Effect of nutrition in edentulous geriatric patients

Gaurav Singh; Shakeba Quadri; Bhumika Kapoor; Shraddha Rathi

doi:10.4103/jorr.jorr_20_17

REVIEW ARTICLE

Year : 2018 | Volume : 10 | Issue : 1 | Page : 33-38

Effect of nutrition in edentulous geriatric patients

Gaurav Singh¹, Shakeba Quadri¹, Bhumika Kapoor², Shraddha Rathi¹
¹ Department of Prosthodontics and Crown and Bridge, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
² Department of Conservative Dentistry and Endodontics, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India

Date of Web Publication

2-Feb-2018

Correspondence Address:
Shakeba Quadri
Department of Prosthodontics and Crown and Bridge, Dr. Ziauddin Ahmad Dental College, Aligarh Muslim University, Aligarh, Uttar Pradesh
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jorr.jorr_20_17

Abstract

Everyone aims to achieve perfect health. It is an industry of its own. People across all ages implement various procedures to attain good health. Physical health is closely related to dental health. There can be no complete fitness attained without attaining complete oral health. An unhealthy mouth might be a source of an unhealthy body and vice versa. The aged are often grieved with dental health issues. Dentistry for them needs more awareness and research. Especially, since with them, there is a bundle of other factors coming in, such as certain biological factors, nutrient receptiveness to various food items, loss of enzymes and glandular secretions, and decreased adaptability. Tissue regeneration in the aged is definitely very low. Therefore, the approach toward them has to be different and caution needs to be acknowledged. The present article will give an overview of Geriatric management in edentulous patients, why we need to review it, how it should be done, the role of nutrition, and research in dentistry for the elderly.

Keywords: Denture wearers, nutrient dense food, oral health

How to cite this article:
Singh G, Quadri S, Kapoor B, Rathi S. Effect of nutrition in edentulous geriatric patients. J Oral Res Rev 2018;10:33-8

How to cite this URL:
Singh G, Quadri S, Kapoor B, Rathi S. Effect of nutrition in edentulous geriatric patients. J Oral Res Rev [serial online] 2018 [cited 2023 Jun 7];10:33-8. Available from: https://www.jorr.org/text.asp?2018/10/1/33/224535

Introduction

Mastication, dentition, and selection of nutrition by a person are closely related. Today, a huge section aged 65 or more are edentulous ^[1],[2],[3] Thereby, reducing their capability of masticating. This, in turn, leads to a shift in the choice of nutrition they prefer to intake. The shift in nutrition intake also has a major effect on their health which is an important subject to be studied.^[4] Wearing dentures have an impact on the oral as well as physical health of a person. Most prefer in taking meals with lesser fiber, carotene, vegetables, and meals which ease the process of mastication. However, this is closely associated with cancer and heart ailments.

Impact of Oral Health on Nutrition in Denture Wearers

Wearing dentures bring about a significant change in the oral health of a person. First and most commonly, the choice of food witnesses a shift. Owing to their oral health issues, the older masses feel a compulsion to choose food other than those they would prefer to consume. This number is as huge as 20%. Every 3 in 20 had a low mastication, thereby decreasing the satisfaction value in meals and 1 in 20 avoided certain nutritional intake due to issues with chewing.^[5],[6]

There are several implications that come along with losing teeth such as:

A ill-fitting denture
Soreness due to ill-fitting dentures which lead to sore spots
Protruding chin
Wrinkling, which extends downward from the oral commissures
Extremely resorbed mandible
Chewing becomes difficult
Decreased food intake unable to arrange food for oneself
Sudden putting on of weight
Sudden weight loss
Mandibular prognathism
Changes in inter alveolar space
Narcotism
And undergoing radiation therapy.^[5],[6],[7]

The effect of complete treatment of edentulous patients is visible directly as well as indirectly. Some direct consequences are as follows:

Denture stomatitis,
Denture irritation
Hyperplasia
Traumatic ulcer
Flabby ridges
Residual ridge resorbtion
Mucosal ulcerations
Altered taste perception
Burning mouth syndrome and
Gagging.

