and sweets. www.indiandentalacademy.com


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The last item on the pyramid, fats, oils, and sweets, is not considered a nutritional category and comes with the admonition that

these

substances

are

to

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be

used

sparingly.


FOOD GUIDE PYRAMID :

This is an outline of what to eat each

day.

It’s

not

a

rigid

prescription, but a general guide that lets you choose a healthful diet that’s right for you.

The

pyramid calls for eating a variety of foods to get the nutrients you need and at the same time the right

amount

of

calories

maintain healthy weight.

to The

pyramid emphasizes foods from the five food groups shown in the three lower sections.

Foods in

one group can’t replace those in

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NUTRITIONAL NEEDS FOR THE ELDERLY MAJOR FOOD SOURCES OF NUTRIENTS NUTRIENTS

Foods

ENERGY

Cereals, pulses, roots and tuber fats and oils, sugar and jaggery

PROTEIN

Milk, egg, fish, meat, liver, pulses, nuts and oilseeds.

FAT

Butter, ghee, vegetable oils, hydrogenated fats, nuts and oilseeds.

CARBOHYDRATES

Cereals, pulses, sugar and jaggery, roots and tubers.

FIBERS

Green leafy vegetables, fruits, unrefined cereals, pulses, and legumes

CALCIUM

Milk and milk products, ragi, green leafy vegetables

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PROTEIN

FAT

Milk, egg, fish, meat, liver, pulses, nuts and oilseeds.

Butter, ghee, vegetable oils, hydrogenated fats, nuts and oilseeds.

CARBOHYDRATES Cereals, pulses, sugar and jaggery, roots and tubers. FIBERS CALCIUM

Green leafy vegetables, fruits, unrefined cereals, pulses, and legumes Milk and milk products, ragi, green leafy vegetables

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BALANCED DIET FOR AN ELDERLY FOR A DAY Foodstuffs

Quantity (raw) in grams Males

Females

Cereals

350

225

Pulses

50

40

Vegetables

200

150

Green leafy vegetables

50

50

Roots and tubers

100

100

Fruits

200

200

Milk and milk products

300

300

Sugar

20

20

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20

Fats and oils

25


BACK

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Assessing nutritional status Methods for evaluation of nutritional status include data collection from

the

examination

following

areas;

(including

both

medical

social

physical

history,

signs

and

clinical certain

anthropometric measures), dietary assessment, and biochemical tests because altered nutritional status can range from inadequate intake of a single nutrient resulting in the simple reduction of nutrient reserves to complex metabolic dysfunctions and clinical deficiency, a multilevel sequence of procedures is presented. www.indiandentalacademy.com


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Medical and social history A thorough review of the patient’s medical history can identify certain high risk conditions that often occur concomitantly with malnutrition, such as (1) compromised digestive or absorptive capacity; (2) acute of chronic diseases from which altered nutrient intake is required for management such as hypertension, diabetes, coronary heart disease; and (3) recent major surgery or treatment that has nutritional implications, such as chemotherapy. An extensive drug history should also be included given the large number of elderly individuals taking one or more medications. www.indiandentalacademy.com


Aspects of social history that should be considered “flag signs� for further investigation into dietary intake are lifestyle factors such as the following: Recent death of spouse Living alone, coupled with lack of extended family or social support network Income limited to the extent that food purchases are affected Depression, senility Disabilities affecting mobility, hearing, sight, swallowing, or chewing Alcoholism www.indiandentalacademy.com


Recommended Daily Allowance Carbohydrate

50-70%

Protein

1gm/kg/day

Fat Vitamin A Beta carotene Vitamin D Vitamin E Vitamin K Vitamin C

20% 750mcg 3000mcg 2.5mcg 5 mcg 10mg 45mcg 40mcg

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Recommended Daily Allowance Riboflavin Naicin Pyridoxine Pantothenic acid Folate Cyanacobolamine Iron Iodine Calcium Fluorine Zinc

0.6mg/1000 kcal 6.6mg/1000 kcal 2mg 10mg 100mcg 1mcg 0.9mg 2.8mg

150mcg 400-500mg 0.5 – 0.8mg/lt www.indiandentalacademy.com 15mg


Clinical signs of Nutritional Deficiency: The physical signs of nutrient deficiency are not early indications that a particular nutrient is lacking. They develop after period of inadequate intake during which tissue stores are depleted and metabolism is disturbed.

