Copy of deeksha's nutrition seminar ii

NUTRITION IN COMPLETE
DENTURE PATIENTS

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com


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
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

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 accounts the as many denture failuresis do the
imperfect designs to resist for forces of occlusion. This ,as
imperfect true in theto resist the forces of occlusion. This is
especially designs later middle years ,and the elderly, the major
especially for the completemiddle years ,and the elderly, the major
recipients true in the later denture prosthesis.
recipients for all the types of the oral prosthesis.

DEFINITIONS


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

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


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


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
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.

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

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 scientific study of the process and phenomenon of
Is the
The branch of medicine that treats all problems peculiar to
aging.
the aging patients, including the clinical problems of senescence
Gerontology
and senility.
DentalAs defined by the Gerontological society in 1959 is the
geriatrics
The branch of dental care involving problems peculiar to
branch of age and agingwhich is concerned with situations and
advanced knowledge, or dentistry for the aged patient.
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 problems in aged or
dentition and dental
Is old age
aging persons. accompanied by infirmity.

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.

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.

Factors contributing to
nutritional problems in the
elderly .

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

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.

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.


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.

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.

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.


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.

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.

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.


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.


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


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 the 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.


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.


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


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


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.


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


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.


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.

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.

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.

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.


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.


Some of the commonly prescribed groups of drugs that produce
xerostomia

are

antihypertensives,

anticonvulsants,

antidepressants, tranquilizers and anti Parkinson drugs.


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.


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.

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.

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 (µ g RE)+

5

5

10

8

60

60

Vitamin E (mg a-TE)

1.2

1.0

Vitamin C (mg)

1.4

1.2

16

13

(lb)
Height (cm)
(in)

Vitamin D (µ.g )+

Thiamine (mg)


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)

800
350
10

Phosphorus (mg)

15

Magnesium

150

Zinc (mg)

BACK

300
10
15
150

Iron (mg)

Iodine (µ.g)

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


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.


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


•One serving of potatoes and other vegetables and fruits


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


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


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


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.


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.

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


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


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


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


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


20

Fats and oils

25

BACK


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.

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.

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

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

Thiamine
0.5mg/1000 C

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
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

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

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)

•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


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.


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.

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


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

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

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
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.

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.


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.


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.


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.


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.


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.

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.

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.


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.

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


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 achievement 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


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.


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

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

Citrus fruits,
tablets

REVIEW OF LITERATURE


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.

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.


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.

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

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

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.


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.

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').

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


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.


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.

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.


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.


Thank you
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