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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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  • 1. NUTRITION CARE OF THE DENTURE PATIENT INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. INTRODUCTION Since the turn of the century, there is considerable increase in the number of elderly patients. Life expectancy has increased from the age of 45 in 1900 to the age of 72 for men and 77 for women in the 1980s. This shift is due in part to improved dietary practices and better over all health. But it is observed that nearly half of older individuals have clinically identifiable nutritional problems. Nutritional risk increases with advancing age. Therefore a large number of denture patients can be expected to have nutritional deficits. The nutritional status of the elderly is adversely affected by low income, loneliness, and poor cooking facilities. Lack of knowledge and interest in desirable food choices also contributes to the poor nutritional status of elderly. www.indiandentalacademy.com
  • 3. Dental and medical infirmities that interfere with chewing, digestion, or metabolism can also contribute to a poor nutritional status. Certain nutrition related maladies for example diabetes, obesity, cardiovascular disease, osteoporosis and cancer – require special dietary regimens. Proper nutrition is essential to the health and comfort of oral tissues, and healthy tissues enhance the possibility of successful prosthodontic treatment of the elderly. A proper nutritional assessment and suitable dietary advice is often a more appropriate way to cope with malnutrition than merely instituting prosthetic therapy. www.indiandentalacademy.com
  • 4. 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).www.indiandentalacademy.com
  • 5. 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. • Provides energy, • 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. • Supplies materials necessary for the regulation of energy production or the processes of growth maintenance, reproduction, or repair. (Z.S.C Okoye) www.indiandentalacademy.com
  • 6. Diet • Diet can be defined as the types and amounts of food eaten daily by an individual (FDI). • The some 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 patho- physiological 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 factors such as disease (Secondary malnutrition). (FDI).www.indiandentalacademy.com
  • 7. • 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) • As stated by GPT – 7 • Geriatrics • The branch of medicine that treats all problems peculiar to the aging patients, including the clinical problems of senescence and senility. • Dental geriatrics • The branch of dental care involving problems peculiar to advanced age and aging or Dentistry for the aged patient. www.indiandentalacademy.com
  • 8. 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).www.indiandentalacademy.com
  • 9. Factors contributing to nutritional problems in the elderly • Physiologic changes associated with aging. • Psychosocial aspects • Drugs • Economic factors • Changes in oral conditions www.indiandentalacademy.com
  • 10. 1. Physiologic changes associated with aging The elderly are often at high risk for developing a nutritional deficiency due to the physiologic changes accompanying aging. Knowledge of the effects of the aging processes on nutritional status, nutrient requirements of the elderly, and the factors affecting dietary intake will help the prosthodontist provide meaningful guidance to the elderly patient in achieving improved oral health. www.indiandentalacademy.com
  • 11. 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. There is a wide variability in the rates at which these changes take place, not only between individuals, but within individuals. Changes might occur more rapidly in one organ system and more slowly in others; for example physical changes might occur at a more rapid rate then mental changes in some individuals.www.indiandentalacademy.com
  • 12. 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. This appears to imply that skeletal muscles are a major contributor to the age associated loss in lean body mass. Because protein tissue is the most physiologically active tissue, its decrease results in a lowered basal metabolic rate. Between the ages of 20 and 90, BMR declines by 20%. If this is not accompanied by a reduction in caloric intake or increase in activity levels, slow weight gain will occur. www.indiandentalacademy.com
  • 13. 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. www.indiandentalacademy.com
  • 14. Metabolic alterations Varying but progressive decrements occur in indices of physiologic function such as cellular enzymes, nerve conduction & velocity, resting cardiac output, renal blood flow, maximum work rate, and maximum oxygen uptake. Nutrient uptake by cells appears to decline with age, suggesting that older organisms may require higher plasma levels of nutrients in order to maintain optimal tissue concentrations. www.indiandentalacademy.com