In addition, they are

nonspecific; in fact, some of the clinical signs of malnutrition are often considered “normal� in the aging process, for example, hair and skin changes, oral signs, missing teeth, muscle wasting and mental confusion.

Table below indicates those physical signs www.indiandentalacademy.com

most often associated with malnutrition.


Physical signs of Nutrient Deficiencies

Nutrient Protein

Physical signs •Edema •Dull, dry, sparse, easily plucked hair •Parotid gland enlargement, •Muscle wasting

Iron

•Pallor •Pale, atrophic tongue •Spoon nails •Pale conjunctiva

Niacin

•Nasolabial seborrhea •Fissuring of eyelid corners •Angular fissures around mouth •Papillary atrophy •Pellagrous dermatitis •Mental confusion www.indiandentalacademy.com


Riboflavin

•Nasolabial seborrhea •Fissuring and redness of eyelid corners and mouth •Magenta colored tongue •Genital dermatosis

Thiamine

•Mental confusion, •Irritability, •Sensory losses •Loss of ankle and knee jerks, •Calf muscle tenderness, •cardiac enlargement

Pyridoxine

Vitamin A

•Nasolabial seborrhea, •Glossitis •Bitot’s spots (eyes), •Conjunctival and corneal xerosis (dryness) www.indiandentalacademy.com


•Xerosis of skin, •Follicular hyperkeratosis •Glossitis, •Skin hyper pigmentation •Glossitis, Vita B 12 •Skin hyper pigmentation •Spongy, bleeding gums, Ascorbic acid •petechiae, •painful joints Folic Acid

Iodine

•Goitre

Vita D

•Bow legs •Beading of ribs

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The Prosthodontist has a particular advantage in detecting clinical signs of malnutrition because many classic signs occur in and around the oral cavity. Moreover, the Prosthodontist should note any exaggerated response of the oral tissues that is inconsistent with the amount of local irritants present.

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Dietary Counseling of Prosthodontic Patients One expectation of patients seeking new dentures is that they will be able to eat a greater variety of foods. Such patients often are receptive to suggestions aimed at improving the quality of their diets. Nutrition screening begins at the first appointment so that counseling and follow up can occur during the course of treatment. www.indiandentalacademy.com


Risk Factors For Malnutrition In patients wearing Complete denture prosthesis: Unplanned weight gain or loss of >10 lb in the last 6 months Undergoing chemotherapy or radiation therapy Poor dentition or ill-fitting prosthesis Oral lesions – glossitis, cheliosis, or burning tongue Severely resorbed mandible Alcohol or drug abuse

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Eating less than 2 meals/day Providing nutrition care for the denture patient entails the following steps. Obtaining a nutrition history and an accurate record of food intake over a 3-, 4- or 5-day period. Evaluating the diet Teaching about the components of a diet that will support the oral mucosa as well as bone health and total body health Guidance in the establishment of goals to improve the diet. Follow up www.indiandentalacademy.com


Nutrition Guidelines For Prosthodontic Patients Eat a variety of foods Build diet around complex carbohydrates fruits vegetables, whole grains, and cereals. Eat at least 5 servings of fruits and vegetable daily Select fish, poultry, lean meat, or diet peas and beans every day. Obtain adequate calcium Limit intake of bakery products high in fat and simple sugars Limit intake of processed foods high in sodium and fat www.indiandentalacademy.com

Consume 8 glasses of water daily.