Indirect consequences include experiencing difficulty in chewing which in turn affects the physical health of a person in toto. Difficulty in chewing, low mastication, painful sores lead to a loss in nutrition which reduces the adaptability toward dentures.^{[6],[7],[8],[9]}

Factors That Affect Diet and Nutritional Status

There are innumerable factors that impact an elderly's interest in using dentures. Decrease in enjoying the taste and texture of food might be one such factor.^[10] A good fitting denture is necessary to avoid painful sores. This is possible by following a contingent dental set of etiquettes right from the beginning of clinical and laboratory settings. An uncomfortable denture might compel the person to discontinue using the denture.^[11] Dental services hired must be systematic and responsible. Yearly dental checkup should be done, and the dentures should be removed each day to maintain hygiene as well as giving scope for gums to relax. Checkups might be more frequent for new users. Not following these guidelines might lead to painful sores and ill fitting dentures.^[10] This may not only lead to poor health but also depression.^[11]

The impact varies among people.^{[9],[12],[13]} Oral impairments have a toll on the ability to eat, analyze taste, bite, or gulp food. However, dentures often have an adverse effect. Geriatric patients with dentures take longer to chew before they gulp the food. The overall mastication efficiency reduces by almost 80% which when compared to those with mandibular implant-retained-over-dentures gives a whopping reduces chewing stroke rate of double to four times the normal stroke rate.^[14],[15]

The elderly with complete upper dentures experience reduced sensitivity as the upper palate is covered. Denture wearers experience the lowest sensitivity among all dentate adults. This decreases the pleasure in eating and reduces nutritional intake.^[13] This is observed more so among those wearing full dentures rather than partial denture users. Vitamin A and Vitamin C deficiencies were observed more in them. Vitamin D deficiency in elderly is a cause of metabolic bone diseases while edentate women consumed more fat as per studies.^[5],[16] Simultaneously, the ease of adjusting to dentures is determined by the salivation of a person and its ability to act as a lube for setting the dentures. This in turn is affected by aging and is related to mental and physical changes that come along with it.^[17]

Along with this, a person may also suffer from Xerostomia which may reduce his ability to completely retain denture as well as experiences difficulty in chewing and reduced nutritional intake and deficiency such as fiber, potassium, Vitamin B-6, iron, calcium, and zinc deficiency.^[11] These deficiencies lead to decreased or modified immune responses. Dehydration is also found among a lot of edentured elderly due to declining kidney functioning and of body water metabolism. About 20% experience dryness. Some experience foul tastes, oral burning sensations, and pain apart from uneasiness while chewing.^[12]

Popular dentures make it difficult to chew hard vegetables. Thus, hard chewing substances are commonly avoided. This leads to a decrease in protein and other essential nutrients such as fiber, calcium, and nonhaem iron. Processed canned food intake compromises for fresh foods. With a loss in mastication efficiency, many experience gastrointestinal disorders. This causes malabsorption of Vitamin B12 found in food. Excessive vitamin deficiency is known to be a source of neurological disorders.^{[16],[18],[19],[20]}

The shift in nutrition intake and decrease in mastication efficiency weave a pathway for various diseases. Research has hypothecated that correct dietary choices may serve precautionary for cancer, coronary heart disease, cataract, scurvy, etc., Dental status despite not determining any important nutrient essential for oral health, it does affect the measures of plasma ascorbate and plasma retinol.^{[21],[22],[23]} Lowering in their measures harm eye sight and cause irritation in thin skin. Dental status is correlated to vitamin C which may be a cause of cataract as well.^[24]

Due to decreased intake of fruits, vegetables, and fibrous substances, the fat intake is higher. This is a cause of colorectal adenoma, obesity, cancer, or cardiovascular sickness. Type II diabetes has also been observed more in those wearing complete dentures. Studies show that edentulous older men have a significantly higher prevalence of type II diabetes than dentate or partially edentulous men.^[25] The decrease in masticulation efficiency might be a cause of gastrointestinal pathology.^[26]

Nutritional Recommendation

Nutrition is not only a balanced diet. Rather, it is the sum total of ingesting the diet, the digestive functioning, and absorption of nutrition by tissues until its complete usage by the cells.