  • 15. Gastrointestinal functioning The physiologic changes in the gastrointestinal tract that occur with aging include decreased peristalsis, decreased hydrochloric acid secretion, and altered oesophageal motility. There is also reduction in the levels of some digestive enzymes including salivary amylase, pancreatic amylase, lipase, trypsin, and pepsin. The overall capacity for absorption, as determined by xylose absorption, has been shown to decrease after the age of 70; and the intestinal mucosal surface area available for absorption also has been shown to be significantly reduced. It is suggested that the degree of malabsorption differs for various nutrients with age. www.indiandentalacademy.com
  • 16. 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. www.indiandentalacademy.com
  • 17. Psychosocial factors Exton Smith has categorized malnutrition in the elderly according to various primary and secondary causes. Primary causes • Ignorance of balanced diet. • Inadequate income • Social isolation • Physical disability • Mental disorders www.indiandentalacademy.com
  • 18. 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. Individuals who have family or friends living in close proximity are more likely to have their needs met (social, economic or physical) than are those living in relative isolation. It has been observed that anemia and low leukocyte ascorbic acid levels are more common in single men living alone, than their age matched counterparts living with relatives. www.indiandentalacademy.com
  • 19. Mental disorders in the older patient can result in confusion, 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.www.indiandentalacademy.com
  • 20. 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. Modified diets It is estimated that 18 – 43% of elderly individuals are following special diets restricting their intake of sodium, fat, cholesterol, calories or carbohydrates because of chronic disease. Although this could have a positive effect on nutritional status if foods are selected wisely, but there also could be adverse effects.www.indiandentalacademy.com
  • 21. 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 odours. In contrast with gustation, olfaction can be stimulated by extremely low chemical concentrations.www.indiandentalacademy.com
  • 22. In the process of aging, taste perception diminishes – the perception for salt at an early age, and for sweet a little later. This is as a result of hyper keratinization of the epithelium that may occlude the taste bud ducts. Vitamin A deficiency may be associated with it. The receptors for the bitter taste in the circumvallated papillae of the tongue seem to survive aging process. Denture wearers, do exhibit a significant decrease in their ability to decipher differences in sweetness of certain foods, along with hardness and texture. This decrease in the sensory aspect of the food can result in a decrease in food consumption because tasteless, odorless food most likely will not be eaten. www.indiandentalacademy.com
  • 23. 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. Some of the commonly prescribed groups of drugs that produce xerostomia are antihypertensives, anticonvulsants, antidepressants, tranquilizers and anti Parkinson drugs. www.indiandentalacademy.com
  • 24. 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. 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. www.indiandentalacademy.com
  • 25. In addition, lack of saliva can affect the nutritional status in a number of ways; • It hinders the chewing of food because it prevents the formation of a bolus. • It makes the mouth sore and chewing painful. • It makes swallowing difficult due to the loss of saliva’s lubricating effect. • It can cause changes in taste perception that decreases adequate food intake. www.indiandentalacademy.com
  • 26. Oral mucosal changes The mucous membranes of the lips, the buccal and palatal tissues and the floor of the mouth change with age. The patient’s chief complaints are a burning sensation, pain and dryness of the mouth, as well as cracks in the lips. Chewing and swallowing become difficult, and taste is altered. The epithelial membrane is thin and friable and easily injured. It heals slowly because of impaired circulation. If the salivary deficiency is pronounced, the oral mucosa may be dry, atrophic, and sometimes inflamed, but more often it is pale and translucent. www.indiandentalacademy.com
  • 27. When flow of saliva is disturbed, food may have a metallic or salty taste, and sensitivity to bitter and sour foods can increase, where as a reduced sensitivity to sweet tastes can generate an unhealthy craving for sugar. These changes potentially have an impact on food choices. In the denture patient it can affect adaptation of the prosthesis and may lead to the development of denture related problems. www.indiandentalacademy.com
  • 28. Muscle function and oral movements People chew more slowly as they get older. Age may impair the central processing of nerve impulses, impede the activity of striated muscle fibers, and retard the ability to make decisions. In addition there may be a reduction in the number of functional motor units along with a decrease in the cross sectional area of the masseter and medial pterygoid muscles. Consequently, older people tend to have poor motor co-ordination and weak muscles. Muscle tone can decrease by as much as 20% to 25% in old age, which probably explains the shorter chewing strokes and prolonged chewing time.www.indiandentalacademy.com