Dietary Suggestions for patients wearing Complete denture prosthesis. Modifying food selection and Food Habits The problem of selecting a properly nutritious diet for an elderly person is not simple, because one or more of the following environmental factors may influence food selection and eating habits: Deficient dentition Low income Ingrained food patterns www.indiandentalacademy.com Excessive introspection


The sense of taste that is lost when the roof of the mouth is covered by dentures can be partially compensated by using herbs and condiments and serving foods that are tolerably hot, thus making the patient more aware of the food aromas. Also, use of onions, chives, parsley and other herbs can heighten food flavors for denture wearers. For maximum taste sensation, the use of sharply contrasting flavors in combinations (such as sweet and sour) has proved beneficial. www.indiandentalacademy.com


Through persistent and rational nutrition education, food habits can be modified. We do not suggest drastic changes, but if the environmental factors are improved and with expression of concern for the patient, significant progress can be made in realistically and constructively modifying food habits.

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TEACHING THE PATIENT TO MASTICATE WITH THE NEW PROSTHESIS: The ability to manage the physical consistency of food can be easier for a new denture wearer if an analysis of the jaw movements involved in mastication is made.

The process of eating actually involves

three steps; biting or incising; chewing, or pulverizing; and, finally swallowing.

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Incision of food involves a grasping and tearing action by the incisor teeth-requiring opening the mouth wide, an action that can cause dislodgment of the denture by the pulling action of overtensed muscle.

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When the leverage force of the incising action is exerted in the anterior segment of the mouth, the only equal and opposite force to prevent dislodging the denture is the seal created by the postdam compressive force of the denture on the soft palate.

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The counter dislodgement forces in the incising action are not as effective as, for example the balancing forces of the occlusal surfaces of the bicuspid and molars used in the chewing process. This makes the first step, the incising action the most difficult of all three masticating actions.

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The chewing and pulverizing of the bolus of the food by the molars and bicuspids are less difficult than incising, but still, the coordination of the many muscles of mastication that produce the hinge and sliding movement of the mandible during eating requires some experience. With patience and persistence, these movements can be mastered as long as there are no sore sports or cuspal interferences created by the dentures.

Actually, the

easiest and least complex step in the eating process is that of swallowing. www.indiandentalacademy.com


Therefore although the logical sequence of eating food is biting chewing and swallowing. It is much easier for the new denture patient to master this complex of Masticatory movements in the reverse order, namely, swallowing first, chewing second, and biting last. Consequently, food of a consistency that will require only swallowing, such a s liquids, should be prescribed for the first day or two after insertion of the denture. www.indiandentalacademy.com


The use of soft foods is advocated for the next few days, and a firm or regular diet can be eaten by the end of the week. Regardless of its consistency, the diet can be made varied balanced, and adequate, as will be shown in following dietary suggestions.

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DIET AFTER INSERTION 0f COMPLETE DENTURE PROSTHESIS On the first postinsertion day : A new denture wearer can choose from the following foods, which are essentially liquids and are arranged according to the four basic food groups. Vegetable fruit group; juices Bread cereal group; gruels cooked in either milk or water Milk group fluid milk may be taken in any form Meat group; for the first day or so eggs will be the first food choice; they may taken in eggnogs; pureed meats, meat broths, or soups may also be eaten. www.indiandentalacademy.com


On the second the third post insertion days, the denture patient can use soft foods that require a minimum of chewing. Vegetable fruit group in addition to fruit and vegetable juices, tender cooked fruits and vegetables (skin and seeds must be removed) cooked carrots, tender green beans. Bread-cereal group: cooked cereals such as cream of wheat and softened bread; boiled rice. Milk group; fluid milk Meat group: chopped beef, ground liver, tender chicken or fish in a cream sauce o even children’s junior food preparations; eggs may be scrambled or soft cooked; dried peas maybe used in a thick, strained soup

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By the fourth day: Or as soon as all the sore spots have healed, in addition to the soft diet, firmer foods can be eaten. In most instances, these foods should be cut into small pieces before eating. In general it has been found that raw vegetables and sandwiches are the foods least preferred by denture wearers. In fact, raw vegetable requires more force during mastication to prepare them for swallowing than most other foods. Therefore if the denture patient is able to manage salads, the ultimate in denture success and patient achievementwww.indiandentalacademy.com will have been realized.