This forms a complicated metabolic chain which may be dysfunctional at any point. Therefore, edentured geriatric patients need to be way more careful about their nutrition and seriously look into their platter.

Often we observe that the elderly dentured patients attempt to compensate for the loss of taste sensation by substituting it with extreme seasoning or sweet dishes. Such food habits need to be amended.^[27]

Uneasiness in chewing or painful ill-fitting dentures may lead to bad chewing process where food is swallowed without adequate chewing. The stomach has a lot of break down to do which in turn leads to bloating, antiperistalsis, indigestion, etc. As metabolism goes down, glandular functioning, salivatory secretions, and release of digestive enzymes reduces. Thus, the food passes through the metabolic chain with lesser than required enzymes and saliva. The stomach therefore has excess targets.^[27],[28]

Russell et al. in 1999^[29] suggested Food Guide Pyramid and the modified Food Guide Pyramid [Figure 1] for adults more than 70 years of age. This was recommended for dietary needs of older adults. In modified food guide, pyramid water was placed at bottom as elderly people do not drink enough water to stay hydrated. A flag was also placed at top of the pyramid which denotes need of calcium, Vitamin B12 and D because many older adults do not get enough of these nutrients in a regular diet. Later in 2008, Lichtenstein et al.^[30] suggested MyPyramid [Figure 2] which recommended the placement of physical activities at the bottom of pyramid. More physical work will lead to more consumption of food which means better intake of nutritional supplements. Physical activity also helps maintaining muscle mass with increasing age.

Figure 1: Original food guide pyramid and modified food pyramid for elderly

Click here to view

Figure 2: MyPyramid for elderly

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The requirement for Vitamin D is increased from 200 IU/day to 400 in individuals of 51–70 years of age and to 600 IU/day for those over 70 years of age. Iron intake from 18 mg/day in women aged 19–50 reduces to 8 mg/day after age fifty. This may be due to better iron conservation and decreased losses in postmenopausal women compared with younger women. Higher level of Vitamin B6 is required in elderly patients as it boosts the level of selenium. Selenium is important to regulate immune function and decrease the susceptibility of infections. Older people require 2 or more meals each day. However, they eat less in each meal. The amount of calories required is less as compared to younger people, but amount of protein and other nutrients is same.

Nutritional Evaluation

Muller et al. evaluated the nutritional status of edentulous patients with either a mandibular conventional or an implant-supported overdenture 1 year previously. No significant differences were observed between two groups. However, conventional denture wearers found chewing harder foods to be more difficult.^[31] The first priority while evaluating nutrition is to understand the differences in metabolic functioning of an individual and how his metabolism reacts to a particular diet. Personal interventions to gather data about food policies, health requirements, and Dietary Reference Intakes for nutrient needs as well as recommendations to get better in this arena will eventually come up as a part of this research. To determine the above, the following fields need to be explored:^[32]

Omics research: this includes such as nutrigenetics and nutrigenomics (example, epigenetic, transcriptomics, proteomics, and metabolomics). The prime objective of this research is to gather information about relation between certain nutrients and genes and metabolism to determine the health of a person. Will help to determine how specific nutrients interact with genes, proteins, and metabolites to predict an individual's health
Micro biome: The human body is home to several microorganisms. Research must be conducted to determine their role in metabolism, responsiveness of body to certain nutrients, diet, diseases, etc.
Biological networks: This include the study of an individual's genes, effect of biological network on food responsiveness, and other environmental factors such as micro-organisms, pollution, chemical ingredient, etc.
Tissue specificity and temporality the effect a diet has on growth, and health is an important field of research and tissues play a prime role in it. Therefore, credible research must be done.

Second, the factor to be considered is the effect of nutrition of growth and development. Energy balance, epigenetic, nutrition and reproductive health, nutritional affect on geriatric patients and studies of these nature fall under this category. Health management through correct diet and nutritional intake must be looked into.

Food habits of a person have to be observed. They cannot be easily altered, especially in old people. Social, psychological, and financial status of a person plays a huge role in determining nutritional intake.