  • 29. Temporomandibular joint pain As a result of masticating very firm foods over many years or as a result of bruxism, attrition of the incisal and occlusal surfaces takes place. The resulting teeth have shortened anatomical crowns, exposed dentin, and wide, flattened chewing surfaces. This type of tooth wear can produce overclosure of the jaws and affect the relations of the mandibular condyle to the glenoid fossa. With age, the glenoid fossa can become shallower and the head of the condyle, flatter. Thus it is possible for the meniscus or articular disc between the condyle and fossa, to be perforated or damaged by this change in temporomandibular relationships, causing pain and limitation of range of movements of thewww.indiandentalacademy.com
  • 30. Another common cause of over closure or loss of vertical dimension is partial or complete edentulism without prosthetic replacement. It is also possible that degenerative changes, such as osteoarthritis (seen in other joints of the body), can affect the temporomandibular joint and can also produce the articular disc changes that creates the clicking of the jaw and discomfort in the ear. There may even be limitation to the opening of the mouth, which may permit only a small sized bolus of food. www.indiandentalacademy.com
  • 31. Edentulism Edentulism increases with age. It is generally agreed that one third to one half of elders over the age of 65 are edentulous in both maxillary and mandibular arches. Lack of dentition does not necessarily mean dietary intake will be compromised but considering that teeth serve as the primary means of mastication as well as has an impact on socialization and communication. Loss of teeth will alter selection of food, often adversely. Frequently, individuals with poor dentition consume soft, easily chewed foods that are low in fiber and have a low nutrient density.www.indiandentalacademy.com
  • 32. Alveolar bone loss The alveolar bone participates in the maintenance of body calcium balance just as the rest of skeletal bone does. Thus calcium is constantly being deposited or resorbed from the alveolar bone to maintain calcium homeostasis in the body. Alveolar bone density, like skeletal mass declines with advancing age. The rate at which this occurs is affected by oral hygiene, (intestinal absorption of calcium) nutrition, genes, hormones, bone density at maturity, exercise and sunlight exposure. www.indiandentalacademy.com
  • 33. In persons with osteoporosis the rate of alveolar bone loss is increased. It has been demonstrated that calcium supplementation can slow down the rate of bone loss including alveolar bone. The relationship of systemic bone loss to jaw bone loss is unclear. Bone loss is accelerated and bone height is diminished when teeth are lost. A greater degree is observed in women than in men. Resorption is much greater in the mandible than in the maxilla. www.indiandentalacademy.com
  • 34. Energy needs of the Body The overall energy needs of the body are calculated to be the sum of three factors • Basal metabolism • Energy for physical activity, • A small amount of additional energy expended during digestion and absorption of carbohydrates, proteins, and fats in the gastrointestinal tract, called the specific dynamic action, or SDA of food. Thus the energy requirement = basal metabolism + physical activity + SDA.www.indiandentalacademy.com
  • 35. Basal metabolism and Basal Metabolic Rate The basal metabolic rate (BMR) is defined as the number of kilocalories expended by the organism per square meter of body surface per hour (kcal/m2/hour). It is determined by body size, age, sex, and secretions of endocrine glands. Physical activity Muscular activity affects both energy expenditure and heat production. Energy expenditure increases with muscular activity. www.indiandentalacademy.com
  • 36. Environmental temperature Environmental temperature is an important factor in heat production. When the body is exposed to a low environmental temperature, it automatically produces more heat to maintain normal body temperature. Specific Dynamic Action (SDA) of Food Specific dynamic action (SDA) is the term used to describe the expenditure of calories during the digestion and absorption of food. www.indiandentalacademy.com
  • 37. Classification of foods By origin a. Plant food – Cereals, legumes, fruits, vegetables, sugars, oils. Animal products – Meat, fish, milk, dairy products, eggs, poultry products. By chemical composition a) Macronutrients – Proteins – Fats – Carbohydrates b) Micronutrients – Vitamins – Minerals By predominant function – Body building foods (Proteins) – Energy giving foods (Carbohydrates, fats) – Protective foods (Minerals, vitamins)www.indiandentalacademy.com
  • 38. Recommended dietary allowances (RDA, s) The recommended dietary allowances (RDA, s) are standards commonly agreed upon for assessing and planning to meet nutrient needs at various ages. RDA for the elderly currently are based on extrapolations from the nutrient and calories needs of adults up to the age of 50. RDA includes two age groupings for energy allowances – persons aged 51 to 75 and those aged 76 or older. But the RDA for vitamins and minerals includes only one age grouping – those aged 51 and older. www.indiandentalacademy.com
