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The Internet Journal of Nutrition and

Original Article

Nutritional Status In Denture Wearers: A e!ie"

M Rathee,A Hooda

#e$"ords denture wearer, disease prevention, elderly: nutrition

%itation M Rathee, A Hooda. Nutritional Status In Denture Wearers: A Review. The Internet Journal o !utrition and "ellness. #$$% &olu'e ($ !u')er #.

A&stract The relationship a'ong dentition status, 'asticatory unction and nutrient inta*e is o i'portance. +ietary actors are related to the cause and prevention o i'portant diseases, including cancer, coronary heart disease, cataracts. ,lderly denture wearers are vulnera)le to co'pro'ised nutritional health due to various actors including: physiologic, psychosocial, oral, unctional, 'edical and dietary supple'entation. +ietary guidance is an integral part o treat'ent or denture wearers. An overview o the relationship )etween denture wearers and 'alnutrition and the nutritional strategies to o)tain good oral and general health in denture wearers are )eing discussed.

Introduction

A large seg'ent o the elderly 'ore than one-third o those aged 'ore than ./ years are edentulous.(-0 The relationship a'ong dentition status, 'asticatory unction and nutrient inta*e is o i'portance. The e ect o edentulous state on nutritional and health status is an i'portant )ut overloo*ed pu)lic health issue.1 The wearing o co'plete denture 'ay have adverse e ect on the oral health and the denture supporting tissues. +iets containing ewer vegeta)les and less carotene and i)er are associated with increased ris* o cancer and heart diseases. The reduced 'asticatory a)ility 'ay lead to changes in dietary selection with ris* o an i'paired nutritional status especially in elderly co'plete denture wearers.( A review o the nutritional re2uire'ents, sy'pto's o 'alnutrition, actors that in luence the ood choices is )eing presented.

e!ie" Im'act of oral health on nutrition in denture "earers

Oral health status is an i'portant actor or nutrition. There is a clear potential or the condition o the 'outh and teeth to have an adverse a ect on nutrition. According to studies, one in ive older people reported that oral condition prevented the' ro' eating the oods they would choose, (/3 too* longer ti'e to co'plete their 'eal and their en4oy'ent o ood was li'ited )y oral condition, /3 avoided eating certain oods )ecause o chewing pro)le's./,. Although the increase in health ris*s due to tooth loss 'ay )e s'all, the i'plications could )e great, as a large seg'ent o the population is a ected. The ris* actors or 'alnutrition in patients with dentures include: loose denture, sore spots under denture, severely resor)ed 'andi)le, di iculty in chewing, eating less ood, una)le to arrange ood or onesel , une5pected e5cessive weight gain or weight loss, alcohol or drug a)use, and undergoing che'otherapy or radiation therapy ./-6 The se2uelae o treat'ent with co'plete denture 'ay have adverse e ects on the health o )oth oral and denture supporting tissues. The e ects can )e direct or indirect. The direct se2uelae include: denture sto'atitis, denture irritation, hyperplasia, trau'atic ulcer, la))y ridges, residual ridge resorption, 'ucosal ulcerations, altered taste perception, )urning 'outh syndro'e and gagging. Indirect se2uelae are related to reduce chewing a)ility with an overall reduction in the unctional capacity and general health. 7urther inade2uate diet can lead to reduced tolerance o the tissues to nor'al wear and tear and this reduced resistance, in turn, can result in poor adaptation to dentures..-%

(actors that affect diet and nutritional status

The e ect o dentures on nutritional status varies greatly a'ong individuals.6-% Oral i'pair'ents a ect diet and nutrition due to changes in the a)ility to taste, )ite, chew and swallow oods. +entures a ect the chewing per or'ance adversely. The elderly people tend to use 'ore stro*es and chew longer to prepare ood or swallowing. According to a recent study, 'asticatory e iciency in co'plete denture wearers was appro5i'ately 8$3 lower than in people with intact natural dentition.($ In co'parison with the su)4ects wearing 'andi)ular i'plant-retained over-dentures, the su)4ects with conventional co'plete dentures needed )etween (./ and 0.. ti'es 'ore chewing stro*es to achieve an e2uivalent reduction in the particle si9e.((