DIETARY SUPPLEMENTS Dietary supplement Act,1994 • Products intended to supplement the diet • contains a vitamin,mineral,amino acid or other botanicals. • Does not represent conventional food. • Ingested in the form of capsule, powder,softgel etc

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FOOD FORTIFICATION Fortification is a public health measure aimed at reinforcing dietary intake of nutrients with additional supplies to prevent or control nutritional disorders in a given area. Example • fortification of salt with iodine.

•

fortification of wheat with vitamins.

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Supplement

Oral use

Forms

Caffeine

Ergogenic aid

Beverage

Capsaicin

Pain relief for tooth ache and trigeminal neuralgia

Chillies, topical ointments

Garlic

Treatment and prevention of oral candidiasis www.indiandentalacademy.com


Supplement

Oral use

Forms

Green tea

Decreases risk of dental caries, cancer prevention

Beverage

Lysine

Vitamin C

Prevents Tablets, Topical recurrence of applications aphthous ulcers, herpes labialis Integrity of gingiva, improved healing www.indiandentalacademy.com

Citrus fruits, tablets


REVIEW OF LITERATURE

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William T Fischer (1955) conducted a study on prosthetics and geriatric nutrition. He concluded that nutrition is one of the main factors that determines the success or failure of the prosthetic appliance in the mouths of aging people. Jamieson C.H. (1958) in his study on “Geriatrics and the denture patient� described that aging is largely due to a gradual loss of energy resulting in structural and functional changes in the body. The rate of change may be hastened by toxic agents in the body and the adverse hereditary influences. www.indiandentalacademy.com


Arthur Elfenbans (1967) observed that the teeth became yellower due to fluoride absorption,over the years, from foods and fluids ,and the teeth become brittle. Wical K.E and Swoope (1974) assessed the relationship of residual ridge resorption .They described the atrophy of the alveolar bone as a systemic disease. Barone JV (1978) analyzed the nutrition of the edentulous patient. The study found that many edentulous patients are "sick patients." Often geriatric considerations are involved, as well obesity and postmenopausal problems. These patients have deficient tissues on which to build dentures. The degenerative processes which initiate the loss of teeth continue after extraction and cause further shrinkage of supporting tissues.

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Wical K.E and Brusse (1979) demonstrated the effects of calcium and vitamin D supplementation on alveolar ridge resorption in immediate denture patients. The purpose of their study was to test the hypothesis that a daily calcium and vitamin D supplementation would tend to reduce the rate and extent of alveolar bone resorption following extraction of the teeth. Massler M (1979) in his study on geriatric nutrition and osteoporosis concluded that the success or failure of an oral prosthesis depends as often on upon the health of the oral tissues as upon the technical skills of the prosthodontist. www.indiandentalacademy.com


Massler M(1979) in his study on geriatric nutrition and dehydration in the elderly states that water balance in the elderly is critical in preventing tissue dehydration .The negative water balance results when more water is lost than retained leading to an overall decrease in all the body secretions. This drying out of the tissues and the organs including the muscles and the joints causes aging . Massler M (1980) described the role of taste and smell in appetite in geriatric nutrition. Proper nutrition is essential to the health of the oral tissues, and healthy tissues enhance prosthodontic treatment of the elderly. All dentists should be www.indiandentalacademy.com


prepared to offer dietary advice to this expanding population. Taste and smell are essential to proper nutrition. In the elderly the peripheral sensory receptors decline, causing the appetite to wane. Taste and aroma are inextricably intertwined in determining the palatability and acceptance of food. For example, during an upper respiratory infection, the olfactory receptors are blocked. Food becomes tasteless; it loses both flavor and aroma and the appetite declines. As a result of aging, the taste buds on the tongue and the olfactory receptors in the roof of the nasal cavity regress. In addition, the gustatory and olfactory nuclei in the brain decline, causing a reduction in appetite

and www.indiandentalacademy.com

diet.


Alan H Wayler (1983) conducted a study on the impact of complete dentures on the masticatory performance and food choice in the healthy aging men. He concluded that the preference for softer and easier to chew foods in persons with complete dentures requires that the food selected meet the daily requirements of nutrient intake. Chauncey HH, et.al (1984) studied the effect of the loss of teeth on diet and nutrition. Human food selection is dependent on a complex interaction of biological, environmental, cultural and behavioral

influences.