  • 39. Nutrient Effect of metabolism Calcium Increases peak bone mass, decreases rate of bone loss in postmenopausal women Vitamin D Increases intestinal absorption of calcium, decreases bone resorption Phosphorus High intake may increase calcium urinary losses Sodium High intake may increase urinary calcium losses if calcium intake is low Fluoride Stimulates osteoblasts, increases trabecular bone mass, new bone may be poorly mineralized Alcohol High intake accelerates menopause, toxic effects on osteoblasts. Caffeine High intake increases calcium urinary losses Protein Urinary calcium losses rise as protein intakes increase, if calcium intake is low. Therefore they should have increased calcium along with high protein. Effects of dietary factors in bone metabolism www.indiandentalacademy.com
  • 40. Effect of nutritional deficiencies on oral health in elderly patients A nutritional deficiency is thought to be an expression of metabolic malfunction caused by lower than desirable intake and use of essential interacting nutrients from the daily diet. www.indiandentalacademy.com
  • 41. Cheliosis Cheilosis (cheilitis or angular stomatitis) is the inflammation of the entire upper and lower lip surfaces. It involves cracks at the corners of the mouth, inflammation and infection at the junction of the upper and lower lips and the adjoining skin characteristically. It may be a sign of deficiency of one or more of the following nutrients; riboflavin, niacin, pyridoxine, folic acid, vitamin B12, protein and iron Non-nutritional etiologic factors like over closure of the jaws must also be considered. Therapeutic doses of vitamin B complex and vitamin C as well as balanced, varied adequate diet.www.indiandentalacademy.com
  • 42. Painful burning tongue A painful burning tongue is often encountered in nutritional anemias associated with deficiencies of vitamin B12, folic acid or iron. Vitamin B12 deficiency (pernicious anemia), is characterized by a triad of symptoms. • generalized weakness • sore painful tongue • numbness or tingling of extremities. www.indiandentalacademy.com
  • 43. There is gradual atrophy of the papillae resulting in a smooth or bald, tongue. Treatment is intramuscular administration of vitamin B12. Folic acid deficiency causes megaloblastic anemia, which is characterized by glossodynia, glossitis, Stomatitis, diarrhea and general weakness. Treatment is to supplement the diet with 5-15 mg. of folacin tablets daily until reticulocytes in the blood increase, then this improvement is maintained with doses of 2-5 mg. daily. Iron deficiency anemia is manifested as glossitis and fissures at the corner of the mouth. Papillae of the tongue are atrophied giving the tongue a smooth, shiny red appearance. Nutritional management consists of ingesting iron – rich or enriched foods, such as liver, eggs and cereals, as well as iron supplements (1gm and ferrous sulfate in four divided doses daily) www.indiandentalacademy.com
  • 44. Inflammation of oral mucosa A patient with an acute vitamin B complex deficiency, as seen in alcoholism, will develop a markedly red and flamed oral mucosa. The epithelial layer very often becomes detached from the underlying tissues, leaving raw red readily infected patches. Pallor of oral mucosa is seen in patients with anemias. There may be apthae with fiery red border. This condition may be improved by a good diet and vitamin supplementation. www.indiandentalacademy.com
  • 45. Xerostomia Xerostomia is a clinical manifestation of salivary gland dysfunction. There are several causes of dry mouth; the use of medications, therapeutic radiation to the head and neck, diabetes, depression, alcoholism, pernicious anemia, menopause, vitamin A or vitamin B complex deficiency, and autoimmune diseases such a sjogren’s syndrome. Aging as the sole cause of decreased salivary flow is unproven. The most common cause of dry mouth is drugs used to manage chronic diseases. The management of xerostomia depends on the cause of the condition. If a drug is suspected to be the cause, consulting with the patient’s physician may result in an alternate drug being prescribed or modification of the doses schedule. www.indiandentalacademy.com
  • 46. Saliva substitutes are available, but regrettably have not proven to be acceptable to many patients and furthermore are expensive. Milk has been proposed as a saliva substitute. Because dry mouth may result in inadequate nutritional intake, the use of milk not only serves as saliva substitute but is an excellent source of nutrients. Sialogogues (agents that stimulate salivary flow) such as sugar free gum, lozenges, or sugar free candies containing citric acid may be recommended. Sorbitol or xylitol sweetened products will decrease the risk of candidiasis developing in susceptible adults. Additional recommendations include beverages that may produce more saliva such as water with a slice of lemon lemonade, or limeade. Carrying a sport bottle when leaving home will allow for frequent sips of water. Sucking ice chips will increase comfort and provide lubrication; sauces, gravies, and dressing will moisten foods and make them easier to swallow. www.indiandentalacademy.com
  • 47. Osteoporosis Osteoporosis results from the loss of bone, especially the spongy spicules of bone which support the weight bearing parts of the skeleton. Osteoporosis is common in the aging person especially in the postmenopausal woman in whom the estrogenic blood level has dropped precipitously. In elderly men as well as women osteoporosis is caused by a variety of factors. • Lack of calcium intake • Lack of calcium absorption • Lactase deficiency • Low estrogen www.indiandentalacademy.com