Taste sensitivity 'ay )e reduced and it is di icult to locate the ood in the 'outh when the upper palate is covered as in case o ull upper denture and these pro)le's are urther increased in cases o co'plete denture wearers. "hen co'pared to the sensory perceptions o dentate adults or partial denture wearer, su)4ective esti'ates o taste, te5ture accepta)ility o test oods and ease o chewing in co'plete denture wearers were the lowest.8 The ina)ility to distinguish the sensory 2ualities o ood reduces patient:s en4oy'ent o eating and leads to reduced calorie inta*e. The co' ort o wearing denture is dependent on the lu)ricating a)ility o saliva in the 'outh. ;erosto'ia can also i'pair co'plete denture retention and is associated with di iculties in chewing and swallowing which can adversely a ect ood selection and contri)ute to poor nutritional status. <ro)le's in lu)ricating, 'asticating, tasting and swallowing ood contri)ute nota)ly to the co'ple5 physiological and psychological 'ani estations o aging..,(# Rhodus and =rown in a study o .6 older adults ro' institutionali9ed and ree living geriatric population having 5erosto'ia on sialo'etry reported that statistically signi icant inade2uacies in the nutritional inta*e patterns. Su)4ects with 5erosto'ia had signi icant de iciencies o i)er, potassiu', vita'in =-., iron, calciu' and 9inc. Taste and ood perception were signi icantly reduced in elders with 5erosto'ia.(# In a study done >oc*er in older adult population, al'ost one- i th participants reported dryness. These cases also co'plained o other oral sy'pto's such as unpleasant taste, a )urning sensation in the tongue and other parts o the 'outh and pain ro' dentures, di iculty in chewing ood. Si'ilar pro)le's associated with dryness o 'outh were also reported )y other authors. / Research also indicates that loss o natural teeth cause reduced 'asticatory e iciency even a ter replace'ent with dentures. (0-(/ The reduced 'asticatory a)ility 'ay lead to changes in dietary selection with ris*s or an i'paired nutritional status.( So'e people co'pensate or declined 'asticatory a)ility )y choosing processed or coo*ed ood rather than resh oods. Others 'ay eli'inate certain ood groups ro' their diets. There is good evidence that people adapt to tooth loss )y altering their dietary inta*e to co'pensate or the increased di iculty o eating certain oods, even i 'asticatory unction is restored with conventional dentures.(1(.

Masticatory status thus in luences the appearance o gastro-intestinal disorders.(6

<apas et al reported that people with ull dentures consu'ed ewer calories and lower levels o several speci ic nutrients than did those who had partial dentures or natural dentition.(/ ?re*sa et al concluded that ull-denture wearers consu'ed signi icantly lower levels o vita'in A and @ than did dentate people.(8 !orlen et al stated that edentulous wo'en had higher inta*e o at and higher co ee consu'ption than dentate ones.% The elderly edentulous avoid 'any types o ood, particularly raw vegeta)les and other hard and tough oods, )ecause they cannot chew these with conventional dentures.(1,(% As a result such individuals consu'e signi icantly less proteins and other *ey nutrients, i)er, calciu', non-hae' iron and so'e vita'ins as co'pared to the dentate individuals.#$ The hard and coarse oods such as ruits, vegeta)les and 'eat, which are typically 'a4or sources o vita'ins , 'inerals, proteins and i)er, are di icult to chew with conventional dentures. +epending on the degree o i'pair'ent, chewing di iculty 'ay result in a shi t in ood selection patterns.(0,(.

&arious studies have i'plicated dietary actors in the cause and prevention o i'portant diseases, including cancer, coronary heart disease, cataracts.#( The )ioche'ical 'easures o plas'a ascor)ate and plas'a retinol is related to dental status. However, dental status is not signi icantly associated with histological and )ioche'ical 'easures or the other *ey nutrients or which inta*e values vary with oral health.##, #0 The relationship )etween dental status and vita'in @ appear to )e )oth real and potentially i'portant to general health. These lower levels o plas'a ascor)ate and plas'a retinol could distur) thin s*in and eye sight. +ecrease in vita'in @ can )e associated with cataracts.#$ Studies show that edentulous older 'en have a signi icantly higher prevalence o type II dia)etes than dentate or partially edentulous 'en. ,dentulous 'en had signi icantly lower consu'ption o ruits, vegeta)les and i)er co'pared with dentate 'en and that edentulous wo'en had higher at consu'ption as co'pared with dentate wo'en.#1 +ecrease in i)er consu'ption can lead to increased ris* o colorectal adeno'a. +iets containing ewer vegeta)les and less carotene and i)er are associated with increased ris* o cancer and heart diseases.#( <oor oral unction thus, is a ris* actor or gastrointestinal pathology.(. The ris*s or cardiovascular disease are also increased in edentulous patients. Johanansson et al co'pared the dietary inta*e and the levels o traditional cardiovascular ris* actors in edentulous 'iddle-aged individuals and individuals o the sa'e age and se5 with natural teeth. They reported that energy inta*e did not di er in two groups )ut edentulous 'en and wo'en ate 'ore sweet snac*s co'pared to those with teeth. 7urther edentulous 'en and wo'en were 'ore o)ese and had lower seru' H+>- cholesterol concentrations. The authors supported the hypothesis that edentulous 'iddle-aged individuals have 'ore un avora)le ris* actors or cardiovascular disease.#1