Last, medical management and disease progression are two factors that need extensive research.^[28]

Dentures make management of chewing very difficult. In fact, it becomes the most loathed part of digestion. The correct way of chewing and swallowing can be taught, to ward off unorganized eating habits.^[27]

Summary

Healthy patients and those with better oral health experience better success in fitting dentures. Nutritional deficiencies have been proven to cause denture failures. On this date, guiding a edentulous patient through an adequate diet plan should be implemented into his prosthodontic treatment. The patient's nutrition history must be analysed, nutrient deficiencies and their causes, his responsiveness to certain nutrients and the mastication efficiency must also be looked into. Prognosis improves when the nutritional status of a elderly patient is analyzed, and specific diet is charted for their needs which improve the health of denture foundation tissues.^{[5],[9],[21],[25]}

As a part of prosthodontics, it is essential to have good knowledge about senile changes occurring in different tissues. Only then is it possible to comprehend correctly and provide correct treatment for the same.

Recommending diet after fitting dentures can help overcome a lot of agonies, psychological, and well as physiological issues. It also aids them cope with the learning phase in a better manner. Psychological evaluation and counseling must also be inculcated in the treatment.^[27]

Many denture failures are the result of nutritional deficiencies. Good health and nutrition of older patients are necessary for the successful wearing of dentures.

The survey reflects that an approximate of 75% edentulous patients recommend a complete denture treatment which includes dietary guidance, counseling, and research into their dietary habits.^{[33],[34],[35]}