  • 48. Management: Effective treatment for established osteoporosis is difficult once bone mass has fallen below the fracture threshold, so emphasis is placed on preventing osteoporosis in high-risk subjects. Physical exercise, ensuring an adequate calcium intake (1500mg. Daily and avoiding cigarette smoking and alcohol abuse are encouraged. Hormone replacement therapy (HRT) should be considered in women with low bone mass following menopause. It is the most effective means of preventing bone loss in women at this stage. But because of the possible side effects of estrogen therapy, such treatment cannot be recommended solely to prevent residual ridge resorption in elderly women www.indiandentalacademy.com
  • 49. If bone loss is not too severe treatment of established symptomatic osteoporosis can be undertaken with antiresorptive drug therapy (calcium supplements, HRT, biphosphonate or calcitonin) and in selected very severe cases with recurrent symptomatic spinal fractures, bone stimulating drug therapy with anabolic steroids and / or fluoride can be attempted. www.indiandentalacademy.com
  • 50. Diet, nutrition, and drug interactions The elderly account for 40% of acute hospital bed days and 15% of psychiatric disturbances. They have a 20% chance of being admitted to nursing care facilities. Four percent of persons aged 65 to 74 years and 20% of those 75 years or older have organic brain impairment. On an average the elderly take 13 prescriptions per year, three times as much as the population under age 65. Of the ambulatory 85% and of institutionalized almost 95% receive drugs; 25% of all the elderly are dependent on prescription drugs for activities of daily living.www.indiandentalacademy.com
  • 51. The most common medications are analgesics and cardiovascular and psychotropic medications, especially those with sedative and hypnotic effects. More than 50% of elderly patients in skilled nursing care facilities are given psychotropic medications (those that affect mental activity). Persons who take these medications also use more prescription drugs of other kinds and tend to consult physicians about medications more often than older persons who do not take them. With age there is an altered sensitivity of psychotropic medications that can lead to central nervous system toxicity if the medication level is not adjusted. The body’s ability to absorb, bind, metabolize, and accept drugs changes with age. It is generally recommended to start with half the normal adult dose and slowly increase it to a therapeutic level. With the numerous medications given to the elderly, care should be taken to avoid adverse drug interactions and drug nutrient interactions. www.indiandentalacademy.com
  • 52. Medications can interact if one changes the metabolism of other through enzyme induction, by altering binding to plasma proteins receptor sites, and by delaying or enhancing excretion. These interactions are dose-dependent and vary from individual to individual. A number of drugs affect the body’s use of nutrients, appetite and food intake nutrient absorption or metabolism or both Also, requirements of persons who receive certain drugs over long periods are different from those who have not taken these drugs before. The purpose of this section is to inform the clinician how to minimize drug-induced malnutrition in geriatric patients. www.indiandentalacademy.com
  • 53. Food Recommended for the Elderly 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 Bread – Cereal Group Four servings of enriched bread, cereals, and flour products www.indiandentalacademy.com
  • 54. Milk - Cheese group Two servings of milk and milk based foods, such as cheese (but not butter) Meat, Poultry, Fish and Beans Group Two servings of meats, fish poultry, eggs, dried beans and peas, and nuts 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. www.indiandentalacademy.com
  • 55. 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: – Bread, cereal, rice, and pasta. – Vegetables. – Fruits. – Milk, yogurt, cheese. – Meat, poultry, fish, dry beans, eggs, and nuts. – Fats, oils and sweets. www.indiandentalacademy.com
  • 56. Dietary Counseling of Prosthodontic Patients One expectation of patients seeking new dentures is that they will be able to eat a greater variety of foods. Such patients often are receptive to suggestions aimed at improving the quality of their diets. Nutrition screening begins at the first appointment so that counseling and follow up can occur during the course of treatment. www.indiandentalacademy.com
  • 57. Risk factors for malnutrition in denture patients: • 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 www.indiandentalacademy.com
  • 58. • Providing nutrition care for the denture patient entails the following steps. • Obtaining a nutrition history and an accurate record of food intake over a 3-, 4- or 5-day period. • Evaluating the diet • Teaching about the components of a diet that will support the oral mucosa as well as bone health and total body health • Guidance in the establishment of goals to improve the diet. • Follow up www.indiandentalacademy.com
  • 59. Nutrition guidelines for prosthodontic patient: • 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.www.indiandentalacademy.com
  • 60. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com