Nutrition )uidelines
+ietary guidance, )ased on the assess'ent o the edentulous patient:s nutrition history and diet, should )e an integral part o co'prehensive prosthodontic treat'ent. The great 'a4ority A6$3to 8$3B o edentulous patients has also ac*nowledged the )ene it o co'plete denture treat'ent and declared the'selves satis ied with their dentures.#/-#6 According to ?eert'an et al the 'asticatory 'uscles respond to the sti'ulus received. The sensitivity achieved )y over-dentures can guarantee and integrate 'uscle reaction, which 'a*es it possi)le to chew ood 'ore e ectively. The clinical evidence in this study suggests that the a)ility to chew 'ainly tough ood depends on the retention o ered )y i'plants placed in the lower 4aw. (( +avis#8 and Meric*se-Strern#% added that over-dentures are clearly indicated or elderly patients that had lost their unctional a)ility or when they had not )een a)le to adapt to a co'plete denture in the lower 4aw. 7urther replacing co'plete denture with osseointegrated i'plants results in signi icant i'prove'ent in the 'asticatory unction.#%

To i'prove diet 2uality, individual patients undergoing prosthodontic treat'ent need dietary counseling. The 'ain o)4ective o diet counseling or these patients is to correct i')alances in nutrient inta*e that inter ere with )ody and oral health. This include o)taining a nutrition history, evaluating the diet, educating the patient a)out diet co'ponents i'portant or oral health, 'otivating the patient to i'prove diet, and ollow up to support patient e orts to change ood )ehaviors./,%,#(,#1 <atients with dentures who pre er so t oods such as doughnuts, ca*e, pastries and coo*ies, which are high in si'ple sugars and at, should )e advised regarding the value o ruits, vegeta)les, grains and cereals in their regular diet. An i'portant co'ponent o co'ple5 car)ohydrates is i)er, which pro'otes nor'al )owel unction, lower glyce'ic response, 'ay reduce seru' cholesterol, and is thought to prevent diverticular disease.(,#( &ita'in-'ineral supple'ents without energy or i)er 'ay oster a alse sense o security in the patients. Older adults o ten select a supple'ent that does not include nutrients 'ost li*ely to )e 'issing in their diet. !utrition goals or the denture-wearing patient are to eat a variety o oods, including protein sources, dairy ood, ruits, vegeta)les, grains and cereals and to li'it salt, at and sugar inta*e. @onsu'ption o water, 4uice and 'il* should )e encouraged%,(.. @o'pliance with dietary advice is 'ore li*ely i ollow up is provided. +ietary progress should )e discussed at uture appoint'ents. Such nutrition care should )e an integral part o the overall prosthodontic treat'ent.

Summar$
+enture wearers can )e at a ris* o poor nutrition or a variety o reasons. The dentist should )e aware o nutritional ris* actors and provide nutritional guidance to the patients to adapt rapidly to well )alanced diets. @o'prehensive health care o the denture wearers re2uires thought ul co''unication and coordination o services. This co'ple5ity de'ands that dentists, not in isolation, )ut dieticians should )e consulted to ensure a good nutritional health and e ective care.

eferences
(. Car) ?A, =olender @>, @arlsson @,, editors. =oucher:s prosthodontic treat'ent or edentulous patients. ((th ed. St. >ouis: @& Mos)yD (%%6. #. Atwood +A. Reduction o residual ridges: a 'a4or oral disease entity. J <rosthet +ent (%6(D #.: #..-6%. 0. Tallgren A. The continuing reduction o the alveolar ridges in co'pletedenture wearersD a 'i5ed- longitudinal study covering #/ years. J <rosthet +ent (%6#D #6: (#$-0#. 1. Marcus S,, +rury T7, =rown >J, Cion ?R. Tooth retention and tooth loss indentition o adults: Enited states, (%88-(%%(. J +ent Res (%%.D 6/: .81-%/. /. >oc*er +. Su)4ective reports o oral dryness in an older adult population.@o''unity +ent Oral ,pide'iol. (%%0D #(: (./-8. .. ?il)ert ?H, He t M", +uncan R<. Mouth dryness as reported )y older 7loridians. @o''unity +ent Oral ,pide'iol. (%%0D #(: 0%$6. 6. Frall ,, Hayes @, ?arcia R. How dentition status and 'asticatory unctiona ect nutrient inta*e. J A' +ent Assoc (%%8D (#%: (#.(-%. 8. Sandstor' =, >ind2uist >". The e ect o di erent prosthetic restoration onthe dietary selection in edentulous patients. A longitudinal study o patients initially treated with opti'al co'plete dentures and inally with tissue integratedprosthesis. Acta Ondontol Scand (%86D 1/: 1#0. %. !orlen <, Steen =, =ir*hed +, =4orn A>. On the relations )etween dietary ha)its, nutrients and oral health in wo'en at the age o retire'ent. Acta Odontol Scand (%%0D /(: #66-81. ($. <al'er @A. ?erodontic nutrition and dietary counseling or <rosthodontic patients. +en @lin !orth A' #$$0D 16: 0//-6(. ((. ?eert'an M,, Slagtewr A<, van "aas MA, Fal* ". @o''inution o oodwith 'andi)ular i'plant-retained overdentures. J +ent Res (%%1D 60: (8/8-.1. (#. Rhodus !>, =rown J. The association o 5erosto'ia and inade2uate inta*e in older adults. J A' +iet Assoc (%%$D %$: (.88-%#. (0. 7onti4n-Te*a'p 7A, van:t Ho MA, Slagter A<, van "aas MA. The state o dentition in relation to nutrition in elderly ,uropeans in the S,!,@A study o (%%0. ,ur J @lin !utr (%%.D /$: ((6-##. (1. "ayler AH, @hauncey HH. I'pact o co'plete dentures and i'paired natural dentition on 'asticatory per or'ance and ood choice in healthy aging 'en. J <rosthet +ent (%80D 1%: 1#6-00. (/. <apas AS, <al'er @A, Rounds M@, Her'an J, Mc?andy R=, Hart9 S@ et al. >ongitudinal relationships )etween nutrition and oral health. Ann !G Acad Sci (%8%D /.(:(#1-1#.