Edentulous patients who prefer fatty, sugary, and soft food for comfort must be advised and explained the value of nutrients. They must be advised to implement fresh food and fiber enriched meals.^[21]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1.	Zarb GA, Bolender CL, Carlsson CE, editors. Boucher's Prosthodontic Treatment for Edentulous Patients. 11^th ed. St. Louis: CV Mosby; 1997.
2.	Atwood DA. Reduction of residual ridges: A major oral disease entity. J Prosthet Dent 1971;26:266-79. [PUBMED]
3.	Tallgren A. The continuing reduction of the residual alveolar ridges in complete denture wearers: A mixed-longitudinal study covering 25 years. J Prosthet Dent 1972;27:120-32. [PUBMED]
4.	Marcus SE, Drury TF, Brown LJ, Zion GR. Tooth retention and tooth loss in the permanent dentition of adults: United States, 1988-1991. J Dent Res 1996;75:684-95. [PUBMED]
5.	Locker D. Subjective reports of oral dryness in an older adult population. Community Dent Oral Epidemiol 1993;21:165-8. [PUBMED]
6.	Gilbert GH, Heft MW, Duncan RP. Mouth dryness as reported by older Floridians. Community Dent Oral Epidemiol 1993;21:390-7. [PUBMED]
7.	Krall E, Hayes C, Garcia R. How dentition status and masticatory function affect nutrient intake. J Am Dent Assoc 1998;129:1261-9. [PUBMED]
8.	Sandström B, Lindquist LW. The effect of different prosthetic restorations on the dietary selection in edentulous patients. A longitudinal study of patients initially treated with optimal complete dentures and finally with tissue-integrated prostheses. Acta Odontol Scand 1987;45:423-8.
9.	Norlén P, Steen B, Birkhed D, Björn AL. On the relations between dietary habits, nutrients, and oral health in women at the age of retirement. Acta Odontol Scand 1993;51:277-84.
10.	Gellar M, et al. Denture wearers at risk for poor nutrition. Tufts Univ Health Nutr Lett 2000;18:3.
11.	Weyant RJ, Pandav RS, Plowman JL, Ganguli M. Medical and cognitive correlates of denture wearing in older community-dwelling adults. J Am Geriatr Soc 2004;52:596-600. [PUBMED]
12.	Krall E, Hayes C, Garcia R. How dentition status and masticatory function affect nutrient intake. J Am Dent Assoc 1998;129:1261-9. [PUBMED]
13.	Sandström B, Lindquist LW. The effect of different prosthetic restorations on the dietary selection in edentulous patients. A longitudinal study of patients initially treated with optimal complete dentures and finally with tissue-integrated prostheses. Acta Odontol Scand 1987;45:423-8.
14.	Palmer CA. Gerodontic nutrition and dietary counseling for prosthodontic patients. Dent Clin North Am 2003;47:355-71. [PUBMED]
15.	Geertman ME, Slagter AP, van Waas MA, Kalk W. Comminution of food with mandibular implant-retained overdentures. J Dent Res 1994;73:1858-64. [PUBMED]
16.	Papas AS, Palmer CA, Rounds MC, Herman J, McGandy RB, Hartz SC, et al. Longitudinal relationships between nutrition and oral health. Ann N Y Acad Sci 1989;561:124-42. [PUBMED]
17.	Greksa LP, Parraga IM, Clark CA. The dietary adequacy of edentulous older adults. J Prosthet Dent 1995;73:142-5. [PUBMED]
18.	Fontijn-Tekamp FA, van't Hof MA, Slagter AP, van Waas MA. The state of dentition in relation to nutrition in elderly Europeans in the SENECA Study of 1993. Eur J Clin Nutr 1996;50 Suppl 2:S117-22.
19.	Wayler AH, Chauncey HH. Impact of complete dentures and impaired natural dentition on masticatory performance and food choice in healthy aging men. J Prosthet Dent 1983;49:427-33. [PUBMED]
20.	Tosello A, Foti B, Sédarat C, Brodeur JM, Ferrigno JM, Tavitian P, et al. Oral functional characteristics and gastrointestinal pathology: An epidemiological approach. J Oral Rehabil 2001;28:668-72.
21.	Willett WC. Diet and health: What should we eat? Science 1994;264:532-7. [PUBMED]
22.	Carlos JP, Wolfe MD. Methodological and nutritional issues in assessing the oral health of aged subjects. Am J Clin Nutr 1989;50 5 Suppl: 1210-8.
23.	Posner BM, Jette A, Smigelski C, Miller D, Mitchell P. Nutritional risk in New England elders. J Gerontol 1994;49:M123-32. [PUBMED]
24.	Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutr 2001;4:797-803. [PUBMED]
25.	Johansson I, Tidehag P, Lundberg V, Hallmans G. Dental status, diet and cardiovascular risk factors in middle-aged people in northern Sweden. Community Dent Oral Epidemiol 1994;22:431-6. [PUBMED]
26.	Chauncey HH, Muench ME, Kapur KK, Wayler AH. The effect of the loss of teeth on diet and nutrition. Int Dent J 1984;34:98-104. [PUBMED]
27.	Naeem A, Pankaj K, Vijay K, Mishra S, Sharma N, Taseer B. Geriatric considerations in the management of edentulous patients. IJAR 2014;1:13-5.
28.	Jamiesan HC. Geriatrics and the denture patient. J Prosthet Dent 1958;8:8-13.
29.	Russell RM, Rasmussen H, Lichtenstein AH. Modified food guide pyramid for people over seventy years of age. J Nutr 1999;129:751-3. [PUBMED]
30.	Lichtenstein AH, Rasmussen H, Yu WW, Epstein SR, Russell RM. Modified MyPyramid for Older Adults. J Nutr 2008;138:5-11. [PUBMED]
31.	Muller K, Morais J, Feine J. Nutritional and anthropometric analysis of edentulous patients wearing implant overdentures or conventional dentures. Braz Dent J 2008;19:145-50. [PUBMED]
32.	Ohlhorst SD, Russell R, Bier D, Klurfeld DM, Li Z, Mein JR, et al. Nutrition research to affect food and a healthy life span. J Nutr 2013;143:1349-54. [PUBMED]
33.	Carlsson GE, LeResche L. Epidemiology of temporomandibular disorders. In: Sessle BJ, Bryant PS, Dionne RA, editors. Temporomandibular Disorders and Related Pain Conditions. Progress in Pain Research and Management. Vol. 4. Seattle: IASP Press; 1995.
34.	Jonkman RE, Van Waas MA, Kalk W. Satisfaction with complete immediate dentures and complete immediate overdentures. A 1 year survey. J Oral Rehabil 1995;22:791-6. [PUBMED]
35.	Müller F, Wahl G, Fuhr K. Age-related satisfaction with complete dentures, desire for improvement and attitudes to implant treatment. Gerodontology 1994;11:7-12.