Numerous

studies

have

provided

evidence that food choice is guided neither by physiologic need nor item availability.

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Knapp A.V.A (1989) did a study on the nutrition and oral health in the elderly. She found that the elderly are often at the risk of developing nutritional deficiencies due to physical changes occurring due to aging, treatment associated with chronic diseases, diets and drugs, economic and social factors, and, changes in the oral status. Nizel and Papas (1989) have written in length about the effects of the diet and the nutrition on the health of the elderly. www.indiandentalacademy.com


Brodeur JM, et.al (1993) studied the nutrient intake and gastrointestinal disorders related to masticatory performance in the

edentulous

elderly.

He

concluded

that

a

reduced

consumption of high-fiber foods could therefore induce the development of gastrointestinal disorders in edentulous elderly subjects with a deficient masticatory performance. Moynihan PJ, et.al (1994)conducted a study on the intake of non-starch polysaccharide (dietary fibre) in edentulous and dentate persons .Compromised masticatory efficiency places edentulous persons at risk of consuming a diet low in nonstarch polysaccharide (NSP) ('dietary fibre'). www.indiandentalacademy.com


Greksa LP, et.al (1995) studied the dietary adequacy of edentulous older adults. This study tested the null hypothesis that there are no differences in dietary patterns or adequacy between edentulous patients and individuals with nearly complete dentitions. Demers M, et.al (1996) studied the indicators of masticatory performance among elderly complete denture wearers. Papas AS, et.al (1998) studied the effects of denture status on nutrition .He concluded that although direct correlations cannot be made with actual nutritional status, the introduction of dentures could further compromise the precarious nutritional intake of the elderly population. With this in mind, dentists need to consider carefully the importance of their elderly patients maintaining at least some natural dentition and should provide adequate information

on

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nutritional

adaptations

to

dentures.


Mills J, et.al (1999) presented a clinical approach to dental nutrition among the elderly wherein they discussed about geriatric nutrition. This paper describes the role of nutrition in dentistry, especially as it relates to elderly patients. Budtz-Jorgensen

E,et.al

(2000)

conducted

a

study

on

�Successful aging –The case for prosthodontic therapy" wherein he observed poor oral health and xerostomia are often present and may have a negative effect on masticatory function and nutrition, precipitating avoidance of difficult-to-chew foods. There is no evidence that the provision of prosthetic therapies can markedly improve dietary intakes; however, it might improve oral comfort and quality of life and avoid enteral alimentation.

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Spanish

Geriatric

Oral

Health

Research

Group

(2001)

investigated the oral health and nutritional status of elderly men and women, including those living in institutions to conclude that there is a need to ensure that the overall balance of the diet is not impaired because of the state of the dentition . HuttonB, et.al (2002) questioned the association between edentulism and the nutritional state. Edentulous people have difficulty chewing foods that are hard or tough in texture, even when wearing well-made dentures. The evidence suggests that edentulous individuals lack specific nutrients and, as a result, may be at risk for various health disorders. www.indiandentalacademy.com


Allen PF, et.al (2003) presented a review of the functional and psychosocial

outcomes

of

edentulousness

treated

with

complete replacement dentures. Loss of natural teeth has functional and psychosocial consequences that can, in many cases, be rectified with complete replacement dentures. However, the outcome of complete denture therapy is variable, and relies on patient factors, as well as the skill of the clinician and laboratory technician making the dentures.

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Ahluwalia N (2004) discussed aging, nutrition and immune function. Aging is usually associated with increase in chronic disease as well as infections and associated morbidity. The long-term benefits of multinutrient supplements to healthy elderly not at risk for nutrient deficiencies, however, are currently not well-established. Priorities for future research and methodological considerations for future studies are discussed.

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•

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•

Leader in continuing dental education

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Deeksha's nutrition seminar ii/ dental implant courses by Indian dental academy  

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