(.. @hauncey HH, Muench M,, Fapur FF, "ayler AH. The e ect o the loss o teeth on diet and nutrition. Int +ent (%81D 01: %8-($1. (6. Tosello A, 7oti =, Sedarat @, =rodeur JM, 7errigno JM, Tavitian <, et al. Oral unctional characteristics and gastrointestinal pathology: An epide'iological approach. J Oral Reha)il #$$(D #8: ..8-6#. (8. ?re*sa ><, <arraga IM, @lar* @A. The dietary ade2uacy o edentulousolder adults. J <rosthet +ent (%%/D 60: (1#-/. (%. Hartsoo* ,I. 7ood selection, dietary ade2uacy and related dental pro)le's o patients with dental prosthesis. J <rosthet +ent (%61D 0#: 0#-1$. #$. Sheiha' A, Steele J. +oes the condition o the 'outh and teeth a ect the a)ility to eat certain oods, nutrient and dietary inta*e and nutritional statusa'ong older peopleH <u)lic Health !utrition #$$(D 1: 6%6-8$0. #(. "illett "@. +iet and health: what should we eatH Science (%%1D #.1: /0#-6. ##. @arlos J<, "ol e M+. Methodological and nutritional issues in assessingoral health o aged su)4ects. A' J @lin !utr (%8%D /$: (#($-8. #0. <osner =M, Jette A, S'igels*i @, Miller +, Mitchell <. !utritional ris* in!ew ,ngland elders. J ?erontol (%%1D 1%: M(#0-0# #1. Johansson I, Tidehag <, >und)erg &, Hall'ans ?. +ental status, diet and cardiovascular ris* actors in 'iddle-aged people in northern Sweden. @o''unity +ent Oral ,pide'iol (%%1D ##: 10(-.. #/. @arlsson ?,, >eResche >. epide'iology o te'poro'andi)ular disorders. In Sessle =J, =ryant <S, +ionne RA, editors. Te'poro'andi)ular disorders and related pain conditions. <rogress in pain research and 'anage'ent. &ol.

1. Seattle: IAS< <ressD (%%/. (. Jon*'an R,, &an was MA, Fal* ". Satis action with co'plete i''ediate dentures and co'plete i''ediate overdentures. A ( year survey. J OralReha)il (%%/D ##: 6%(-.. #. Muller 7, "ahl ?, 7uhr F. Age-related satis action with co'plete dentures, desire or i'prove'ent and attitudes to i'plant treat'ent. ?erodontology (%%1D ((: 6-(#. 0. +avis +M. The shi t in the therapeutic paradig': osseointegration. J <rosthet +ent (%%8D 6%: 06-1#.

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Merics*e-Stern R. Treat'ent outco'es with i'plant-supported overdentures: clinical consideration. J <rosthet +ent (%%8D 6%: ..-60. I ullJcitationK

Author Information
*anu athee+ *DS Prosthodontics Assistant <ro essor, +epart'ent o <rosthodontics, ?overn'ent +ental @ollege, <t. =.+ Shar'a Eniversity o Health Sciences Anita ,ooda+ *DS Prosthodontics Associate <ro essor and Head, +epart'ent o Oral Anato'y, ?overn'ent +ental @ollege, <t. =.+ Shar'a Eniversity o Health Sciences

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