N

U
T
R
I NUTRITION-It deals with the process by which the
T
I components of ingested food are made available to the
O
N individual for purposes of energy,building of tissues & in
-
general,maintaining the individual in a proper functional
state.

BASAL METABOLIC RATE-The rate of energy production under

basal conditions per unit time & per square meter of body
surface is known as BMR.
MALNUTRITION-It is a state arising from an ---
 -Insufficient caloric intake causing
undernutrition.
Insufficient intake of one or more of
the essential nutrients.
Nutritional status of elderly patients affect the wearing of denture
& denture also affect the food choice of elderly patients.

Nutrition support maintain the health & integrity of the denture

bearing tissues which improve the tolerance of oral mucosa to new
denture & prevent rejection of denture.
Nutritional status affected by ---
 Loose teeth
 Edentulism
 Ill fitting denture

Other---
 Economical Status
 Social isolation
 Degenerative diseases
 Medication
 Dietary supplementation practice.
 
 DIABETES
LOW CALORIC INTAKE ALCOHOL ABUSE

MEDICATION UNHEALTHY ORAL TISSUE SMOKING

XEROSTOMIA LOW NUTRIENT INTAKE

SOFT DIET
NUTRITIONAL REQUIREMENTS
&
DEFICIENCIES
CARBOHYDRATE -

55-70% of total requirement of the body.

Complex carbohydrate should be used which contain fiber which promotes

Normal bowel function
Lower glycemic response
May reduce serum cholesterol
Prevent diverticular disease.
Complex carbohydrate are present in cereals,grams,flour,legumes,
potatoes,polysaccharides.

FAT-
33% of total calories in diet.
PROTEIN
10-35% of total calories.

Requirement – 1 gm per kg of body weight.

Deficiency-

Decreased salivary flow

Enlarged parotid gland
VITAMINS-

WATER SOLUBLE – Vitamin B complex

Vitamin C
FAT SOLUBLE - Vitamin A,D,E,K

Vitamin B complex – Daily requirement (mg)

Vitamin B1- Thiamine 1-1.4 mg
Vitamin B2-Riboflavin 0.4 -1.4 mg
Vitamin B3-(Niacin) 13 -17 mg
Vitamin B5-(Pantothenic acid) 10 mg
Vitamin B6-(Pyridoxine) 2 – 2.5 mg
Vitamin B8-(Biotin) 100-200 mcg
Vitamin B9-(Folic acid) 0.4 –0.8 mg
Vitamin B12-(Cyanocobalmin) 1 mcg

Vitamin C 40 mg
Vitamin Daily requirement

Vitamin A 600 mcg

Vitamin D 1000-2000 I.U.
Vitamin E 8-10 mg
Vitamin K 70-140 mcg
Vit. B complex,iron & protein

Lips-- Cheilosis
Angular stomatitis
Angular Scars

Tongue—Edema
Magenta tongue
Atrophy of filliform papillae
Burning sensation
Soreness
Pale, Bald
Vitamin-C
 Edematous oral mucosa
 Tender gingiva
Spontaneous
bleeding of gingiva

 Haemorrage in interdental
papillae.
 Delayed wound healing
Vitamin B1 deficiency
Beri-beri
Sources- Yeast,Outer coating of seed,Cereals,Legumes,
Wheat,Pork,Eggs.

Oral manifestations-
Hypersensitivity of oral mucosa
Pain in tongue,teeth,jaws & face.

Management – 50mg thiamin I.V. followed by 50mg daily by

oral route for a week.
Vitamin B2

Sources-Yeast,milk meat,liver,kidney,
Green leafy vegeatables.

Oral manifestations-Glossits
Cheilitis
Atrophy of papillae
Redness of lip

Management-
Riboflavin 25,000 – 50,000 mcg is given daily.
Vitamin-B3

Sources- yeast,meat,liver,eggs,fish,legumes
Deficiency- PELLAGRA

Oral manifestation-
Red & painful oral mucosa
Bald tongue
Angular stomatitis

Management-
Niacin 10 mg per day,
VITAMIN SOURCES ORAL MANIFESTATION MANAGAMENT

B6 Yeast,Liver,Egg yolk, Cheilosis 10 –50 mg daily

Rice polishing Glossitis
Angular stomatitis

B9 Yeast,Liver,Kidney, Bald tongue 5000-10,000 mcg daily

Green vegetable Redness of lips

B12 Liver,Kidney,Meat, Glossitis 150 mcg daily oral

Fish,Egg yolk Weakened muscular tone

C Citrus fruits,Tomatoes, Scurvy 250 mg 3 times daily

Spinach,Potato
A Carrot,Papayas,
Tomatoes,Fish liver oil,
Milk products
D Fish liver oil,Egg yolk,
Milk
k Spinach,Cabbage,
Cauliflower,Egg yolk,Liver
Hypoplasia of teeth 7500-15000mcg per
Delayed eruption day
Defective enamel formation
Hypoplasia of teeth 1000 –2000 I.U. OF
Delayed eruption Vit. D with 500-1000
Defective enamel formation mg calcium
Gingival bleeding 10-20 mg per day
BALANCED DIET-A diet is said to be balanced when it
includes proportionate quantities of food items selected
from the different food groups so as to supply the essential
nutrients in complete fulfillment of the requirement of the
body.

RECOMMENDED DIETARY ALLOWANCE-

Food & Nutrition board of the National Research
Council published the daily need for essential nutrients,
called RDA.
 COMPONENTS OF BLANCED DIET

ENERGY COMPONENT ESSENTIAL COMPONENT

CARBOHYDRATE ESSENTIAL AMINO ACIDS

FAT ESSENTIAL FATTY ACIDS
PROTEIN VITAMINS
MINERALS
WATER
NUTRITIONAL FACTOR WHICH SHOULD BE CONSIDERED
FOR PROGNOSTIC JUDGEMENT

 Xerostomia
 Negative calcium balance
 Nitrogen-Protein balance
 DEHYDRATION
Water is most important & essential nutrient

Daily requirement------2500 cc per day

TISSUE DEHYDRATION may influence the rate of aging

EFFECTS----

E
F
F
E
C
T
S
SALIVA ------ Decreased salivary flow
 Xerostomia
Skin ------ Wrinkles
Muscle ---- Sagging of muscle
 Muscle mass shrinks
Secretions ----- Sweat & sebaceous
gland secreation decreases
 Digestive enzymes decrease

Eyes ----- Xeropthalmia
 Bitot spot
 Dry & wrinkled cornea
Dry mouth ----- Xerostomia
 Dry & fragile mucosa
Tongue ----- Coated
 Degeneration of taste buds
 Smooth ( bald ) & atrophic
 PRODROMAL SIGNS

Nocturia
Tissue edema ---- Palatal edema
More retentive upper denture in morning
Phicial discomfort ----- Fatigue & Pain
Arthalgia & Myalgia
Emotional factors
 CALCIUM & BONE HEALTH

l
Bone loss is normal
l part of aging that affect maxilla &
mandible,as well
l as spine & long bones.
l
o

Low calcium intake------ OSTEOPOROSIS

Loss of bone affect women earlier than men
Trabecular bone in alveolar process is a source of calcium
Resoption of alveolar ridge ----- Unstable denture

Loss of teeth ---- Resorption accelerated ( bone loss

increased in first 6 month after teeth extractions)
Serum calcium maintaioned by mobilization of calcium
from bone leading to demineralization of skeletion.
Osteoporosis is due to -------
 Lack of calcium intake
 Lack of calcium absorption
 Low estrogen

Oxalate & Phylate ----- Reduce calcium

absorption by forming insoluble complex.
 1997 DIETARY REFERANCE INTAKE VALUES

AGE CALCIUM VITAMIN D

31 –50 100 mcg 5 mcg
51 -70 1200 mcg 10 mcg
> 70 1200 mcg 15 mcg
EFFECT OF PROTEIN LOSS

Decrease in size & strength of skeletal muscle.

Daily requirement --- 56 gm for male

46 gm for females
 VITAMIN & HERBAL SUPPLEMENTATION

Vitamin, mineral & herbal supplementation

Used for ----
To increase energy level
To extent life
To prevent onset of degenerative diseases
To relieve symptom of chronic diseases

Multivitamin mineral supplement --- Recommanded by American

diectric association.

Once a day vitamin tablet ---- It include Vit. D, Vit. B12 & Folic
acid needed for patient receiving dentures.

HERBAL SUPPLEMENT ---- Direct effect on the outcome of oral

surgery to remove remaining teeth before denture insertion
PROSTHETIC FAILURE TAKES PLACE DUE TO -----
1. Tissue dehydration due to negative water balance.
2. Calcium deficiency & Osteoporosis.
3. Epithelial thinning & fragility.
4. Muscle weakness ---- Protein deficiency.
DIETARY COUNSELLING OF PATIENT
UNDERGOING PROSTHODONTIC TREATMENT

Quality of a denture bearing patients diet can be improved by

nutrition counselling.

Main objective --- Nutrition care & oral health.

.
RISK FACTORS FOR MALNUTRITION
IN PATIENTS WITH DENTURES

Eating less than two meals per day

Difficulty in chewing and swallowing
Unplanned weight gain or loss of more than 10 lb in the last six month
Undergoing chemotherapy or radiation therapy
Loose denture or sore spots under denture
Oral lesions (glossitis,cheilosis, or burning Tongue )
Severely resorbed mandible
Alcohal or drug abuse
Unable to shop for,cook for or feed oneself
NUTRITION GUIDELINES FOR PATIENTS UNDERGOING
PROSTHODONTICS

1 Eat a variety of foods.

2 Build diet around complex carbohydrates (fruits,vegetables,whole grain
breads and enriched cereals ).
3 Eat at least five servings of fruits and vegetables daily.
4 Select fish, poultry, lean meat, eggs or dried peas and beans every day.
5 Consume four serving of calcium-rich food.
6 Limit intake of bakery products high in fat and simple sugars.
7 Limit intake of prepared and processed foods high in sodium and fat.
8 Consume eight glasses of water,juice,or milk daily.
 Steps for providing nutrition care----
 1. Obtain a nutrition history & accurate record of food intake over
a 3 to 5 day period or complete a food frequency form.

 2. Evaluate the diet --- Assess nutritional risk.

 3. Teach about the component of diet that will support the oral
mucosa,,bone health & total body health.
 4. Food frequency form record obtained.
 5. Food guide period --- Food classified into five basic food group.
MINIUM RECOMMENDATIONS------

FOOD GROUP SERVING

Dairy group 3-4

Meat group 1
Fruit group 1
Vegetable group 3
Bread cereal group 6

Minimum recommended member of serving will

provide about 1600 kcal.
NUTRITION PROGRAM

COMMUNITY BASED NUTRITION PROGRAM INCLUED ---

Home delivery system

Food stamp
Communal meal program.
DIETARY MANAGEMENT WHEN TEETH ARE EXTRACTED

Well nourished people ---Rapid tissue healing & lower risk of infection
after surgery.

Smoking ,alcohol abusers,patients with uncontrolled diabetes &

hypertention----- Greater risk of complication after surgery.

Protein,Vit.A & C, Folic acid, Pyridoxine,Vit. B12, Iron & Zn must be

available for the support of phagocytic activity,cell mediated
immunity.collagen synthesis & regeneration of epithelial cells.
 REFERANCES

1. Prosthodontic treatment for edentulous patients – complete denture

& implant supported prosthesis - by – ZARB BOLENDER
2. Syllabus of complete denture- HEARTWELL
3. Essential of complete denture,prosthodontics- SHELDEN WINKLER
4. Medical biochemestry-Sucheta P Dandekar
5. Herper’s Biochemistry
6. Textbook of oral medcine -Anil govindrao Ghom